\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7594",leadTitle:null,fullTitle:"Current Topics in Biochemical Engineering",title:"Current Topics in Biochemical Engineering",subtitle:null,reviewType:"peer-reviewed",abstract:"Genetic and cellular technologies in life science have recently achieved remarkable progress, and thus the roles of biochemical engineers have also been changed to incorporate the use of new technology. Therefore, this book deals with current topics in biochemical engineering. The chapters of this book discuss research that has introduced artificial enzymes, kinetic models in bioprocessing, a small-scale production process, and production of energy with microbial fuel. These chapters offer novel ideas for the production of effective compounds and energy. Moreover, other research has introduced the production technology of stem cells and biomedical processes using nanoshells and extracellular vesicles. These chapters will provide novel ideas to produce effective compounds and develop therapies for various diseases.",isbn:"978-1-83881-210-2",printIsbn:"978-1-83881-209-6",pdfIsbn:"978-1-83881-211-9",doi:"10.5772/intechopen.77355",price:119,priceEur:129,priceUsd:155,slug:"current-topics-in-biochemical-engineering",numberOfPages:138,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"391609f1f0cb3bba32befeb3aa40ccf3",bookSignature:"Naofumi Shiomi",publishedDate:"August 7th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7594.jpg",numberOfDownloads:10687,numberOfWosCitations:10,numberOfCrossrefCitations:15,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:32,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:57,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 12th 2018",dateEndSecondStepPublish:"September 6th 2018",dateEndThirdStepPublish:"November 5th 2018",dateEndFourthStepPublish:"January 24th 2019",dateEndFifthStepPublish:"March 25th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"163777",title:"Dr.",name:"Naofumi",middleName:null,surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi",profilePictureURL:"https://mts.intechopen.com/storage/users/163777/images/system/163777.jpeg",biography:"Dr. Naofumi Shiomi studied recombinant yeast and its utilization as a researcher at the Laboratory of Production Technology of Kanena Corporation for 15 years until 1998 and earned his Ph.D. in Engineering from Kyoto University, Japan. He now works as a professor at the School of Human Sciences of Kobe College in Japan, where he teaches applied microbiology, biotechnology, and life science in his Applied Life Science laboratory. He has studied bioremediation for 24 years at Kobe College and has published more than 40 papers and several book chapters on recombinant microorganisms, bioremediation, and functional foods. His recent research has also focused on the prevention of obesity and aging.",institutionString:"Kobe College",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"6",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1346",title:"Biotechnology",slug:"technology-biomedical-engineering-biotechnology"}],chapters:[{id:"66488",title:"Introductory Chapter: Artificial Enzyme Produced by Directed Evolution Technology",doi:"10.5772/intechopen.85738",slug:"introductory-chapter-artificial-enzyme-produced-by-directed-evolution-technology",totalDownloads:1103,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Naofumi Shiomi",downloadPdfUrl:"/chapter/pdf-download/66488",previewPdfUrl:"/chapter/pdf-preview/66488",authors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],corrections:null},{id:"64476",title:"Fermentation: Metabolism, Kinetic Models, and Bioprocessing",doi:"10.5772/intechopen.82195",slug:"fermentation-metabolism-kinetic-models-and-bioprocessing",totalDownloads:2526,totalCrossrefCites:3,totalDimensionsCites:9,hasAltmetrics:0,abstract:"Biochemical and metabolic interpretation of microbial growth is an important topic in bioreactor design. We intend to address valuable information about the relation of critical operation variables and the simulation of bioprocesses with unstructured and structured kinetic models. Process parameters such as nutrient supply, pH, dissolved oxygen, and metabolic end-products directly impact the physiology and metabolism of microorganisms. Changes in the membrane as well as cell viability are of interest since protein expression and maturation in prokaryota are directly related to membrane integrity. This chapter intends to deliver an insight of different alternatives in kinetic modeling.",signatures:"Carlos González-Figueredo, René Alejandro Flores-Estrella and Oscar A. Rojas-Rejón",downloadPdfUrl:"/chapter/pdf-download/64476",previewPdfUrl:"/chapter/pdf-preview/64476",authors:[{id:"262807",title:"Dr.",name:"Oscar A.",surname:"Rojas-Rejon",slug:"oscar-a.-rojas-rejon",fullName:"Oscar A. Rojas-Rejon"},{id:"262810",title:"Dr.",name:"Carlos",surname:"González-Figueredo",slug:"carlos-gonzalez-figueredo",fullName:"Carlos González-Figueredo"},{id:"263482",title:"Dr.",name:"Rene Alejandro",surname:"Flores Estrella",slug:"rene-alejandro-flores-estrella",fullName:"Rene Alejandro Flores Estrella"}],corrections:null},{id:"64503",title:"Small-Scale Process for the Production of Kefiran through Culture Optimization by Use of Central Composite Design from Whey and Kefir Granules",doi:"10.5772/intechopen.82257",slug:"small-scale-process-for-the-production-of-kefiran-through-culture-optimization-by-use-of-central-com",totalDownloads:1023,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Cheese is one of the most demanded dairy products worldwide. However, during the conversion of milk to cheese, about 10 liters of milk are employed and about 9 liters of whey are generated for each 1 kg of cheese produced. The whey has traditionally been used for animal feed and as starting material for obtaining whey proteins. Furthermore, whey has the significant values of BOD and COD, becoming the most important contaminant in the dairy industry. For this reason, further growth of cheese sector is being limited by the surplus of whey as a by-product of the production of the cheeses. One of the many possibilities offered by the whey is its use as a starting material to produce many biotech products with a higher added value. The kefiran is a degradable biopolymer and is formed by galactose and glucose units, in almost similar proportions, which have been found with numerous benefits for human health. It is produced by a consortium of acid-lactic bacteria and yeasts, which coexist within the kefir granules, which are able to grow and multiply using the lactose present in the whey. The objective of the present study is to establish a small-scale process that allows the obtaining of kefiran.",signatures:"José Manuel Pais-Chanfrau, Lorena D. Carrera Acosta, Paola M. Alvarado Cóndor, Jimmy Núñez Pérez and Milton J. Cuaran Guerrero",downloadPdfUrl:"/chapter/pdf-download/64503",previewPdfUrl:"/chapter/pdf-preview/64503",authors:[{id:"262859",title:"Ph.D.",name:"José Manuel",surname:"Pais-Chanfrau",slug:"jose-manuel-pais-chanfrau",fullName:"José Manuel Pais-Chanfrau"},{id:"273370",title:"BSc.",name:"Lorena Dominique",surname:"Carrera Acosta",slug:"lorena-dominique-carrera-acosta",fullName:"Lorena Dominique Carrera Acosta"},{id:"273372",title:"BSc.",name:"Paola Margarita",surname:"Alvarado Cóndor",slug:"paola-margarita-alvarado-condor",fullName:"Paola Margarita Alvarado Cóndor"},{id:"273373",title:"MSc.",name:"Jimmy",surname:"Núñez Pérez",slug:"jimmy-nunez-perez",fullName:"Jimmy Núñez Pérez"},{id:"273374",title:"MSc.",name:"Milton Jimmy",surname:"Cuaran Guerrero",slug:"milton-jimmy-cuaran-guerrero",fullName:"Milton Jimmy Cuaran Guerrero"}],corrections:null},{id:"64014",title:"Catalyst Development of Microbial Fuel Cells for Renewable-Energy Production",doi:"10.5772/intechopen.81442",slug:"catalyst-development-of-microbial-fuel-cells-for-renewable-energy-production",totalDownloads:1988,totalCrossrefCites:4,totalDimensionsCites:10,hasAltmetrics:0,abstract:"In this chapter, we focus on microbial fuel cells (MFCs) that convert the energy from organic matters into electrical energy using microorganisms. MFCs are greatly expected to be used as a relatively low-cost and safe device for generating renewable energy using waste biomass as a raw material. At present, however, it has not reached the desired practical application because of the low-power generation; hence, improvements on fuel cell efficiency, such as electrode materials, are still being examined. Here, we focus on the microorganisms that can be used as catalysts and play a central role in improving the efficiency of the fuel cells. Several kinds of microbial catalysts are used in MFCs. For example, Shewanella oneidensis has been well studied, and as known, since S. oneidensis transports the electrons generated within the cell to the surface layer, it does not require a mediator to pass the electrons from the cells to the electrode. Furthermore, Escherichia coli and Saccharomyces cerevisiae, a model organism for MFCs, are also used. The improvements of such microbial catalysts have also been proceeding actively. Here, we elaborated on the principle of MFCs as well as the current situation and latest research on the catalyst development.",signatures:"Masayuki Azuma and Yoshihiro Ojima",downloadPdfUrl:"/chapter/pdf-download/64014",previewPdfUrl:"/chapter/pdf-preview/64014",authors:[{id:"265735",title:"Prof.",name:"Masayuki",surname:"Azuma",slug:"masayuki-azuma",fullName:"Masayuki Azuma"},{id:"265738",title:"Dr.",name:"Yoshihiro",surname:"Ojima",slug:"yoshihiro-ojima",fullName:"Yoshihiro Ojima"}],corrections:null},{id:"65234",title:"Integrated Biologics Manufacturing in Stirred-Suspension Bioreactor: A Stem Cell Perspective",doi:"10.5772/intechopen.83813",slug:"integrated-biologics-manufacturing-in-stirred-suspension-bioreactor-a-stem-cell-perspective",totalDownloads:1307,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Stem cell therapy is garnering attention as several clinical trials have taken place in the recent years by using human pluripotent stem cells (hPSCs). Hundreds of biotechnological companies are investing to find a permanent cure for difficult-to-treat diseases like age-related macular degeneration, Parkinson’s disease, diabetes, etc. by using hPSCs. Therefore, clinical-grade cell manufacturing has become an important issue to make cell therapy products safe and effective. Current manufacturing practices are adopted from conventional antibody or protein production in the pharmaceutical industry where cells are used as a vector for producing the desired products. In cell therapy applications, cells are the products that are sensitive to physicochemical parameters and storage conditions anywhere between isolation to patient administration. Moreover, cell-based product manufacturing consists of multi-step processing, including isolation from patients, genetic modification, derivation, expansion, differentiation, purification, characterization, cryopreservation, etc. This can require long processing times and pose high risk of product contamination as well as high production cost. Herein, we discuss the current methods of biologics manufacturing and its limitations. We also review current practices for integrating and automating cell manufacturing facilities. Finally, we propose how to integrate multi-step cell processing in a single bioreactor to make the cell manufacturing practices more direct.",signatures:"Suman C. Nath and Derrick E. Rancourt",downloadPdfUrl:"/chapter/pdf-download/65234",previewPdfUrl:"/chapter/pdf-preview/65234",authors:[{id:"62721",title:"Dr.",name:"Derrick E.",surname:"Rancourt",slug:"derrick-e.-rancourt",fullName:"Derrick E. Rancourt"},{id:"272287",title:"Dr.",name:"Suman",surname:"Nath",slug:"suman-nath",fullName:"Suman Nath"}],corrections:null},{id:"64780",title:"A Simple Way to Produce Gold Nanoshells for Cancer Therapy",doi:"10.5772/intechopen.82495",slug:"a-simple-way-to-produce-gold-nanoshells-for-cancer-therapy",totalDownloads:1071,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Gold nanoshells (GNSs), formed by a silica core surrounded by a gold shell, present a shift on their surface plasmon resonance (SPR) to the near-infrared (NIR) part of the electromagnetic spectrum when synthesized with specific dimensions. This chapter presents a simple method to prepare the nanoshells, a step-by-step characterization, as well as their absorbance spectrum. For the synthesis, silica spheres, with approximately 190 ± 5 nm in diameter, were prepared using the Stöber method and then functionalized with 3-aminopropyltriethoxysilane (APTES). The gold nanoparticles (GNPs), with a diameter of 7 ± 3 nm, were produced by the reduction of chloroauric acid. Then, the silica was seeded with the GNPs to later grow a gold shell with the help of Au(OH)4¯ ions and formaldehyde. UV-Vis spectroscopy results showed an increase of absorbance starting at 520 nm. It reached its maximum around 600 nm and kept absorbing all through 1200 nm. Transmission electron microscope (TEM) and scanning electron microscope (SEM) images suggest that the absorption peak movement coincided with the completion of the shell. Furthermore, when the sample was irradiated with an 820 nm wavelength/3.1 mW laser, its temperatures increased by 6.3°C in 2 min, showing its absorbance in the NIR.",signatures:"Rosa Isela Ruvalcaba Ontiveros, José Alberto Duarte Moller, Anel Rocío Carrasco Hernandez, Hilda Esperanza Esparza-Ponce, Erasmo Orrantia Borunda, Cynthia Deisy Gómez Esparza and Juan Manuel Olivares Ramírez",downloadPdfUrl:"/chapter/pdf-download/64780",previewPdfUrl:"/chapter/pdf-preview/64780",authors:[{id:"34191",title:"Prof.",name:"Erasmo",surname:"Orrantia-Borunda",slug:"erasmo-orrantia-borunda",fullName:"Erasmo Orrantia-Borunda"},{id:"101380",title:"Dr.",name:"José Alberto",surname:"Duarte-Moller",slug:"jose-alberto-duarte-moller",fullName:"José Alberto Duarte-Moller"},{id:"283383",title:"MSc.",name:"Rosa Isela",surname:"Ruvalcaba",slug:"rosa-isela-ruvalcaba",fullName:"Rosa Isela Ruvalcaba"},{id:"283384",title:"MSc.",name:"Anel Rocio",surname:"Carrasco",slug:"anel-rocio-carrasco",fullName:"Anel Rocio Carrasco"},{id:"283385",title:"Dr.",name:"Hilda Esperanza",surname:"Esparza Ponce",slug:"hilda-esperanza-esparza-ponce",fullName:"Hilda Esperanza Esparza Ponce"}],corrections:null},{id:"65340",title:"Engineering of Surface Proteins in Extracellular Vesicles for Tissue-Specific Targeting",doi:"10.5772/intechopen.83537",slug:"engineering-of-surface-proteins-in-extracellular-vesicles-for-tissue-specific-targeting",totalDownloads:1670,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:1,abstract:"Extracellular vesicles (EVs) have in the recent decades gained an important stand as vehicles enabling cell-to-cell transport and communication. With the advanced development towards their clinical use and increasing versatility of potential applications, improving their tissue-specific targeting in order to enhance their functionality in drug delivery opened as a challenging engineering field. In the past, the question of specific intercellular contact has been addressed by decoration of the EV surface with agents able of specific target recognition. An attractive possibility here is the modification of strongly overexpressed EV surface marker proteins towards recognition of target cells. As these proteins are involved in a plethora of biological functions in EV biogenesis, cargo targeting and intercellular transfer, a minimal impact on protein architecture upon modifications is desirable, which would also increase the stability of the exosomal preparation intended for therapeutic use. This chapter focuses on the possibilities of engineering of the EV marker proteins towards antigen-recognition units broadly applicable to endow EVs with tissue-targeting functionality.",signatures:"Stefan Vogt, Gerhard Stadlmayr, Johannes Grillari, Florian Rüker and Gordana Wozniak-Knopp",downloadPdfUrl:"/chapter/pdf-download/65340",previewPdfUrl:"/chapter/pdf-preview/65340",authors:[{id:"273010",title:"Dr.",name:"Gordana",surname:"Wozniak-Knopp",slug:"gordana-wozniak-knopp",fullName:"Gordana Wozniak-Knopp"},{id:"273012",title:"M.Sc.",name:"Stefan",surname:"Vogt",slug:"stefan-vogt",fullName:"Stefan Vogt"},{id:"273013",title:"Dr.",name:"Gerhard",surname:"Stadlmayr",slug:"gerhard-stadlmayr",fullName:"Gerhard Stadlmayr"},{id:"273014",title:"Prof.",name:"Florian",surname:"Rüker",slug:"florian-ruker",fullName:"Florian Rüker"},{id:"273015",title:"Prof.",name:"Johannes",surname:"Grillari",slug:"johannes-grillari",fullName:"Johannes Grillari"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"5701",title:"Superfood and Functional Food",subtitle:"The Development of Superfoods and Their Roles as Medicine",isOpenForSubmission:!1,hash:"0c3c4e9924a0f6c2fe2df43d5dfc50fb",slug:"superfood-and-functional-food-the-development-of-superfoods-and-their-roles-as-medicine",bookSignature:"Naofumi Shiomi and Viduranga Waisundara",coverURL:"https://cdn.intechopen.com/books/images_new/5701.jpg",editedByType:"Edited by",editors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4602",title:"Advances in Bioremediation of Wastewater and Polluted Soil",subtitle:null,isOpenForSubmission:!1,hash:"8b879725924ff3e5b59fb2f8cc12c562",slug:"advances-in-bioremediation-of-wastewater-and-polluted-soil",bookSignature:"Naofumi Shiomi",coverURL:"https://cdn.intechopen.com/books/images_new/4602.jpg",editedByType:"Edited by",editors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6062",title:"Advances in Bioremediation and Phytoremediation",subtitle:null,isOpenForSubmission:!1,hash:"7b537906414bbdbbe7a318c5702ef67e",slug:"advances-in-bioremediation-and-phytoremediation",bookSignature:"Naofumi Shiomi",coverURL:"https://cdn.intechopen.com/books/images_new/6062.jpg",editedByType:"Edited by",editors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6538",title:"Current Topics on Superfoods",subtitle:null,isOpenForSubmission:!1,hash:"42525eaf5a539bc1e2318f4eb8dfea5a",slug:"current-topics-on-superfoods",bookSignature:"Naofumi Shiomi",coverURL:"https://cdn.intechopen.com/books/images_new/6538.jpg",editedByType:"Edited by",editors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5258",title:"Molecular Mechanisms of the Aging Process and Rejuvenation",subtitle:null,isOpenForSubmission:!1,hash:"fd825c8a444ab91728c15f350df7b5ea",slug:"molecular-mechanisms-of-the-aging-process-and-rejuvenation",bookSignature:"Naofumi Shiomi",coverURL:"https://cdn.intechopen.com/books/images_new/5258.jpg",editedByType:"Edited by",editors:[{id:"163777",title:"Dr.",name:"Naofumi",surname:"Shiomi",slug:"naofumi-shiomi",fullName:"Naofumi Shiomi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5951",title:"Biomaterials in Regenerative Medicine",subtitle:null,isOpenForSubmission:!1,hash:"a4ff8af6190bb48a5857450c9c2612d7",slug:"biomaterials-in-regenerative-medicine",bookSignature:"Leszek A. 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Upon entering the host, the parasite first encounters a host immune reaction following activation of the complement system. With respect to this process, four distinct activation pathways have been identified: the classical pathway, the alternative pathway, the lectin pathway and the extrinsic pathway [3]. In humans, the parasite can evade the immune response by inhibiting complement-mediated lysis, which occurs within the phagolysosomes of macrophages. This protective effect is conferred by the membrane protease gp63, or leishmanolysin, which inhibits attacks against the parasite cell membrane by adhering to complement components [4]. Promastigote-stage parasites differentiate into small, round cells 3-5 µm in size that lack flagella, known as amastigotes. This form can be readily observed within host cells by microscopy, where they are referred to as Leishman-Donovan [5] bodies. Finally, when multiplication of the parasites exceeds the holding capacity of the phagocytic cell, cell lysis occurs, releasing the parasites to infect new cells.
By some conservative estimates, a vector might release between 1-1000 metacyclic promastigotes into the host during feeding [6-7]. However, other estimates based on molecular biology techniques indicate that a vector might release as many as 600 to 100,000 metacyclic promastigotes during a feeding period and that this number varies as function of feeding time. In addition, it is known that large numbers of parasites actually increase vector feeding time, as the parasites physically obstruct proper functioning of the proboscis [8]. Therefore, based on these findings, between 100 and 100,000 metacyclic parasites are commonly used to inoculate the footpads or pinnae of animals in
Therapeutic advances in a wide variety of medical fields have dramatically improved overall quality of life and life expectancy in modern societies. This has partly been achieved through the development of techniques such as organ transplantation, hemodialysis, and blood transfusion, which are particularly useful for the treatment of chronic disease. However, the transmission of infectious diseases during such procedures must account for and avoided. Furthermore, human migration can easily transport diseases transmitted by vectors from endemic locations to non-endemic locations, as often happens with protozoan parasites of the blood, such as
During organ transplantations, there are several possible ways in which microorganisms such as
Infrequent or atypical symptoms can cause delayed diagnosis of leishmaniasis. The primary clinical signs and symptoms related to
Blood volume loss or deficiencies in specific blood components are indicators that a transfusion of blood or blood-derivatives from a donor to a recipient may be necessary. Blood transfusions are frequently performed during or after surgical interventions, and in the case of leishmaniasis patients with a history of organ transplantation and blood transfusion, the disease is generally considered to be a complication of the transplantation process [15, 32-33]. In patients without such a background, infections are generally considered to have occurred through the transfusion of blood or blood-derived products. The first case of
In general, the causative agents of visceral leishmaniasis belong to the
Among other notable cases of secondary leishmaniasis due to blood products and transfusions, there was the case of a patient with an autoimmune disease, idiopathic thrombocytopenic purpura. The patient was transfused with concentrated platelets on multiple occasions over the 2-3 year period prior to the development of leishmaniasis, a diagnosis that was confirmed by bone marrow aspiration [36].
Another case involved an infant who received a blood transfusion within 7 days of birth due to integument pallor with a subsequent diagnosis of myelofibrosis. The blood donor was a relative who died three months after the donation, after developing hepatosplenomegaly, pyrexia and a fever of unknown origin; the diagnosis was made
In a case involving an elderly patient, a 77-year-old woman with a history of chronic atrial fibrillation, hypertension and chronic kidney disease with hemodialysis treatment underwent surgery due to cholecystitis, during which time she received two units of blood. A month and a half later, she presented with fever, diaphoresis and chills during a hemodialysis session and over the next 24 hours; she also showed occasional diarrhea and weight loss. These symptoms did not improve despite treatment with antibiotics. In the intensive care unit following hemodialysis, the patient showed thrombocytopenia and hypotension with good ventricular systolic function, requiring volume recovery and vasopressor therapy; hydrocortisone was also included in the treatment. A bone marrow aspirate confirmed the presence of intracellular amastigotes and numerous extracellular promastigotes, although these were not observed in the peripheral blood. Treatment with Amphotericin B increased her platelet numbers, although hemodynamic deterioration continued until the patient’s death. Cultures begun previous to death showed the presence of
Seven U.S. military groups assigned to Operation Desert Storm in the 1990s developed atypical clinical presentations of
Transmission of
There have also been various clinical studies carried out on individuals attending blood banks in which the presence of the parasite was assessed for using techniques such as ELISA (enzyme-linked immunosorbent assay) [45], IFAT [46], Western blotting, culturing and PCR [44-45]. ELISA experiments showed that 2.4% of the individuals had
Furthermore, questioning may be insufficient to exclude donors that have visited endemic areas within the last 12 months or that have had clinical diagnoses of leishmaniasis, as recommended by the WHO publication
In cutaneous species, such as those belonging to the
In individuals with chronic kidney disease, hemodialysis is a therapy that can greatly improve patient prognosis and prolong and improve their quality of life. However, like many other therapeutic procedures, hemodialysis can have adverse effects, including bacteremia and sepsis due to poor aseptic techniques during treatment [47]. Indeed, it has been documented that if proper care is not taken to sterilize hemodialysis equipment, including the cleaning and replacement of disposable parts, there is high risk of acquiring infectious/contagious diseases [47], including parasitic infections. Unlike with the situation with
Cases of leishmaniasis of the sexual organs have been reported, manifesting as lesions on the genitals, and such cases have been reported in both humans [52-56] and in animals [57-58]. Three possible mechanisms for the development of leishmaniasis of the sexual organs and genitals have been suggested: (1) local infection derived from a wider systemic infection; (2) infection due to exposure of the genitals to a vector in an endemic area; and (3) infection due to direct contact of the genitals with an ulcerated lesion during intercourse [59].
By questioning patients, such cases of genital leishmaniasis in humans could not always be directly linked to either intercourse [52-53] or to sleeping naked in endemic areas [55]. However, in cases where the lesions were observed on the vulvar regions [53], direct vector-mediated infection can be ruled out, leaving open the possibility for localized infection of systemic origin or from intercourse with a previously infected individual.
It should be noted that genital ulcers can have numerous causes, and thorough diagnoses should be conducted in all cases to avoid confusion with other diseases, such as squamous cell carcinoma or primary syphilis [55]. Likewise, the presence of other types of infectious microorganisms should also be ruled out [59].
Among animals, domestic dogs are considered to be the main reservoir of
It has been observed that when
Vertical transmission is defined as the congenital transmission of a pathogenic microorganism, condition, or characteristic from one generation to the next via the placenta, hematogenous, the birth canal, or nursing at the maternal breast [64]. Vertical transmission has been demonstrated for visceral leishmaniasis caused by
The epidemiological antecedents of leishmaniasis are crucial when pediatric patients or those of childbearing age develop symptoms suggestive of leishmaniasis. A mother who was diagnosed with
In Germany, there have been two reported cases of leishmaniasis involving mothers who visited endemic zones prior to their pregnancies. The first case involved a 16-month-old pediatric patient with visceral leishmaniasis whose mother had traveled to endemic zones two years earlier [67]. The second case was a 15-month-old child with visceral leishmaniasis whose mother was on a farm in an endemic zone between 20 and 22 weeks of pregnancy [68].
Chronic visceral leishmaniasis has been linked to premature birth and materno-fetal deaths. [69] A histological analysis of the placenta and an aspirate of the lymphatic ganglion revealed the presence of thrombotic, vascular changes in the placenta of a fetus at five months of gestation in a mother that had been infected with leishmaniasis for two months [70]. Neonates carried to term from infected mothers have remained asymptomatic during the first weeks or months of life. However, Leishman bodies have ultimately been detected in the bone marrow, and anti-
Leishmaniasis can be accompanied by concomitant infections by organisms from similar genera. During the second trimester, a pregnant patient was initially treated for leishmaniasis and showed improvement at 30 days. The baby was born vaginally at 36 weeks without complications and weighed 1,700 grams. He was readmitted three days later for deterioration due to probable malaria and tuberculosis, but he did not show improvement following treatment. Amastigotes were detected in an aspirate of the lymphatic ganglion of the mother. In addition, IgG antibodies were detected in the baby; these antibodies were attributed to passive transplacental transfer of parasite-specific antibodies from the mother to the fetus, negating the need for treatment. He was admitted once more at seven months old for symptoms suggestive of
Individuals, whether mother or offspring, in endemic zones can be infected for months or years prior to the onset of symptoms. For example, a woman visited an endemic zone and became pregnant two years later. She did not experience any symptoms during her pregnancy or post-partum while in the non-endemic zone nor was there evidence of the existence of the vector in the geographic area. While the mother remained asymptomatic, the infant exhibited symptoms of possible visceral leishmaniasis, which was confirmed by various laboratory tests [67].
There is evidence that cutaneous leishmaniasis is associated with perinatal health problems, as has been observed in Brazil, where women with
In Brazil, a trial was performed with asymptomatic and symptomatic mixed-breed dogs that were infected with
In a murine model of visceral leishmaniasis, twenty 12-week -old female BALB/c mice were infected with
In experimental model in which hamsters were infected with 106 parasites/mL of
In cases of leishmaniasis infection due to fomites, such as sharp, contaminated objects, the most vulnerable population are illicit drug users. In a Spanish study of syringes used for recreational drug use, it was reported that 32-52% of the syringes were contaminated by
As described above,
According to the CDC, the
The
Taken together, there is a clear need for the health system to reevaluate the global situation concerning leishmaniasis transmission and to implement strategies to reduce the exposure of individuals to
Financial support: The chapter was sponsored by Instituto Nacional de Perinatologia (212250-22701). Primary investigator: Dr. Norma Galindo-Sevilla.
The central nervous system controls autonomic function in several areas. These areas are interconnected and then distributed throughout the neuroaxis. The area is called the central autonomous network (CAN); they control many other functions, of which the tasks of arousal and respiration are included [1]. One of the main outputs of this integrated network is mediated by preganglionic sympathetic and parasympathetic nerves. Hierarchically, the central autonomous control area has been arranged. The delivery of interoceptive information to the forebrain and the mediation of the cardiovascular, respiratory, gastrointestinal, and micturition reflex systems are regulated by the medullary and lower pons areas. The solitary tract nucleus (NTS), the reticular formation of the rostral ventrolateral medulla (VLM), rostral ventromedial medulla (RVMM), including the caudal raphe nucleus, medullary respiratory group, parabrachial nucleus (PB), and pelvic organ stimulation center (Barrington Nucleus) belong to this area [1, 2].
Autonomic control by modulating pain, response to stress, behavioral stimuli, and motor responses is integrated by areas in the upper pons and midbrain. These areas include the periaqueductal gray (PAG), the pedunculopontine tegmental nucleus/ pedunculopontine nucleus (PPT/PPN), and the locus coeruleus (LC) [3]. The hypothalamus takes over the generators of integrated autonomic, endocrine, and behavioral response patterns. This is done to ensure homeostasis and adaptation of the body to the environment. Hypothalamic autonomic output mainly comes from the paraventricular nucleus (PVH), dorsomedial nucleus (DMH), and lateral hypothalamic regions, including the orexin-synthesizing group of neurons (Orx, also known as hypocretin, Hcrt). The midcingulate cortex, anterior insular cortex, and amygdala are core areas of the telencephalon that control autonomic functions. Although the functional anatomy of the central control of autonomic function has been best characterized in experimental animals, several functional neuroimaging studies show that many of the same areas are activated during autonomic responses in humans [3, 4].
Autonomic functions are controlled by areas of the brain whose input is received and integrated from four main sources: interoceptive, humoral, limbic, and circadian. Spinal afferents relay information about interoceptive input from visceral, pain, and thermal receptors via ascending projections to lamina I of the dorsal horn or via cranial nerve afferents relayed in the NTS. The central autonomic regions, directly or indirectly, are reached by humoral signals from blood (such as glucose or cytokine levels) or cerebrospinal fluid (CSF, such as pH) via the circumventricular sensory organs. It is also the main neurotransmitter (sometimes along with the inhibitory amino acid glycine) of the circuits that control respiration and the sleep-wake cycle [5]. Autonomic, respiratory, and arousal circuits are modulated in state-dependent function by cholinergic, monoaminergic, and peptidergic influences from the brainstem, basal forebrain, hypothalamus, and local interactions mediated by local interactions by nitric oxide (NO), purines, endocannabinoids, and other signals [5, 6].
Sympathetic neurons and parasympathetic preganglionic neurons are the final effectors of the control center for autonomic function and are cholinergic. These neurons stimulate the excitatory signal of autonomic ganglia and enteric neurons through ganglion-type nicotinic receptors. Sympathetic preganglionic neurons are in the thoracolumbar spinal cord in segments T1 to L2, primarily in lamina VII, which forms the intermediolateral column (IML) and forms separate functional units that are selectively activated in response to different stimuli [5]. Sympathetic output is critical for maintaining blood pressure, local regulation of blood flow, thermoregulation, and response to exercise and internal or external stressors [5, 6]. Preganglionic sympathetic axons terminate in the paravertebral, prevertebral, terminal ganglia, and the adrenal medulla [6]. Norepinephrine is the main neurotransmitter in postganglionic sympathetic neurons. Except for the postganglionic sympathetic nerves, which innervate the sweat glands, they are cholinergic nerves and vasodilators in muscles and coronary arteries. From a functional point of view, the parasympathetic output can be further subdivided into outputs to cranial effectors via cranial nerves III, VII, and IX, output to the thoracic and abdominal viscera mediated by the vagus nerve (cranial nerve X), and outputs from the pelvic organs (bladder, rectum, and sexual organs) from sacral preganglionic neurons [4, 6]. Organ-specific reflexes are mediated by sympathetic output. Acetylcholine is the main neurotransmitter of the most parasympathetic ganglion and enteric nervous system (ENS) neurons. Noncholinergic neurons also mediate parasympathetic output, releasing NO and vasoactive intestinal polypeptide (VIP) [6].
Two conventionally divided subtypes of the autonomic nervous system (ANS), the sympathetic and parasympathetic nervous systems, are defined as peripheral efferent fibers. Recent studies have revealed the presence of general visceral afferent fibers. The autonomic innervation of the larynx had been veiled; however, recent studies have identified the autonomic nerve fibers in the larynx and illuminated the distribution of autonomic innervation [5, 6].
The postganglionic neurons of the laryngeal sympathetic nervous system have their cell body mainly in the superior cervical ganglion. The preganglionic neurons originate in the gray matter of the upper thoracic spinal cord. Sympathetic innervation of the larynx had been considered to be innervated along with superior or inferior laryngeal arteries and veins [6]. However, study by Hisa
Many noradrenergic nerve fibers are contained in the superior laryngeal nerve and the recurrent laryngeal nerve. The supraglottic and subglottic submucosal glands received the noradrenergic nerve fibers from the internal branch of the superior laryngeal nerve and the recurrent laryngeal nerve, respectively [7]. The external branch of superior laryngeal nerve supplies noradrenergic fibers to the cricothyroid muscle, while other intrinsic muscles received noradrenergic fibers from the internal branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The noradrenergic nerve fibers in the superior laryngeal nerve originated from the superior cervical ganglion. Noradrenergic nerve fibers are contained in the recurrent laryngeal nerve. Noradrenergic nerve fibers originate from the middle cervical ganglion and superior cervical ganglion via the vagus nerve [7, 9].
The parasympathetic nervous system plays a major role in the motor control of mucus secretion in the larynx. The cell body of the postganglionic neuron is present in the intralaryngeal ganglion [9]. As Yoshida
Heart rate (HR) is controlled by the autonomic nervous system. Changes in sympathetic and parasympathetic nervous system activity result in beat-by-beat variations in heart rate; therefore, these variations reflect autonomic nervous system activity. Heart rate variability (HRV) is pathological, like ischemic heart disease, and decreased variability predicts poorer outcomes. Heart rate variability (HRV) is the result of the interaction between the autonomic nervous system (ANS) and sinoatrial node (SAN) activity; experts then assume that HRV is a surrogate marker for autonomic nerve dysfunction [11]. Heart rate variability (HRV) is the fluctuation in the time interval between adjacent heartbeats. HRV is thought to reflect the heart’s ability to adapt to changing circumstances by detecting and rapidly responding to unpredictable stimuli. HRV measures neurocardiac function produced by heart-brain interactions and a dynamic nonlinear autonomic nervous system activity. HRV is an emergent response from interconnected regulatory systems working at various time scales that aids individuals in adapting to environmental and psychological stresses. Autonomic balance, blood pressure, gas exchange, intestinal motility, heart, rhythm, and vascular tone are all regulated by HRV (which refers to the diameter of blood vessels that regulate blood pressure) [11, 12, 13].
A healthy heart is not a metronome. Healthy heart oscillations are complex and nonlinear. The nonlinear system variability provides the flexibility to quickly adapt to an uncertain and changing environment. Optimal HRV status is always associated with health and self-regulation capacity, as well as adaptability or resilience of an individual. Higher levels of HRV, mediated by the vagal nerve at rest, were strongly associated with the performance of executive functions such as attention and emotional processing by the prefrontal cortex. The processing of afferent information by the intrinsic cardiac nervous system can modulate frontocortical activity and influence human executive and cognitive functions at higher levels [11].
HRV analysis is one of the modalities that can be used to assess overall cardiac health, especially with regard to the state of the autonomic nervous system, which is responsible for regulating heart activity and rhythm. HRV refers to the variation of the pulse interval or is related to the response to instantaneous changes in heart rate. Normal variability in heart rate is modulated by the autonomic nervous regulation of the heart and circulatory system. The balance mechanism of the sympathetic nervous system and the parasympathetic nervous system branch of the autonomic nervous system then control the heart rate. Increased sympathetic or reduced parasympathetic activity will cause accelerated cardiac activity; conversely, low sympathetic activity or high parasympathetic activity can cause cardiac deceleration. The degree of variability in heart rate can provide information about the function of neural control of heart rate and the ability of the heart to respond to changing conditions [11, 12, 13].
The classic measurement of HRV can be calculated from the electrocardiogram (ECG) i.e., at R-R intervals and consensus guidelines regarding appropriate indicators are available. Arroyo-Carmona
HRV can be measured by pulse photoplethysmography (PPG) method with finger plethysmogram (FPG). Measurement only takes about 20 minutes. The research of Lu
Vagal nerve is the longest nerve of the autonomic nervous system and is one of the most important nerves in the body. Altered vagal nerve activity caused by impaired autonomic regulation was thought to be responsible for several clinical entities related to laryngology diseases, such as laryngopharyngeal reflux (LPR), sleep-disordered breathing (SDB), chronic cough (CC), and vocal cord dysfunction (VCD) [15].
Esophageal sphincter and gastrointestinal tract are innervated by the vagal nerve; therefore, deteriorated vagal nerve function may be an important factor in LPR regarding the incompetence of esophageal sphincter. Chronic inflammation in the larynx is also thought to be responsible in the occurrence of vagal neuropathy, a condition where laryngeal mucosa is in the hyposensitive and hypersensitive state simultaneously. This mechanism is thought to contribute in the pathogenesis of CC and VCD. Since CAN also plays an important role in regulating sleep-wake cycle, it is known that hypoxia and apnea during sleep will alter the neural modulation in the CAN through some neurotransmitters. These theories have supported the evidence on where autonomic nerve dysfunction could contribute in several laryngology diseases and SDB [1, 9, 15].
LPR is an inflammatory condition of the upper gastrointestinal tract associated with the direct and indirect effects of the retrograde flow of gastroduodenal contents, which can cause morphological changes in the upper aerodigestive tract. LPR causes many laryngeal diseases. Reflux laryngitis, subglottic stenosis, granulomas, laryngeal carcinoma, contact ulcers, and vocal cord nodules are caused by LPR. Because the signs and symptoms of LPR are nonspecific and may be manifestations of other etiologies, e.g., infection, voice abuse, allergies, smoking, inhalation of irritants, alcoholism, and nonpathological changes, patients with LPR may experience prolonged and generalized suffering if their physician is unable to make a diagnosis [16, 17].
Coughing, hoarseness, and globus pharyngeus (a lump sensation in the throat) are the most prevalent symptoms. Hoarseness is a symptom that usually starts in the morning and improves over the day. Belafsky
Belafsky
LPR and gastroesophageal reflux disease (GERD) are considered as a continuum of similar basic pathophysiological mechanisms with some overlapping symptoms. The long-standing controversial differences between the two diseases still exist today. Most patients with throat complaints related to LPR deny the classic symptoms of GERD, especially heartburn. On the other hand, many LPR patients report no endoscopic findings of esophagitis, and the severity of esophagitis based on endoscopic examination is not related to the level of symptoms and signs of LPR. LPR and GERD are disease entities that are both caused by the retrograde flow of gastric contents, but the pathogenesis of these two conditions is different even though they are interrelated. The lower esophageal sphincter (LES) and gastrointestinal tract are innervated by the vagal nerve, and the pathogenesis of GERD itself mainly involves the presence of lesions in LES. According to research, the vagal nerve regulates the parasympathetic regulation of the gastrointestinal system. The malfunction of the LES and the transiently increased relaxation of the lower esophageal sphincter seen in GERD, which results in an increased amount of gastric acid going back into the esophagus, appear to be caused by decreased vagal nerve activity induced by inadequate autonomic regulation [18, 20, 21].
It is also known that there is a relationship between gastrointestinal symptoms and the incidence of cardiac dysrhythmias, as one of the disorders of the autonomic system in GERD patients. This phenomenon has been described as a gastrocardiac syndrome. The severity of esophageal inflammation is not related to the dysfunction of the autonomic nervous system itself, given that the presence of vagal dysfunction has been observed in those with or without severe esophageal inflammation. Several studies have suggested that this parasympathetic dysfunction is not only a consequence of esophageal inflammation, but also a major factor in the etiopathogenesis of GERD. Disturbances in autonomic nervous system activity affect the temporary contraction and relaxation of LES, which then causes GERD and affects its severity [15, 16, 22].
Decreased vagal nerve activity, caused by impaired autonomic regulation, appears to be responsible for the dysfunction of LES and the increased transient lower esophageal sphincter relaxation (TLESR) seen in GERD, which results in the increased volume of gastric acid reflux to the esophagus. The exact stimulus and mechanism underlying TLESR are still debatable, although it is currently thought that TLESR and experimentally induced relaxation of the LES are controlled by neural feedback involving the vagal nerve. The TLESR is triggered by the nerve stimulation of the pharynx, and the relaxation of the LES is triggered by the stimulation of the superior laryngeal and vagal nerves. In addition, gastric distention can also trigger TLESR, but is then inhibited or controlled by vagal efferent and vagal afferent pathways. Most of the sensory neurons that innervate the LES are integrated in the vagal nodular ganglion. There are two things to note before concluding that TLESR is mediated by the vagal pathway. The first is related to vagal efferent fibers that modulate the occurrence of TLESR and the relaxation of the LES; it is still not known whether these two processes are mediated by the same fibers. Second, nonvagal pathways also contribute to the control of the LES. Experimental studies in experimental animals have shown that there is a contribution from spinal afferent innervation in cats, and the relaxation of the LES has also been shown to involve the vagospinal pathway in ferrets. In general, the published literature is consistent with the motion that LES regulation is primarily based on vagal afferent - vagal efferent (vagovagal) reflex mechanisms [15, 16].
In 1980, Heatley
The study of Wang
Wang
LPR is an inflammatory condition in the upper gastrointestinal tract associated with the direct and indirect effects of exposure to reflux of gastroduodenal contents and can cause morphological changes in the upper aerodigestive tract. The etiology of this disease is multifactorial, the diagnosis is still a challenge in itself, and the pathogenesis aspect has not been conclusively explained. This has an impact on the management of patients and the burden of health financing. Autonomic nerve dysfunction is thought to play a role in the occurrence of LPR. It is known that decreased vagal nerve activity caused by autonomic dysregulation is responsible for GERD, but whether the same pathomechanism associated with autonomic dysfunction occurs in LPR requires further research [25, 27].
Obstructive sleep apnea (OSA) is characterized by an episodic collapse of the upper airway during sleep, resulting in the periodic reduction or pause in ventilation and hypoxia, hypercapnia, or awakening from sleep. The prevalence in the general population is estimated to be 3% in women and 10% in men with ages ranging from 30 to 49 years [28, 29]. Overnight polysomnography is required to document the frequency of respiratory events, apnea, and hypopnea during sleep in OSA diagnosis. Obstructive apnea is the complete (>90%) or nearly complete cessation of airflow for more than 10 seconds during sleep despite ventilation efforts. Hypopnea is a decrease in airflow of at least 30% followed by a decrease in oxygen saturation of at least 3% or awakening from sleep. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. OSA criteria are the occurrence of AHI at least five events per hour. Therefore, traditionally, AHI is categorized based on the number of events per hour. AHI in the mild category is 5–15 AHI events per hour, the moderate category means 16–30 events per hour, while the severe category is more than 30 events per hour [28, 29, 30, 31].
Events in which 15 or more AHIs per hour were associated with a decrease in psychomotor speed are equivalent to 5 years of aging. The higher the AHI, the lower the subjective quality of life. Untreated OSA triples the risk of motor accidents compared to the general population. Most importantly, OSA was associated with an increased risk of cardiovascular disease, particularly stroke, hypertension, heart failure, and coronary artery disease, even after adjustment for body mass index (BMI) and other risk factors. In addition, OSA patients also tend to increase the risk of heart arrhythmias, including atrioventricular block, ventricular tachycardia, and sinus bradycardia [29, 30, 31].
In healthy individuals, hypoxia (i.e., decreased oxygen levels with an arterial pO2 of less than 60 mmHg) causes chemoreceptor activation and triggers tachycardia and an increase in blood pressure. Hypoxia and hypercapnia increase the incidence of hyperventilation (resulting in an increased distribution of oxygen to the peripheral blood), and increased sympathetic efferent activity resulting in vasoconstriction to redistribute oxygenated blood flow. Baroreflex activation in healthy individuals eliminates the increase (reduction) in sympathetic activity caused by hypoxia, which can lead to vagal activation and bradycardia [29, 32, 33].
Convergent evidence obtained from studies with neuromuscular sympathetic nerve activity, plasma catecholamine levels, and analyses of heart rate variability suggests that in patients with OSA, hypoxia and apnea trigger a cascade of excitability that results in an acute elevation of efferent sympathetic activity during sleep when maintained over a prolonged period of time. Over time, it can induce the chronic sustained elevation of the sympathetic outflow regulatory point during wakefulness. This has implications for a higher risk of chronic hypertension, coronary artery disease, and cerebrovascular disease. Excessive sympathetic outflow, in turn, causes baroreflex-mediated cardiovagal efferent activity and bradycardia, atrioventricular block, and ventricular tachycardia, potentially resulting in sudden cardiac death. The incidence of arousal during obstructive apnea is associated with sleep fragmentation and further sympathetic efferent activity, leading to peripheral vasoconstriction and sudden increases in systolic and diastolic blood pressure and heart rate [ 29, 32, 33].
Upper airway collapse during sleep resulting in obstructive apnea causes changes in intrathoracic pressure resulting in myocardial stretching of the heart chambers and changes in the transmural pressure gradient, particularly affecting the atria. It can also cause atrial fibrillation and other arrhythmias. In addition to hypoxia and apnea, other mechanisms may be associated with sympathetic efferent overactivity that develops in OSA patients. Obesity, apart from mechanically obstructing the airway and causing OSA, is also responsible for increasing sympathetic afferent activity through mechanisms of leptin, insulin, angiotensin, and cytokines. On the other hand, many OSA patients are not obese. Studies with animal models have confirmed carotid chemoreceptor hypersensitivity due to intermittent hypoxia that contributes to the pathogenesis of OSA in humans. Overactivation of the nucleus in the CNS induces neural changes that increase excitatory impulses to the rostral ventrolateral medulla and maintain high sympathetic tone independently of peripheral sensory signals [32, 33, 34].
During sleep, the frequency of TLESR decreases because the stimulus is thought to be associated with gastric distension. During a person’s sleep, there is no eating or chewing process, resulting in a reduction in saliva production and a decrease in neuromuscular coordination activity in the swallowing process; this will have implications for the lengthening of the esophageal clearance so that there will be a longer contact between the irritant refluxate and the esophageal mucosa (prolonged contact). This phenomenon then underlies a new entity called sleep-related GERD. Although the frequency of TLESR decreases during sleep, transient relaxation has been observed to occur during cortical arousals in patients with sleep-disordered breathing (SDB). These findings also corroborate the results of Gottesmann’s study regarding the association of sleep disorders with the incidence of autonomic dysfunction through the modulation of the neurotransmitter gamma aminobutyric acid (GABA). Gottesmann found that TLESR is vagal mediated and can be inhibited by GABA-b. Lang
This EDR consists of several subtypes of pathways that can be evoked through pressure inflation-related stimuli (slow air and rapid air stimulation) instead of volume on mechanoreceptors in the mucous or muscular layers of the pharynx, larynx, and esophagus. In the slow air distention pathway, a secondary peristaltic reflex (2P) will occur, which then stimulates the esophago-UES contraction reflex (EUCR); this pathway will certainly play a role in preventing reflux episodes from occurring. Meanwhile, through the rapid air distention pathway, four other reflex pathways [esophago-UES relaxation reflex (EUSR), esophago-glottal closure reflex (EGCR), esophago-esophageal contraction reflex (EECR), and esophago-hyoid distraction reflex (EHDR)] will be activated and strongly suspected to play a role in the occurrence of belching. Lang
Sleep disturbances in GERD patients have been shown to induce changes in visceral perception and pain threshold. This investigation showed that in GERD patients with sleep disturbances documented by actigraphy, acid-infusion-induced chest pain was markedly exacerbated after three nights of sleep deprivation. These functions are modulated by afferent branches of the vagus nerve. Gottesmann also found that low levels of GABA in the CNS will affect a person’s sleep quality. This would have implications for decreasing slow waved sleep and increasing paradoxical sleep (fragmentation and arousals) [35]. These observations prompted Chen and Orr to conduct a study to test the hypothesis that changes in autonomic function play a role in the pathogenesis of GERD. They achieved it by using spectral analysis of heart rate variability during their study’s esophageal infusion of 0.1 N hydrochloric acid. This study proves that the infusion of water and acid can cause a decrease in vagal tone in GERD patients compared to normal [36, 37, 38].
Cough is the most common complaint of patient admitting to hospital. In the United States, as many as 27–30 million cases of cough are found in primary care each year [39]. Chronic cough is estimated to occur in 10–20% of the general population, and an important cause of morbidity in 3–40% of the population [39, 40]. The coughing process consists of a complex process; there are: (1) afferent pathways: sensory nerve fibers (branches of the vagus nerve) located in the ciliated epithelium of the upper airway; (2) central pathway (cough center): a central coordinating region for coughing that located in the upper brain stem and pons; and (3) efferent pathway: stimuli from the cough center travel to the diaphragm, abdominal wall, and muscles via the vagus, phrenic, and spinal motor nerves. The nucleus retroambigualis of the phrenic and spinal motor nerves transmits these stimuli to the inspiratory and expiratory muscles, while the ambiguous nucleus of the laryngeal branches of the vagus nerve transmits to the larynx [40]. Coughing is a physiological reaction of the body that can produce intrathoracic pressure up to 300 mmHg and particle velocities of up to 800 kilometers/hour. While these pressures and velocities are important on mucus clearance, they are also responsible for many of the complications such as exhaustion, insomnia, headache, dizziness, musculoskeletal pain, hoarseness, excessive perspiration, urinary and fecal incontinence, to rib fractures [41]. Based on cough duration, it is classified into three subtypes: acute (less than 3 weeks, usually due to viral upper respiratory tract infection), subacute (3–8 weeks), and chronic (more than 8 weeks) [39, 40]. Chronic cough is often associated with smoking. Chronic smokers are three times more likely to have a chronic cough than nonsmokers [41]. Chronic coughs are more difficult to diagnose and require an examination by a specialist for further evaluation.
Sensory neuropathy or autonomic dysfunction of the laryngeal branch of the vagus nerve can also lead a chronic cough manifestation. The autonomic dysfunction of the vagus nerve puts the laryngeal mucosa in a hyposensitive and hypersensitive state. The most common cause of this symptom is laryngopharyngeal reflux (LPR) [42]. Another etiology of neuropathy is viral infection, especially in the upper respiratory tract. However, it is very difficult for the clinician to determine the etiology because of the atypical clinical symptoms and limited diagnostic modalities. Cough can be mediated by the detection of irritant stimuli in the airway by vagal sensory nerve fibers leading to cough induction via the brainstem without any conscious control or regulation. In neurogenic cough, there was an increase of cough reflex at brainstem level or central sensitization [39, 43].
Because of its neurogenic pain-like characteristic, some of the neuromodulator treatments were considered as a potential therapeutic option for neuropathy cough therapy. Neuromodulator therapy such as gabapentin, pregabalin, and amitriptyline, along with other agents such as baclofen and tramadol [44]. The study by Lee and Woo [45] examined 28 patients with suspected recurrent/superior laryngeal nerve neuropathy. All patients were given gabapentin therapy, with an initial dose of 100 mg/day, which then gradually increased to a maximum of 900 mg/day for 4 weeks. Overall, 68% of patient showed improvement of cough complaints and sensory neuropathy after therapy, especially in the group with clear signs of motor neuropathy.
Chronic cough due to post viral vagal neuropathy is one of the conditions that become the differential diagnosis in cases with unclear etiology. This type of cough is included in the neurogenic cough and is one of the symptoms of laryngeal hypersensitivity syndrome. This theory was originally stated by Morrison
Paradoxical vocal cord movement (PVCM) is a laryngeal disorder, an inappropriate adduction of the vocal cords during inhalation and sometimes exhalation that affects respiratory function and serves as a mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underpredicted and misdiagnosed as asthma or other airway disorder and causing inappropriate treatment [46].
The vocal cords normally open (abduction) into a V opening, called the glottic chink during inspiration and close (adduction) into a narrower V shape during expiration. The contraction of the posterior cricoarytenoid muscle allows the outward rotation of the arytenoid on the cricoid cartilage opening the airway during inspiration. Passive relaxation of the posterior cricoarytenoid muscle during expiration, causing adduction of the vocal cords and close the laryngeal airway, with thyroarytenoid muscle movement supports and provides positive pressure at the end of expiration and prevents bronchial collapse [46, 47], while the lateral cricoarytenoid muscle allows inward rotation of the arytenoid on the cricoid cartilage, closing the laryngeal airway during deglutition, vocalization, and expiration.
The term of PVCM is laryngeal dyskinesia when there is adduction of the vocal cords during inspiration, thereby restricting the airway opening leading to episodic dyspnoea, wheezing and/or stridor, so that it is usually mistaken for asthma. Direct visualization by using laryngoscopy of the vocal cords while the patient is having symptoms is the gold standard for diagnosing PVCM [46]. The etiology of PVCM is unclear but has been hypothesized triggered by a psychological, neurological, or physiological component. Laryngopharyngeal reflux, GERD, croup disease, or exposure to toxic inhalants were suspected as PVCM triggers [47]. In a study by George
PVCM is defined as voice disorder in the absence of organic pathology and suspected have association with autonomic nervous system (ANS) function. Study of Helou
A study of Morrison
The LAR is also called the glottal closure reflex, which is a protective mechanism of the larynx to prevent material entering the upper respiratory system. The muscle that plays a role in this mechanism is the thyroarytenoid muscle, which responds to mechanical stimuli and chemical irritants in the laryngeal mucosa. LAR is mediated by the brain stem, which is an involuntary reflex innervated by the internal branch of the superior laryngeal nerve as an afferent and the recurrent laryngeal nerve as an efferent component [51]. In patients with LAR disorder, laryngeal hypersensitivity, chronic cough, and vocal cord dysfunction also might be found [43].
Episodes of PCVM can be triggered by the irritation of the laryngeal mucosa, as in tobacco abuse, allergic laryngitis, viral illness, and untreated sleep apnea, making treatment more difficult. Irritation of the vocal cords can be directly caused by rhinosinusitis and the resulting postnasal drip. However, inflammation can also occur indirectly due to the release of inflammatory mediators [47]. Patients with PVCM usually present with shortness of breath (stridor or wheezing) that appears suddenly and worsens rapidly to apnea and aphonia. Complaints appear for a few seconds but can continue for several minutes before disappearing. Attacks can occur at any time, even during sleep. Complaints of wheezing are usually more common during inspiration than expiration [46, 47].
In acute attacks, patients with PVCM can show signs such as upper airway obstruction, namely shortness of breath, stridor, respiratory muscle retraction, difficulty in speaking, and anxiety and even loss of consciousness. Some typical symptoms such as a feeling of suffocation in the neck or throat, more difficult to inhale than exhale, partial response or no response to inhalation [47]. At the time of an acute attack, patients with PVCM may show signs such as upper airway obstruction, namely shortness of breath, stridor, respiratory muscle retraction, difficulty in speaking, and anxiety and even loss of consciousness [52]. Auscultation should be performed on the neck and lungs to exclude lower respiratory disorders, i.e., asthma and other pulmonary diseases. On auscultation of the neck, wheezing or stridor will be found, especially during inspiration [53].
The diagnosis of PVCM requires flexible fiber-optic laryngoscopy as the gold standard, and vocal cord movement is observed when breathing. Typical findings in PVCM are paradoxical movement of the vocal cords, adduction on inspiration, and narrowing of the glottis during acute attacks. Complete adduction of the vocal cords during inspiration with or without formation of a small posterior diamond shaped, known as posterior chink, is the pathognomonic of PVCM. These findings may also be present during expiration [47, 53]. The differential diagnosis of PVCM is laryngeal edema, vocal cord paresis, laryngeal or tracheal neoplasms, subglottic stenosis, aspiration of foreign bodies, laryngomalacia or tracheomalacia, laryngeal granulomas, and laryngeal spasm [54].
Management of PVCM requires a multidisciplinary approach. Mentally support by calming the patient or reassurance can reduce symptoms significantly. The patient is directed to inhale slowly through the nose and exhale through the mouth [46, 55]. There is no standard pharmacologic management of PVCM besides that used to control comorbid conditions. Medical therapy such as benzodiazepines can also be given to patients with PVCM who have an acute attack. The management of chronic PVCM through breathing exercises, supportive counseling, can be effective. Laryngeal control therapy (LCT) given by a speech pathologist can reduce symptoms in the long term [55]. Proton pump inhibitor therapy and lifestyle modifications can also be given to patients with PVCM associated with an irritated larynx due to gastric acid reflux. The recommended PPI that can be given is omeprazole 20 mg or lansoprazole 30 mg 2 times per day for 3–6 months or for child dose of 1 mg/kg/time given two times per day [55].
Altered vagal nerve activity caused by impaired autonomic regulation may appear to play a role in the pathogenesis of laryngeal clinical manifestation and have an impact in person’s quality of life. This often leads to high economic and social burdens on patients due to delay in diagnosis, numerous tertiary care referrals, and lack of effective medications. The degree of dysfunction may have correlation with disease severity. Impaired autonomic regulation in the larynx was thought to be responsible for clinical entities, such as laryngopharyngeal reflux (LPR), sleep-disordered breathing (SDB), chronic cough (CC), and paradoxical vocal cord movement (PVCM). Treating the underlying specific conditions and symptoms are needed, and research with a large series of subjects and application of autonomic modulation as a therapeutic target is recommended in the future.
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In order to lay out the roots of current debates, on such matters we review the history of fashion studies from the mid‐19th century through to today, drawing attention to both the ontological assumptions and the epistemological and methodological dilemmas that have shaped the field, and that in some ways continue to do so today. We finish with some suggestions as to what the future may hold for the field if the ecumenical promise of global fashion research is truly realized.",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Anna-Mari Almila and David Inglis",authors:[{id:"202010",title:"Prof.",name:"David",middleName:null,surname:"Inglis",slug:"david-inglis",fullName:"David Inglis"},{id:"202118",title:"Dr.",name:"Anna-Mari",middleName:null,surname:"Almila",slug:"anna-mari-almila",fullName:"Anna-Mari Almila"}]},{id:"55680",doi:"10.5772/intechopen.68613",title:"The Post‐Modern Transcendental of Language in Science and Philosophy",slug:"the-post-modern-transcendental-of-language-in-science-and-philosophy",totalDownloads:1596,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In this chapter I discuss the deep mutations occurring today in our society and in our culture, the natural and mathematical sciences included, from the standpoint of the “transcendental of language”, and of the primacy of language over knowledge. That is, from the standpoint of the “completion of the linguistic turn” in the foundations of logic and mathematics using Peirce’s algebra of relations. This evolved during the last century till the development of the Category Theory as universal language for mathematics, in many senses wider than set theory. Therefore, starting from the fundamental M. Stone’s representation theorem for Boolean algebras, computer scientists developed a coalgebraic first-order semantics defined on Stone’s spaces, for Boolean algebras, till arriving to the definition of a non-Turing paradigm of coalgebraic universality in computation. Independently, theoretical physicists developed a coalgebraic modelling of dissipative quantum systems in quantum field theory, interpreted as a thermo-field dynamics. The deep connection between these two coalgebraic constructions is the fact that the topologies of Stone spaces in computer science are the same of the C*-algebras of quantum physics. 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Question one searches for answering: nowadays, in global age, why is a thinker like John Locke still so important in order to support reflections about epistemological, political, religious and educational questions? Kind of research reported is a theoretical approach. Discourse development has followed these steps: first, considerations about his theory of knowledge; second, approaches concerning his political theory; third, reflections under his ideas on religion; fourth, discussions concerning his thoughts over education. Results of this inquiry: he is one of the most eminent theorists of experience and it is essential to build knowledge; therefore, his thought must not be neglected; he is also very important to reflect about natural rights of mankind, which must be granted by Commonwealth; his ideas over toleration, which reinforce distinction between Church and Commonwealth, are still useful to think about how to deal with several religious beliefs and political opinions; his educational thought outlines that education is a psychophysical process that must equally treat both body and soul. 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These globalized technologies in the form of either game apps (i.e., Pokémon Go) or robotics like drones become through the Internet multimedia a structural part of planetary digitalization. While this development takes place, traditional virtue epistemology responds insufficiently to the devitalization of knowledge regarding manners (savoir vivre) and ways (savoir faire) of practicing and the need to respond to the sudden expansion of augmented games and drone use with personal and social intellect, responsibility, and consequently safety. The chapter intends to discuss this analysis in order to argue that a postindustrial epistemic reconfiguration of digital ethics is necessary, since augmented reality games and robotics are taking the form of massive trends for adults and nonadults, while for the first time, digital gaming and robot entertainment exceed the limits of the personal space and the virtual mode of the screen, moving out into the public realm, where reality is mixed with virtuality and human environment with unmanned robots.",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Theodore Kabouridis",authors:[{id:"200390",title:"Dr.",name:"Theodore",middleName:null,surname:"Kabouridis",slug:"theodore-kabouridis",fullName:"Theodore Kabouridis"}]},{id:"55786",doi:"10.5772/intechopen.69322",title:"Theoretical-Epistemological Perspectives of Knowledge in the Global Era: A Conceptual Proposal",slug:"theoretical-epistemological-perspectives-of-knowledge-in-the-global-era-a-conceptual-proposal",totalDownloads:1317,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"It deals with the perspectives of knowledge in the global era. It indicates as a starting point in the following question: how is it possible to represent knowledge in a theoretical-conceptual character in the global era considering the construction of knowledge in networked society, as well as the relations between knowledge of knowledge and other terminologies? It aims to investigate the main fundamentals and characteristics of knowledge in the global era, representing the multiple conceptual relations in the social, valuing, procedural, technical, and psychic context, aiming at the reflection and construction of an integrated concept on knowledge. It concludes that each typology of knowledge presents a concept, and the junction of concepts institutes a general concept about knowledge.",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Jonathas Luiz Carvalho Silva, Maria Cleide Rodrigues Bernardino\nand Henriette Ferreira Gomes",authors:[{id:"201171",title:"Dr.",name:"Jonathas Carvalho",middleName:null,surname:"Silva",slug:"jonathas-carvalho-silva",fullName:"Jonathas Carvalho Silva"}]}],mostDownloadedChaptersLast30Days:[{id:"56390",title:"Introductory Chapter: Sociology of Knowledge and Epistemological Paradox of Globalization",slug:"introductory-chapter-sociology-of-knowledge-and-epistemological-paradox-of-globalization",totalDownloads:1823,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Zlatan Delić",authors:[{id:"31746",title:"Dr.",name:"Zlatan",middleName:null,surname:"Delic",slug:"zlatan-delic",fullName:"Zlatan Delic"}]},{id:"55786",title:"Theoretical-Epistemological Perspectives of Knowledge in the Global Era: A Conceptual Proposal",slug:"theoretical-epistemological-perspectives-of-knowledge-in-the-global-era-a-conceptual-proposal",totalDownloads:1317,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"It deals with the perspectives of knowledge in the global era. 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It concludes that each typology of knowledge presents a concept, and the junction of concepts institutes a general concept about knowledge.",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Jonathas Luiz Carvalho Silva, Maria Cleide Rodrigues Bernardino\nand Henriette Ferreira Gomes",authors:[{id:"201171",title:"Dr.",name:"Jonathas Carvalho",middleName:null,surname:"Silva",slug:"jonathas-carvalho-silva",fullName:"Jonathas Carvalho Silva"}]},{id:"55680",title:"The Post‐Modern Transcendental of Language in Science and Philosophy",slug:"the-post-modern-transcendental-of-language-in-science-and-philosophy",totalDownloads:1596,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In this chapter I discuss the deep mutations occurring today in our society and in our culture, the natural and mathematical sciences included, from the standpoint of the “transcendental of language”, and of the primacy of language over knowledge. 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These globalized technologies in the form of either game apps (i.e., Pokémon Go) or robotics like drones become through the Internet multimedia a structural part of planetary digitalization. While this development takes place, traditional virtue epistemology responds insufficiently to the devitalization of knowledge regarding manners (savoir vivre) and ways (savoir faire) of practicing and the need to respond to the sudden expansion of augmented games and drone use with personal and social intellect, responsibility, and consequently safety. The chapter intends to discuss this analysis in order to argue that a postindustrial epistemic reconfiguration of digital ethics is necessary, since augmented reality games and robotics are taking the form of massive trends for adults and nonadults, while for the first time, digital gaming and robot entertainment exceed the limits of the personal space and the virtual mode of the screen, moving out into the public realm, where reality is mixed with virtuality and human environment with unmanned robots.",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Theodore Kabouridis",authors:[{id:"200390",title:"Dr.",name:"Theodore",middleName:null,surname:"Kabouridis",slug:"theodore-kabouridis",fullName:"Theodore Kabouridis"}]},{id:"55806",title:"Epistemology and the Transformation of Knowledge in the Global Age: God and the Epistemology of Mathematics",slug:"epistemology-and-the-transformation-of-knowledge-in-the-global-age-god-and-the-epistemology-of-mathe",totalDownloads:1153,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Mathematics, as a scientific discipline, developed from the rather humble beginnings of practical counting and measurements. The Pythagoreans shifted this discipline to the ideal, intelligible world—the “Pythagorean paradise”—where it remains to this day. However, there have been doubts as to whether some of the more peculiar mathematical concepts (irrational numbers, zero, negative numbers, infinity…) also belong to this “Paradise”. Within Theo-Platonism of the fourth century, the Christian God legitimised the concept of infinity. God then acted as guarantor for the existence of infinity even in the nineteenth and twentieth centuries. Later, however, God was played down with explicit references to Him having been eliminated. He remained hidden, as it were, in the “supernatural axioms” of set theory. Attempts to “excommunicate” Him consistently from the foundation of mathematics had only a negligible impact on the mathematics itself. Was it due to the fact that those formal foundations of mathematics (the set theory) are not the true foundations, with the actual basis being in mathematical practice?",book:{id:"5924",slug:"epistemology-and-transformation-of-knowledge-in-global-age",title:"Epistemology and Transformation of Knowledge in Global Age",fullTitle:"Epistemology and Transformation of Knowledge in Global Age"},signatures:"Peter Zamarovský",authors:[{id:"199806",title:"Dr.",name:"Peter",middleName:null,surname:"Zamarovský",slug:"peter-zamarovsky",fullName:"Peter Zamarovský"}]}],onlineFirstChaptersFilter:{topicId:"1332",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"June 11th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,annualVolume:11418,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,annualVolume:11419,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,annualVolume:11420,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,annualVolume:11422,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,annualVolume:11423,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:[],overviewPagePublishedBooks:[],openForSubmissionBooks:{paginationCount:3,paginationItems:[{id:"11446",title:"Industry 4.0 - Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11446.jpg",hash:"be984f45b90c1003798661ef885d8a34",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 12th 2022",isOpenForSubmission:!0,editors:[{id:"303193",title:"Dr.",name:"Meisam",surname:"Gordan",slug:"meisam-gordan",fullName:"Meisam Gordan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11448",title:"Artificial Neural Networks - Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11448.jpg",hash:"e57ff97a39cfc6fe68a1ac62b503dbe9",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"June 3rd 2022",isOpenForSubmission:!0,editors:[{id:"22866",title:"Dr.",name:"Chi Leung Patrick",surname:"Hui",slug:"chi-leung-patrick-hui",fullName:"Chi Leung Patrick Hui"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11447",title:"Swarm Intelligence - Recent Advances and Current Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11447.jpg",hash:"f68e3c3430a74fc7a7eb97f6ea2bb42e",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 22nd 2022",isOpenForSubmission:!0,editors:[{id:"24555",title:"Dr.",name:"Marco Antonio",surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{}},subseries:{item:{id:"6",type:"subseries",title:"Viral Infectious Diseases",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. 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