Types of pneumothoraces.
\r\n\tThis book chapter’s main theme will be focused on transmission dynamics, pathogenesis, mechanisms of host interaction and response, epigenetics and markers, molecular diagnosis, RNA interacting proteins, RNA binding proteins, advanced development of tools for diagnosis, possible development of concepts for vaccines and anti drugs for RNA viruses, immunological mechanisms, treatment, prevention and control.
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Spinocerebellar ataxia (SCA) is a term that refers to a group of inherited autosomal dominant ataxias characterized by degenerative changes in the part of the brain related to movement control (cerebellum) and in the spinal cord, its connections with progressive decline in functional capacity [1, 2, 3].
The significant improvement in the classification and correlation of the clinical profile of the different forms of cerebellar ataxias is due to genetic advances in medical diagnosis. Although several subtypes of SCAs have been identified, phenotypically, cerebellar ataxia is a common feature of each type with individual differences regarding mutations in many different genes and the involvement of the cerebellum and its connections [3, 4, 5, 6, 7, 8, 9, 10].
On the other hand, despite these advances in genetics, modifying therapies targeting specific genes or stem cells, there is no current definitive treatment able to stop the progression of most cases as in most degenerative neurological diseases. Strategic management of SCA to improve quality of life and reduce suffering, addressing complex medical symptoms, psychosocial issues, general well-being, and planning requires a broad and dedicated multidisciplinary involving palliative care approach. For patients with more complex needs help from a palliative care specialist team may be necessary [11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24].
In this chapter, it would be reviewed the main clinical aspects, the perspectives of therapeutic management, directed symptomatic management, support, and multidisciplinary team including the current guidelines regarding patients living and coping with SCA.
Genetically and phenotypically, several subtypes of SCAs have been identified. Cerebellar ataxia is a feature of each type; other distinguishing features may suggest a specific type. However, more than ⅔ of patients with SCA have mutations at known loci that can be identified through genetic testing. In addition, among patients with apparently idiopathic sporadic cerebellar ataxia (no family history), an SCA mutation (types 1, 2, 3, 6, 7, 8, or 12; most often SCA-6) or Friedreich’s ataxia can be identified in approximately ¼ of patients [1, 2, 3, 4, 10, 25].
In most subtypes of SCAs (SCA 1, 2, 3, 6, 7, and 17) a genetic abnormality will be identified related to the expansion of CAG repeats in the region that encodes the polyglutamine tracts in protein products, like what is observed in Huntington’s disease. Wild-type chromosomes with a stable CAG repeat have 6–34 repeat units; more than 36 repeats result in an unstable, expanded, disease-causing allele.
Clinically disorders associated with CAG repeat expansion share several relevant medical condition features [6, 7]:
Middle age beginning with progressive ataxia, neuronal dysfunction, and eventual neuronal loss over the next 10–20 years.
The greater the number of CAG repeats in expanded alleles, the earlier the age of onset and the more severe the disease.
Repeats show somatic and germinal instability. Then, successive generations of affected families experience the anticipation, a phenomenon characterized by earlier onset and a progressively worse phenotype in subsequent generations.
Only a certain subset of neurons is vulnerable to dysfunction, although the relevant protein is widely expressed throughout the brain and other tissues.
Cerebellar atrophy is the most reported finding. Brainstem atrophy is variable, being more characteristic of SCA types 1, 2, and 7.
Neurodegeneration of the tegmental pontine reticular nucleus has been reported in patients with SCA types 1, 2, and 3; this nucleus plays a role in the performance of smooth horizontal searching eye movements and the accuracy of the horizontal saccade.
The nihilistic view of the treatment of SCA, as it happens for long past years with many other neurodegenerative diseases, is no longer justified. In addition to rehabilitation therapies, there are specific complications to be looked for and treated. These interventions can significantly alleviate the problems of progressive ataxia and prevent potentially fatal complications. An enthusiastic, motivational, and well-informed medical approach in addition to follow-up by a multidisciplinary team can provide valuable support to a patient with SCA. When a patient approaches the end-of-life, specialized palliative care services should be involved to help to meet their specific needs as will be described in this chapter [20, 21, 22, 23, 24, 26, 27, 28, 29, 30, 31, 32, 33].
A patient living with SCA, the care team services should be involved to help to meet their specific symptomatic needs. A variety of potential symptoms will need to be managed as treatment “strategies” are often derived from other neurological conditions with similar symptoms and work equally well.
The approach to treating spasticity and bladder symptoms, for example, is the same as for people with other neurological diseases [22, 23]. The assessment and management of these complications is best done by involving therapy specialists, and the work of the multidisciplinary team can improve patient care. Speech and language therapy are essential along the patient’s journey, from monitoring the swallowing function in the initial stages and providing useful tips on how to avoid complications, to planning feeding by percutaneous gastrostomy [24].
The impact of cerebellar disease on cognition is not widely known, but it can have a significant impact on morbidity. These “remote” effects of cerebellar dysfunction can include frontal subcortical impairments affecting personality, behavior, and judgment.
Mental health complications (anxiety, depression) can exacerbate people’s sense of isolation nowadays with Covid-19 pandemic and fear of the future. These symptoms often accompany sleep disturbances and fatigue but are barely recognized [26].
Management of cardiac complications is especially important in Friedreich’s ataxia; it can be applied to SCA and patients need regular electrocardiographic checks and echocardiograms to detect the development of cardiomyopathy. Echocardiography may show concentric left ventricular hypertrophy (possibly in more than half of cases, especially early-onset ones).
As the disease progresses, hypertrophy regresses, resulting in a thin, dilated left ventricle. Cardiac enzymes may be asymptomatically elevated (in the absence of arrhythmia or acute coronary syndrome) and may help to have baseline values for future comparison. It is essential to involve an experienced cardiologist with knowledge in the treatment of neuromuscular disorders, initially to advise on medications to treat cardiomyopathy and heart failure, and later to manage arrhythmias and other complications related [27, 28].
The multidisciplinary team is clearly important in evaluating and managing patients with SCA. Patients with SCA should be offered several times a year’s reviews, ideally by a specialized team including a neurologist, advanced palliative care, nurse, and when it would be necessary, other members as social workers, psychiatrists, therapists, physiatrists.
Speech and linguistic therapy (for both communication and feeding), occupational therapy, and physiotherapy can each make important contributions at different stages of the patient’s life. Patients require regular review to identify any new symptoms that may need treatment, and for patients to take advantage of advances in diagnosis and any newly available treatments [20, 21, 22, 23, 24].
These multidisciplinary interventions can significantly alleviate the problems of progressive ataxia and prevent potentially fatal complications. An enthusiastic and well-informed medical approach in addition to follow-up by a multidisciplinary team can provide valuable support to an SCA’s patient.
In addition, those with no established cause for their ataxia can undergo a thorough and repeated review of the clinical features and investigation results, which sometimes leads to a clearer diagnosis. Patients and their families should be encouraged to contact patient support groups. When a family first receives the diagnosis of progressive ataxia, patients are usually not heard of the condition or come across other people with it. Support from patient organizations can, therefore, be particularly important at this stage. The possibility of meeting others in the same situation, receiving emotional support and information, and the opportunity to learn about research developments can all help [30, 33].
Given that most cases of SCA are difficult to manage, can progress rapidly and have a shortened life. Studies on their palliation and end-of-life care are needed. Most of the recommendations in guidelines at present are drawn from the broader field of other progressive neurological conditions. The supportive care comes alongside your current medical and neurology team to give an extra layer of support not only for patients but also for family [29, 30, 31, 32].
Palliative care is for anyone living with a serious illness at any stage and can be offered at any facility wherever the patient is at the hospital, clinic outpatients, and at home [30]. To provide support to physical and psychological symptoms, social issues, community groups, talking about end-of-life worries, other issues (for example, copying distress) and spiritual concerns. Compared to usual care, it provides relief from suffering, works in quality of life, plans for decline, advances care planning, focuses on patient and family, and requires a consistent team approach and strategy. The members of neuro-palliative care are doctors who are going to review the history and physical examination, establishing goals of care, symptoms management and education, about disease and prognosis discussion which is very difficult related to SCA due to lack of key markers then normally is done about the point of care of each individual case.
The nursing team is going to make the medication review, identification of medical durable power of attorney, discussion of advanced care planning at the appropriate time besides for screening caregiver distress. The chaplain is going to address spiritual/existential concerns, exploring social and family issues, identifying, and discussing grief and screening for caregiver distress. The social worker is going to advice on financial and insurance issues. Providing resources for home health care, and logistical aspects of transition care.
As stated in our book and described in several chapters, the symptoms of ACS are much more than ataxia or movement disorders and include variability in cognitive complaints, mood disorders, fatigue, vision problems, problems eating, swallowing, neuropathy, cramps, muscle, heart, intestinal, and urinary problems among many others.
The psychiatrist Viktor Frankl identified three main sources for meaning in care and life [31]:
At work, doing something significant.
In love, caring for another person.
In courage during difficult times. Suffering itself is meaningless, but our response to it gives it meaning.
Then understating an individual’s value goals of care allows clinical to align the care with what is the most important to the patients with SCA and their families. Mainly addressing the value goals of care, for example, doing exploration about what was life before SCA? and other several important matters, asking questions about the quality of life and hoping to realize what is most important for the patient. Patients with intractable and/or distressing physical symptoms may benefit from referral for a specialist palliative care, which might also help those with complex social, psychological, or spiritual needs and plan of care.
The time for planning end-of-life care is when the clinician answers ‘No’ to the ‘surprise question’—‘Would you be surprised if this patient died in the next 12 months?’—as well there being generic and specific (for ataxia) indicators that the patients have reached the terminal phase of their illness. Management in this phase should be geared toward enabling a ‘good death’: being treated as an individual, with dignity and respect, without pain or other distressing symptoms, in familiar surroundings, and the company of close friends and family.
The plan of care will be a negotiation of goals of care and realistic medical options for management. Besides that, the unique psychosocial stressors such as changing roles in a relationship, loss of autonomy, financial strain, communication difficulties, social isolation (especially during Covid-19 pandemic), cosmetic effects, a social stigma that will require referral to an attorney, psychotherapy, support groups, ataxia specific programming in rehabilitation centers.
The spiritual distress includes grief, guilt, fear of cognitive decline, existential crisis, and death anxiety and needs to be addressed the caregiver distress as well as high levels of burden and depression. Establishing an advance care plan to ensure that patient wishes are known and planning the future associated with improvement of patient satisfaction, lower hospital admission rates, decreases significantly the psychological comorbidities and suffering for the family.
Having a diagnosis of SCA is very important to identify a care team to strategize how to bring back meaning to life, getting extra support at home, and community resources. Also, despite care holistic symptom management, long-term relationship with the care team, and establishing a plan for future advanced care planning [30, 32, 33].
In conclusion, the palliative care approach in patients living and coping with SCA should benefit the patient’s life in many aspects, such as better quality of life, improved symptom burden, better life of patient and family, greater satisfaction with care, higher rates and quality of the advance plan of future and no adverse effects. In addition to that, further studies are needed as clinical priorities included to develop and implement models to integrate palliative care into neurology and to develop and implement informative quality measures to evaluate and compare palliative approaches in SCA through validated trials.
The authors declare no conflict of interest or disclosures.
Although pneumothorax has been known in medical history since the times of Hippocrates and Galen, it was the first time that Itard named the term pneumothorax in 1803 [1]. Spontaneous pneumothorax due to bullae rupture was defined for the first time in 1926, and in 1932, Kjaergaard reported that pneumothorax may occur in completely healthy individuals due to isolated lung blebs [2]. In the treatment of pneumothorax, which was tried to be corrected with long bed rest, Noble has used a cannula, plastic drain, and underwater drainage system for the first time in 1873 [3]. The first thoracotomy and bulla resection was performed by Bigger in 1937, pleural abrasion by Churchill in 1941, subtotal parietal pleurectomy by Gaensler in 1956, and the first axillary thoracotomy and bulla excision and apical parietal pleurectomy by Deslauriers in 1980 [3].
Pneumothorax is defined as the free accumulation of air between visceral and parietal pleural space for various reasons. Pneumothorax can be spontaneous, iatrogenic, and traumatic in both neonatal and juvenile patients. Spontaneous pneumothorax is divided into two as primary and secondary. Primary spontaneous pneumothorax occurs secondary to apical blebs or bullae without evidence of other lung pathologies. Secondary spontaneous pneumothorax happens in the context of underlying lung diseases such as cystic fibrosis, asthma, connective tissue disorders, or pneumonia [4, 5].
Apart from these, if we define pneumothorax according to age, we should also mention neonatal and catamenial pneumothorax. Neonatal pneumothorax is the most common pneumothorax in childhood. It is reported that the cause is most likely the high transpulmonary pressure with the onset of breathing [6]. Catamenial pneumothorax is often associated with thoracic endometriosis syndrome.
Pressure in the pleural space is negative throughout the entire respiratory cycle, as the chest wall tends to expand and collapse in the lung. The pressure of −2 to −5 cm H2O in expiration decreases to −25 to −30 cm H2O in inspiration, and this pressure increases approximately 0.25 cm H2O per cm from the lung basal to the apex [7]. Alveolar pressure is always greater than intrapleural pressure. Therefore, due to the high alveolar pressure and tension in the apical region, existing bleps and bullae in the apex may rupture. Thus, it causes air entry from the alveoli to the pleural space. Airflow continues until the pressure in the pleural space is equalized or until air leakage from the alveoli into the pleural space stops. This condition is called pneumothorax. Pneumothorax physiology includes a reduction in vital capacity and a decrease in oxygen partial pressure.
Pneumothoraces can be classified as spontaneous (primary and secondary), iatrogenic, traumatic, neonatal, and catamenial pneumothorax. The types of pneumothoraces are shown in Table 1.
Spontaneous pneumothorax (SP) is a comparatively rare condition in children. The peak age of occurrence in children is either in the neonatal period or in the late adolescent period [8]. Air enters the pleural space without any evident traumatic or iatrogenic mechanism. The incidence of pediatric SP is 4 per 100,000 in males and 1.1 per 100,000 in females with most occurring in patients 16–24 years of age [5, 9, 10]. SP is generally categorized into primary and secondary. In primary spontaneous pneumothorax (PSP), there is no underlying pathology and occurs unknown etiology. PSP refers to a pneumothorax from apical blebs or bullae [10]. However, secondary spontaneous pneumothoraces occur in children with underlying lung problems.
A primary spontaneous pneumothorax (PSP) occurs without a precipitating event and in the absence of clinical lung disease and has an estimated incidence of 3.4 per 100,000 children with 4:1 male predilection [11]. In pediatric studies, the peak age of incidence occurs between 14 and 17 years of age, mainly in late teenagers [8]. The risk factors of PSP include tall and thin stature with low body weight [8]. Smoking is also the primary environmental risk factor for primary spontaneous pneumothorax, especially in teenage patients [12]. Some studies have shown that familial and genetic forms of PSP are related to mutations in the folliculin gene on chromosome 17 in the literatüre [5, 12].
It has been recommended that subpleural blebs and bullae are causally related to the development of primary SP and may be clarified by that these tall and slim children tend to have higher transpulmonary pressure at lung apex, and their rapid growth relative to pulmonary vasculature may result in ischemia and thus blebs evolution at these regions [5, 8].
Most patients are clinically stable on initial evaluation and small cases may present in fulminant distress [1]. