Overview of available studies on nonpharmacological interventions in patients with systemic sclerosis.
\\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:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6498",leadTitle:null,fullTitle:"Mobile Computing - Technology and Applications",title:"Mobile Computing",subtitle:"Technology and Applications",reviewType:"peer-reviewed",abstract:"Nowadays, mobile communication services are penetrating into our society at an explosive growth rate. Applications in mobile devices offer limitations, restriction, and guidelines on how mobile software can be used in order to simplify the mobile usage. As smart phones and tablets are becoming the daily computing device of choice for young ages, it is expected that mobile applications and services should be as flexible, high quality, and secure as the desktop systems. In this book, latest trends in mobile computing will be discussed. In the first section, cloud computing topics will be discussed widely into four chapters to give information to the reader about topics such as challenges, services, edge computing, and distributed clouds needed to integrate this promising issue into the next generation.",isbn:"978-1-78923-223-3",printIsbn:"978-1-78923-222-6",pdfIsbn:"978-1-83881-504-2",doi:"10.5772/intechopen.70979",price:119,priceEur:129,priceUsd:155,slug:"mobile-computing-technology-and-applications",numberOfPages:122,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"ad8ae044b3a753dcd905348a5219549c",bookSignature:"Mutamed Khatib and Nael Salman",publishedDate:"May 30th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6498.jpg",numberOfDownloads:6665,numberOfWosCitations:8,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:11,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:25,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 21st 2017",dateEndSecondStepPublish:"October 12th 2017",dateEndThirdStepPublish:"December 11th 2017",dateEndFourthStepPublish:"March 1st 2018",dateEndFifthStepPublish:"April 30th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"22273",title:"Dr.",name:"Mutamed",middleName:null,surname:"Khatib",slug:"mutamed-khatib",fullName:"Mutamed Khatib",profilePictureURL:"https://mts.intechopen.com/storage/users/22273/images/system/22273.jpeg",biography:"Mutamed Khatib received his Ph.D. Degree in Wireless and Mobile Systems from USM in 2009. His research interests are in the field of mobile networks and coding. Since 2005, he worked as an instructor in the Engineering Faculty at Palestine Technical University (Kadoorie), Tulkarm – Palestine. He was the head of telecommunication department for two years, the dean of faculty of engineering for four years, and he is now the VP for academics, and is teaching advanced courses in telecommunications and coding as an Associate Professor. Dr. Khatib has a number of publications in various international journals and conferences, he is also an author of books as well as the editor for both books and journals where he also serves as a reviewer.",institutionString:"Palestine Technical University - Kadoorie",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Palestine Technical University - Kadoorie",institutionURL:null,country:{name:"Palestine"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"214692",title:"Dr.",name:"Nael",middleName:null,surname:"Salman",slug:"nael-salman",fullName:"Nael Salman",profilePictureURL:"https://mts.intechopen.com/storage/users/214692/images/5746_n.png",biography:"Nael Salman received his PhD in Computer Engineering from Middle East Technical University (METU), Ankara, Turkey in 2006. He is an assistant professor in computer engineering at Palestine Technical University–Kadoorie (PTUK). Currently, Dr. Salman is the Dean of Admission and Registration. Dr. Salman started his job as a lecturer at PTUK in 1996. From 2000 to 2007 he worked as an instructor at Cankaya University, Turkey. In January, 2007, Dr. Salman returned to PTUK and held several academic and administrative positions. Dr. Salman has a number of publications in various international journals and refereed conference proceedings. Dr. Salman also participated as an IT consultant in several TEMPUS, QIF funded projects. His research interests include the fields of Software Engineering, Software measurement, Web Application development, Network security, and Database systems.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"536",title:"Mobile Computing",slug:"communications-and-security-mobile-computing"}],chapters:[{id:"60665",title:"Taxonomy of Cloud Lock-in Challenges",doi:"10.5772/intechopen.74459",slug:"taxonomy-of-cloud-lock-in-challenges",totalDownloads:1146,totalCrossrefCites:3,totalDimensionsCites:5,hasAltmetrics:0,abstract:"This chapter reviews key concepts and terminologies needed for understanding the complexity of the vendor lock-in problem being investigated in this book. Firstly, we present aspects of cloud computing that contribute to vendor lock-in and briefly introduce existing results from cloud-related areas of computer science that contributes to understanding and tackling vendor lock-in. Secondly, we explore the literature on proprietary lock-in risks in cloud computing environments to identify its causes (i.e., restrictions), consequences, mitigations strategies, and related challenges faced by enterprise consumers migrating to cloud-based services. Then, we propose taxonomy of cloud lock-in perspectives based on reports of real experiences on migration to understand the overall cloud SaaS migration challenges. Finally, we narrow down to our perspective on cloud lock-in to three main perspectives which takes the use of sound techniques from IS research discipline and cloud-related literature into consideration, to improve the portability, security and interoperability of cloud (and on-premise) applications in hybrid environments. Collectively, the discussions presented herein, accordingly enables both academia and IT practitioners in the cloud computing community to get an overarching view of the process of combating application and data lock-in challenges, and security risks in the cloud.",signatures:"Justice Opara-Martins",downloadPdfUrl:"/chapter/pdf-download/60665",previewPdfUrl:"/chapter/pdf-preview/60665",authors:[{id:"222657",title:"Dr.",name:"Justice",surname:"Opara-Martins",slug:"justice-opara-martins",fullName:"Justice Opara-Martins"}],corrections:null},{id:"59721",title:"Integrating Cloud Computing with Next-Generation Telematics for Energy Sustainability in Vehicular Networks",doi:"10.5772/intechopen.74460",slug:"integrating-cloud-computing-with-next-generation-telematics-for-energy-sustainability-in-vehicular-n",totalDownloads:1148,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This research focuses on new approaches to enhance the economic viability of newer hybrid/electric vehicle technology utilizing a telematic and cloud computing framework. First, an economic foundation is proposed that rewards drivers for energy efficient driver behavior in units of energy based on a predefined standard. Next, a service model is presented that allows drivers to transfer information regarding their energy efficiency through a telematic and cloud computing network. Based on existing cloud computing technology and telematic standards, a network architecture is proposed to transfer this information to service integrators and content providers that can use this information to create vehicle energy resource management capabilities for vehicle users and fleet owners. Such an architecture would enable drivers or fleet owners to redeem energy units for monetary or promotional incentives, thereby realizing more economic value for the vehicle investment.",signatures:"Matthew Liotine",downloadPdfUrl:"/chapter/pdf-download/59721",previewPdfUrl:"/chapter/pdf-preview/59721",authors:[{id:"223643",title:"Dr.",name:"Matthew",surname:"Liotine",slug:"matthew-liotine",fullName:"Matthew Liotine"}],corrections:null},{id:"60315",title:"Mobile Services Meet Distributed Cloud: Benefits, Applications, and Challenges",doi:"10.5772/intechopen.75818",slug:"mobile-services-meet-distributed-cloud-benefits-applications-and-challenges",totalDownloads:1144,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"As the explosive growth of smart devices and enormous new applications, the variety of corresponding cloud services has been growing quickly. The conventional centralized cloud was faced with an overhead on backhaul links and high latency. Accordingly, a decentralized cloud paradigm including edge computing, mobile edge computing, cloudlet, and so on, was introduced to distribute cloud services to the edge network which located in proximity to mobile devices few years ago. However, this paradigm was not paid attention at that time since cloud technology and mobile network communication were immature to motivate mobile services. Recently, with the overwhelming growth of mobile communication technology and cloud technology, distributed cloud is emerging as a paradigm well equipped with technologies to support a broad range of mobile services. The 5G mobile communication technology provides high-speed data and low latency. Cloud services can be automatically deployed in the edge networks quickly and easily. Distributed cloud can prove itself to bring many benefits for mobile service such as reducing network latency, as well as computational and network overhead at the central cloud. Besides, we present some applications to emphasize the necessity of distributed cloud for mobile service and discuss further technical challenges in distributed cloud.",signatures:"Tien-Dung Nguyen, Yunkon Kim, Xuan-Qui Pham, Tri D.T. Nguyen\nand Eui-Nam Huh",downloadPdfUrl:"/chapter/pdf-download/60315",previewPdfUrl:"/chapter/pdf-preview/60315",authors:[{id:"17491",title:"Prof.",name:"Eui-Nam",surname:"Huh",slug:"eui-nam-huh",fullName:"Eui-Nam Huh"},{id:"226813",title:"Dr.",name:"Tien-Dung",surname:"Nguyen",slug:"tien-dung-nguyen",fullName:"Tien-Dung Nguyen"},{id:"239290",title:"Mr.",name:"Yunkon",surname:"Kim",slug:"yunkon-kim",fullName:"Yunkon Kim"},{id:"239291",title:"Mr.",name:"Xuan-Qui",surname:"Pham",slug:"xuan-qui-pham",fullName:"Xuan-Qui Pham"},{id:"239292",title:"Mr.",name:"Tri",surname:"Nguyen",slug:"tri-nguyen",fullName:"Tri Nguyen"}],corrections:null},{id:"60636",title:"Reliable Web Service Consumption Through Mobile Cloud Computing",doi:"10.5772/intechopen.74461",slug:"reliable-web-service-consumption-through-mobile-cloud-computing",totalDownloads:865,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The mobile intermittent wireless connectivity limits the evolution of the mobile landscape. Achieving web service reliability results in low communication overhead and correct retrieval of the appropriate state response. In this chapter, we discuss and analyze two approaches based on middleware approach, Reliable Service Architecture using Middleware (RSAM), and Reliable Approach using Middleware and WebSocket (RAMWS). These approaches achieve the reliability of web services consumed by mobile devices and propose an enhanced architecture that achieves the reliability under various conditions with minimum communication data overhead. In these experiments, we covered several cases to prove the achievement of reliability. Results also show that the request size was found to be constant, the response size is identical to the traditional architecture, and the increase in the consumption time was less than 5% with the different response sizes.",signatures:"Amr S. Abdelfattah, Tamer Abdelkader and EI-Sayed M. EI-Horbaty",downloadPdfUrl:"/chapter/pdf-download/60636",previewPdfUrl:"/chapter/pdf-preview/60636",authors:[{id:"222758",title:"Prof.",name:"El-Sayed M.",surname:"El-Horbaty",slug:"el-sayed-m.-el-horbaty",fullName:"El-Sayed M. El-Horbaty"},{id:"223952",title:"M.Sc.",name:"Amr",surname:"Elsayed",slug:"amr-elsayed",fullName:"Amr Elsayed"},{id:"224594",title:"Dr.",name:"Tamer",surname:"Abdelkader",slug:"tamer-abdelkader",fullName:"Tamer Abdelkader"}],corrections:null},{id:"60391",title:"Validating Activity-Based Travel Demand Models Using Mobile Phone Data",doi:"10.5772/intechopen.75810",slug:"validating-activity-based-travel-demand-models-using-mobile-phone-data",totalDownloads:944,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Activity-based travel demand models predict travel sequences on a day for each individual in a study region. These sequences serve as important input for travel demand estimate and forecast in the area. However, a reliable method to evaluate the generated sequences has been lacking, hampering further development and application of the models. In this chapter, we use travel behavioral information inferred from mobile phone data for such validation purposes. Our method is composed of three major steps. First, locations where a user made calls on a day are extracted from his/her mobile phone records, and these locations form a location trajectory. All the trajectories from the user across multiple days are then transformed into actual travel sequences. The sequences derived from all phone users are further classified into typical patterns which, along with their relative frequencies, define travel profiles. These profiles characterize current travel behavior in the study region and can thus be utilized for assessing sequences generated from activity-based models. By comparing the obtained profiles with statistics drawn from conventional travel surveys, the validation potential of the proposed method is demonstrated.",signatures:"Feng Liu, Ziyou Gao, Bin Jia, Xuedong Yan, Davy Janssens and Geert\nWets",downloadPdfUrl:"/chapter/pdf-download/60391",previewPdfUrl:"/chapter/pdf-preview/60391",authors:[{id:"55720",title:"Dr.",name:"Feng",surname:"Liu",slug:"feng-liu",fullName:"Feng Liu"},{id:"57852",title:"Prof.",name:"Geert",surname:"Wets",slug:"geert-wets",fullName:"Geert Wets"},{id:"206586",title:"Dr.",name:"Davy",surname:"Janssens",slug:"davy-janssens",fullName:"Davy Janssens"},{id:"239581",title:"Prof.",name:"Ziyou",surname:"Gao",slug:"ziyou-gao",fullName:"Ziyou Gao"},{id:"239582",title:"Prof.",name:"Bin",surname:"Jia",slug:"bin-jia",fullName:"Bin Jia"}],corrections:null},{id:"60121",title:"Adaptive Security Framework in Internet of Things (IoT) for Providing Mobile Cloud Computing",doi:"10.5772/intechopen.75190",slug:"adaptive-security-framework-in-internet-of-things-iot-for-providing-mobile-cloud-computing",totalDownloads:1421,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Internet of Things (IoT) has immense potential to change many of our daily activities, routines and behaviors. The pervasive nature of the information sources means that a great amount of data pertaining to possibly every aspect of human activity, both public and private, will be produced, transmitted, collected, stored and processed. Consequently, integrity and confidentiality of transmitted data as well as the authentication of (and trust in) the services that offer the data is crucial. Hence, security is a critical functionality for the IoT. Enormous growth of mobile devices capability, critical automation of industry fields and the widespread of wireless communication cast need for seamless provision of mobile web services in the Internet of Things (IoT) environment. These are enriched by mobile cloud computing. However, it poses a challenge for its reliability, data authentication, power consumption and security issues. There is also a need for auto self-operated sensors for geo-sensing, agriculture, automatic cars, factories, roads, medicals application and more. IoT is still highly not reliable in points of integration between how its devices are connected, that is, there is poor utilization of the existing IP security protocols. In this chapter, we propose a deep penetration method for the IoT connected set of devices, along with the mobile cloud. An architecture and testing framework for providing mobile cloud computing in the IoT that is based on the object security, power utilization, latency measures and packet loss rate is explained. Our solution is based on the use of existing security protocols between clients and the mobile hosts as well as a key management protocol between the individual mobile hosts implementing an out-of-band key exchange that is simple in practice, flexible and secure. We study the performance of this approach by evaluating a prototype implementation of our security framework. This chapter, in a preliminary manner, discusses the threats, hacks, misguided packets and over read sensor message. These packets are then translated by hardware and pushed through the web for later-on action or support. Our testing of a set of sensor-triggered scenario and setup clearly indicates the security threats from wireless connected small LAN environments and the overestimated sensor messages resulting from the initial set of the sensor readings, while we emphasize more on the security level of the web services serving the IoT-connected device. Also, we add a remark on how mobile web services and their enabling devices are by far vulnerable to a 4G hack over the utilization of power pack and a serious battery use power draining issues.",signatures:"Feda AlShahwan",downloadPdfUrl:"/chapter/pdf-download/60121",previewPdfUrl:"/chapter/pdf-preview/60121",authors:[{id:"225941",title:"Dr.",name:"Feda",surname:"Alshahwan",slug:"feda-alshahwan",fullName:"Feda Alshahwan"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"130",title:"Advanced Trends in Wireless Communications",subtitle:null,isOpenForSubmission:!1,hash:"5e4ee43695942661257e91c418eedb11",slug:"advanced-trends-in-wireless-communications",bookSignature:"Mutamed Khatib",coverURL:"https://cdn.intechopen.com/books/images_new/130.jpg",editedByType:"Edited by",editors:[{id:"22273",title:"Dr.",name:"Mutamed",surname:"Khatib",slug:"mutamed-khatib",fullName:"Mutamed Khatib"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4473",title:"Contemporary Issues in Wireless Communications",subtitle:null,isOpenForSubmission:!1,hash:"91c724af279ed119184289a5e6cf691f",slug:"contemporary-issues-in-wireless-communications",bookSignature:"Mutamed Khatib",coverURL:"https://cdn.intechopen.com/books/images_new/4473.jpg",editedByType:"Edited by",editors:[{id:"22273",title:"Dr.",name:"Mutamed",surname:"Khatib",slug:"mutamed-khatib",fullName:"Mutamed Khatib"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7322",title:"Wireless Mesh Networks",subtitle:"Security, Architectures and Protocols",isOpenForSubmission:!1,hash:"db5ab870ec11f9d4d1ebb54c7dd6e2bf",slug:"wireless-mesh-networks-security-architectures-and-protocols",bookSignature:"Mutamed Khatib and Samer Alsadi",coverURL:"https://cdn.intechopen.com/books/images_new/7322.jpg",editedByType:"Edited by",editors:[{id:"22273",title:"Dr.",name:"Mutamed",surname:"Khatib",slug:"mutamed-khatib",fullName:"Mutamed Khatib"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"858",title:"Recent Developments in Mobile Communications",subtitle:"A Multidisciplinary Approach",isOpenForSubmission:!1,hash:"d9051720bd0c3f7ff7f171bcbbb599f0",slug:"recent-developments-in-mobile-communications-a-multidisciplinary-approach",bookSignature:"Juan P. Maícas",coverURL:"https://cdn.intechopen.com/books/images_new/858.jpg",editedByType:"Edited by",editors:[{id:"66181",title:"Dr",name:"Juan P.",surname:"Maícas",slug:"juan-p.-maicas",fullName:"Juan P. Maícas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1636",title:"Telecommunications Networks",subtitle:"Current Status and Future Trends",isOpenForSubmission:!1,hash:"3cd52027cd1f450d5770cede2b712b46",slug:"telecommunications-networks-current-status-and-future-trends",bookSignature:"Jesus Hamilton Ortiz",coverURL:"https://cdn.intechopen.com/books/images_new/1636.jpg",editedByType:"Edited by",editors:[{id:"97704",title:"Dr.",name:"Jesús Hamilton",surname:"Ortiz",slug:"jesus-hamilton-ortiz",fullName:"Jesús Hamilton Ortiz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"856",title:"Mobile Multimedia",subtitle:"User and Technology Perspectives",isOpenForSubmission:!1,hash:"9e415ab7b4b8bec2caabd9e3daf961ef",slug:"mobile-multimedia-user-and-technology-perspectives",bookSignature:"Dian Tjondronegoro",coverURL:"https://cdn.intechopen.com/books/images_new/856.jpg",editedByType:"Edited by",editors:[{id:"70836",title:"Dr.",name:"Dian",surname:"Tjondronegoro",slug:"dian-tjondronegoro",fullName:"Dian Tjondronegoro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"189",title:"Novel Applications of the UWB Technologies",subtitle:null,isOpenForSubmission:!1,hash:"ed2f8e92a107244ca4c22888843e374f",slug:"novel-applications-of-the-uwb-technologies",bookSignature:"Boris Lembrikov",coverURL:"https://cdn.intechopen.com/books/images_new/189.jpg",editedByType:"Edited by",editors:[{id:"2359",title:"Dr.",name:"Boris I.",surname:"Lembrikov",slug:"boris-i.-lembrikov",fullName:"Boris I. Lembrikov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3629",title:"Mobile and Wireless Communications",subtitle:"Physical Layer Development and Implementatiom",isOpenForSubmission:!1,hash:null,slug:"mobile-and-wireless-communications-physical-layer-development-and-implementatiom",bookSignature:"Salma Ait Fares and Fumiyuki Adachi",coverURL:"https://cdn.intechopen.com/books/images_new/3629.jpg",editedByType:"Edited by",editors:[{id:"3125",title:"Dr.",name:"Salma",surname:"Ait Fares",slug:"salma-ait-fares",fullName:"Salma Ait Fares"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1902",title:"Mobile Networks",subtitle:null,isOpenForSubmission:!1,hash:"5351aa9d45ae2f6c117f48979caa469a",slug:"mobile-networks",bookSignature:"Jesus Hamilton Ortiz",coverURL:"https://cdn.intechopen.com/books/images_new/1902.jpg",editedByType:"Edited by",editors:[{id:"97704",title:"Dr.",name:"Jesús Hamilton",surname:"Ortiz",slug:"jesus-hamilton-ortiz",fullName:"Jesús Hamilton Ortiz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1937",title:"Advances and Applications in Mobile Computing",subtitle:null,isOpenForSubmission:!1,hash:"6849926929e1a2a8dbc973860c55e882",slug:"advances-and-applications-in-mobile-computing",bookSignature:"Adem Karahoca",coverURL:"https://cdn.intechopen.com/books/images_new/1937.jpg",editedByType:"Edited by",editors:[{id:"1586",title:"Associate Prof.",name:"Adem",surname:"Karahoca",slug:"adem-karahoca",fullName:"Adem Karahoca"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],ofsBooks:[]},correction:{item:{id:"79356",slug:"corrigendum-to-a-brief-overview-of-ophthalmic-ultrasound-imaging",title:"Corrigendum to: A Brief Overview of Ophthalmic Ultrasound Imaging",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/69566.pdf",downloadPdfUrl:"/chapter/pdf-download/69566",previewPdfUrl:"/chapter/pdf-preview/69566",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/69566",risUrl:"/chapter/ris/69566",chapter:{id:"65491",slug:"a-brief-overview-of-ophthalmic-ultrasound-imaging",signatures:"David B. Rosen, Mandi D. Conway, Charles P. Ingram, Robin D. Ross and Leonardo G. Montilla",dateSubmitted:"November 6th 2018",dateReviewed:"December 12th 2018",datePrePublished:"February 5th 2019",datePublished:"September 4th 2019",book:{id:"8633",title:"Novel Diagnostic Methods in Ophthalmology",subtitle:null,fullTitle:"Novel Diagnostic Methods in Ophthalmology",slug:"novel-diagnostic-methods-in-ophthalmology",publishedDate:"September 4th 2019",bookSignature:"Anna Nowinska",coverURL:"https://cdn.intechopen.com/books/images_new/8633.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"261466",title:"Dr.",name:"Anna",middleName:"Karolina",surname:"Nowińska",slug:"anna-nowinska",fullName:"Anna Nowińska"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"274007",title:"Prof.",name:"Mandi D.",middleName:null,surname:"Conway",fullName:"Mandi D. Conway",slug:"mandi-d.-conway",email:"mconway1@yahoo.com",position:null,institution:null},{id:"283754",title:"Dr.",name:"Robin",middleName:"Demi",surname:"Ross",fullName:"Robin Ross",slug:"robin-ross",email:"robindross@email.arizona.edu",position:null,institution:null},{id:"284051",title:"BSc.",name:"David",middleName:null,surname:"Rosen",fullName:"David Rosen",slug:"david-rosen",email:"davidrosen@email.arizona.edu",position:null,institution:null},{id:"284377",title:"BSc.",name:"Leonardo",middleName:null,surname:"Montilla",fullName:"Leonardo Montilla",slug:"leonardo-montilla",email:"funrunner13@gmail.com",position:null,institution:null},{id:"284378",title:"MSc.",name:"Charles",middleName:null,surname:"Ingram",fullName:"Charles Ingram",slug:"charles-ingram",email:"cingram@optics.arizona.edu",position:null,institution:null}]}},chapter:{id:"65491",slug:"a-brief-overview-of-ophthalmic-ultrasound-imaging",signatures:"David B. Rosen, Mandi D. Conway, Charles P. Ingram, Robin D. Ross and Leonardo G. Montilla",dateSubmitted:"November 6th 2018",dateReviewed:"December 12th 2018",datePrePublished:"February 5th 2019",datePublished:"September 4th 2019",book:{id:"8633",title:"Novel Diagnostic Methods in Ophthalmology",subtitle:null,fullTitle:"Novel Diagnostic Methods in Ophthalmology",slug:"novel-diagnostic-methods-in-ophthalmology",publishedDate:"September 4th 2019",bookSignature:"Anna Nowinska",coverURL:"https://cdn.intechopen.com/books/images_new/8633.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"261466",title:"Dr.",name:"Anna",middleName:"Karolina",surname:"Nowińska",slug:"anna-nowinska",fullName:"Anna Nowińska"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"274007",title:"Prof.",name:"Mandi D.",middleName:null,surname:"Conway",fullName:"Mandi D. Conway",slug:"mandi-d.-conway",email:"mconway1@yahoo.com",position:null,institution:null},{id:"283754",title:"Dr.",name:"Robin",middleName:"Demi",surname:"Ross",fullName:"Robin Ross",slug:"robin-ross",email:"robindross@email.arizona.edu",position:null,institution:null},{id:"284051",title:"BSc.",name:"David",middleName:null,surname:"Rosen",fullName:"David Rosen",slug:"david-rosen",email:"davidrosen@email.arizona.edu",position:null,institution:null},{id:"284377",title:"BSc.",name:"Leonardo",middleName:null,surname:"Montilla",fullName:"Leonardo Montilla",slug:"leonardo-montilla",email:"funrunner13@gmail.com",position:null,institution:null},{id:"284378",title:"MSc.",name:"Charles",middleName:null,surname:"Ingram",fullName:"Charles Ingram",slug:"charles-ingram",email:"cingram@optics.arizona.edu",position:null,institution:null}]},book:{id:"8633",title:"Novel Diagnostic Methods in Ophthalmology",subtitle:null,fullTitle:"Novel Diagnostic Methods in Ophthalmology",slug:"novel-diagnostic-methods-in-ophthalmology",publishedDate:"September 4th 2019",bookSignature:"Anna Nowinska",coverURL:"https://cdn.intechopen.com/books/images_new/8633.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"261466",title:"Dr.",name:"Anna",middleName:"Karolina",surname:"Nowińska",slug:"anna-nowinska",fullName:"Anna Nowińska"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"7536",leadTitle:null,title:"Modern Medical Genetics and Genomics",subtitle:null,reviewType:"peer-reviewed",abstract:"The field of medical genetics and genomics has been constantly revolutionized by new breakthroughs, which bring more knowledge into the etiology and help improve the health care of individuals with either rare or common diseases. Nevertheless, as technologies evolve, novel challenges emerge, both technically and ethically, so they must be prudentially addressed. Among the myriad applications of genomics in medicine, this book depicts a glimpse of the advances achieved that have been leading us to the personalized/precision medicine era.",isbn:"978-1-83968-143-1",printIsbn:"978-1-83968-142-4",pdfIsbn:"978-1-83968-144-8",doi:"10.5772/intechopen.76597",price:119,priceEur:129,priceUsd:155,slug:"modern-medical-genetics-and-genomics",numberOfPages:104,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"0809faf783cd9332a668976694b69931",bookSignature:"Israel Gomy",publishedDate:"December 18th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7536.jpg",keywords:null,numberOfDownloads:5130,numberOfWosCitations:1,numberOfCrossrefCitations:2,numberOfDimensionsCitations:3,numberOfTotalCitations:6,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 29th 2018",dateEndSecondStepPublish:"May 21st 2018",dateEndThirdStepPublish:"July 20th 2018",dateEndFourthStepPublish:"October 8th 2018",dateEndFifthStepPublish:"December 7th 2018",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"4 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:"Edited by",kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"126844",title:"Dr.",name:"Israel",middleName:null,surname:"Gomy",slug:"israel-gomy",fullName:"Israel Gomy",profilePictureURL:"https://mts.intechopen.com/storage/users/126844/images/9892_n.jpg",biography:"Dr. Israel Gomy graduated in Medicine at Pontificia Universidade Católica do Paraná, Curitiba, Brazil. He received his Master´s degree in Biomedical Research at Universidade de São Paulo, Ribeirão Preto, Brazil and his PhD in Oncology at Fundação Antônio Prudente, São Paulo, Brazil. Dr. Gomy is Assistant professor at Faculdades Pequeno Príncipe, Curitiba, Brazil and Assistant physician at Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.",institutionString:"Federal University Of Parana",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"186",title:"Medical Genetics",slug:"medical-genetics"}],chapters:[{id:"65761",title:"Modern Medical Genetics and Genomics in the Era of Personalized/Precision Medicine",slug:"modern-medical-genetics-and-genomics-in-the-era-of-personalized-precision-medicine",totalDownloads:1169,totalCrossrefCites:0,authors:[{id:"126844",title:"Dr.",name:"Israel",surname:"Gomy",slug:"israel-gomy",fullName:"Israel Gomy"}]},{id:"63938",title:"The Genetic and Biochemical Blueprint of Endometrial Receptivity: Past, Present, and Future Factors Involved in Embryo Implantation Success",slug:"the-genetic-and-biochemical-blueprint-of-endometrial-receptivity-past-present-and-future-factors-inv",totalDownloads:1334,totalCrossrefCites:1,authors:[null]},{id:"64479",title:"Aneuploidy Rates Inversely Correlate with Implantation during In Vitro Fertilization Procedures: In Favor of PGT",slug:"aneuploidy-rates-inversely-correlate-with-implantation-during-em-in-vitro-em-fertilization-procedure",totalDownloads:1027,totalCrossrefCites:1,authors:[null]},{id:"68112",title:"Screening (Bi Test, Triple Test, Panorama Test) and Amniocentesis for Early Diagnosis of Congenital Malformations",slug:"screening-bi-test-triple-test-panorama-test-and-amniocentesis-for-early-diagnosis-of-congenital-malf",totalDownloads:830,totalCrossrefCites:0,authors:[null]},{id:"64229",title:"Genetic Contributors to Hereditary Cancer Predispositions: Do We Have Enough Information?",slug:"genetic-contributors-to-hereditary-cancer-predispositions-do-we-have-enough-information-",totalDownloads:772,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"177731",firstName:"Dajana",lastName:"Pemac",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/177731/images/4726_n.jpg",email:"dajana@intechopen.com",biography:"As a Commissioning Editor at IntechOpen, I work closely with our collaborators in the selection of book topics for the yearly publishing plan and in preparing new book catalogues for each season. This requires extensive analysis of developing trends in scientific research in order to offer our readers relevant content. Creating the book catalogue is also based on keeping track of the most read, downloaded and highly cited chapters and books and relaunching similar topics. I am also responsible for consulting with our Scientific Advisors on which book topics to add to our catalogue and sending possible book proposal topics to them for evaluation. Once the catalogue is complete, I contact leading researchers in their respective fields and ask them to become possible Academic Editors for each book project. Once an editor is appointed, I prepare all necessary information required for them to begin their work, as well as guide them through the editorship process. I also assist editors in inviting suitable authors to contribute to a specific book project and each year, I identify and invite exceptional editors to join IntechOpen as Scientific Advisors. I am responsible for developing and maintaining strong relationships with all collaborators to ensure an effective and efficient publishing process and support other departments in developing and maintaining such relationships."}},relatedBooks:[{type:"book",id:"8171",title:"Genes and Cancer",subtitle:null,isOpenForSubmission:!1,hash:"209b5cea5cbc980442ef0c22782b3792",slug:"genes-and-cancer",bookSignature:"Guy-Joseph Lemamy",coverURL:"https://cdn.intechopen.com/books/images_new/8171.jpg",editedByType:"Edited by",editors:[{id:"182568",title:"Dr.",name:"Guy-Joseph",surname:"Lemamy",slug:"guy-joseph-lemamy",fullName:"Guy-Joseph Lemamy"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11348",title:"Mutagenesis and Mitochondrial-Associated Pathologies",subtitle:null,isOpenForSubmission:!1,hash:"001972b3c5b49367314b13025a449232",slug:"mutagenesis-and-mitochondrial-associated-pathologies",bookSignature:"Michael Fasullo and Angel Catala",coverURL:"https://cdn.intechopen.com/books/images_new/11348.jpg",editedByType:"Edited by",editors:[{id:"258231",title:"Dr.",name:"Michael",surname:"Fasullo",slug:"michael-fasullo",fullName:"Michael Fasullo"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10333",title:"Down Syndrome and Other Chromosome Abnormalities",subtitle:null,isOpenForSubmission:!1,hash:"eab6b739a0eb0f82920b8b23cc39fac5",slug:"down-syndrome-and-other-chromosome-abnormalities",bookSignature:"Subrata Kumar Dey",coverURL:"https://cdn.intechopen.com/books/images_new/10333.jpg",editedByType:"Edited by",editors:[{id:"31178",title:"Prof.",name:"Subrata",surname:"Dey",slug:"subrata-dey",fullName:"Subrata Dey"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"55187",title:"Nonpharmacological Treatment in Systemic Sclerosis",doi:"10.5772/intechopen.68537",slug:"nonpharmacological-treatment-in-systemic-sclerosis",body:'In the last few years, increased attention has been focused on nonpharmacological interventions in rare rheumatic diseases such as systemic sclerosis (SSc). However, there is still an unmet need to ensure medical awareness of the importance of physical therapy among patients, health professionals, rheumatologists, and other specialists to implement these nonpharmacological interventions into the daily care of patients with SSc.
Currently, physical therapy is considered a process by which patients try to restore and maintain their optimal physical, mental, social, occupational, and emotional state. It is therefore a comprehensive approach to the patient, which includes physical activity, as well as the principles of secondary prevention and healthy lifestyles, which are based on the patient’s collaboration, activity, and compliance. It is beyond doubt that physical inactivity is a major risk factor for both cardiovascular and respiratory systems, but also for functional limitations and reduced quality of life.
To acknowledge the importance of prevention and adherence to healthy lifestyle even before the onset of the disease, we can draw inspiration from the results of a recently published study on another, less rare, rheumatic disease, rheumatoid arthritis (RA): about the influence of environmental factors (e.g., the intensity and frequency of physical activity, of smoking, and different exposures) showing that patients with regular physical activity before the onset of RA suffer from a milder form of the disease and that obesity reduces the chance of achieving a good response to standard pharmacological approaches in RA [1, 2].
Tissue fibrosis is the dominant feature of SSc and affects both the skin and internal organs—especially the lungs, heart, and gastrointestinal tract [3]. While visceral involvement is responsible for increased mortality, musculoskeletal involvement (e.g., arthralgia/arthritis, flection contractures, and muscle weakness) and skin involvement (skin thickening and tethering) pose a significant burden for the patient in terms of reduction of functionality, quality of life, and ability to work or perform activities of daily living [4].
Current recommendations for the treatment of SSc include symptomatic therapy of individual organ manifestations and complications of SSc. However, to date, we have no effective treatment of tissue fibrosis, for example, skin, lung, heart, and gastrointestinal tract. Nonpharmacological management of patients with SSc with the main focus on the musculoskeletal system and the affected skin may be useful to reduce disability and improve quality of life and contribute to reducing the burden of disease on the organism. Nevertheless, the major limitations of most of the small number of existing publications focused on physical interventions in patients with SSc include the diversity of interventions, small cohorts of patients, the absence of a control group, randomization and/or a follow-up, and a short duration of intervention [3].
The most frequently investigated nonpharmacological interventions include commonly used methods such as paraffin, manual lymphatic drainage, soft tissue techniques, stretching exercises for hands and face, massage, exercises to maintain range of motion in joints, mobilization, aerobic exercise, and strength training. Other studies focus on occupational therapy, physical therapy, sleep disturbances, sexual function, and depression.
The following paragraphs will provide an overview of the results of the available publications, which are divided according to the nature of the intervention.
One of the methods frequently used in physiotherapy of rheumatic diseases is paraffin treatment. Paraffin solidifies at a temperature of 52–62°C and yet gives latent heat. In order to utilize this heat, paraffin must be applied to the body in a fluid state and allowed to solidify in the course of application. There are a few studies of paraffin in SSc patients: two randomized controlled studies (RCTs), one nonrandomized controlled trial and a series of three individual case studies.
The RCT by Sandqvist et al. evaluated the difference in intervention outcomes in 17 patients with SSc who underwent therapy with paraffin in combination with exercise on one hand chosen by random, and on the other hand received only exercise. Interventions continued daily for 1 month. Hand function was assessed at the beginning of the intervention and after the first month according to hand mobility and strength, the perception of pain, stiffness and elasticity of the skin. The authors demonstrated a significant improvement in flexion and extension of the fingers, thumb abduction, plantar flexion, perceived stiffness, and elasticity of the skin in patients who underwent paraffin intervention in combination with exercise compared to baseline levels. Furthermore, significant improvement in hand function (specifically in extension deficit, perception of stiffness, and elasticity of skin) was significantly greater in the hand that was treated with paraffin in combination with exercise than in the hand treated with exercise only [5].
In another RCT study [6], 16 patients with SSc underwent 12 times paraffin wrap therapy and then were randomly assigned to the intervention and control groups. The intervention group continued with paraffin therapy for 3 months, and the control group did not. Skin thickness decreased in all patients after 12 sessions of paraffin treatment. However, at the end of 3 months therapy in the intervention group, there was no significant difference between the intervention and control group [6].
One of the first studies, a nonrandomized controlled trial by Askew et al., recruited 10 patients with SSc and examined the effectiveness of once performed interventions including paraffin, friction massage, and exercise maintaining range of motion in the joints of the wrist and hand. Compared with seven patients with SSc, who did not attend any sessions, the interventions lead to significant improvements in the articular range of motion, skin elasticity, and overall function of the hand [7].
In a series of three individual case studies [8], respondents conducted active exercises with their hands after paraffin wrap 5 times per week for 8 weeks. The authors detected clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities in all participants [8].
Orofacial region has many functions. Primarily, it ensures food intake and contributes to breathing. Coordinated interplay of activity of facial muscles allows for expression of verbal, articulate speech. In the orofacial region, we find more than fifty facial muscles that enable people to communicate nonverbally, to express their feelings. No other part of the human body possesses such a social function as the orofacial region. Through this region we communicate, we speak to others, express our feelings, and create new relationships. In patients with SSc, tightening of the skin and muscle atrophy in orofacial region lead to loss of facial expressions and an appearance of a mask-like face. The affected orofacial region with skin thickening often contribute to inability of mechanical mouth opening, microstomia, which along with other symptoms, such as dry mouth, can lead to dental and mouth hygiene issues, and hampered alimentation.
In the RCT by Yuen Hon et al., the authors studied the effect of orofacial home exercise program to increase the orifice in adults with SSc. The study included 48 adult patients with SSc who were randomly divided into two groups and examined for oral aperture at baseline, 3-month, and 6-month intervals. The intervention group underwent a multifaceted oral health intervention including adaptive oral hygiene devices, instruction and demonstration on the use of the devices, brushing teeth for 2 min and flossing twice a day for 6 months. The control group received the usual dental care. Participants with orifices <40 mm in the intervention group underwent orofacial exercise program, which included manual mouth-stretching and oral augmentation exercises with a wooden stick, twice a day with a total of 6 minutes for 6 months. The results showed a significant increase in oral orifice in patients of the intervention group at 3 months, but not after 6 months evaluation. However, compliance with the program was low (48.9%), which could distort the results of this study [9].
An RCT by Maddali-Bongi et al. evaluated the effectiveness of an intervention program based on a combination of the Kabat’s technique (proprioceptive neuromuscular facilitation, PNF), connective tissue massage, and kinesiotherapy specially developed for the face of SSc patients. Out of the 40 recruited SSc patients, 20 patients were randomly selected into the intervention group and underwent the intervention program for 9 weeks, 2 times a week for 1 h with a home exercise program. Twenty patients were randomly assigned into the control group, which underwent home exercise program only. Patients of both groups were evaluated at baseline, after 9 weeks and after 9 weeks of follow-up in terms of quality of life and health, stiffness of the facial area, opening of the mouth, and oral handicap. At the end of treatment, both groups showed improved orifice. However, in the follow-up period, improvement persisted only in the intervention group. The facial score in the intervention group improved both at the end of therapy and follow-up period, whereas in the control group, there were no changes. According to the results of quality of life and health status, no effect of therapy was detected in any group. A significant improvement was also found in oral handicap at the end of therapy in the intervention group, whereas in the control group, no changes were observed [10].
In an observational study by Poole et al., the authors investigated the improvement in oral hygiene in SSc patients who underwent a program involving structured oral hygiene and exercises for the face and hands. The authors recruited 17 patients with SSc who previously underwent basic dental checkup, including examination for decayed or missing teeth, calculus, sites that bleed upon probing, measures of oral aperture, and the patient hygiene performance index. The study also evaluated upper limb function involving strength, joint range and maneuverability. Participants underwent a structured exercise program including education on brushing and flossing techniques used, hand exercise of three series with five repetitions, once daily stretching, once daily facial exercise of five times stretching 3–5 seconds, individually adjusted dental equipment, and a 6-month supply of dental products. This program was performed one or two times a day for 6 months. At the end of the 6-month intervention, there were a significant improvement in oral hygiene and a significant decline in the number of teeth with calculus and a reduction in bleeding gums. There were no differences in any of the upper extremity measures or oral aperture [11].
Another observational study by Pizzo et al. examined the effects of nonsurgical exercise program in 10 patients with severe SSc-associated microstomia (maximal mouth opening ≤ 30 mm). Patients were instructed to perform an exercise program, which included mouth stretching exercises for at least 15 minutes, twice a day, and oral augmentation exercise with a stick of soft wood daily during 18 weeks. After 18 weeks, the effect of exercise was evaluated measuring the maximal mouth opening. The exercise program improved mouth opening of all subjects. At the end of the period of 18 weeks, all patients noted that eating, speaking, and oral hygiene were easier [12].
In 2009, Maddali-Bongi et al. performed two other RCTs that examined the effect of specialized intervention programs and pointed out their safety and improvements in the hands and mouth (facial). These studies will be discussed in the following sections of this chapter.
At this point, it is worth to mention a study that can be useful for dentists treating this area in such a rare disease as SSc. Alantar et al. reviewed the literature and collected expert opinion for the design of preventive and curative treatment of oral and dental disability in patients with SSc. The authors point out that prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and on-going treatments [13].
Physiotherapy is a vital part of nonpharmacological approaches, which deals with the prevention and treatment of disorders of the musculoskeletal system. Based on a comprehensive approach, physiotherapy pays special attention to the life situations, in which the person is. The aim of comprehensive physiotherapy is to find the best way to mitigate or eliminate health problems and to maintain the current effect in a long term. There are several studies available in this area of research.
In 2009, Maddali-Bongi et al. performed two RCTs that examined the effect of a specialized intervention program in the area of hands and mouth (face). The first study aimed to evaluate the effectiveness of the intervention program based on a combination of connective tissue massage and joint manipulation according to Mc Mennell specially designed for the hands of SSc patients. Of the 40 recruited SSc patients, 20 patients were randomly assigned to intervention and underwent the exercise program for 9 weeks, twice a week for one hour, and a home exercise program. Twenty patients were randomly assigned to the control group which underwent only the home exercise program. Patients of both groups were evaluated at baseline, after 9 weeks and after 9 weeks of follow-up in terms of quality of life, hand involvement, hand functional disability, and the measurements of range of motion. The intervention group demonstrated a significant improvement in all measured parameters, whereas the home exercise program in the control group improved just closing the hand into a fist at the end of therapy [14].
The aim of the second study was to evaluate the efficacy of a specific and comprehensive rehabilitation program tailored for patients with SSc. Hand involvement was treated with a combination of connective tissue massage and Mc Mennell joint manipulation. Manual lymph drainage was applied if patients had edematous hands. Face involvement was treated with a combination of Kabat’s method, connective tissue massage, and kinesiotherapy. Other techniques used in the study included hydrokinesiotherapy (for patients without ulcers), land-based rehabilitation (for patients with ulcers), and respiratory rehabilitation exercises. The authors recruited twenty patients with SSc, who were randomly divided into two groups and evaluated at baseline and after 9 weeks in terms of quality of life, health, hand function, range of motion, water volumetric test, orifice, Duruoz scale, and purpose-built-questionnaire for hand and face Involvement. The intervention group was evaluated also after 9 weeks of follow-up. The intervention group 10 patients underwent a specific rehabilitation program, one or two times per week for 9 weeks. The control group underwent only educational advice and medical information for patients with SSc. At the end of treatment, patients in the intervention group improved in all measured parameters. In follow-up, orofacial function and mobility as well as general health condition were partially lost, whereas only the mobility and function of the hand were preserved. No changes in the examined parameters were observed in the control group [15].
In a controlled clinical study by Antonioli et al., the authors evaluated the effect of a specialized individual rehabilitation program that consisted of warm-up and cool-down exercises, training of motor functions, diaphragmatic breathing, controlled coughing exercises, treadmill, freewalking, finger stretching, and occupational therapy for 2 weeks of daily 30-minute sessions (10 sessions in total). Physical therapy was also prescribed to 13 patients with joint-related problems. At-home exercise program was prescribed on days when the intervention program was terminated. Patients were reevaluated after 2 and 4 months. The control group consisted of 17 patients who did not receive any form of rehabilitation. The authors evaluated aerobic capacity, hand function, limitations in activities of daily living, quality of life, and skin-related problems. At the end of the 4-month period, the examiners observed an improvement in the perception of quality of life, better exercise tolerance, and better mobility of hand in a significant number of patients with SSc [16].
Since patients with SSc reported great need to receive support and education regarding their disease, Kwakkenbos et al. developed a short, group-based psychoeducational program, and evaluated it in an observational study using pre- and posttest design. Participants filled out a questionnaire assessing their physical and mental condition. Subsequently, patients were asked to evaluate the program content using a questionnaire. Completely filled questionnaires were available for data analysis from 41 patients. The authors detected a high satisfaction of patients with the program, smaller helplessness after the intervention, and a higher acceptance of patients’ limitations. However, no differences were observed in depressed mood or in physical function. Thus, this psychoeducational program contributed to meeting the reported needs of patients and to improving the care of patients with SSc [17].
In an RCT by Schouffoer et al., the authors compared the effectiveness of a 12-week multidisciplinary nursing program with usual outpatient care for SSc patients. The multidisciplinary nursing program included individual treatment goals once a week for 12 weeks, general exercises, hand/mouth exercises, educational sessions under supervision of a local physical therapist, and a home-based exercise program at least 6 days a week for 12 weeks. Twenty-eight patients with SSc were randomly selected into the intervention group (twenty-five of them completed the treatment), and twenty-five patients were randomly assigned to the control group. The examiners evaluated the hand function, grip strength, maximal mouth opening, aerobic capacity, gait, quality of life, and health status at baseline, at the end of treatment (12 weeks), and at the end of follow up (after 24 weeks). Results showed that the 12-week daily multidisciplinary care program was more effective than regular outpatient care with regard to significant improvement in grip strength, mouth opening, gait, and quality of life after 12 weeks, whereas the results in other followed parameters showed no difference between the intervention and control group. At the end of the follow-up period, after 24 weeks, only improvement in grip strength was maintained [18].
Our own preliminary results (unpublished data) from an ongoing single-center controlled study further support the role of intensive physiotherapy in patients with SSc. Our project aimed to address some limitations of existing studies and to assess the efficacy of a long-term (24-week intervention, 24-week follow-up), intensive (1 h physiotherapy + 0.5 h occupational therapy twice weekly, and home-exercise for 0.5 h five times a week), tailored physiotherapy program on function and impairment of the hands and face, and quality of life and disability in patients with SSc. We recruited 27 SSc patients into the intervention group, which underwent the 24-week intervention, and 29 SSc patients into the control group, which received an education and textbook on home exercise at baseline only. The intervention program unit comprised several physiotherapy/occupational therapy techniques, such as warm-up with infrared lamp, manual lymphatic drainage, skin wrinkling, fascial techniques, postisometric muscle relaxation, joint mobilization, passive/active muscle stretching and exaggerated facial mimicry training, soft ball facilitation techniques, senosoric stimulation with terabeans and therapeutic plasticine. Our program not only prevented the natural course of progressive deterioration of function of hands/mouth (observed in the control group) but also led to a significant improvement in monitored parameters (e.g., delta finger to palm, hand/finger grip strength, HAMIS-Hand Mobility in Scleroderma, interincisor/lip distance), which was clinically meaningful in a substantial proportion of patients.
Stretching includes special exercises leading to increased mobility of the body that can address a variety of health-related issues. It is a method, which can gently prepare your muscles to increased physical stress, but also to very ordinary functioning of our body during daily life activities. Stretching increases performance, maintains the elasticity of muscles and tendons, prevents muscle imbalance, improves joint mobility, and helps to maintain correct posture, proper breathing, and efficient and economical movement. Furthermore, stretching reduces muscle tone and brings overall relaxation, provides prevention from muscle- and joint-related injuries, improves response and readiness, and increases resistance to fatigue. To sum up the benefits of stretching, this technique maintains overall good physical and mental condition. For patients, most of all, it is a method/technique that maintains the elasticity of tendons, muscles, and improves joint mobility. Therefore, not only in healthy individuals but also in patients with SSc, it is the only way to recover, or aim to restore physiologic length of shortened muscles.
Mugii et al., in their observational study, compared the effect of autostretching of individual fingers in patients with SSc. Forty-five patients with SSc were instructed how to autostretch their fingers. The individual fingers were held with the other hand in the stretched position for 10 s, and this was repeated 3–10 times a day. To evaluate the effect of autostretching intervention, passive range of motion of the fingers was evaluated using a goniometer during the first visit, after 1 month and 1 year of the autostretching program. Quality of life was also assessed at the first visit and after a year using the Health Assessment Questionnaire (HAQ). The authors demonstrated a significant improvement in the overall range of passive joint motion of each finger after 1 month of autostretching, which was further improved or maintained even after 1 year. Although the range of motion of the fingers was lower in patients with diffuse cutaneous (dc) SSc than in patients with limited cutaneous (lc) SSc during the first visit, the examiners detected a significant improvement regardless of the disease duration or severity of skin sclerosis. The study team noted that stretching your fingers can improve the function of fingers, because HAQ score assessing the hand function activities, such as eating and grasping, decreased significantly [19].
An RCT by Vannajak et al. recruited 28 patients with SSc who were divided into two groups of 14 patients. Both groups received the same daily home treatment with one difference: one group with gloves and the other group without gloves. The 2-week daily home intervention included a Thai massage, stretching exercises and heating. The authors assessed the function of the hand using Hand Mobility in Scleroderma (HAMIS). Both groups showed a significant improvement in the function of the hand. Wearing gloves, however, lead to greater thumb mobility [20].
The rehabilitation of patients with impaired cardiovascular system is based on endurance, aerobic training, that is, a prolonged dynamic loading at or below the anaerobic threshold. Regular aerobic exercise improves the efficiency of the cardiovascular system (lungs, heart, and circulatory system), and regular endurance and strength training induce characteristic changes that lead to improved physical condition. These changes represent the training effect and help to achieve greater physical load with lower heart-rate responses.
Pinto et al. in their observational study focused on the effects of 12 weeks of combined resistance and aerobic training program (concurrent training) in 11 SSc patients. Supervised concurrent training session consisted of treadmill warm-up (5 min) followed by resistance training (30 min), treadmill aerobic training (20 min), and stretching exercises (5 min). Resistance training included five exercises for the main muscle groups: bench press, leg press, latissimus pull down, leg extension, and seated row. The concurrent training program was performed in one hour sessions, twice per week for 12 weeks. The study showed that concurrent 12-week training program was safe and significantly improved muscle strength, function and aerobic capacity in SSc patients [21].
The aim of a pilot study by Alexanderson et al. was to determine the effect of 8-week intense aerobic and endurance training program in four patients (three women and one man) with SSc with 50–100% of forced vital capacity (FVC). The authors detected significantly improved muscular endurance in three participants and significantly or clinically significantly improved aerobic capacity in two participants [22].
Oliveira et al., in their prospective nonrandomized controlled trial, examined whether patients with SSc have reduced exercise capacity compared to healthy individuals, and whether aerobic exercise is safe for patients with SSc and improves their aerobic capacity. In this study, 7 patients with SSc (without interstitial lung disease) and 7 healthy controls underwent an 8-week aerobic exercise program of moderate intensity. Participants were evaluated by cardiopulmonary stress test before and after 8 weeks of training, and examined for blood lactate concentration and oxygen saturation at each visit and at rest, and quality of life. Patients with SSc and healthy controls underwent 40-min training twice weekly. The first five minutes of the exercise program were reserved for the warm-up, when the speed was gradually increased until a target heart rate. The last five minutes of exercise were represented by the cool-down with slowing down the speed to a standstill. In the first session of the program, the participants underwent 15 min of aerobic exercise at their respective target heart rate. In the second session, aerobic training was increased to 20 min, in the third session to 25 min, and in all subsequent sessions to 30 min. Both groups showed a significant improvement in peak VO2 but with no significant difference between the study groups. Furthermore, both groups improved in exercise intensity which was documented by significantly increased peak lactate concentration in blood. No significant changes in SSc skin score or quality of life were detected [23].
In SSc commonly affected area of the body is the lower limbs, especially their muscular strength and function, the loss of which has an impact on quality of life of patients with SSc. Therefore, Lima et al. in their cross-sectional study assessed peripheral and respiratory muscle strength in patients with SSc and examined their correlation with the 6-minute walk test and quality of life. Secondary aim of this study was to characterize the nutritional status, lung function, functional ability and quality of life of SSc patients compared with healthy controls. The study included 20 patients with SSc and 20 healthy control subjects. Results showed that patients with SSc have significantly reduced respiratory muscle strength, decreased strength in m. quadriceps femoris, and increased fatigability compared to healthy controls [24].
Poole et al., in 2013 and 2014, assessed their two self-management programs and their impact on self-management for patients with SSc. The first program (2013) consisted of a workbook and a DVD (sent by postmail) that provided information on medical aspects of the disease, dysphagia, fatigue management, advocacy, activities of daily living, oral hygiene, skin and wound care, psychosocial changes, exercises, and other features of the condition. Forty-nine participants evaluated the effect of the program providing feedback through series of questions, filling out the protocol on health condition, and through their participation in the evaluation interview. The results of the study showed a decrease in depression, fatigue and pain, and an improvement in the hand function, self-efficacy for controlling pain, and self-efficacy “other.” However, the only statistically significant change was in self-sufficient pain control. Moreover, the study showed that the program was easy to use and should help individuals with SSc in self-sufficiency [25].
In another pilot study (2014), Poole et al. assessed the effectiveness of internet-based self-management program for patients with SSc. Participants logged on to a password-protected web site and completed the program, which consisted of 10 modules (e.g., coping and body image/appearance, fatigue and energy conservation, self-advocacy), an exercise video, learning activities, worksheets, and resources. Participants proceeded through the modules at their own pace over 10 weeks. Participants were encouraged to log on to the discussion board, participate in an interactive component of the web site, and respond to questions posted for each module. Participants completed pre- and postintervention questionnaires on perceived self-efficacy, health efficacy, ability to manage care, functional disability, depression, pain, and fatigue. They also completed an eight-question evaluation form regarding satisfaction with the web site, program content, discussion boards, and learning activities. Sixteen participants completed the study and postintervention measures. The authors demonstrated significant improvements in mean scores for ability to manage health care and efficacy, and significant decreases in fatigue and depression. Self-efficacy was improved as well, but not significantly [26].
Functional impairment of the hand in SSc patients is one of the major problems encountered in rehabilitation practice. Research in this area also includes splinting interventions of the hand and wrist, which aim to facilitate restoration of the lost function. In a 2-month study by Seeger et al., the authors investigated splinting effect on the secondary contractures in 19 patients with SSc. Specifically, whether dynamic splinting can improve flexion contractures in the proximal interphalangeal joints (PIP). Of the eight patients who completed the study, only one had significant improvement in range of motion as a result of PIP joint splinting, which shows that the study failed to demonstrate the use of splints as a suitable method to maintain PIP extension compared with the control hand [27].
In addition to the abovementioned list of interventions, there are few studies that evaluate the effectiveness of some other nonpharmacological approaches in SSc including the use of physical therapy, which is the practical application of physical treatments procedures and methods on living organism.
Manual lymphatic drainage (MLD) stimulates the lymphatic system and reduces swelling. It is one of the main components of a combined physical therapy, which is used for the treatment of lymphedema [28]. It is a technique that applies a force to the interstitial fluid and proteins within the initial lymphatics, thereby shifting toward collaterals and/or normally functioning lymphatics [29]. This technique not only directly softens the tissues, but perhaps also removes excessive local fluid. Therefore, it is speculated that the MLD technique should modify the mechanical properties, such as strain, of the skin and subcutaneous tissue. Strain is defined as deformation of a solid due to stress and is considered to be one of the measures representing tissue hardness [30].
