Clinical characteristics of the patients.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Left ventricular aneurysm (LVA) in postinfarction period makes for worse prognosis of coronary artery disease (CAD) course due to concomitant complications. With the natural course of postinfarction aneurysms 5 year survival varies from 25 to 60%, according to various authors. Ventricular arrhythmias cause death in 50% of the patients with remodelled left ventricle (LV) after myocardial infarction [1].
Contrast-enhanced magnetic resonance imaging (MRI) is the method of choice for the evaluation of myocardial viability in patients with chronic CAD and with LVA in particular [2,3,4].
Meanwhile, data of contrast-enhanced MRI pictures with condition of electrophysiological activity and topical diagnosis of ventricular tachycardia in patients who had experienced myocardial infarction complicated with LVA have not been compared. At the same time, need for surgical treatment of cardiac aneurysm combined with intraoperative ablation of arrhythmogenic areas of myocardium arises no doubts since it allows for better treatment outcomes in the early postoperative period and in the late follow-up [4,5,6].
Thus, the objective of our study was to enhance efficacy of topical diagnostics and of surgical treatment in patients with postinfarction LV aneurysms complicated with ventricular rhythm disorders through application of contrast-enhanced MRI, electrophysiological study (EPhS) of the heart and optimal dissection or ablation of scarred and arrhythmogenic endocardium.
The study included 188 patients operated for postinfarction anterior septal and apical LVA. The disease was diagnosed basing on the data of echocardiography (EchoCG), coronary ventriculography (CVG) and contrast-enhanced MRI.
Prior to the surgery the patients mostly had III-IV CC angina class, their condition corresponded to that of New York Heart Association (NYHA) class II-III for chronic heart failure. All the patients demonstrated evidence of postinfarction LV remodeling according to the results of ventriculography and EchoCG.
Cardiac inversion recovery and T-1 spin-echo weighed MRI study with ECG synchronization was performed with a patient lying flat with no additional functional stress. Axial slices on the level of thorax with the complete coverage of heart area were recorded. The field of view was 350-380 mm wide and 7-8mm thick slices were recorded into the matrix of 256x256 voxels. Synchronization of the recordings of MRI pictures with ECG was performed by standard means of an open PRI scanner Magnetom-Open (0,2 T by Siemens Medical) or high field open MRI scanner Vantage Titan (1,5 Т, by Toshiba) by R-wave of ECG; end-diastolic images were acquired in all the cases. Parameters of the acquired T1-weighed images in spin-echo mode were as follows: repetition time (TR) 550 – 1040ms, echo time (TE) – 20 ms. MRI included slices with long axis two-chamber and four-chamber views as well as short axis view covering all the myocardial volume of LV. The study was performed in 12-20 minutes after injection of paramagnetic contrast agents with the concentration of paramagnetic agent itself of 0,5М (Omniscan, Magnevist, Optimark, Cyclomang, Viewgam) in dosage of 2ml/10kg of a body weight. The short-axis and long-axis slices in four-chamber view were divided semi-automatically into 17 segments taking into account generally accepted segmentation of LV myocardium (Fig.1) [7].
In particular, for each segment i (i = 1 – 17) we calculated the depth of damage by the degree of paramagnetic contrast agent uptake as follows: [Index of Transmurality]i = (maximum thicknesses of paramagnetic contrast agent uptake)i / (thickness of myocardium in a particular segment) i (Figure 2). (original data)
To see the association between MR images with the data of electrophysiological condition of heart muscle, and in particular with the location of the areas with lowered voltage of local electrical activity, the patients underwent electrophysiological study of the heart (EPhS) with electroanatomical CARTO reconstruction of LV [20]. Besides, there were identified the areas of delayed conduction, zones of possible re-entry and inducible VT (Figure 3).
Locations of intracardiac leads and thus of segmental electrical activity corresponded to the locations of left ventricular segments during contrast-enhanced MRI. In accordance with the amplitude of the curve during EPhS for a definite myocardial segment, degree of potential reduction was graded as follows: 0 – for the amplitude of the potential from 1,5 to 8 mV, when the segment was considered to be a zone of normal potential; 1 — for the amplitude of 0,5 — 1,5 mV, a transient zone; 2 — for the amplitude 0,05 — 0,5 mV, low potential zone; 3 — zone of «electrical scar» - lack of electrical activity when the amplitude was 0 — 0,05 mV. This grading was preconditioned by the fact that myocardial areas with the 1st or 2nd grades of lowered potential were, as a rule, sources of life threatening tachycardias, while for grade 3 “electrical scar” this was less possible and in the zones with normal electrical activity of grade 0 VTs did not occur [9,10].
Segmentation of LV myocardium, used in evaluation of a local paramagnetic contrast agent uptake during myocardial MRI
The scheme of TI calculation by the data of delayed contrast-enhanced MRI of myocardium. The values of thickness of the infarction zone (accumulation of paramagnetic) and the value of the total myocardial thickness were identified on the LV slices in short axis. Thickness of the contrast-paramagnetic accumulation in myocardium is thought to be the thickness of lesion resulting from acute myocardial infarction. Thus TI is equal to {(thickness of an infracted area)/ (thickness of the myocardium)}. (original data)
Patient T, 56 year old. Before the surgery. EPhS with LV reconstruction of a patient with LV aneurysm. The area of electrical “silence” (scar) is highlighted with grey color; the low-amplitude ventricular potential area of 0,5 mV – with red; the transient zone of 0,5 - 1,5 mV – with yellow-green; the zone of viable myocardium – with violet; the double potential zone – with blue dots and the zone of delayed potential – with pink dots. Front view, right oblique view. (original data)
Surgical ventricular reconstruction (SVR) was performed by the standard methods by V.Dor and in L.Menicanti modification. [4,6]. After cardiac arrest with a calculated injection of cardioplegia solution (Kustodiol) there was performed grafting of distal coronary anastomoses. Left ventricle was opened with a longitudinal incision in the apical area to be parallel to the anterior descending artery along visually identified scarred tissue. After revision of left ventricular cavity thrombotic mass if any was eliminated. In case of endocardectomy we performed resection of scarred and transient areas of LV. Residual volume of LV cavity was calculated by a physiological norm of 50-60 ml/m2 of a patient’s body surface, and was limited by a special sizer (Chase Medical Richardson, TX, USA). To close LV cavity we used an endocardial synthetic patch (Gore-tex). When L. Menicanti modification was applied, LV neoapex was formed with one or two u-shaped sutures. LV was closed with a double running suture [11,12].
Endocardectomy was performed in 84 patients who were referred to the study group (LVR+EE); on average there was dissected 44cm2 of LV endocardium (from 17 to 84 cm2) including ventricular septum. The control group consisted of 104 patients in which endocardial resection was not performed (LVR without EE). The patients were allocated into the groups randomly. All the patients signed the informed consent form. The study was approved by the local ethic committee.
Resection of aneurysm and left ventricular reconstruction (LVR) was performed by V. Dor procedure in 130 patients, by L. Menicanti modification - in 58 patients. In 29 patients from both groups mitral valve fibrous ring repair was done. All the patients underwent coronary artery bypass grafting (CABG). The area of an endocardial synthetic patch varied from 5 to 20 cm2. Clinical data and the data of instrumental examinations did not show significant differences between the patient groups (Table 1).
\n\t\t\t\tCharacteristics\n\t\t\t | \n\t\t\tLVR with EEn=84 | \n\t\t\t\n\t\t\t\tLVR without EE n=104\n\t\t\t | \n\t\t|
Age, years old | \n\t\t\t55 | \n\t\t\t56 | \n\t\t|
Angina class Canadian Cardiovascular Society, (%) | \n\t\t\tII | \n\t\t\t10 | \n\t\t\t10 | \n\t\t
III | \n\t\t\t37 | \n\t\t\t40 | \n\t\t|
IV | \n\t\t\t34 | \n\t\t\t33 | \n\t\t|
Unstable angina | \n\t\t\t19 | \n\t\t\t17 | \n\t\t|
Current NYHA heart failure class, (%) | \n\t\t\tI | \n\t\t\t5 | \n\t\t\t6 | \n\t\t
II | \n\t\t\t20 | \n\t\t\t21 | \n\t\t|
III | \n\t\t\t70 | \n\t\t\t69 | \n\t\t|
IV | \n\t\t\t5 | \n\t\t\t4% | \n\t\t|
Type of LV aneurysm, (%) | \n\t\t\t1 | \n\t\t\t56 | \n\t\t\t58 | \n\t\t
2 | \n\t\t\t35 | \n\t\t\t34 | \n\t\t|
3 | \n\t\t\t9 | \n\t\t\t8 | \n\t\t|
Ventricular tachycardia, (%) | \n\t\t\tSpontaneous | \n\t\t\t14 | \n\t\t\t13 | \n\t\t
Induced | \n\t\t\t32 | \n\t\t\t30 | \n\t\t|
Ventricular extrasystoly, (%) | \n\t\t\t44 | \n\t\t\t48 | \n\t\t|
Mitral regurgitation 2+, fibrous ring more than 35 mm, (%) | \n\t\t\t18 | \n\t\t\t13 | \n\t\t|
Lesions of coronary arteries, (%) | \n\t\t\t1 | \n\t\t\t30 | \n\t\t\t34 | \n\t\t
2 | \n\t\t\t35 | \n\t\t\t36 | \n\t\t|
3 | \n\t\t\t35 | \n\t\t\t30 | \n\t\t
Clinical characteristics of the patients.
SSPS 11.5 for Windows software was used for the analysis. Shapiro-Wilk test was applied to assess normality of distribution law of quantitative values. The parameters conforming with the normal distribution test were described with the use of a mean value (M) and a standard deviation (SD). Qualitative data were described by the rate of occurrence or its percentage. Student’s t-test was used to evaluate significance of the differences of quantitative values in the compared groups when distribution law was normal. To see the significance of differences among quantitative values Z criterion (Fisher’s exact test) was used. Evaluation of significance of differences in postoperative mortality was carried out by Kaplan-Meier method. With p<0.05 all the statistical parameters were considered significant.
Intraoperative mortality for the patients underwent LVR comprised 5% (9/188). For the patients of the study group (LVR with EE) mortality was 4% (3/84), for the patients of the control group (LVR without EE) – 6% (6/104). One year survival was 92% (77/84) for the patients subjected to LVR with EE and 87% (90/104) for those from the control group. The causes of mortality are shown in Table 2.
\n\t\t\t\tCauses of postoperative mortality\n\t\t\t | \n\t\t\tLVR with EE(N=7 from 84) | \n\t\t\t\n\t\t\t\tLVR without EE (N = 14 from 104)\n\t\t\t | \n\t\t
Low cardiac output syndrome | \n\t\t\t1 | \n\t\t\t2 | \n\t\t
Progressing HF | \n\t\t\t3 | \n\t\t\t4 | \n\t\t
Acute myocardial infarction | \n\t\t\t2 | \n\t\t\t1 | \n\t\t
Stroke | \n\t\t\t- | \n\t\t\t2 | \n\t\t
Sudden cardiac death | \n\t\t\t- | \n\t\t\t4 | \n\t\t
Non-cardiac reason | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
Surgical outcomes of the patients in 1 year after the intervention.
Thus, in the study group patients left ventricular end-diastolic volume index (LV EDVI) was increased on average up to 118 ml/m2, end-systolic volume index (LV ESVI) – up to 74 ml/m2, LV ejection fraction (EF) was lowered to 38% and in the control group patients these parameters were: LV EDVI - 114 ml/m2, LV ESVI – 69 ml/m2, EF - 40%. MRI of diastolic phase in synchronizing mode showed perimeters of affected myocardium; on average they were 52% and 49% of the entire myocardial perimeter in the groups.
EchoCG performed in 2 weeks after the surgical intervention showed statistically significant (p<0,01) change of the values in comparison with preoperative data: increased EF up to 49% и 52%, decreased EDVI down to 79 and 77 ml/m2, ESVI to 49 and 48 ml/m2 in the patients of the study group and control group correspondingly. There were no statistically significant differences found between the groups as for preoperative and postoperative hemodynamic values.
Analyzing the results we decided to allocate the patients who underwent EPhS with electroanatomical LVR before and after the surgery into separate groups. Fourty patients from the study group were included into group 1 and 38 from the control group into group 2. In the early postoperative period in the patients of group 1 the values of EPhS improved: “electrical scar” zones were found on endoventricular patch only, areas of lowered potential disappeared completely, transient zones (from 0,5 to 1,5 mV) took a limited area without possibility of re-entry and VT induction (Figure 2).
In 2nd group patients spontaneous VT spells were registered by Holter monitoring in 6 cases; in 8 cases VT was induced during EPhS which made in total 37% of the patients. In 12 patients cardioverters-defibrillators were implanted for the secondary prevention of a sudden cardiac death.
Analyzing the obtained MRI values characterizing local morphological condition of the myocardium with values of local electrical myocardial potential we found a significant difference as for the thickness of viable myocardium (i.e. myocardium which does not accumulate contrast paramagnetic agent) in comparable segments. Thus in the zones with normal potential (0 decrease) the thickness of viable myocardium was more than 7 mm - on average 9,8mm; in transient zone (lowered potential 1) it was 6,2mm; in low potential zone (lowered potential 2) – 5,3mm and in “electrical scar” zone (lowered potential 3) – 2,8 mm. In the latter case viable myocardium was thinner than 3,5mm in all the segments. Figure 4 shows an example of a typical MR image in a patient with a previous acute myocardial infarction and affected lateral LV wall.
Patient K, has had an acute MI in the circulation of a left circumferential artery with a long area of subendocardial lesion of a lateral wall. Fig.4а – Т1- weighed spin-echo ECG-gated MRI study before injection of paramagnetic contrast; Fig. 4b – T1-weighted spin-echo ECG-gated MRI 15 min after injection of paramagnetics, as 2ml of 0,5M solution per 10 kg of BW. Fig. 4c – the same as 4b, after semi-automatic bordering of subendocardial contrast uptake.
In the segments 10,11, 12 the uptake of contrast with the index of transmurality ranging from 0,20 to 0,55 is obviously seen. Later on during the electrophysiological study the activity of proarrhythmogenic type 2 was revealed. (original data)
Besides, the value of transmural index (TI) of paramagnetic contrast agent accumulation in myocardium differed significantly between unaffected segments with 0 degree potential lowering and segments with the 1st and 2nd degrees of potential lowering –the most arrhythmogenic degrees (Figure 4). In electrically normal myocardial segments, in particular, TI value was 0,072 ± 0,020. In the group of segments in transient zone TI was 0,46 ± 0,046, and in the low potential zone - 0,32 ± 0,052. Finally, the most affected myocardium with TI of 0,32 ± 0,052 was found in the area of an “electrical scar” with no electrical potential.
By the data of ROC analysis and discriminative analysis the most appropriate breaking value allowing to differentiate segments with abnormal electrical activity became TI value of 0,27. In other words, when TI ≥ 0,27 one should consider probable arrhythmogenic activity in such a segment and pay closer attention to such areas during EPhS.
Patient T, 56 year old was admitted to the department of cardiovascular surgery at Tomsk Institute of Cardiology in 4 months after transmural anterior-septal myocardial infarction with complaints on occasional angina pangs and dyspnea. The patient was examined routinely. Holter monitoring showed ventricular extrasystoly (grade III by Lown). By EchoCG ejection fraction was 25% lower than normal (in B mode), LV was dilated with LV EDVI as high as 154 ml/m2 and LV ESVI of 116 ml/m2; local LV contractility was disturbed, there was found akinesis of apical, medial septal and anterior segments as well as hypokinesis of lateral and posterior-lateral segments. EchoCG also showed the 2nd type aneurysm.
By MRI there were found postinfarction cicatricial changes in all apical and, ventricular septal and anterior segments; perimeter of the affected LV endocardium was 43%. In the apical and septal segments TI varied from 0,35 to 0,56. Data of coronaroventriculography showed LV deformation due to the aneurysm on the plane of anterior-lateral and apical segments and due to atherosclerosis of coronary arteries which included occlusion of the LAD artery in its proximal third and 75% stenosis of the right coronary artery. After mapping and electroanatomical LV reconstruction (Figure 3) there were identified the areas of an “electrical scar” on the apex, ventricular septum and anterior LV wall, zones of delayed conduction (pink dots in the picture) and those of double potential (blue dots) in transient zone, around the scar on ventricular septum and partially on the lateral LV wall. On the border of affected areas and viable myocardium radiofrequent (RF) dotty tags were applied (maroon dots in the picture) by an ablation lead.
After careful examination the decision was made to perform surgical myocardial revascularization and LV endoventriculoplasty with endocardectomy of the affected area. During the surgery we performed epicardial EPhS with overdriving stimulation of 200 impulses a minute; VT was induced. In conditions of CP bypass and cardioplegia mammary-coronary artery bypass grafting of the LAD artery, LV aneurysm dissection, endocardectomy of the apex, ventricular septum, anterior and lateral LV walls along RF tags were performed as well as SVR including endoventricular circular repair with a synthetic patch by the method of V.Dor. Postoperatively the patient received routine care. Postoperative period was uneventful. By EChoG done in 3 weeks after the surgery one could notice better contractile cardiac function – LV EF grew up to 40% (B-made), LV sizes became smaller – EDVI was 70ml, ESVI – 48ml. The data of 24-hour ECG monitoring did not reveal any signs of ventricular rhythm disturbances. Postoperative mapping (Figure 5) showed significantly smaller transient zone, lack of re-entry and VT.
Patient T, 56 year old. EPhS with LV reconstruction of the patient after LV aneurysmectomy (LVR) : electrical scar in the area of the patch. Low-potential areas with the potential from 0,5 mV and transient zones (from 0,5 to1,5 mV) take a limited area with no possibility of re-entry and VT induction. Front view, right oblique view. (original data)
The patient was discharged from the hospital in satisfactory condition.
In 1956 Couch O.A. performed LV aneurysm resection in a patient with VT thus beginning an era of surgical treatment of ventricular rhythm disorders [13].
It has been more than 50 years since; nevertheless the issue of complications and approaches of surgical treatment associated with the appearance of VT in patients with remodelled LV after previous MI is still quite challenging [14]. It was at that time already when specialists were aware of the fact that LV myocardium affected by infarction was a source of fatal ventricular rhythm disorders. Initially there were offered methods of indirect surgical intervention such as thoracic sympathectomy, CABG, resection of a cardiac wall for the treatment of recurrent ventricular arrhythmias associated with CAD [15,16,17]. Since these methods appeared to be inefficient, over the course of time there were implemented direct endocardial methods performed under control of intraoperative electrophysiological mapping. The first endocardial procedure developed for the treatment of VT combined with CAD was a circular endocardial resection performed by Guiraudon in 1978 [18]. This procedure involves endocardial incision made on the borderline between endocardial fibrosis and viable myocardium and continued around the whole base of aneurysm or infraction area. In 1982 to enhance efficiency of a circular endocardial resection J. Moran modified this procedure by resecting all the fibrous endocardium connected with LV aneurysm or infarction and called it an expanded endocardial resection [19]. Supporting development of the ideas referred to endocardial resection V.Dor offered resection of fibrous endocardium from the side of interventricular septum during surgical LV reconstruction [11].
This kind of intervention appeared to be efficient for the treatment of «refractory» ischemic VTs but did not make any effect on VTs coming from papillary muscles’ base or from areas adjacent to a ring of an aortic or mitral valves.
In 1981 Leo Bokeria one of the first in the world began resection of LV aneurysm and cardiodestruction in the areas of early activity after intraoperative epicardial EPhS [20]. Developing cryosurgical methods of intervention in 1985 J.Cox performed endocardial cardiodestruction but the procedure resulted in lethal outcome in 27% of the cases and was ineffective in 17% of the cases [15]. I 1980th M.Mirovsky (the USA) offered an alternative method of VT treatment – implantation of cardioverter-defibrillator [21].
As a result, for the treatment of postinfarction LV aneurysms and associated ventricular tachyarrhythmias there have been used different methods, either alone or in combination. Significant clinical experience have been acquired.
Thus, Bokeria L.A. in his study including 59 patients demonstrated a clear dependence of actuarial survival rate from the type of tachycardia and from the presence of VT relapse in the early postoperative period [20]; the worst prognosis was noticed with the presence of polymorphic ventricular extrasystoly (Figures 6, 7).
Interesting data were presented by the group of authors headed by M. Di Donato [22]; they analyzed data of 382 patients proving that spontaneous VTs after surgical treatment of LV aneurysms and VT significantly worsen prognosis for late postoperative period if compare with induced VTs of cases without arrhythmias (Figure 8).
After careful study of immediate ablation results in 71 patients with LV aneurysm and VT J. Pirk showed that epicardial cryoablation alone was successful in 63,3% of the cases and aneurysmectomy and endocardial cryoablation and/or subendocardial resection were successful in 73,2% of the cases [23].
Sartipy U. studying combination of V. Dor procedure and surgery for VT in 53 patients came to the conclusion that combination of these procedures keeps survival rate high in the postoperative period (Figure 9) and that majority of the patients did not need implantation of an automatic implantable cardioverter-defibrillator (AICD) [24].
Actuarial survival curve depending on a type of VT (Kaplan-Meier); p=0,00739 (Bokeria L.A et al.// Journal of Thoracic and Cardiovascular Surgery –1999.– №6.).
Actuarial survival curve depending on VT relapse (Kaplan-Meier); p=0,012 (Bokeria L.A et al.// Journal of Thoracic and Cardiovascular Surgery –1999.– №6.).
Kaplan-Meier survival curves by the groups with VT in postoperative period (months) after surgical treatment of LV aneurysm and VT. (Di Donato et al. Seminars in Thorac and Cardiovasc Surg.Vol.13;4:480-485).
Overall actuarial survival after the Dor procedure including ventricular tachycardia surgery. Dotted curves are upper and lower 95% confidence intervals (Sartipy U. et al.; Ann Thorac Surg 2006;81:65-71).
Contemporary therapeutic methods are not able to solve this problem also. By the data of a multicenter trial MADIT II implantation of AICD in patients with ventricular rhythm disturbances lowers the risk of a sudden cardiac death for 31 % which is more efficient than antiarrhythmic therapy but still is not 100% saving [21]. In a year after endovascular treatment of VT the rate of relapses comprises 20% [25,26]. Nevertheless, antiarrhythmic therapy, implantation of AICD, catheter isolation of ectopic focuses do not touch an issue of coronary arteries lesion.
According to the data of a multicenter STICH trial there were no significant differences found between the patients with ICMP and postinfarction LV aneurysm subjected to CABG only (group 1) and those subjected to CABG with LV reconstruction (group 2) during 5 year follow-up. Nevertheless, postoperatively AICD was implanted into 20% of the patients from group 1 and into 17% from group 2 [27]. The study did not suppose to perform extended endocardectomy during LV reconstruction. Taking into account the aforesaid, one may claim that almost every 5th patient is destined for AICD implantation after surgical remodeling of LV. Although, by the data of multiple authors endocardial resection either with intraoperative mapping or without it prevents VT paroxysms in 90% of the cases and more [19, 24].
Thus, we saw clearly that at that time to treat patients with postinfarction LV aneurysm complicated with ventricular rhythm disorders is was necessary to perform reconstruction of LV cavity with endocardial resection and CABG; to use contemporary antiarrhythmics and AICD implantation in postoperative period if necessary.
Though, at that point there were unclear issues connected with topical diagnostics of potential re-entry zones which was important for adequate resection of affected endocardium. In our study we tried to enhance efficacy of topical diagnostics and surgical treatment of the patients with postinfarction LV aneurysm complicated with VT, due to combined application of contrast-enhanced MRI, EPhS and advanced surgical treatment (SVR and EE). It is well-known that MRI is a golden standard in diagnostics of LV aneurysm [4, 28], but MRI data may provide only indirect evidences about the presence of arrhythmogenic zones.
Prognostic role of contrast-enhanced MRI in evaluation of myocardial viability were reported in literature in as far as 1986 [29]. In particular, it was supposed, that with the presence of irreversible ischemic lesion of myocardium MRI made at rest demonstrated significant decrease of end-diastolic thickness of myocardium (EDTM) and simultaneously – contractility index. At the same time it was assumed that secure thickness of myocardium evaluated by the value EDTM meant also a secure viability of myocardium in that location.
Comparison of myocardial MRI made at rest with the results of PET with 18F-FDG and SPECT with repeated injection of tallim-201 in patients with chronic coronary disease and pronounced LV dysfunction was made in a number of studies [30]. It was found, that as a rule MRI visualized secure thickness of myocardium and the value of EDTM more than 5,5-6,0 mm in the affected areas in LV segments classified as viable by PET and SPECT. Later, Baer et al [31] making a direct comparison of MRI at rest and PET data with 18F-FDG found that with EDTM ≤ 5,5mm there were no signs of viability on myocardial tomography slices during radionuclide study. As for prognosis for restoration of myocardial viability and contractility after CABG in such patients, their criterion { EDTM ≤ 5,5 mm } had high sensitivity up to 92-95%, but low specificity – just about 56-60%.
As a rule, for contrast-enhanced MRI visualization of affected myocardium contrasting agents – paramegnetics are used, usually they are complexes of Gd or Mn with derivatives or analogues of diaethylentriaminpentacetic acid (DTPA). Their intravenous bolus injection makes possible qualitative evaluation of myocardial perfusion by the degree of changing brightness of myocardial image during the first few seconds after injection. Later on, in 12-20 minutes after injection one can evaluate the picture of myocardial lesion by accumulation of contrasting agent in affected areas.
There exist an established and commonly accepted opinion that transmural accumulation of paramagnetics in myocardium during contrast-enhanced MRI means irreversible lesion, and lack of accumulation vice versa evidences viability of myocardium and makes for favourable prognosis [32]. Nevertheless, relationship of contrast-enhanced MRI picture with the possibility of arrhythmogenesis in this or that myocardial area is still of a great interest.
Electrophysiological mechanism of the observed interrelationship between results of cardiac contrast-enhanced MRI and decrease of electrical potential in a definite LV segment is nothing but a particular case of a well-studied pathogenesis of arrhythmias appearance in the area of ischemic myocardial lesion [33].
It is in the area of thickened and partially replaced by subendocardial scarred tissue of myocardium where one can notice lowered electrical potential proportionally to the lowering mass of viable myocardium. This fact, in its turn, is favorable for the functioning of local re-entry circuits which are electrophysiological basis for ventricular tachycardias [33, 34].
That is why during contrast-enhanced MRI it makes sense to calculate TI index value in all the cases keeping in mind further electrophysiological study and evaluation of risks for ventricular tachycardias. Epicardial mapping provides information about the presence of excitement zones in LV and approximate anatomy of their localization for a further surgical treatment [4, 35]. Preoperative endocardial EPhS with electroanatomical LV reconstruction is able to demonstrate vividly disturbances in cardiac conduction system. Examining the results of endocardial EPhS we found consistency of myocardial lesion and its elctrophysiological properties. In patients suffered from extensive myocardial infarction complicated with aneurysm one can identify zones of low-amplitude ventricular potential less than 0,5mV which is a scarred zone more often anatomically involving an apex of LV with a part of anterior wall and ventricular septum. Viable myocardium has potential amplitude higher than 1,5 mV. A subject of a special interest is a transient zone from 0,5 to 1,5 mV situated between the scar and viable myocardium where they register double potential and/or delayed conduction able to cause re-entry and ventricular tachycardia; a surgeon is just to perform dissection of affected endocardium. EPhS and MRI allow to identify borders for endocardial dissection.
Postoperative EPhS worth electroanatomical LV reconstruction performed in patients without endocardectomy showed that re-entry and VT sources revealed preoperatively were still there and made for a high risk for the patients’ lives. Contrast-enhanced MRI gives additional prognostic information about arrhythmogenisity of particular areas and segments of LV after myocardial infarction. More often arrhythmogenic areas are located in the areas of a pronounced non-transmural lesion of LV myocardium with TI higher than 0,27.
Thus, data of contrast-enhanced MRI not only have diagnostic significance concerning a degree of a cardiac muscle lesion but also identify arrhythmogenisisty of this or that myocardial area. In surgical treatment of postinfarction aneurysm endocardectomy of scarred and transient LV zones’ endocardium is an inseparable stage to prevent VT spells. MRI and endocardial EPhS with electroanatomical LV reconstruction allow to find potential areas where re-entry may occur.
Solid waste can be broadly classified as putrescible and non-putrescible, based on its biodegradability. Putrescible waste contains organic matter. This waste is suitable for digestion and land disposal. Non-putrescible waste is generally non-biodegradable waste which cannot be digested. Municipal solid waste contains food waste, papers, plastic, paints, heavy metals and rubber. Municipal waste needs to be classified based on biodegradability for further treatment. Local civic bodies are now putting stringent norms for classification of solid waste. In India green and blue containers are provided to households to separate this waste and source. Industrial solid waste may contain, waste adsorbent, waste catalyst sludge, solid residue of by-product, residue of reactions, etc. This solid waste may contain hazardous material also. Dewatering, centrifugal filtration, drying and incineration are usual steps used for solid waste treatment in industries. Bio-degradable solid waste, rich in organic content can be used to synthesize various useful organic compounds. Non-biodegradable waste like plastic, rubber can be reused or recycled. Reduce, reuse and recycle are nowadays trending concepts in solid waste management. Non-government organizations (NGOs) in developing countries are playing key role in developing awareness among people about proper segregation and collection of solid waste. Recycling industry is promoted by government through various schemes and initiatives. This chapter briefly explains initiatives and investigations aimed at various solid minimizations, reuse and recycle methods and methods used for synthesis of value-added products from solid wastes. Initiatives taken by governments; non-government organizations are briefed in the chapter. Also, investigations carried out by scientific community to treat and recycle solid waste are reviewed. The chapter contains efforts taken for solid waste recycle and reuse in Asian countries, though it contains some significant efforts in other developing countries also. This review is based on available literature, research papers and available reports on solid waste management.
Solid waste contains bio-degradable and non-bio-degradable material. Non-bio-degradable material cannot be digested and hence reuse or recycle of this type of waste is becoming important area of investigation. Countries like China, Taiwan and Malaysia are taking initiatives to reduce plastic waste by reuse and recycle principle. First three sections (Sections 3–5) of the chapter are devoted to plastic and non-bio-degradable waste. In remaining sections, reuse, recycle, recovery and energy generation methods for biodegradable waste are explained with the help of available literature and research papers. Domestic and municipal solid waste treatment needs to be more familiar with people. For this, efforts are being taken by government authorities by adopting regulations and stricter norms. These regulations along with awareness created by social groups and organizations can improve waste management scenario in developing countries. Another aspect of solid waste treatment discussed in this chapter is investigations carried out by researchers to optimize the waste reuse and recycle technologies. This aspect is briefed with the help of research papers published by investigators from these developing countries.
Plastic bags are used for containing and transporting goods. Also, they are used for vegetables, groceries and other domestic items as a container. Plastic, which sometimes is non-replaceable, is very important material if used sensibly. The plastic bags are very thin and flexible. The disposal of these plastic bags is creating huge problems in developing countries. If these bags are recycled, the disposal problem would not arise. But lack of awareness and willpower has played a great roll in plastic ban. Nowadays the governments have banned the use of plastic bags above certain thickness. Even many other civic bodies are banning plastic use. Studies show that increase in reuse of plastic can reduce the eco-impact of plastic to a great extent [1]. In developing countries, blockage of drainage due to plastic causes calamities such as flood. Also, it can be a reason for mosquito breeding. Lack of sophistication of the recycle and waste treatment facility develops concern about manufacture and use of plastic [2]. Many developing countries in Africa have adopted use of glass container instead of plastic. They are promoting use of cloth bags instead of plastic bags [3, 4].
Waste plastic and rubber can be used in road construction [5]. Semi-dense bitumen concrete can be prepared and used for road construction. Waste plastic material such as high-density polyethylene (HDPE-2), low-density polyethylene (LDPE-4), poly propylene (PP-5) and polystyrene (PS-6) can be used for obtaining different products [6]. Slurry formation, liquefaction, recovery and condensation are the steps in the process. Use of superplasticizer can enhance the properties of waste plastic in road construction [7]. Biomedical plastic waste finds application in road construction. Compared to normal the bituminous mix, bio-medical plastic waste coated mix had better properties [8]. Pyrolysis oil can be derived from the waste plastic and can be used to derive diesel. Studies indicate that this diesel is suitable for use in engine [9]. Use of plastic waste in the flexible pavements increases strength and durability [10, 11]. Bitumen requirement can be reduced by 8–12% by using plastic waste for pavement material [12]. Thermal cracking of waste plastic can convert them into usable oil form [13]. Also, plastic bottles can be used for the construction of house. It is observed that these houses are bioclimatic. It means that when it is cold outside is warm inside and vice versa [14].
Discarded, obsolete, end of life electrical and electronics equipment forms Electronic waste (E-waste). Heavy metals such as lead, cadmium, chromium, mercury, barium is present in E-waste [15]. The E-waste recycling needs quantitative measures for recycling and reuse of E-waste [16]. Illegally imported E-waste from developed countries is additional E-waste problem faced by India like countries [17]. There is need for increasing awareness about health effects of E-waste and importance of recycling. Inventorization and unhealthy conditions of informal recycling, inadequate legislation, poor awareness and reluctance on part of the corporate to address solid waste issues are drawbacks of waste minimization programs in India [18]. Waste materials from discarded computers, televisions, stereos, copiers, fax machines, electric lamps, cell phones, audio equipment and batteries can be hazardous to health. For example, lead can leach out from the E-waste materials, and enter into human bodies through oral route [19]. According to Kumar and Shah, the crude recycling activities cause irreversible health and environmental hazards [20]. So, there is need of refinement of the process adopted for recycle. According to Kumar and Karishma, India is fifth largest producer of E-waste in the world. In India only recycling of E-waste is 10% of recycle business [21]. About 65% of E-waste is generated in urban Area in India [21]. About 21% of this E-waste is plastic. E-waste is fastest growing waste stream in the world [22, 23]. Around seven lakh tons of E-waste were produced in India in 2016 [24]. Individual and government contributions can help to tackle this E-waste problem [25]. It is important to bridge the gap between the formal and informal divide in E-waste management in India [26]. E-waste recycling provides jobs to thousands of people in India. There needs to be coordination between formal and non-formal sectors for proper treatment and recycling of E-waste. There is need for the collection, segregation and primary dismantling of non-hazardous fractions of E-waste. Compatible and efficient technology for E-waste was a matter of concern for India and many developing countries. According to Vats and Singh, informal recyclers are treating 95% of the E-waste generated with hazardous practices [27].
Food waste can be used for synthesis of various useful chemicals. Source separated food waste can be used for synthesis of ethanol with thermophilic enzymes [28]. Food waste biomass can be used in treating wastewater. Anaerobic digestion of this waste upon acidogenesis produces volatile fatty acids [29]. Ethanol cultivated biomass can be used effectively for the effluent of the food waste digestion. Food waste can be processed in long-term operation of a laboratory anaerobic reactor in mesophilic conditions for anaerobic fermentation to produce biogas and useful products [30]. Shukla et al. have explored the possibility of biohydrogen production from food waste [31]. Degradation of food waste and energy recovery through biogas production are twin benefits of the anaerobic digestion [32]. Factors such as organic loading rate, temperature, time, pH, carbon to nitrogen ratio play vital role in the process. With increase in methanogenic bacteria, the methane percent in biogas increases significantly [33]. An investigation by Akpan indicated that producing ethanol from food waste is more economical than producing it from other waste organic sources like old newspapers [34]. For synthesis of biohydrogen from waste, methods such as the methods like electrolysis of water, steam reforming of hydrocarbons and auto-thermal processes can be used [35]. According to Kapdan and Kargi, use of photosynthetic algae is one of the important methods for hydrogen synthesis from waste [36]. Investigations are reported on synthesis of bioplastic from food waste. Ingredients from food waste such as starch, cellulose, fatty acids, sugars and proteins can be used for bioplastic synthesis [37]. Many investigations are reported on hydrolysis of food waste and subsequent ethanol formation [38, 39]. Various investigations are reported on synthesis of lactic acid, vinegar and citric acid from waste materials including food waste [40, 41, 42, 43].
Anaerobic methods reduce the sludge volume significantly and produce biogas fuel. Major disadvantage of this method is that it causes nuisance to nearby population [44, 45]. Aerobic thermophiling composting reduces odor problem [46]. pH, temperature, moisture content, organic carbon, volatile solids are vital factors during aerobic composting [47]. Also, C/N ratio and volume reduction are performance indicators of the process [48]. Obtaining optimal performance system is very vital in increasing acceptability of the waste treatment method [49]. Waste management strategy includes many steps such as disposal, treatment, reduction, recycling, segregation and modification [50].
Vermicomposting has advantages over aerobic and anaerobic digestion methods as it overcomes few drawbacks like odor, space and cost of these two methods. Vermicomposting is a method used to convert organic waste into fertilizers with the help of worms. Factors affecting the process are parameters like the growth rate (pH), number of worms, number of cocoons and worm biomass [51]. Bedding material has also influence on the process. Newspaper bedding was effective in the investigation carried out by Manaf et al. [51]. Studies have shown that vermicomposting improves the soil structure, enhancing soil fertility, moisture holding capacity and in turn increase the crop yield [52, 53]. Vermicomposting derived liquid can be used for agriculture [54]. This liquid has very high nutrient value. Studies confirm that home composting has potential to reduce the greenhouse gas emission [55]. Investigation carried out by Kulkarni and Sose indicated that pH values between 6.4 and 7.6 are favorable for vermicomposting. 30–50% moisture is required for vermicomposting [56]. Optimum temperature lies between 25 and 30°C.
Paper waste can be used for applications like biofuel synthesis and ceiling boards, bioelectricity production, and fuel gas generation. Also, it can be used in mixed concrete. Papers are normally recycled. In order to prepare good quality paper only limited number of recycles can be done. So finally, it results into huge amount of waste, this waste sludge can be used in the concrete up to 30% concentration, as investigation revealed that up to 30% addition the concrete quality increases and it decreases after that [57]. Also, waste paper sludge can be used for biofuel synthesis. The sludge can be converted into simple fermentable sugar by microbial process [58]. The waste sludge can be mixed in 1:1 proportion with calcium carbonate additive to form good quality ceiling boards [59]. Detachment of ink from the-waste papers increases their drainability [60]. According to Allahvakil et al. [60], it is possible to modify the chemical or physical bonds with enzymes such as pectinase, cellulase and hemicellulose. This helps in detachment of ink from the paper. The waste papers can also be used as raw material for bioelectricity generation. Microbial fuel cell with Clostridium species can be used for the purpose [61]. According to research carried out by Mathuria and Sharma [61], a microwave plasma reactor can be used for conversion of waste papers to fuel gas. Waste paper sludge ash can be used for stabilization of clay soil. An investigation by Khalid et al. [62] indicated that the waste sludge ash up to 10% can exhibit excellent binding properties in the clay. According to Arshad and Pawade [63], the addition of waste paper also reduces the quantity of clay required.
Electronic and mobile component contain valuable materials like gold and platinum. Ammonium thiosulfate can be used for leaching gold from mobile circuit boards [64]. According to Chehade et al. [65], the printed circuit board contains about 0.15% of gold. Aqua regia can be used as a leaching agent for recovery of gold [66]. This process can be automized to provide solution to gold recovery [67]. Fibrous ion exchange resins can improve gold and platinum recovery. Catalyst industry waste contains gold, platinum and valuable metals [68]. About 3 vol% NaClO, 5 kmol/m3 HCl and 1 vol% H2O2 can be used for leaching platinum compounds [69]. In case of hydrochloric acid (HCl), the recovery is 99%. Platinum and gold removal from the industrial waste is necessity from ecological and environmental point of view [70].
Factors such as pH, organic loading, moisture content plays significant role in biogas production. Various types of biomass like fruit waste, domestic waste and crop residues can be used for biogas production. Pineapple waste biomass 48% concentration in biogas was obtained in less than 50 days [71]. Cow dung is also very good source of biomass. Paper waste exhibits highest methane concentration in biogas, about 73% than other solid wastes such as cow dung, saw dust, rice husk and millet waste. However, hydrogen sulfide concentration is highest in this biogas [72]. A mixture of equal percentage of paper waste and biomass can be used for biogas production to increase quality of biogas. It is observed that the biogas production increases by 50% than paper waste alone. In case of orange peels, it is needed to pre-treat the peels as that content limonene, which is antimicrobial [73]. Many such investigations are reported on biogas synthesis from various type of solid waste [74, 75, 76, 77]. Disposal of the final sludge from treatment plants needs to undergo drying and further incineration or dumping of dry biomass [78].
Putrescible solid waste like food and fruit waste, food grain waste, vegetable waste can be used for production of various products by employing bioconversion with suitable bacteria or microorganism [79]. Single cell protein can be obtained from orange peels and cucumber peel by using Aspergillus niger and Saccharomyces cerevisiae [79, 80]. These investigations suggested that glucose addition to the supplemented fruit hydrolysate medium. Solid state fermentation of orange peels with Aspergillus niger yields pectinase [81]. Content of ammonium sulfate, glucose and water in the culture medium affects the process [81]. Ethanol synthesis from fruit and other biodegradable waste is very common method of utilizing waste [82, 83, 84, 85, 86, 87]. Number of other products such as citric acid, acetic acid, lactic acid, lactic acid, etc. can be obtained by using suitable microorganisms and operating conditions [84, 85, 86, 87]. These conditions differ from product to product and waste type.
Hazardous waste poses serious problem to human being and environment. These hazardous wastes may contain biological waste, nuclear waste, heavy metals and flammable materials to considerable extent. Stricter laws and their implementation are required to save the environmental from the hazardous waste [88]. Proper classification and monitoring of hazardous waste can help to treat the waste efficiently [89]. Incineration and recycling are two most sustainable waste management practices [90, 91].
Bio-degradable solid waste, rich in organic content can be used to synthesize various useful organic compounds. Non-biodegradable waste like plastic, rubber can be reused or recycled. Reduce, reuse and recycle are nowadays trending concepts in solid waste management. Non-government organizations (NGOs) in developing countries are playing key role in developing awareness among people about proper segregation and collection of solid waste. Recycling industry is promoted by government through various schemes and initiatives. Local civic bodies are now putting stringent norms for classification of solid waste. In India green and blue containers are provided to households to separate this waste and source. Industrial solid waste may contain, waste adsorbent, waste catalyst sludge, solid residue of by-product, residue of reactions, etc. This solid waste may contain hazardous material also. Dewatering, centrifugal filtration, drying and incineration are usual steps used for solid waste treatment in industries. In developing countries, blockage of drainage due to plastic causes calamities such as flood. Also, it can be a reason for mosquito breeding. Lack of sophistication of the recycle and waste treatment facility develops concern about manufacture and use of plastic. Following observations were made based on study of literature on solid waste treatment.
Many developing countries in Africa have adopted use of glass container instead of plastic.
Compatible and efficient technology for E-waste was a matter of concern for India and many developing countries.
Various investigations are reported on synthesis of lactic acid, vinegar and citric acid from waste materials including food waste.
Waste management strategy includes many steps such as disposal, treatment, reduction, recycling, segregation and modification.
Various types of biomass like fruit waste, domestic waste and crop residues can be used for biogas production.
Studies have shown that vermicomposting improves the soil structure, enhancing soil fertility, moisture holding capacity and in turn increase the crop yield.
Paper waste can be used for applications like biofuel synthesis and ceiling boards, bioelectricity production, and fuel gas generation. Also, it can be used in mixed concrete.
Hazardous waste poses serious problem to human being and environment. These hazardous wastes may contain biological waste, nuclear waste, heavy metals and flammable materials to considerable extent. Stricter laws and their implementation are required to save the environmental from the hazardous waste.
Platinum and gold removal from the industrial waste is necessity from ecological and environmental point of view.
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\\n\\nEXAMPLES OF CONFLICTS OF INTEREST:
\\n\\nFINANCIAL AND MATERIAL
\\n\\nNON-FINANCIAL
\\n\\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\\n\\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\\n\\nEXAMPLES:
\\n\\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\\n\\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\\n\\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\\n\\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\\n\\nPolicy last updated: 2016-06-09
\\n"}]'},components:[{type:"htmlEditorComponent",content:"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\nA Conflict of Interest can be identified at different phases of the publishing process.
\n\nIntechOpen requires:
\n\nCONFLICT OF INTEREST - AUTHOR
\n\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\n\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\n\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\nCONFLICT OF INTEREST - REVIEWER
\n\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\n\nEXAMPLES OF CONFLICTS OF INTEREST:
\n\nFINANCIAL AND MATERIAL
\n\nNON-FINANCIAL
\n\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\n\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\n\nEXAMPLES:
\n\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\n\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\n\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\n\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\nPolicy last updated: 2016-06-09
\n"}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"105746",title:"Dr.",name:"A.W.M.M.",middleName:null,surname:"Koopman-van Gemert",slug:"a.w.m.m.-koopman-van-gemert",fullName:"A.W.M.M. Koopman-van Gemert",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105746/images/5803_n.jpg",biography:"Dr. Anna Wilhelmina Margaretha Maria Koopman-van Gemert MD, PhD, became anaesthesiologist-intensivist from the Radboud University Nijmegen (the Netherlands) in 1987. She worked for a couple of years also as a blood bank director in Nijmegen and introduced in the Netherlands the Cell Saver and blood transfusion alternatives. She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. 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