The effect of manual lymphatic drainage to reduce swelling, improve the functionality of the hand and the perceived quality of life (QoL) in patients with SSc in edematous stage of disease was assessed in an RCT by Bongi et al. The study recruited 35 patients with SSc who were in the edematous disease stage (swelling of the hands), 20 of which were randomly assigned to the intervention group, and underwent MLD 1h once a week for 5 weeks according to the Vodder procedures, and 15 of which served as a control group. The study demonstrated a reduction in the hand volume, improved hand function, and perceived swelling and pain. Reduction in the volume and improvement in hand function were also maintained at follow-up. Furthermore, the authors detected an improvement in overall disability and quality of life in patients who received therapy. In the control group, no improvement was observed. The authors concluded that the application of MLD is effective in the treatment of the hand in edematous SSc by reducing hand volume, edema, and pain, and improving hand function and perceived quality of life. A study on a larger cohort of patients and with a longer follow-up is needed to assess the effect of MLD on different disease subsets as well, and to verify whether the technique could be of help in preventing the transition from hand edema to fibrosis [31].
Beyond examining the effects of MLD, researchers also investigated the effects of other types of physical therapy in the rehabilitation of patients with SSc.
Sallam et al. evaluated the impact of 14-day transcutaneous electrical nerve stimulation (TENS) of gastrointestinal (GI) acupoints on GI symptoms and quality of life in 17 SSc patients. This treatment significantly increased sympathetic and vagal activity in comparison with the basal value, lead to normalization of sympathovagal balance, and increased physical function score, which is closely related to the change in the sympathovagal balance. This provides the potential to treat the upper GI tract symptoms; however, further studies are needed to support these results [32].
In a pilot study by Tinazzi et al., the authors investigated the effect of extracorporeal shock wave therapy on the skin of 30 patients with SSc. This study was based on a hypothesis that the treatment effect of extracorporeal shock wave may decrease damage to the endothelial cells and skin fibrosis in patients with SSc. The authors demonstrated rapid and sustained reduction in Rodnan skin scores and a reduction in visual analog scale. Furthermore, an improvement in skin structure and vascularization was recorded 90 days after treatment. The number of endothelial progenitor cells and circulating endothelial cells increased 60 and 90 days after treatment, whereas serological biomarkers showed no differences before and after treatment [33].
Results of a prospective RCT by Sporbeck et al. point out the beneficial impact of biofeedback and deep oscillation (three times a week for 4 weeks) on Raynaud’s phenomenon in patients with SSc [34].
In an observational study by Uhlemann et al., the authors evaluated the effect of ultrasound applied to the hands with an intensity of 0.6 W/cm2, for 6 minutes, 3 times a day for 6 days on the hand function and strength. Pain decreased in 18 of 24 patients. At the end of therapy, no increase in pain was observed, and the hand strength significantly improved in all patients [35].
Milačić et al. examined the change in volume of orifice before and after combined hyperbaric oxygen (HBO) therapy with facial physical therapy. Patients received HBO therapy ten times (2.0 ATA) and infrared phototherapy using Solux lamp 15 min before kinesiotherapy in front of mirrors daily for 10 days. This treatment targeted facial muscles. The results showed a statistically highly significant difference in improvement before and after treatment, and that use of HBO in the treatment of these patients has a significant role [36].
Chronic rheumatic diseases have a significant impact on the function, quality of life, and ability to work and represent a significant clinical and economic burden on healthcare systems. It is generally known that adequate physical activity is considered one of the adequate means to maintain or improve the quality of life, both physically and mentally. Nonpharmacological therapy plays a key role in the treatment of most rheumatic diseases. However, its effect for some of them has not been adequately studied or been little researched. A limitation of most of the small number of existing works aimed at nonpharmacological treatment for patients with SSc is low methodological quality, low number of patients, lack of a control group or monitoring (follow-up), and short-term intervention. The purpose of this chapter was to introduce the few studies that have examined this issue (Table 1) and to show that nonpharmacological therapies for diseases such as systemic sclerosis have been the focus of some research teams in recent years, the studies of which have demonstrated safety and benefits of these approaches.
Name of study | Author, year | Study design | Type of intervention | Description of intervention in intervention group | Description of intervention in control group | Number of individuals in intervention group | Number of individuals in control group | Duration of the intervention | Postintervention assessment | Results |
---|---|---|---|---|---|---|---|---|---|---|
Evaluation of paraffin bath treatment in patients with systemic sclerosis [5] | SANDQVIST, 2004 | RCT | Paraffin | Paraffin in combination with exercise | Only exercise | 17 SSc patients | 17 SSc patients | 1 month daily | After 1 month | The results showed that hand exercise in combination with paraffin bath seemed to be a suitable form of treatment in the effort to improve mobility and perceived hand stiffness |
Paraffin hand bath for scleroderma [6] | PILS, 1991 | RCT | Paraffin | 12 times paraffin wrap therapy which continued for next 3 months | 12 times paraffin wrap therapy | 8 SSc patients | 8 SSc patients | 3 months | After 3 months | Skin thickness decreased in all patients after 12 sessions of paraffin treatment. However, at the end of 3 months therapy in the intervention group, there was no significant difference between the intervention and control group |
Objective evaluation of hand function in scleroderma patients to assess effectiveness of physical therapy [7] | ASKEW, 1983 | CCT | Paraffin | Paraffin, friction massage and exercise maintaining ROM in the joints of the wrist and hand | – | 10 SSc patients | 7 SSc patients | Once performed interventions | After 2 hours | Significant improvement in the articular ROM, skin elasticity and overall function of the hand |
The effect of paraffin and exercise on hand function in persons with scleroderma: a series of single case studies [8] | MANCUSO and POOLE, 2009 | 3x single case study | Paraffin | Active exercises with hands after paraffin wrap | - | 3 SSc patients | - | 5 times per week for 8 weeks | 1 month and at 2 months after intervention | The results of this study suggest clinical efficacy of paraffin and exercises to improve activity/participation involving the use of the hands |
Effect of orofacial exercises on oral aperture in adults with systemic sclerosis [9] | YUEN, 2012 | RCT | Orofacial treatment | Multifaceted oral health intervention | Usual dental care | 26 SSc patients | 22 SSc patients | Twice a day with a total of 6 minutes for 6 months | After 3 months, and 6 months | A significantly larger increase in oral aperture for participants receiving the orofacial exercise program was found when compared to those in the usual care at 3 months, but not at 6 months evaluation. Participants’ adherence rate to the exercise program was low (48.9%) |
The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat’s technique and kinesitherapy [10] | MADDALI-BONGI, 2011 | RCT | Orofacial treatment | Combination of the Kabat’s technique, connective tissue massage, and kinesiotherapy specially developed for the face of SSc patients with a home exercise program | Only home exercise program | 20 SSc patients | 20 SSc patients | 9 weeks, 2 times a week for 1 hour | After 9 weeks and after 9 weeks of follow-up | The combination of connective tissue massage, Kabat’s technique, kinesiotherapy, and home-based exercises was more effective than a home exercise program alone in the rehabilitative treatment of SSc facial involvement |
Oral hygiene in scleroderma: the effectiveness of a multidisciplinary intervention program [11] | POOLE, 2010 | OD | Orofacial treatment | Structured oral hygiene and exercises for the face and hands | – | 17 SSc patients | – | 6 months daily | After 6 month intervention | There was a significant improvement in oral hygiene and a significant decrease in the number of teeth that bled on probing and in subgingival calculus |
Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma [12] | PIZZO, 2003 | OD | Orofacial treatment | Mouth stretching exercises for at least 15 minutes, twice a day, and oral augmentation exercise with a stick of soft wood daily | – | 10 SSc patients | – | 18 weeks | After 18 weeks | The exercise program improved the mouth opening of all subjects. At the end of the 18 week period, all patients commented that eating, speaking and oral hygiene measures were easier |
Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis [14] | BONGI, 2009 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Combination of connective tissue massage and joint manipulation according to Mc Mennell specially designed for the hands, and a home exercise program | Only home exercise program | 20 SSc patients | 20 SSc patients | 9 weeks twice a week, 1 h per session | After 9 weeks, and after 9 weeks of follow-up | The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise program was effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement in hand function and QoL |
Efficacy of a tailored rehabilitation program for systemic sclerosis [15] | BONGI, 2009 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Combination of connective tissue massage and Mc Mennell joint manipulation (MLD if patients had edematous hands. Face involvement was treated with a combination of Kabat’s method, connective tissue massage, and kinesiotherapy. Hydrokinesiotherapy (for patients without ulcers) or land-based rehabilitation (for patients with ulcers), and respiratory rehabilitation exercises) | Educational advices and medical information | 10 SSc patients | 10 SSc patients | One or two times per week for 9 weeks | After 9 weeks and after 9 weeks of follow-up | The association of disease-specific and global rehabilitative techniques designed and tailored for SSc patients improved disability, HRQoL, hand and face disability and functionality, with its effects partially maintained at the follow-up |
An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility [16] | ANTONIOLI, 2009 | CCT | Comprehensive physical therapy for physical and/or psychological functioning | Rehabilitation program that consisted of warm-up and cool-down exercises, training of motor functions, diaphragmatic breathing, controlled coughing exercises, treadmill, freewalking, finger stretching, and occupational therapy (physical therapy was also prescribed to 13 patients with articular problems) and home exercise program | – | 16 SSc patients | 17 SSc patients | 2 weeks daily 30-minute sessions (10 sessions in total) | After 2 and 4 months | This study suggests that a significant proportion of patients with SSc experience an improvement in their perception of QoL, a better exercise tolerance, and a better hand mobility after a rehabilitation program consisting of a 2-week period of daily individual 30-min sessions of outpatient care, followed by at-home exercise program |
Addressing patient health care demands in systemic sclerosis: pre- and postassessment of a psychoeducational group programme [17] | KWAKKENBOS, 2011 | OD | Comprehensive physical therapy for physical and/or psychological functioning | A short, group-based psychoeducational program | – | 41 SSc patients | – | The intervention was scheduled over 3 weekends | 6 weeks after the intervention and 6 months postintervention | Patients reported less helplessness after the intervention, and higher acceptance of their limitations. However, no difference in depressed mood and physical functioning was observed. Patients reported high satisfaction with the content of the program |
Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis [18] | SCHOUFFOER, 2011 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Multidisciplinary team care program (1 day per week; individual treatments, group exercises, and group education) | Regular outpatient care | 25 SSc patients | 25 SSc patients | 12 weeks | 0, 12, and 24 weeks | In patients with SSc, a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care |
The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis [19] | MUGII, 2006 | OD | Stretching | Autostretching (individual fingers were maintained in a stretched position using the opposite hand for 10 seconds and this was repeated 3–10 times) | - | 45 SSc patients | - | 1 year | After 1 month and 1 year | The total passive ROM was significantly improved in each finger after 1 month of finger stretching and 1 year after the first visit. Eating and gripping was also significantly improved |
The short-term effect of gloving in combination with traditional Thai massage, heat, and stretching exercise to improve hand mobility in scleroderma patients [20] | VANNAJAK, 2014 | RCT | Stretching | The home program combined traditional Thai massage with stretching exercises and heat with gloves | Same program without gloves | 14 SSc patients | 14 SSc patients | 2 weeks daily | After intervention | Both groups showed a significant improvement in hand mobility after 2 weeks of daily home exercise program. Wearing the glove, however, resulted in better thumb mobility |
Efficacy and safety of concurrent training in systemic sclerosis [21] | PINTO, 2011 | OD | Aerobic training and combined endurance/resistance training | Combined resistance and aerobic training program (concurrent training) | – | 11 SSc patients | – | 12 weeks | After intervention | This study demonstrates that a 12-week concurrent training program is safe and substantially improves muscle strength, function, and aerobic capacity in SSc patients |
Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study [22] | ALEXANDERSON, 2014 | Pilot study | Aerobic training and combined endurance/resistance training | Intense aerobic and endurance training program | – | 4 SSc patients | – | 6 weeks (noninterventional baseline period) and 8 weeks (exercise intervention period 3× a week) | Every other week throughout the 14-week study | Three participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevantly in aerobic capacity. All other variables remained unchanged, except for a trend toward reduced fatigue |
Aerobic exercise is safe and effective in systemic sclerosis [23] | OLIVEIRA, 2009 | CCT | Aerobic training and combined endurance/resistance training | Aerobic exercise program of moderate intensity | Aerobic exercise program of moderate intensity | 7 SSc patients | 7 healthy volunteers | 8 weeks | Pre- and posttest | Both groups showed a significant improvement in peak VO2 but with no significant difference between the study groups. Furthermore, both groups improved in exercise intensity which was documented by significantly increased peak lactate concentration in blood. No significant changes in SSc skin score or QoL were detected |
Lower limb muscle strength is associated with functional performance and quality of life in patients with systemic sclerosis [24] | LIMA, 2015 | Cross-sectional study | Lower extremities treatment | Study assesses the peripheral and respiratory muscle strength in individuals with SSc and investigates their correlation with the 6MWD and QoL measurements | 20 SSc patients | 20 healthy volunteers | April 2013 and January 2014 | Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and an increase in its fatigability. In these individuals, there was a relationship between quadriceps strength, functional capacity, and QoL | ||
Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis [25] | POOLE, 2013 | Pilot study | Self-management program | The program consisted of a workbook and exercise DVD that provided information on medical aspects of the disease, dysphagia, fatigue management, advocacy, activities of daily living, oral hygiene, skin and wound care, psychosocial changes, exercises, and other features of the condition | – | 49 SSc patients | – | 4–6 weeks | – | Participants consistently reported that the program was easy to use. Depression, fatigue, and pain decreased, and hand function, self-efficacy for controlling pain, and self-efficacy “other” improved; however, the only statistically significant change was in self-efficacy for pain |
Taking charge of systemic sclerosis: a pilot study to assess the effectiveness of an internet self‐management program [26] | POOLE, 2014 | Pilot study | Self-management program | The program consisted of 10 modules (e.g. coping and body image/appearance, fatigue and energy conservation, self-advocacy), an exercise video, learning activities, worksheets, and resources | – | 16 SSc patients | – | Over 10 weeks | – | There were significant improvements in mean scores for ability to manage care and health, and significant decreases in fatigue and depression. Self-efficacy improved, but not significantly |
Effects of splinting in the treatment of hand contractures in progressive systemic sclerosis [27] | SEEGER, 1987 | Pilot study | Splinting interventions | Dynamic splinting of the hand daily for 8 hours (could decrease proximal interphalangeal (PIP) flexion contractures?) | The nonsplinted hand | 8 SSc patients | 8 SSc patients | 2 months | After 1 and 2 months | Just one of eight patients experienced a statistically significant improvement in PIP range of motion as a result of the splinting. There was no evidence that the use of the splints served to maintain PIP extension when compared with the control hand |
Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase [31] | BONGI, 2011 | RCT | Physical therapy | MLD 1 session a week (lasting 1 hour) | – | 20 SSc patients | 15 SSc patients | 14 weeks: 5 weeks of rehabilitation and 9 weeks of follow-up | At the end of the treatment, and after a follow-up of 9 weeks | The application of MLD is effective in the treatment of the hand in edematous SSc by reducing hand volume, edema, and pain, and improving hand function and perceived QoL |
Transcutaneous electrical nerve stimulation (TENS) improves upper GI symptoms and balances the sympathovagal activity in scleroderma patients [32] | SALLAM, 2007 | CCT | Physical therapy | Home use TENS application at two GI acupoints on GI symptoms and QoL | 17 SSc patients | 9 healthy controls | 14 days | The electrocardiogram was recorded for two intervals: baseline and TENS application | Prolonged TENS application improved GI symptoms and restored the sympathovagal balance, with an impressive correlation with improved physical functioning scores | |
Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study [33] | TINAZZI, 2011 | CCT | Physical therapy | ESWT of the arm and the hand of one arm | Second arm was without intervention | 30 SSc patients | 30 SSc patients | Three sittings | Before and immediately after ESWT and at 7, 30, 60, and 90 days after the treatment | The results of this study suggest that ESWT is a novel and efficacious treatment that can be added to the pharmacological therapy in order to decrease endothelial cell damage and skin fibrosis in patients with SSc. This treatment is well tolerated and can be repeated without side effects; in the majority of cases it determines a rapid improvement in skin elasticity and skin wellness, even if the effects tend to reduce during the time |
Effect of biofeedback and deep oscillation on Raynaud’s phenomenon secondary to systemic sclerosis: results of a controlled prospective randomized clinical trial [34] | SPORBECK, 2012 | RCT | Physical therapy | The effect of deep oscillation and biofeedback on RP secondary to SSc | No intervention or therapies with an expected effect | 8 SSc patients biofeedback and 10 SSc patients—deep oscillation | 10 SSc patients | 3 times per week for 4 weeks | After 4 and 12 weeks | Biofeedback resulted in an improvement in RP as determined by score reduction of visual analogue scale compared with patients of the control group, whereas deep oscillation revealed a tendency for improvement. The study underlines the beneficial role of physiotherapy for the treatment of SSc-related RP |
Multiple daily ultrasound treatment of patients with progressive systemic scleroderma [35] | UHLEMANN, 1990 | OD | Physical therapy | Ultrasound therapy of the hands with an intensity of 0.6W/cm2, 6 minutes per region | – | 24 SSc patients | – | 3 times a day during 6 days | After 6 days | Pain decreased in 18 of 24 patients. At the end of therapy, no increase in pain was observed, and the hand strength significantly improved in all patients |
Mouth opening scope in the patients with systemic sclerosis: Simultaneous application of a hyperbaric oxygenation and physical therapy [36] | MILAČIĆ, 2014 | Prospective study | Physical therapy | Combined HBO therapy with facial physical therapy | – | 13 SSc patients | – | Daily 10 days | After intervention | The therapy showed a statistically significant difference and proved that the combination of HBO therapy and physical therapy has its place in treating these patients |
Overview of available studies on nonpharmacological interventions in patients with systemic sclerosis.
Nonpharmacological therapy in patients with SSc includes, in particular, methods commonly used, for example, paraffin, manual lymphatic drainage, massage, stretching exercises to maintain range of motion in joints, mobilization, aerobic exercises, specially developed programs for the face and hands, self-management programs, splinting, and physical therapy. Other studies also investigated occupational therapy, sexual dysfunction, education, psychosocial status, and nutrition in patients with SSc.
Quality of treatment depends on the cooperation of a multidisciplinary team. A physician should properly choose the right medical treatment. A physiotherapist must select an adequate therapy to be individually tailored for a specific patient. An exercise program should be feasible even in the home environment, and patient’s family or partner should get involved. Modifications to the home and work environments should be consulted with an occupational therapist. A psychologist or a psychosomatic medicine specialist can help not only the patient but also the family or a partner to solve the psychological problems that could be associated with the establishment of the diagnosis.
It is clear from the systematic literature search of available studies that nonpharmacological treatment for these patients has its positive results and has been investigated worldwide. However, since it is a rare disease, the strength of evidence of efficacy of nonpharmacological treatment is limited. The aforementioned limitations suggest that there is an unmet need for international multicentric cooperation, teamwork, and unified projects with a solid design in order to explore this area to arrive at definite conclusions and treatment recommendations. Thus, even nonpharmacological approaches could offer specific techniques that could be implemented and would effectively contribute to greater self-sufficiency, and easier self-management of patients with SSc.
It is also important to carry out further studies to assess other neglected areas such as psychosocial status, depression or sexual dysfunction in order to provide a complex therapy by a team of specialist offering a versatile assistance to patients with SSc.
This chapter was supported by grant projects AZV 16-33542A, AZV 16-33574A, SVV for FTVS UK 2017, UNCE, PRVOUK P38, GAUK 214615, and the Ministry of Health of the Czech Republic [Research Project No. 00023728].
Recurrent pneumothorax which is associated with menstruation is named as “catamenial pneumothorax” (CPX). It was first reported by Maurer et al. [1] and was presented to be a form of ectopic endometriosis and the term CPX was stated by Lillington et al. [2].
“Catamenial” is a name from Greek meaning “monthly.” CPX is most commonly associated with endometriosis, but other etiological mechanisms of this disease exist [3, 4, 5, 6].
In the literature, CPX is defined to be a recurrent pneumothorax occurring up to 24 h before or within 72 h after the onset of menstruation [4, 6], and on the other hand, not necessarily appearing every month [7]. Symptoms and signs of CPX are mostly unspecific so much clinical suspicion has to be maintained [8]. CPX is a rare entity; however, regarding literature, about one-third of all surgically treated cases of pneumothorax in women are diagnosed to be CPX [9, 10, 11, 12].
Therefore, thoracic endometriosis should always be suspected in reproductive-age woman who suffer chest pain from spontaneous pneumothorax.
Thoracic endometriosis syndrome may be associated with other causes than pelvic endometriosis. In the first 24–48 h of menstruation, symptoms begin to appear and are usually seen on the right side of the chest. In 90% of the patients, chest pain is the most common symptom, and in one-third of the patients, shortness of breath is rarely seen, but hemoptysis is also added to the clinical picture [13]. In the light of these findings, the diagnosis of the disease is made clinically.
From 3 to 6% of spontaneous pneumothorax cases are catamenial pneumothorax, about one-third of all surgically treated cases of pneumothorax in affected women.
The mean age of onset is reported to be 32–35 years [3, 4, 12, 14, 15, 16, 17]. CPX may also develop as late as at 39 years of age [18, 19]. CPX occurs most often (85–95%) unilaterally, usually occurring on the right side of the chest, but there are cases on which pneumothorax also occurs on the left side or bilaterally [11, 15, 16, 17, 18, 19, 20, 21].
CPX is generally considered to be a rare entity, and there is an incidence less than 3–6% among women who suffer from spontaneous pneumothorax. Such a low incidence rate may be a result of decreased disease awareness and underdiagnosis [4, 8, 9, 10, 19, 22, 23, 24, 25, 26, 27, 28, 29].
Yet, the incidence of catamenial pneumothorax was much higher among women at reproductive age who were referred for surgical treatment because of recurrent spontaneous pneumothorax, ranging between 18 and 33% [9, 10, 11, 12, 22].
In a recent study [24, 29, 30], 156 premenopausal women who underwent surgery for spontaneous pneumothorax were reviewed retrospectively, and 31.4% (49/156) of the patients were classified as CPX.
In a retrospective study, Alifano et al. reported thoracic endometriosis in 13 out of 35 (37%) patients who underwent reoperation for recurrent spontaneous pneumothorax [29]. Catamenial pneumothorax was the initial diagnosis in eight cases and idiopathic pneumothorax in four cases [29]. Under/misdiagnosis of thoracic endometriosis can be referred to several causes, including decreased disease awareness, incomplete scanning for the lesions, variations in the size, appearance, and number of the lesions [24, 30].
The etiopathology of catamenial pneumothorax remains unclear, but there are some theories explaining the etiopathogenesis of catamenial pneumothorax. These theories include physiological, migrational, microembolic-metastatic, and the diaphragmatic theory of air passage [17] (Table 1).
Physiological hypothesis | High levels of circulating prostaglandin F2 during menstrual cycle cause vasoconstriction, and this induces alveolar rupture and pneumothorax. |
Metastatic or lymphovascular microembolization hypothesis | Endometrial tissue spreads through the venous and/or the lymphatic system to the lungs, and subsequent catamenial necrosis of endometrial parenchymal site adjacent to visceral pleura causes pneumothorax |
Transgenital-transdiaphragmatic passage of air hypothesis | Absence of cervical mucus during menstruation provides air passage from the vagina to the uterus, through the cervix. Then air enters the peritoneal cavity straight through the fallopian tubes and reaches to the pleural space by diaphragmatic defects. |
Migration hypothesis | Following catamenial necrosis of this diaphragmatic endometrial implants results in diaphragmatic perforations. Endometrial tissue then passes through this diaphragmatic perforation and spreads into the thoracic cavity. Ectopic endometrial tissue implants to the visceral pleura and following catamenial necrosis of this tissue causes rupture of the underlying alveoli, and pneumothorax occurs. |
The etiopathology of catamenial pneumothorax remains unclear, but there are some theories explaining the etiopathogenesis of catamenial pneumothorax.
These theories include physiological, migrational, microembolic-metastatic, and the diaphragmatic theory of air passage.
According to the physiologic hypothesis, high levels of circulating prostaglandin F2 during menstrual cycle cause vasoconstriction and this induces alveolar rupture and pneumothorax. Pulmonary bullae blebs may be more sensitive to ruptures during hormonal changes. There are no pathognomonic lesions in such cases and this issue supports the physiologic theory [4, 7, 8, 24, 31].
In metastatic or lymphovascular microembolization theory, endometrial tissue spread through the venous and/or the lymphatic system to the lungs, and subsequent catamenial necrosis of endometrial parenchymal site adjacent to visceral pleura causes pneumothorax. If parenchymal endometrial focus is located centrally, hemoptysis may be present as a symptom [3, 4, 7, 8, 22, 24, 30, 31, 32]. Endometrial tissue can be detected in the lung parenchyma, at knee, in the brain, and in the eye. This supports the metastatic theory [12].
According to the transgenital-transdiaphragmatic passage of air theory, absence of cervical mucus during menstruation provides air passage from the vagina to the uterus, through the cervix. Then, air enters the peritoneal cavity straight through the fallopian tubes and reaches to the pleural space by diaphragmatic defects [4, 7, 8, 22, 24, 31]. This passage is facilitated by the difference in atmospheric pressures between pleural space and peritoneal space since the atmospheric pressure in the pleural cavity is less than the pressure in the peritoneal cavity.
There are few reports in the literature regarding transgenital-transdiaphragmatic passage of air theory. There are rare cases reporting simultaneous [33, 34] or undulating episodes CPX and pneumoperitoneum [35], and also case reports defining radiologic findings of small diaphragmatic defects associated with ipsilateral CPX [21]. But repeated episodes of pneumothorax after hysterectomy, fallopian tube ligation, and diaphragmatic resection provide evidence that all the CPX cases can be explained by this theory [7, 24, 29, 36].
Migration theory is based on retrograde menstruation which causes in pelvic seeding of endometrial tissue and migration of this tissue to the subdiaphragmatic sites through the peritoneal fluid flow. Endometrial tissue is mostly implanted to the right hemidiaphragm because peritoneal circulation prefers a clockwise flow through the right paracolic gutter to right hemidiaphragm and the liver facilitates flow with its piston-like activity. Catamenial necrosis of this diaphragmatic endometrial implants results in diaphragmatic perforations. Endometrial tissue then passes through this diaphragmatic perforation and spreads into the thoracic cavity. Ectopic endometrial tissue implants to the visceral pleura and following catamenial necrosis of this tissue cause rupture of the underlying alveoli, and pneumothorax occurs [3, 4, 7, 8, 22, 24, 30, 31]. Endometrial diaphragmatic implants exist along with diaphragmatic perforations [37], and endometrial tissue can be seen at the edges of the diaphragmatic perforations in many cases of CPX [22]; these findings may support the migration theory in the etiopathology of catamenial pneumothorax.
The typical clinical manifestations of CPX include spontaneous pneumothorax with or before menses presented with pain, dyspnea, and cough. Scapular and thoracic pain may also be present before or during menstruation. There may also be a history of previous episodes of spontaneous pneumothorax, history of previous uterine surgery, primary or secondary infertility or uterine scratching, pelvic endometriosis diagnosis, and history of catamenial hemoptysis or catamenial hemothorax [30].
Medical history and occurrence of typical symptoms are crucial for the diagnosis of catamenial pneumothorax, and these findings should be systematically investigated [11]. Although existence of these findings creates high suspicion on catamenial pneumothorax, their absence does not exclude a diagnosis of catamenial pneumothorax [24, 30].
Intermittent presentations out of menstrual bleeding time should not exclude the diagnosis of noncatamenial endometriosis-associated pneumothorax even in the absence of symptoms and pelvic endometriosis [9, 24, 38].
The clinical course of CPX is usually mild or moderate, but sometimes be life-threatening. Widespread thoracic endometriosis after previous operations is reported in the literature as case reports [39]. A young woman who experienced an episode of life-threatening hemopneumothorax who has been treated by urgent tube thoracostomy and thoracotomy was reported by Morcos et al. [39]. Lung wedge resection, parietal pleurectomy, and partial diaphragmatic excision have also been performed in this case.
Patients with CPX are reported to have a mean age of 35 (range 15–54) years at presentation [40].
Catamenial pneumothorax can also have very rare presentations in the literature. Simultaneous occurrence of pneumoperitoneum and catamenial pneumothorax [33, 34], catamenial pneumoperitoneum mimicking acute abdomen in a woman with multiple episodes of pneumothorax [35], pneumothorax, and pneumoperitoneum in a patient with spontaneous diaphragmatic rupture has been reported in the literature [41].
Medical history is the main pathway on the way to the diagnosis of CPX. Synchronicity of the clinical course with menses is the main character of the disease, but on the other hand intraoperative visual inspection and appropriate histological examination of the pathognomonic lesions are crucial for the diagnosis of endometriosis-related pneumothorax. The surgeon needs to be vigilant because it can easily be missed if not cautious [7, 24, 29, 42].
Chest radiogram, computed tomography, and magnetic resonance imaging are the imaging modalities that can be used for the diagnosis of catamenial pneumothorax. Although there are no disease-specific diagnostic criteria, pneumothorax is usually right sided. On the other hand, left-sided or bilateral cases are present. Air-fluid leveling may also occur at chest radiogram, in some cases. Hemopneumothorax may also be a part of clinical course [24, 30]. Loculated fluids can be seen in cases with the history of previous surgery [39].
Only in a few number of cases, small diaphragmatic defects can be detected with careful examination of chest radiogram, which refers to diaphragmatic perforations. Also when a right-sided pneumothorax with a round opacity on the right hemidiaphragm occurs, liver protrusion into a large diaphragm defect is suspected [21, 43]. This type of partial intrathoracic liver herniation at the right hemidiaphragm on chest radiogram and CT [24, 44] has been reported in the literature. There are also reports in the literature regarding diaphragmatic masses on CT [23] and pleural masses on MRI that refers to endometrial implants [45].
CT findings of hemoptysis are nonspecific; they may differ from a focal ground-glass opacity to consolidation because of alveolar filling, similarly in hemoptysis caused by other disease [46]. Especially in nondependent lung parenchyma, these findings facilitate the location of the site of bleeding. In the early period of the disease, endobronchial clots may be present, which cause atelectasis in some cases. There are also reports revealing band-like opacities referring to linear fibrosis sites, which result from chronic hemorrhage [46].
MRI is another imaging modality that can be used for confirming thoracic endometriosis in some cases. CT has some disadvantages especially in spatial resolution, but MRI has high-contrast resolution and can better characterize hemorrhagic lesions. Representation of diaphragmatic or pleural implants with MRI can help to clarify the diagnosis and management of the patient with catamenial pneumothorax [46].
MRI may also be useful for patients with catamenial hydropneumothorax; small pleural endometriomas characterized by the presence of small cystic hyperintense lesions can be revealed by MRI images of visceral or parietal pleura [46].
Coexisting pneumothorax and pneumoperitoneum are other findings that can be seen on radiography and computed tomography [33, 34].
Increased levels of cancer antigen 125 have been associated with endometriosis. It is not considered a specific marker, but it can play a role in early diagnosis of endometriosis-related pneumothorax [47, 48].
Characteristic lesions of the catamenial pneumothorax include single or multiple diaphragmatic spots, perforations, nodules, and visceral or parietal pleural spots and nodules. Pericardial nodules have also been reported in some cases.
These lesions have not been found in all patients with catamenial pneumothorax, but they have been revealed in some cases with noncatamenial pneumothorax. Detection of endometrial tissue is not mandatory in these lesions. On the other hand, endometrial tissue has usually been found in diaphragmatic and pleural nodules, but it is rarely detected at the edges of the diaphragmatic perforations [30].
Visceral and parietal pleural lesions are less frequently detected than diaphragmatic defects, spots, and nodules.
The diaphragmatic lesions usually located at the centrum tendineum and can be single or multiple. They usually settle adjacent to nodules. They can be outlined as perforations, fenestrations, holes, stomata, and pores [24, 30, 49] (Figure 1a and b).
(a) and (b) Thoracoscopic view of diaphragmatic endometriosis. Fenestrations can be seen on the surface of the diaphragm (arrows). (c) The liver is visible after surgical resection. (d) Sutured diaphragm after endometriosis resection. Images are used with the permission of Demetrio Larrain [
They can be tiny holes measuring 1–3 millimeters in diameter [7, 50], or larger defects measuring up to 10 mm [4, 18] or more than 10 mm [8] or represent as undetected holes proven only by diagnostic pneumoperitoneum [42].
Diaphragmatic defects are usually found close to coexisting nodules or spots, and endometrial tissue is sporadically found at the edges of the defects [4, 9, 11, 22]. This situation supports the theory claiming that the diaphragmatic defects represent the breakdown of endometrial implants during menstrual cycle [22, 24].
There are also case reports of larger lacerations that accompany with intrathoracic liver protrusion, but these presentations are very rare.
A patient with catamenial pneumothorax on the right hemithorax was reported by Pryshchepau et al. Liver of the patient was protruded through a large diaphragmatic defect [44].
Visouli et al. also reported five cases of catamenial pneumothorax [24], which contains a case very similar regarding liver protrusion, and they have recommended that these findings should be included in the characteristic findings of catamenial and thoracic endometriosis-related pneumothorax, although this presentation is very rare [24].
Catamenial pneumothorax with a huge diaphragmatic laceration and partial intrathoracic liver herniation was reported by Bobbio et al. [43], and Makhija et al. [51] reported a patient with multiple diaphragmatic fenestrations. The largest lesion was reported to have a diameter of 10 cm.
Spontaneous rupture of the right hemidiaphragm and intrathoracic liver herniation was also reported in the literature [41]. Pneumothorax and pneumoperitoneum was detected in a patient with a history of premenstrual periscapular pain. At the edge of the diaphragmatic defect, a nodule looking like an endometrial implant was found in that patient. Histological examination of the nodule revealed endometriosis with hemosiderin-loaded macrophages. This case is considered as endometriosis-related, but the histological criteria set by the authors was not appropriate [9, 11]. Additionally, previously mentioned cases of large diaphragmatic defects were considered to be limited diaphragmatic ruptures and stated that endometriosis was responsible for these ruptures [43, 44].
Endometrial tissue is usually detected on histopathological examination of the spots or nodules accompanying catamenial pneumothorax so these lesions are considered to be endometrial implants. Diaphragm, visceral, and parietal pleura are the common sites for location. Pericardial implants were also reported by Fonseca et al. [52]. The lesions may be single or multiple and may have varying size. They may have different presentations in color as brown, purple, red, violet, blueberry, black, white, grayish, and grayish-purple [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 51].
Diaphragmatic and thoracic lesions may be present in all cases, but on the other hand, only one or more of them can be seen either [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 39, 53, 54].
In some cases of catamenial pneumothorax, characteristic findings may be absent and blebs and bullae may be the only pathological findings. In some cases, no characteristic thoracic findings may be detected [7, 12, 20, 22, 23, 24].
Detection of characteristic lesions during thoracotomy or thoracoscopy depends on thorough and deliberate examination of the thorax, including the diaphragm. This also depends on the stage of the disease and catamenial behavior of the disease and longer-term variation [22, 24, 30, 42].
Surgical treatment is the gold standard in treatment of catamenial pneumothorax, not only for its better results but less recurrences after treatment as well. Surgery has better results compared with medical treatment [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20].
Korom et al. [7] reviewed 195 cases of CPX among 229 cases and reported that 154 cases (78%) were treated surgically. Among surgically treated patients, diaphragmatic repair (38%), pleurodesis (81%), and lung wedge resection (20%) were performed.
There is common consensus in the literature that the appropriate approach to CPX has to be minimally invasive so video-assisted thoracoscopic surgery (VATS) is the choice of treatment. VATS not only provides magnification but complete visualization of diaphragm as well [23].
Video-assisted thoracoscopic surgery (VATS) has been mainly in use since 2000 in the treatment of thoracic diseases with several advantages over conventional thoracotomy. Incision may be extended when extensive diaphragmatic repair is required, and also a muscle-sparing thoracotomy may offer better access in such cases. Thoracotomy may be an option especially in recurrent interventions or in reoperations [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30].
The lung examination for bullae, bleb, and air leakage is very important, but the diaphragm should also be carefully examined for fenestrations and spots or nodules. In addition, it is critical to examine the parietal pleura, lung, and pericardium in terms of spots and nodules.
Bagan et al. recommended the use of surgical treatment during menstruation. Thus, they stated that endometriotic lesions may be better visualized during menstrual period [22]. Slasky et al. used the pneumoperitoneum method to reveal unseen diaphragmatic fenestrations [42]. Identification of the lesions within the thorax is made easier by the magnification provided by VATS [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30]. The tissue samples from these lesions make it easy to diagnose thoracic endometriosis [10].
Resection of all visible lesions such as bullae or bleb and also resection of endometriosis-induced thoracic lesions have been recommended by Alifano et al. Limited wedge resection of the diseased lung tissue, limited parietal pleurectomy, and partial diaphragmatic resection were suggested surgical techniques for the elimination of intrathoracic lesions [4].
Excision and wedge resection of bullae and blebs [7, 12, 23, 30], along with pleurodesis or pleurectomy, has been mainly performed in the literature [7, 8, 12, 23, 30, 47]. Pleurodesis was found to be the most common intervention [29]. The majority of pleurodesis performed was mechanical pleurodesis (abrasion or pleurectomy), which has been found to be more successful in comparison to chemical pleurodesis [6].
Addressing the diaphragmatic pathology is of paramount importance. Diaphragmatic plication and/or resection of the diseased area have been reported [7, 12, 23, 24, 30, 49] (Figure 1c and d).
Recurrence is the most common complication of CPX, and there are reported recurrence rates of 20–40% [4, 7, 41, 51]. Alifano et al. suggested that diaphragmatic resection with removal of endometrial implants is the preferred method compared to single diaphragmatic plication because plication has an disadvantage of leaving endometrial implants untreated [29, 38]. Still, recurrences may develop even after diaphragmatic resection [29].
Fewer recurrences after diaphragmatic coverage with a polyglactin mesh were reported by Bagan et al. To prevent recurrences, they suggested a systematic diaphragmatic covering, including the normal appearance of diaphragms, treating ocular defects, strengthening the diaphragm, and inducing adhesions to the lung [7].
There are also reports on diaphragmatic coverage with a polyglactin or polypropylene mesh [8], a polytetrafluoroethylene (PTFE) mesh [15], or a bovine pericardial patch [24], which has been reported with good mid-term results.
Hormonal treatment has a supplementary role in the treatment of catamenial pneumothorax. With the administration of hormonal therapy, it is possible to prevent recurrences of catamenial pneumothorax.
A multidisciplinary approach is mandatory for the management of the disease and administration of gonadotrophin-releasing hormone (GnRH) analogue, which results in the lack of menses, and is suggested for all patients with proven catamenial pneumothorax in the early postoperative period for 6–12 months [4, 7, 8, 22, 24, 30, 48]. Patients without documented catamenial character or histologically proven thoracic endometriosis may also benefit from hormonal treatment even in the presence of characteristic lesions [24, 30].
Woman’s plans concerning pregnancy are very crucial, when deciding whether to start hormonal therapy or not. In such therapies, oral contraceptive pills (estrogen-progestogen) are usually used which induce menses every 28 days or they are used continuously without inducing menses. These pills also include progestogens, and they may be administered orally, intramuscularly, or in intrauterine way. There are also several medications, which are currently in use. Medical treatment is recommended in patients when catamenial pneumothorax is associated with endometriosis [17].
The aim of early GnRH analogue delivery is to prevent cyclic hormonal changes and to suppress the activity of the ectopic endometrium until effective pleurodesis occurs, because time is needed for the formation of effective pleural adhesions [38].
Hormonal treatment is advised for longer periods especially after reoperations for catamenial pneumothorax.
Proven ineffectiveness of the therapy or significant side effects of the drugs are the contraindications of hormonal therapy [29].
There is an accepted surgical algorithm and treatment in catamenial pneumothorax [55], which is described in Figure 2 in detail.
Accepted surgical algorithm and treatment in catamenial pneumothorax.
Practically, surgery for catamenial pneumothorax has very low mortality and morbidity. Recurrence is the most common complication of CPX, and there are reported recurrence rates of 20–40% [4, 7, 41, 53].
High recurrence rates are much higher than surgically treated idiopathic pneumothorax [8, 9, 10, 22, 23, 24, 29].
A low recurrence rate (8.3%), at a mean follow-up of 45.8 months, was reported by Attaran et al., by video thoracoscopic abrasion and pleurectomy, diaphragmatic repair and PTFE mesh coverage for the repair of diaphragmatic defects, and a routine postoperative hormonal treatment [55].
Also Alifano et al. reported that the highest postoperative recurrence rate in 114 women who were operated due to recurrent spontaneous pneumothorax was in the catamenial pneumothorax group (32%), and this was followed by a noncatamenial endometriosis-associated pneumothorax group (27%). They also reported a recurrence rate of 5.3%, at a mean of 32.7 months of follow-up, in patients with noncatamenial nonendometriosis-associated pneumothorax [32].
Incomplete surgical treatment of lesions and lack of additional hormonal treatment in the early postoperative period [23, 24, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54] may increase the risk of recurrence [24, 30, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56].
Young women with pneumothorax, especially in the perimenstrual period, should be suspected of catamenial pneumothorax. Failure occurs most frequently when recurrent catamenial pneumothorax occurs.
The lesions of the parietal and visceral pleura should be carefully examined and removed during surgery. Diaphragm reconstruction is required every time when fenestrations are detected in diaphragm.
Hormonal therapy is also recommended because it facilitates the effectiveness of the surgical results.
Multidisciplinary approach with early postoperative hormonal treatment, which deals with all thoracic pathologies including disease awareness, early diagnosis, diaphragmatic repair, and surgical management of the main chronic systemic disease, may eventually lead to a reduction in the rate of recurrence of catamenial pneumothorax [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 23, 24, 30, 32].
Treatment of women of childbearing age is different from men of the same age group. CPX should be excluded in the cohort of women, especially when the pneumothorax is repeated. Full examination of the diaphragm should be part of the operation. Surgeons who perform VATS should be experienced to resect and repair diaphragms with fenestrations and endometrial deposits, including keyhole laying down of synthetic mesh.
There is no conflict of interest.
We would like to thank Dr. Demetrio Larraín who kindly gave us permission to use his images in our chapter.
These Terms and Conditions outline the rules and regulations pertaining to the use of IntechOpen’s website www.intechopen.com and all the subdomains owned by IntechOpen located at 5 Princes Gate Court, London, SW7 2QJ, United Kingdom.
',metaTitle:"Terms and Conditions",metaDescription:"These terms and conditions outline the rules and regulations for the use of IntechOpen Website at https://intechopen.com and all its subdomains owned by Intech Limited located at 7th floor, 10 Lower Thames Street, London, EC3R 6AF, UK.",metaKeywords:null,canonicalURL:"/page/terms-and-conditions",contentRaw:'[{"type":"htmlEditorComponent","content":"By accessing the website at www.intechopen.com you are agreeing to be bound by these Terms of Service, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. Use and/or access to this site is based on full agreement and compliance of these Terms. All materials contained on this website are protected by applicable copyright and trademark laws.
\\n\\nThe following terminology applies to these Terms and Conditions, Privacy Statement, Disclaimer Notice, and any or all Agreements:
\\n\\n“Client”, “Customer”, “You” and “Your” refers to you, the person accessing this website and accepting the Company’s Terms and Conditions;
\\n\\n“The Company”, “Ourselves”, “We”, “Our” and “Us”, refers to our Company, IntechOpen;
\\n\\n“Party”, “Parties”, or “Us”, refers to both the Client and ourselves, or either the Client or ourselves.
\\n\\nAll Terms refer to the offer, acceptance, and consideration of payment necessary to provide assistance to the Client in the most appropriate manner, whether by formal meetings of a fixed duration, or by any other agreed means, for the express purpose of meeting the Client’s needs in respect of provision of the Company’s stated services/products, and in accordance with, and subject to, the prevailing laws of the United Kingdom.
\\n\\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\\n\\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\\n\\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\\n\\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\\n\\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\\n\\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\\n\\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\\n\\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\\n\\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
\\n\\nIntechOpen may revise its Terms of Service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of all Terms at the time of use.
\\n\\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\\n\\nCroatian version of Terms and Conditions available here
\\n"}]'},components:[{type:"htmlEditorComponent",content:'By accessing the website at www.intechopen.com you are agreeing to be bound by these Terms of Service, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. Use and/or access to this site is based on full agreement and compliance of these Terms. All materials contained on this website are protected by applicable copyright and trademark laws.
\n\nThe following terminology applies to these Terms and Conditions, Privacy Statement, Disclaimer Notice, and any or all Agreements:
\n\n“Client”, “Customer”, “You” and “Your” refers to you, the person accessing this website and accepting the Company’s Terms and Conditions;
\n\n“The Company”, “Ourselves”, “We”, “Our” and “Us”, refers to our Company, IntechOpen;
\n\n“Party”, “Parties”, or “Us”, refers to both the Client and ourselves, or either the Client or ourselves.
\n\nAll Terms refer to the offer, acceptance, and consideration of payment necessary to provide assistance to the Client in the most appropriate manner, whether by formal meetings of a fixed duration, or by any other agreed means, for the express purpose of meeting the Client’s needs in respect of provision of the Company’s stated services/products, and in accordance with, and subject to, the prevailing laws of the United Kingdom.
\n\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\n\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\n\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\n\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\n\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\n\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\n\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\n\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\n\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
\n\nIntechOpen may revise its Terms of Service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of all Terms at the time of use.
\n\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\n\nCroatian version of Terms and Conditions available here
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"396",title:"Dr.",name:"Vedran",middleName:null,surname:"Kordic",slug:"vedran-kordic",fullName:"Vedran Kordic",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/396/images/7281_n.png",biography:"After obtaining his Master's degree in Mechanical Engineering he continued his education at the Vienna University of Technology where he obtained his PhD degree in 2004. He worked as a researcher at the Automation and Control Institute, Faculty of Electrical Engineering, Vienna University of Technology until 2008. His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. In the Engineering side, Digital Signal Processing, Computer Architecture, Electronics Devices, Digital Filtering and Engineering Management.\nApart from his Academic Interest and activities he loves sport especially, Cricket, Football, Snooker and Squash. He plays cricket for Esbjerg city in the second division team as an opener wicket keeper batsman. He is a very good player of squash but has not played squash since his arrival in Denmark.",institutionString:null,institution:null},{id:"611",title:"Prof.",name:"T",middleName:null,surname:"Nagarajan",slug:"t-nagarajan",fullName:"T Nagarajan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universiti Teknologi Petronas",country:{name:"Malaysia"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:13389},{group:"region",caption:"Middle and South America",value:2,count:11661},{group:"region",caption:"Africa",value:3,count:4168},{group:"region",caption:"Asia",value:4,count:22334},{group:"region",caption:"Australia and Oceania",value:5,count:2019},{group:"region",caption:"Europe",value:6,count:33642}],offset:12,limit:12,total:135275},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{sort:"-dateEndThirdStepPublish"},books:[{type:"book",id:"9985",title:"Geostatistics",subtitle:null,isOpenForSubmission:!0,hash:"423cb3896195a618c4acb493ce4fd23d",slug:null,bookSignature:"Prof. Jeffrey M. Yarus, Dr. Marko Maucec, Dr. Timothy C. Coburn and Associate Prof. Michael Pyrcz",coverURL:"https://cdn.intechopen.com/books/images_new/9985.jpg",editedByType:null,editors:[{id:"78011",title:"Prof.",name:"Jeffrey M.",surname:"Yarus",slug:"jeffrey-m.-yarus",fullName:"Jeffrey M. Yarus"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12456",title:"Arthroscopis Surgery",subtitle:null,isOpenForSubmission:!0,hash:"7c8c783b20d7e2e1ee6cf53df3bf0750",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12456.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12112",title:"The Colorectal Surgery",subtitle:null,isOpenForSubmission:!0,hash:"21c65e742d31d5b69fb681ef78cfa0be",slug:null,bookSignature:"Dr. Muhammad Shamim",coverURL:"https://cdn.intechopen.com/books/images_new/12112.jpg",editedByType:null,editors:[{id:"235128",title:"Dr.",name:"Muhammad",surname:"Shamim",slug:"muhammad-shamim",fullName:"Muhammad Shamim"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12215",title:"Cell Death and Disease",subtitle:null,isOpenForSubmission:!0,hash:"dfd456a29478fccf4ebd3294137eb1e3",slug:null,bookSignature:"Dr. Ke Xu",coverURL:"https://cdn.intechopen.com/books/images_new/12215.jpg",editedByType:null,editors:[{id:"59529",title:"Dr.",name:"Ke",surname:"Xu",slug:"ke-xu",fullName:"Ke Xu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11998",title:"Biocomposites - Recent Advances",subtitle:null,isOpenForSubmission:!0,hash:"8bc7ffd7544fff1901301c787e64fada",slug:null,bookSignature:"Prof. Magdy Elnashar",coverURL:"https://cdn.intechopen.com/books/images_new/11998.jpg",editedByType:null,editors:[{id:"12075",title:"Prof.",name:"Magdy",surname:"Elnashar",slug:"magdy-elnashar",fullName:"Magdy Elnashar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11999",title:"Earthquakes - Recent Advances, New Perspectives and Applications",subtitle:null,isOpenForSubmission:!0,hash:"b2af07109b13b76e5af9583532ab5bee",slug:null,bookSignature:"Dr. Walter Salazar",coverURL:"https://cdn.intechopen.com/books/images_new/11999.jpg",editedByType:null,editors:[{id:"236461",title:"Dr.",name:"Walter",surname:"Salazar",slug:"walter-salazar",fullName:"Walter Salazar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12058",title:"Future Housing",subtitle:null,isOpenForSubmission:!0,hash:"e7f4a1e57fab392b61156956c1247b9e",slug:null,bookSignature:"Dr. Ivan Oropeza-Perez and Dr. Astrid Helena Petzold-Rodríguez",coverURL:"https://cdn.intechopen.com/books/images_new/12058.jpg",editedByType:null,editors:[{id:"282172",title:"Dr.",name:"Ivan",surname:"Oropeza-Perez",slug:"ivan-oropeza-perez",fullName:"Ivan Oropeza-Perez"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12079",title:"Strategies Towards the Synthesis of Heterocycles and Their Applications",subtitle:null,isOpenForSubmission:!0,hash:"bc4022af925c0883636e0819008971ee",slug:null,bookSignature:"Dr. Premlata Kumari and Dr. Amit B Patel",coverURL:"https://cdn.intechopen.com/books/images_new/12079.jpg",editedByType:null,editors:[{id:"177041",title:"Dr.",name:"Premlata",surname:"Kumari",slug:"premlata-kumari",fullName:"Premlata Kumari"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12208",title:"Metformin - A Prospective Alternative for the Treatment of Chronic Diseases",subtitle:null,isOpenForSubmission:!0,hash:"aa4b8aac3f44ba3ab334530c5d5646ea",slug:null,bookSignature:"Prof. Farid A. Badria",coverURL:"https://cdn.intechopen.com/books/images_new/12208.jpg",editedByType:null,editors:[{id:"41865",title:"Prof.",name:"Farid A.",surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12172",title:"Health Risks of Food Additives - Recent Developments and Trends in Food Sector",subtitle:null,isOpenForSubmission:!0,hash:"f6aa23b1045d266d0928fcef04fa3417",slug:null,bookSignature:"Dr. Muhammad Sajid Arshad and Mr. Waseem Khalid",coverURL:"https://cdn.intechopen.com/books/images_new/12172.jpg",editedByType:null,editors:[{id:"192998",title:"Dr.",name:"Muhammad Sajid",surname:"Arshad",slug:"muhammad-sajid-arshad",fullName:"Muhammad Sajid Arshad"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12196",title:"Sepsis - New Perspectives",subtitle:null,isOpenForSubmission:!0,hash:"3590e6f6047122bd96d1d57da29c4054",slug:null,bookSignature:"Dr. Lixing Huang, Dr. Youyu Zhang and Dr. Lingbin Sun",coverURL:"https://cdn.intechopen.com/books/images_new/12196.jpg",editedByType:null,editors:[{id:"333148",title:"Dr.",name:"Lixing",surname:"Huang",slug:"lixing-huang",fullName:"Lixing Huang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12113",title:"Tendons - Trauma, Inflammation, Degeneration, and Treatment",subtitle:null,isOpenForSubmission:!0,hash:"2387a4e0d2a76883b16dcccd452281ab",slug:null,bookSignature:"Dr. Nahum Rosenberg",coverURL:"https://cdn.intechopen.com/books/images_new/12113.jpg",editedByType:null,editors:[{id:"68911",title:"Dr.",name:"Nahum",surname:"Rosenberg",slug:"nahum-rosenberg",fullName:"Nahum Rosenberg"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:24},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:7},{group:"topic",caption:"Business, Management and Economics",value:7,count:4},{group:"topic",caption:"Chemistry",value:8,count:16},{group:"topic",caption:"Computer and Information Science",value:9,count:18},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:8},{group:"topic",caption:"Engineering",value:11,count:39},{group:"topic",caption:"Environmental Sciences",value:12,count:5},{group:"topic",caption:"Immunology and Microbiology",value:13,count:8},{group:"topic",caption:"Materials Science",value:14,count:15},{group:"topic",caption:"Mathematics",value:15,count:9},{group:"topic",caption:"Medicine",value:16,count:64},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:2},{group:"topic",caption:"Neuroscience",value:18,count:3},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:7},{group:"topic",caption:"Physics",value:20,count:5},{group:"topic",caption:"Psychology",value:21,count:5},{group:"topic",caption:"Robotics",value:22,count:2},{group:"topic",caption:"Social Sciences",value:23,count:8},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:12,limit:12,total:480},popularBooks:{featuredBooks:[{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10796",title:"Extracellular Vesicles",subtitle:"Role in Diseases, Pathogenesis and Therapy",isOpenForSubmission:!1,hash:"eb5407fcf93baff7bca3fae5640153a2",slug:"extracellular-vesicles-role-in-diseases-pathogenesis-and-therapy",bookSignature:"Manash K. Paul",coverURL:"https://cdn.intechopen.com/books/images_new/10796.jpg",editors:[{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"95",title:"Applications and Experiences of Quality Control",subtitle:null,isOpenForSubmission:!1,hash:"4bcb22b1eee68210a977a97d5a0f363a",slug:"applications-and-experiences-of-quality-control",bookSignature:"Ognyan Ivanov",coverURL:"https://cdn.intechopen.com/books/images_new/95.jpg",editors:[{id:"22230",title:"Prof.",name:"Ognyan",middleName:null,surname:"Ivanov",slug:"ognyan-ivanov",fullName:"Ognyan Ivanov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"2160",title:"MATLAB",subtitle:"A Fundamental Tool for Scientific Computing and Engineering Applications - Volume 1",isOpenForSubmission:!1,hash:"dd9c658341fbd264ed4f8d9e6aa8ca29",slug:"matlab-a-fundamental-tool-for-scientific-computing-and-engineering-applications-volume-1",bookSignature:"Vasilios N. Katsikis",coverURL:"https://cdn.intechopen.com/books/images_new/2160.jpg",editors:[{id:"12289",title:"Prof.",name:"Vasilios",middleName:"N.",surname:"Katsikis",slug:"vasilios-katsikis",fullName:"Vasilios Katsikis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3560",title:"Advances in Landscape Architecture",subtitle:null,isOpenForSubmission:!1,hash:"a20614517ec5f7e91188fe8e42832138",slug:"advances-in-landscape-architecture",bookSignature:"Murat Özyavuz",coverURL:"https://cdn.intechopen.com/books/images_new/3560.jpg",editors:[{id:"93073",title:"Dr.",name:"Murat",middleName:null,surname:"Ozyavuz",slug:"murat-ozyavuz",fullName:"Murat Ozyavuz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10739",title:"Global Decline of Insects",subtitle:null,isOpenForSubmission:!1,hash:"543783652b9092962a8fa4bed38eeb17",slug:"global-decline-of-insects",bookSignature:"Hamadttu Abdel Farag El-Shafie",coverURL:"https://cdn.intechopen.com/books/images_new/10739.jpg",editors:[{id:"192142",title:"Dr.",name:"Hamadttu",middleName:null,surname:"Abdel Farag El-Shafie",slug:"hamadttu-abdel-farag-el-shafie",fullName:"Hamadttu Abdel Farag El-Shafie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10911",title:"Higher Education",subtitle:"New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",isOpenForSubmission:!1,hash:"223a02337498e535e967174c1f648fbc",slug:"higher-education-new-approaches-to-accreditation-digitalization-and-globalization-in-the-age-of-covid",bookSignature:"Lee Waller and Sharon Waller",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg",editors:[{id:"263301",title:"Dr.",name:"Lee",middleName:null,surname:"Waller",slug:"lee-waller",fullName:"Lee Waller"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3568",title:"Recent Advances in Plant in vitro Culture",subtitle:null,isOpenForSubmission:!1,hash:"830bbb601742c85a3fb0eeafe1454c43",slug:"recent-advances-in-plant-in-vitro-culture",bookSignature:"Annarita Leva and Laura M. R. Rinaldi",coverURL:"https://cdn.intechopen.com/books/images_new/3568.jpg",editors:[{id:"142145",title:"Dr.",name:"Annarita",middleName:null,surname:"Leva",slug:"annarita-leva",fullName:"Annarita Leva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3737",title:"MATLAB",subtitle:"Modelling, Programming and Simulations",isOpenForSubmission:!1,hash:null,slug:"matlab-modelling-programming-and-simulations",bookSignature:"Emilson Pereira Leite",coverURL:"https://cdn.intechopen.com/books/images_new/3737.jpg",editors:[{id:"12051",title:"Prof.",name:"Emilson",middleName:null,surname:"Pereira Leite",slug:"emilson-pereira-leite",fullName:"Emilson Pereira Leite"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"1770",title:"Gel Electrophoresis",subtitle:"Principles and Basics",isOpenForSubmission:!1,hash:"279701f6c802cf02deef45103e0611ff",slug:"gel-electrophoresis-principles-and-basics",bookSignature:"Sameh Magdeldin",coverURL:"https://cdn.intechopen.com/books/images_new/1770.jpg",editors:[{id:"123648",title:"Dr.",name:"Sameh",middleName:null,surname:"Magdeldin",slug:"sameh-magdeldin",fullName:"Sameh Magdeldin"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4797},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",publishedDate:"July 27th 2022",numberOfDownloads:7175,editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",publishedDate:"July 27th 2022",numberOfDownloads:1981,editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10796",title:"Extracellular Vesicles",subtitle:"Role in Diseases, Pathogenesis and Therapy",isOpenForSubmission:!1,hash:"eb5407fcf93baff7bca3fae5640153a2",slug:"extracellular-vesicles-role-in-diseases-pathogenesis-and-therapy",bookSignature:"Manash K. Paul",coverURL:"https://cdn.intechopen.com/books/images_new/10796.jpg",publishedDate:"July 20th 2022",numberOfDownloads:2308,editors:[{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",publishedDate:"July 27th 2022",numberOfDownloads:1473,editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"95",title:"Applications and Experiences of Quality Control",subtitle:null,isOpenForSubmission:!1,hash:"4bcb22b1eee68210a977a97d5a0f363a",slug:"applications-and-experiences-of-quality-control",bookSignature:"Ognyan Ivanov",coverURL:"https://cdn.intechopen.com/books/images_new/95.jpg",publishedDate:"April 26th 2011",numberOfDownloads:318571,editors:[{id:"22230",title:"Prof.",name:"Ognyan",middleName:null,surname:"Ivanov",slug:"ognyan-ivanov",fullName:"Ognyan Ivanov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"2160",title:"MATLAB",subtitle:"A Fundamental Tool for Scientific Computing and Engineering Applications - Volume 1",isOpenForSubmission:!1,hash:"dd9c658341fbd264ed4f8d9e6aa8ca29",slug:"matlab-a-fundamental-tool-for-scientific-computing-and-engineering-applications-volume-1",bookSignature:"Vasilios N. Katsikis",coverURL:"https://cdn.intechopen.com/books/images_new/2160.jpg",publishedDate:"September 26th 2012",numberOfDownloads:271836,editors:[{id:"12289",title:"Prof.",name:"Vasilios",middleName:"N.",surname:"Katsikis",slug:"vasilios-katsikis",fullName:"Vasilios Katsikis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3560",title:"Advances in Landscape Architecture",subtitle:null,isOpenForSubmission:!1,hash:"a20614517ec5f7e91188fe8e42832138",slug:"advances-in-landscape-architecture",bookSignature:"Murat Özyavuz",coverURL:"https://cdn.intechopen.com/books/images_new/3560.jpg",publishedDate:"July 1st 2013",numberOfDownloads:243450,editors:[{id:"93073",title:"Dr.",name:"Murat",middleName:null,surname:"Ozyavuz",slug:"murat-ozyavuz",fullName:"Murat Ozyavuz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10739",title:"Global Decline of Insects",subtitle:null,isOpenForSubmission:!1,hash:"543783652b9092962a8fa4bed38eeb17",slug:"global-decline-of-insects",bookSignature:"Hamadttu Abdel Farag El-Shafie",coverURL:"https://cdn.intechopen.com/books/images_new/10739.jpg",publishedDate:"July 20th 2022",numberOfDownloads:1582,editors:[{id:"192142",title:"Dr.",name:"Hamadttu",middleName:null,surname:"Abdel Farag El-Shafie",slug:"hamadttu-abdel-farag-el-shafie",fullName:"Hamadttu Abdel Farag El-Shafie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10911",title:"Higher Education",subtitle:"New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",isOpenForSubmission:!1,hash:"223a02337498e535e967174c1f648fbc",slug:"higher-education-new-approaches-to-accreditation-digitalization-and-globalization-in-the-age-of-covid",bookSignature:"Lee Waller and Sharon Waller",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg",publishedDate:"July 13th 2022",numberOfDownloads:2082,editors:[{id:"263301",title:"Dr.",name:"Lee",middleName:null,surname:"Waller",slug:"lee-waller",fullName:"Lee Waller"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3568",title:"Recent Advances in Plant in vitro Culture",subtitle:null,isOpenForSubmission:!1,hash:"830bbb601742c85a3fb0eeafe1454c43",slug:"recent-advances-in-plant-in-vitro-culture",bookSignature:"Annarita Leva and Laura M. R. Rinaldi",coverURL:"https://cdn.intechopen.com/books/images_new/3568.jpg",publishedDate:"October 17th 2012",numberOfDownloads:256294,editors:[{id:"142145",title:"Dr.",name:"Annarita",middleName:null,surname:"Leva",slug:"annarita-leva",fullName:"Annarita Leva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11328",title:"Botulinum Toxin",subtitle:"Recent Topics and Applications",isOpenForSubmission:!1,hash:"7dd05a316001cef143e209eda51387a7",slug:"botulinum-toxin-recent-topics-and-applications",bookSignature:"Suna Sabuncuoglu",coverURL:"https://cdn.intechopen.com/books/images_new/11328.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"270856",title:"Associate Prof.",name:"Suna",middleName:null,surname:"Sabuncuoglu",slug:"suna-sabuncuoglu",fullName:"Suna Sabuncuoglu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11085",title:"Polycystic Ovary Syndrome",subtitle:"Functional Investigation and Clinical Application",isOpenForSubmission:!1,hash:"3066dd3ff29e1fac072fd60b08d4d3e7",slug:"polycystic-ovary-syndrome-functional-investigation-and-clinical-application",bookSignature:"Zhengchao Wang",coverURL:"https://cdn.intechopen.com/books/images_new/11085.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"204883",title:"Dr.",name:"Zhengchao",middleName:null,surname:"Wang",slug:"zhengchao-wang",fullName:"Zhengchao Wang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10833",title:"Tumor Angiogenesis and Modulators",subtitle:null,isOpenForSubmission:!1,hash:"f29b575c46128b2da061ef7f9bd1070b",slug:"tumor-angiogenesis-and-modulators",bookSignature:"Ke Xu",coverURL:"https://cdn.intechopen.com/books/images_new/10833.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"59529",title:"Dr.",name:"Ke",middleName:null,surname:"Xu",slug:"ke-xu",fullName:"Ke Xu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11356",title:"Molecular Cloning",subtitle:null,isOpenForSubmission:!1,hash:"671c629dd86e97f0fb467b9e70e92296",slug:"molecular-cloning",bookSignature:"Sadık Dincer, Hatice Aysun Mercimek Takcı and Melis Sumengen Ozdenef",coverURL:"https://cdn.intechopen.com/books/images_new/11356.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"188141",title:"Prof.",name:"Sadik",middleName:null,surname:"Dincer",slug:"sadik-dincer",fullName:"Sadik Dincer"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10669",title:"Corrosion",subtitle:"Fundamentals and Protection Mechanisms",isOpenForSubmission:!1,hash:"4a76d54f8a40fc2e7002a8d13fd617c1",slug:"corrosion-fundamentals-and-protection-mechanisms",bookSignature:"Fahmina Zafar, Anujit Ghosal and Eram Sharmin",coverURL:"https://cdn.intechopen.com/books/images_new/10669.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"89672",title:"Dr.",name:"Fahmina",middleName:null,surname:"Zafar",slug:"fahmina-zafar",fullName:"Fahmina Zafar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10677",title:"Advanced Topics of Topology",subtitle:null,isOpenForSubmission:!1,hash:"bf964c52f9e653fac20a7fcab58070e5",slug:"advanced-topics-of-topology",bookSignature:"Francisco Bulnes",coverURL:"https://cdn.intechopen.com/books/images_new/10677.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"92918",title:"Dr.",name:"Francisco",middleName:null,surname:"Bulnes",slug:"francisco-bulnes",fullName:"Francisco Bulnes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11195",title:"Recent Advances in Biometrics",subtitle:null,isOpenForSubmission:!1,hash:"2d32e33e0f499cb5241734bb75dd2a83",slug:"recent-advances-in-biometrics",bookSignature:"Muhammad Sarfraz",coverURL:"https://cdn.intechopen.com/books/images_new/11195.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"12",title:"Environmental Sciences",slug:"environmental-sciences",parent:{id:"2",title:"Life Sciences",slug:"life-sciences"},numberOfBooks:218,numberOfSeries:0,numberOfAuthorsAndEditors:6095,numberOfWosCitations:7998,numberOfCrossrefCitations:5344,numberOfDimensionsCitations:13012,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"12",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"11083",title:"Hazardous Waste Management",subtitle:null,isOpenForSubmission:!1,hash:"d553bd4f6f1c4b115ca69bd19faac7dc",slug:"hazardous-waste-management",bookSignature:"Rajesh Banu Jeyakumar, Kavitha Sankarapandian and Yukesh Kannah Ravi",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg",editedByType:"Edited by",editors:[{id:"218539",title:"Dr.",name:"Rajesh Banu",middleName:null,surname:"Jeyakumar",slug:"rajesh-banu-jeyakumar",fullName:"Rajesh Banu Jeyakumar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11120",title:"Environmental Impact and Remediation of Heavy Metals",subtitle:null,isOpenForSubmission:!1,hash:"9e77514288e7394f1e6cd13481af3509",slug:"environmental-impact-and-remediation-of-heavy-metals",bookSignature:"Hosam M. Saleh and Amal I. Hassan",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10983",title:"Conifers",subtitle:"Recent Advances",isOpenForSubmission:!1,hash:"3e524d29fc3f95c3389efbd41463dab6",slug:"conifers-recent-advances",bookSignature:"Ana Cristina Gonçalves and Teresa Fonseca",coverURL:"https://cdn.intechopen.com/books/images_new/10983.jpg",editedByType:"Edited by",editors:[{id:"194484",title:"Prof.",name:"Ana Cristina",middleName:null,surname:"Gonçalves",slug:"ana-cristina-goncalves",fullName:"Ana Cristina Gonçalves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11175",title:"Nearly Zero Energy Building (NZEB)",subtitle:"Materials, Design and New Approaches",isOpenForSubmission:!1,hash:"7e4718f36725ff9ce60b349b7681d7cc",slug:"nearly-zero-energy-building-nzeb-materials-design-and-new-approaches",bookSignature:"David Bienvenido-Huertas",coverURL:"https://cdn.intechopen.com/books/images_new/11175.jpg",editedByType:"Edited by",editors:[{id:"320815",title:"Dr.",name:"David",middleName:null,surname:"Bienvenido Huertas",slug:"david-bienvenido-huertas",fullName:"David Bienvenido Huertas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10682",title:"Pathways and Challenges for Efficient Desalination",subtitle:null,isOpenForSubmission:!1,hash:"ca25e9eca70d54deb503d2663f75218c",slug:"pathways-and-challenges-for-efficient-desalination",bookSignature:"Muhammad Wakil Shahzad, Mike Dixon, Giancarlo Barassi, Ben Bin Xu and Yinzhu Jiang",coverURL:"https://cdn.intechopen.com/books/images_new/10682.jpg",editedByType:"Edited by",editors:[{id:"174208",title:"Dr.",name:"Muhammad Wakil",middleName:null,surname:"Shahzad",slug:"muhammad-wakil-shahzad",fullName:"Muhammad Wakil Shahzad"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10976",title:"Water Conservation",subtitle:"Inevitable Strategy",isOpenForSubmission:!1,hash:"2a5f75a1eed9cb67133fe6ce0f8848f5",slug:"water-conservation-inevitable-strategy",bookSignature:"Murat Eyvaz, Ahmed Albahnasawi, Ercan Gürbulak and Ebubekir Yüksel",coverURL:"https://cdn.intechopen.com/books/images_new/10976.jpg",editedByType:"Edited by",editors:[{id:"170083",title:"Associate Prof.",name:"Murat",middleName:null,surname:"Eyvaz",slug:"murat-eyvaz",fullName:"Murat Eyvaz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10980",title:"Biogas",subtitle:"Basics, Integrated Approaches, and Case Studies",isOpenForSubmission:!1,hash:"5ae044532b8c1b30f5802c74ba76e1ae",slug:"biogas-basics-integrated-approaches-and-case-studies",bookSignature:"Abd El-Fatah Abomohra and El-Sayed Salama",coverURL:"https://cdn.intechopen.com/books/images_new/10980.jpg",editedByType:"Edited by",editors:[{id:"186114",title:"Dr.",name:"Abdelfatah",middleName:null,surname:"Abomohra",slug:"abdelfatah-abomohra",fullName:"Abdelfatah Abomohra"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10766",title:"Landscape Architecture Framed from an Environmental and Ecological Perspective",subtitle:null,isOpenForSubmission:!1,hash:"bf47534a17fef030dc256b541482553c",slug:"landscape-architecture-framed-from-an-environmental-and-ecological-perspective",bookSignature:"Mustafa Ergen and Yaşar Bahri Ergen",coverURL:"https://cdn.intechopen.com/books/images_new/10766.jpg",editedByType:"Edited by",editors:[{id:"166961",title:"Dr.Ing.",name:"Mustafa",middleName:null,surname:"Ergen",slug:"mustafa-ergen",fullName:"Mustafa Ergen"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10684",title:"Biorefineries",subtitle:"Selected Processes",isOpenForSubmission:!1,hash:"fb63a798f34d4f00e4681291ae2c0e10",slug:"biorefineries-selected-processes",bookSignature:"Krzysztof Biernat",coverURL:"https://cdn.intechopen.com/books/images_new/10684.jpg",editedByType:"Edited by",editors:[{id:"155009",title:"Prof.",name:"Krzysztof",middleName:null,surname:"Biernat",slug:"krzysztof-biernat",fullName:"Krzysztof Biernat"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10855",title:"Waste Material Recycling in the Circular Economy",subtitle:"Challenges and Developments",isOpenForSubmission:!1,hash:"d19317ef8e4a35c32f3af20bd8d5d829",slug:"waste-material-recycling-in-the-circular-economy-challenges-and-developments",bookSignature:"Dimitris S. Achilias",coverURL:"https://cdn.intechopen.com/books/images_new/10855.jpg",editedByType:"Edited by",editors:[{id:"95620",title:"Dr.",name:"Dimitris S.",middleName:null,surname:"Achilias",slug:"dimitris-s.-achilias",fullName:"Dimitris S. Achilias"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10681",title:"Biodegradation Technology of Organic and Inorganic Pollutants",subtitle:null,isOpenForSubmission:!1,hash:"9a6e10e02788092872fd249436898e97",slug:"biodegradation-technology-of-organic-and-inorganic-pollutants",bookSignature:"Kassio Ferreira Mendes, Rodrigo Nogueira de Sousa and Kamila Cabral Mielke",coverURL:"https://cdn.intechopen.com/books/images_new/10681.jpg",editedByType:"Edited by",editors:[{id:"197720",title:"Ph.D.",name:"Kassio",middleName:null,surname:"Ferreira Mendes",slug:"kassio-ferreira-mendes",fullName:"Kassio Ferreira Mendes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10843",title:"Persistent Organic Pollutants (POPs)",subtitle:"Monitoring, Impact and Treatment",isOpenForSubmission:!1,hash:"f5b1589f0a990b6114fef2dadc735dd9",slug:"persistent-organic-pollutants-pops-monitoring-impact-and-treatment",bookSignature:"Mohamed Nageeb Rashed",coverURL:"https://cdn.intechopen.com/books/images_new/10843.jpg",editedByType:"Edited by",editors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:218,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"29369",doi:"10.5772/32373",title:"Textile Organic Dyes – Characteristics, Polluting Effects and Separation/Elimination Procedures from Industrial Effluents – A Critical Overview",slug:"textile-organic-dyes-characteristics-polluting-effects-and-separation-elimination-procedures-from-in",totalDownloads:29487,totalCrossrefCites:128,totalDimensionsCites:321,abstract:null,book:{id:"872",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",title:"Organic Pollutants Ten Years After the Stockholm Convention",fullTitle:"Organic Pollutants Ten Years After the Stockholm Convention - Environmental and Analytical Update"},signatures:"Zaharia Carmen and Suteu Daniela",authors:[{id:"91196",title:"Prof.",name:"Carmen",middleName:null,surname:"Zaharia",slug:"carmen-zaharia",fullName:"Carmen Zaharia"},{id:"92084",title:"Dr.",name:"Daniela",middleName:null,surname:"Suteu",slug:"daniela-suteu",fullName:"Daniela Suteu"}]},{id:"42059",doi:"10.5772/54048",title:"Adsorption Technique for the Removal of Organic Pollutants from Water and Wastewater",slug:"adsorption-technique-for-the-removal-of-organic-pollutants-from-water-and-wastewater",totalDownloads:30043,totalCrossrefCites:51,totalDimensionsCites:221,abstract:null,book:{id:"3426",slug:"organic-pollutants-monitoring-risk-and-treatment",title:"Organic Pollutants",fullTitle:"Organic Pollutants - Monitoring, Risk and Treatment"},signatures:"Mohamed Nageeb Rashed",authors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed"}]},{id:"27305",doi:"10.5772/39363",title:"Water Stress in Plants: Causes, Effects and Responses",slug:"water-stress-in-plants-causes-effects-and-responses",totalDownloads:28496,totalCrossrefCites:72,totalDimensionsCites:172,abstract:null,book:{id:"911",slug:"water-stress",title:"Water Stress",fullTitle:"Water Stress"},signatures:"Seyed Y. S. Lisar, Rouhollah Motafakkerazad, Mosharraf M. Hossain and Ismail M. M. Rahman",authors:[{id:"110740",title:"Dr.",name:"Ismail M.M.",middleName:null,surname:"Rahman",slug:"ismail-m.m.-rahman",fullName:"Ismail M.M. Rahman"}]},{id:"62247",doi:"10.5772/intechopen.77315",title:"Application of Biosorption for Removal of Heavy Metals from Wastewater",slug:"application-of-biosorption-for-removal-of-heavy-metals-from-wastewater",totalDownloads:7645,totalCrossrefCites:75,totalDimensionsCites:152,abstract:"Fresh water accounts for 3% of water resources on the Earth. Human and industrial activities produce and discharge wastes containing heavy metals into the water resources making them unavailable and threatening human health and the ecosystem. Conventional methods for the removal of metal ions such as chemical precipitation and membrane filtration are extremely expensive when treating large amounts of water, inefficient at low concentrations of metal (incomplete metal removal) and generate large quantities of sludge and other toxic products that require careful disposal. Biosorption and bioaccumulation are ecofriendly alternatives. These alternative methods have advantages over conventional methods. Abundant natural materials like microbial biomass, agro-wastes, and industrial byproducts have been suggested as potential biosorbents for heavy metal removal due to the presence of metal-binding functional groups. Biosorption is influenced by various process parameters such as pH, temperature, initial concentration of the metal ions, biosorbent dose, and speed of agitation. Also, the biomass can be modified by physical and chemical treatment before use. The process can be made economical by regenerating and reusing the biosorbent after removing the heavy metals. Various bioreactors can be used in biosorption for the removal of metal ions from large volumes of water or effluents. The recent developments and the future scope for biosorption as a wastewater treatment option are discussed.",book:{id:"6137",slug:"biosorption",title:"Biosorption",fullTitle:"Biosorption"},signatures:"Sri Lakshmi Ramya Krishna Kanamarlapudi, Vinay Kumar\nChintalpudi and Sudhamani Muddada",authors:[{id:"238433",title:"Associate Prof.",name:"Sudhamani",middleName:null,surname:"Muddada",slug:"sudhamani-muddada",fullName:"Sudhamani Muddada"},{id:"244937",title:"Mrs.",name:"S L Ramyakrishna",middleName:null,surname:"Kanamarlapudi",slug:"s-l-ramyakrishna-kanamarlapudi",fullName:"S L Ramyakrishna Kanamarlapudi"},{id:"244938",title:"Mr.",name:"Vinay Kumar",middleName:null,surname:"Chintalpudi",slug:"vinay-kumar-chintalpudi",fullName:"Vinay Kumar Chintalpudi"}]},{id:"53211",doi:"10.5772/66416",title:"Biofloc Technology (BFT): A Tool for Water Quality Management in Aquaculture",slug:"biofloc-technology-bft-a-tool-for-water-quality-management-in-aquaculture",totalDownloads:16966,totalCrossrefCites:65,totalDimensionsCites:148,abstract:"Biofloc technology (BFT) is considered the new “blue revolution” in aquaculture. Such technique is based on in situ microorganism production which plays three major roles: (i) maintenance of water quality, by the uptake of nitrogen compounds generating in situ microbial protein; (ii) nutrition, increasing culture feasibility by reducing feed conversion ratio (FCR) and a decrease of feed costs; and (iii) competition with pathogens. The aggregates (bioflocs) are a rich protein-lipid natural source of food available in situ 24 hours per day due to a complex interaction between organic matter, physical substrate, and large range of microorganisms. This natural productivity plays an important role recycling nutrients and maintaining the water quality. The present chapter will discuss some insights of the role of microorganisms in BFT, main water quality parameters, the importance of the correct carbon-to-nitrogen ratio in the culture media, its calculations, and different types, as well as metagenomics of microorganisms and future perspectives.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Maurício Gustavo Coelho Emerenciano, Luis Rafael Martínez-\nCórdova, Marcel Martínez-Porchas and Anselmo Miranda-Baeza",authors:[{id:"146126",title:"Dr.",name:"Maurício Gustavo Coelho",middleName:null,surname:"Emerenciano",slug:"mauricio-gustavo-coelho-emerenciano",fullName:"Maurício Gustavo Coelho Emerenciano"},{id:"186970",title:"Prof.",name:"Marcel",middleName:null,surname:"Martínez-Porchas",slug:"marcel-martinez-porchas",fullName:"Marcel Martínez-Porchas"},{id:"186971",title:"Prof.",name:"Anselmo",middleName:null,surname:"Miranda-Baeza",slug:"anselmo-miranda-baeza",fullName:"Anselmo Miranda-Baeza"},{id:"195101",title:"Dr.",name:"Luis Rafael",middleName:null,surname:"Martínez-Córdoba",slug:"luis-rafael-martinez-cordoba",fullName:"Luis Rafael Martínez-Córdoba"}]}],mostDownloadedChaptersLast30Days:[{id:"69568",title:"Water Quality Parameters",slug:"water-quality-parameters",totalDownloads:10165,totalCrossrefCites:14,totalDimensionsCites:36,abstract:"Since the industrial revolution in the late eighteenth century, the world has discovered new sources of pollution nearly every day. So, air and water can potentially become polluted everywhere. Little is known about changes in pollution rates. The increase in water-related diseases provides a real assessment of the degree of pollution in the environment. This chapter summarizes water quality parameters from an ecological perspective not only for humans but also for other living things. According to its quality, water can be classified into four types. Those four water quality types are discussed through an extensive review of their important common attributes including physical, chemical, and biological parameters. These water quality parameters are reviewed in terms of definition, sources, impacts, effects, and measuring methods.",book:{id:"7718",slug:"water-quality-science-assessments-and-policy",title:"Water Quality",fullTitle:"Water Quality - Science, Assessments and Policy"},signatures:"Nayla Hassan Omer",authors:null},{id:"58138",title:"Water Pollution: Effects, Prevention, and Climatic Impact",slug:"water-pollution-effects-prevention-and-climatic-impact",totalDownloads:21554,totalCrossrefCites:18,totalDimensionsCites:38,abstract:"The stress on our water environment as a result of increased industrialization, which aids urbanization, is becoming very high thus reducing the availability of clean water. Polluted water is of great concern to the aquatic organism, plants, humans, and climate and indeed alters the ecosystem. The preservation of our water environment, which is embedded in sustainable development, must be well driven by all sectors. While effective wastewater treatment has the tendency of salvaging the water environment, integration of environmental policies into the actor firms core objectives coupled with continuous periodical enlightenment on the present and future consequences of environmental/water pollution will greatly assist in conserving the water environment.",book:{id:"6157",slug:"water-challenges-of-an-urbanizing-world",title:"Water Challenges of an Urbanizing World",fullTitle:"Water Challenges of an Urbanizing World"},signatures:"Inyinbor Adejumoke A., Adebesin Babatunde O., Oluyori Abimbola\nP., Adelani-Akande Tabitha A., Dada Adewumi O. and Oreofe Toyin\nA.",authors:[{id:"101570",title:"MSc.",name:"Babatunde Olufemi",middleName:null,surname:"Adebesin",slug:"babatunde-olufemi-adebesin",fullName:"Babatunde Olufemi Adebesin"},{id:"187738",title:"Dr.",name:"Adejumoke",middleName:"Abosede",surname:"Inyinbor",slug:"adejumoke-inyinbor",fullName:"Adejumoke Inyinbor"},{id:"188818",title:"Dr.",name:"Abimbola",middleName:null,surname:"Oluyori",slug:"abimbola-oluyori",fullName:"Abimbola Oluyori"},{id:"188819",title:"Mrs.",name:"Tabitha",middleName:null,surname:"Adelani-Akande",slug:"tabitha-adelani-akande",fullName:"Tabitha Adelani-Akande"},{id:"208501",title:"Dr.",name:"Adewumi",middleName:null,surname:"Dada",slug:"adewumi-dada",fullName:"Adewumi Dada"},{id:"208502",title:"Ms.",name:"Toyin",middleName:null,surname:"Oreofe",slug:"toyin-oreofe",fullName:"Toyin Oreofe"}]},{id:"45422",title:"Urban Waterfront Regenerations",slug:"urban-waterfront-regenerations",totalDownloads:14203,totalCrossrefCites:4,totalDimensionsCites:12,abstract:null,book:{id:"3560",slug:"advances-in-landscape-architecture",title:"Advances in Landscape Architecture",fullTitle:"Advances in Landscape Architecture"},signatures:"Umut Pekin Timur",authors:[{id:"165480",title:"Dr.",name:"Umut",middleName:null,surname:"Pekin Timur",slug:"umut-pekin-timur",fullName:"Umut Pekin Timur"}]},{id:"24941",title:"Tsunami in Makran Region and Its Effect on the Persian Gulf",slug:"tsunami-in-makran-region-and-its-effect-on-the-persian-gulf",totalDownloads:7575,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"406",slug:"tsunami-a-growing-disaster",title:"Tsunami",fullTitle:"Tsunami - A Growing Disaster"},signatures:"Mohammad Mokhtari",authors:[{id:"52451",title:"Dr.",name:"Mohammad",middleName:null,surname:"Mokhtari",slug:"mohammad-mokhtari",fullName:"Mohammad Mokhtari"}]},{id:"66307",title:"Bio-hydrogen and Methane Production from Lignocellulosic Materials",slug:"bio-hydrogen-and-methane-production-from-lignocellulosic-materials",totalDownloads:2953,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"This chapter covers the information on bio-hydrogen and methane production from lignocellulosic materials. Pretreatment methods of lignocellulosic materials and the factors affecting bio-hydrogen production, both dark- and photo-fermentation, and methane production are addressed. Last but not least, the processes for bio-hydrogen and methane production from lignocellulosic materials are discussed.",book:{id:"7608",slug:"biomass-for-bioenergy-recent-trends-and-future-challenges",title:"Biomass for Bioenergy",fullTitle:"Biomass for Bioenergy - Recent Trends and Future Challenges"},signatures:"Apilak Salakkam, Pensri Plangklang, Sureewan Sittijunda, Mallika Boonmee Kongkeitkajorn, Siriporn Lunprom and Alissara Reungsang",authors:null}],onlineFirstChaptersFilter:{topicId:"12",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82465",title:"Agroforestry: An Approach for Sustainability and Climate Mitigation",slug:"agroforestry-an-approach-for-sustainability-and-climate-mitigation",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.105406",abstract:"Agroforestry Systems (AFS), or the association of trees with crops (or animals), is a strategy for land management and use that allows production within the sustainable development: (a) environmentally (production environmentally harmonic); (b) technically (integrating existing resources on the farm); (c) economically (increase in production), and (d) socially (equality of duties and opportunities, quality of life of the family group). As an intentional integration of trees or shrubs with crop and animal production, this practice makes environmental, economic, and social benefits to farmers. Given that there is a set of definitions, rather than a single definition of Agroforestry (AF) and AFS, it is justified to explore the historical evolution and the minimum coincidences of criteria to define them and apply them in the recovery of degraded areas. Knowing how to classify AFS allows us to indicate which type or group of AFS is suitable for a particular area with its characteristics. The greatest benefit that AFS can bring to degraded or sloping areas lies in their ability to combine soil conservation with productive functions. In other words, AF is arborizing agriculture and animal production to obtain more benefits including climate change adaptation and mitigation by ecosystem services.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ricardo O. Russo"},{id:"82754",title:"Impact of Revegetation on Ecological Restoration of a Constructed Soil in a Coal Mining in Southern Brazil",slug:"impact-of-revegetation-on-ecological-restoration-of-a-constructed-soil-in-a-coal-mining-in-southern-",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.105895",abstract:"The main problems in the constructed soils are the generation of acid mine drainage promoted by the presence of coal debris in the overburden layer and the compaction of the topsoil promoted by the machine traffic when the material used in the overburden cover is more clayey. This book chapter aimed to show an overview of the impact of more than a decade of revegetation with different perennial grasses on the chemical, physical, and biological quality of constructed soil after coal mining. The study was carried out in a coal mining area, located in southern Brazil. The soil was constructed in early 2003 and the perennial grasses, Hemarthria altissima; Paspalum notatum cv. Pensacola; Cynodon dactylon cv Tifton; and Urochloa brizantha; were implanted in November/December 2003. In 11.5, 17.6 and 18 years of revegetation soil samples were collected and the chemical, physical, and biological attributes were determined. Our results show that liming is an important practice in the restoration of these strongly anthropized soils because this positively impacts the plants’ development, facilitating the roots system expansion. Biological attributes such as soil fauna and the microorganism’s population are the attributes that possibly takes longer to establish itself in these areas.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Lizete Stumpf, Maria Bertaso De Garcia Fernandez, Pablo Miguel, Luiz Fernando Spinelli Pinto, Ryan Noremberg Schubert, Luís Carlos Iuñes de Oliveira Filho, Tania Hipolito Montiel, Lucas Da Silva Barbosa, Jeferson Diego Leidemer and Thábata Barbosa Duarte"},{id:"82936",title:"Soil Degradation Processes Linked to Long-Term Forest-Type Damage",slug:"soil-degradation-processes-linked-to-long-term-forest-type-damage",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.106390",abstract:"Forest degradation impairs ability of the whole landscape adaptation to environmental change. The impacts of forest degradation on landscape are caused by a self-organization decline. At the present time, the self-organization decline was largely due to nitrogen deposition and deforestation which exacerbated impacts of climate change. Nevertheless, forest degradation processes are either reversible or irreversible. Irreversible forest degradation begins with soil damage. In this paper, we present processes of forest soil degradation in relation to vulnerability of regulation adaptability on global environmental change. The regulatory forest capabilities were indicated through soil organic matter sequestration dynamics. We devided the degradation processes into quantitative and qualitative damages of physical or chemical soil properties. Quantitative soil degradation includes irreversible loss of an earth’s body after claim, erosion or desertification, while qualitative degradation consists of predominantly reversible consequences after soil disintegration, leaching, acidification, salinization and intoxication. As a result of deforestation, the forest soil vulnerability is spreading through quantitative degradation replacing hitherto predominantly qualitative changes under continuous vegetation cover. Increasing needs to natural resources using and accompanying waste pollution destroy soil self-organization through biodiversity loss, simplification in functional links among living forms and substance losses from ecosystem. We concluded that subsequent irreversible changes in ecosystem self-organization cause a change of biome potential natural vegetation and the land usability decrease.",book:{id:"11457",title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg"},signatures:"Pavel Samec, Aleš Kučera and Gabriela Tomášová"},{id:"82828",title:"Vegetation and Avifauna Distribution in the Serengeti National Park",slug:"vegetation-and-avifauna-distribution-in-the-serengeti-national-park",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106165",abstract:"In order to examine the bird species changes within different vegetation structures, the variations were compared between Commiphora-dominated vegetations with those of Vachellia tortilis and Vachellia robusta-dominated vegetations, and also compared the birds of grassland with those of Vachellia drepanolobium and Vachellia seyal-dominated vegetations. This study was conducted between February 2010 and April 2012. A total of 40 plots of 100 m × 100 m were established. Nonparametric Mann-Whitney U-test was used to examine differences in bird species between vegetations. Species richness estimates were obtained using the Species Diversity and Richness. A total of 171 bird species representing 103 genera, 12 orders, and 54 families were recorded. We found differences in bird species distribution whereby V. tortilis has higher bird species richness (102 species), abundance, and diversity when compared with Commiphora with 66 species and V. robusta with 59 species. These results suggest that variations in bird species abundance, diversity, and distribution could be attributed to differences in the structural diversity of vegetation. Therefore it is important to maintain different types of vegetation by keeping the frequency of fire to a minimum and prescribed fire should be employed and encouraged to control wildfire and so maintain a diversity of vegetation and birds community.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ally K. Nkwabi and Pius Y. Kavana"},{id:"82808",title:"Climate Change and Anthropogenic Impacts on the Ecosystem of the Transgressive Mud Coastal Region of Bight of Benin, Nigeria",slug:"climate-change-and-anthropogenic-impacts-on-the-ecosystem-of-the-transgressive-mud-coastal-region-of",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.105760",abstract:"The transgressive mud coastal area of Bight of Benin is a muddy coastal complex that lies east of the Barrier/lagoon coast and stretches to the Benin River in the northwestern flank of the Niger Delta Nigeria. It constitutes a fragile buffer zone between the tranquil waters of the swamps and the menacing waves of the Atlantic Ocean. Extensive breaching of this narrow coastal plain results in massive incursion of the sea into the inland swamps with serious implications for national security and the economy. Climate change impacts from the results of meteorological information of the regions shows a gradual degradation in the past 30 years. Temperature, rainfall and humidity increase annually depict climate change, resulting from uncontrolled exploitation of natural resources is rapidly pushing the region towards ecological disasters. The ecosystem is very unique being the only transgressive mud coastal area of the Gulf of Guinea. The chapter describes the geomorphology, tidal hydrology, relief/drainage, topography, climate/meteorology, vegetation, economic characteristics, anthropogenic activities and their impacts on the ecosystem.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Patrick O. Ayeku"},{id:"82697",title:"Analyzing the Evolution of Land-Use Changes Related to Vegetation, in the Galicia Region, Spain: From 1990 to 2018",slug:"analyzing-the-evolution-of-land-use-changes-related-to-vegetation-in-the-galicia-region-spain-from-1",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106015",abstract:"Considering the complex dynamics, patterns, and particularities that the Galicia region present—e.g., the fragility, shown to achieve sustainable development and growth—a study that analyzes the Land-Use related to the vegetation of this region is seen as pivotal to identifying barriers and opportunities for long-term sustainable development. Using GIS (Geographic Information Systems), the present chapter enables us to identify the dynamics and patterns of the evolution of the Land-Use Changes related to vegetation in the Galicia Region from 1990 to 2018 (years 1990, 2000, 2012, and 2018 using CORINE (Coordination of Information on the Environment) data). This study permits us to reinforce that the Land-Use Changes related to vegetation in the Galicia Region have undergone multiple changes—marked by increasing and decreasing periods. Also, can be considered a surveying baseline for the comparative analysis of similar works for different Land-Use Changes related to vegetation trends in Europe or worldwide. Land-Use Changes related to vegetation studies are reliable tools to evaluate the human activities and footprint of proposed strategies and policies in a territory. This chapter also enables us to understand that the main actors should design development policies to protect, preserve and conserve these incomparable landscapes, environments, ecosystems, and the region as a whole.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Sérgio Lousada and José Manuel Naranjo Gómez"}],onlineFirstChaptersTotal:77},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:"2753-6580",scope:"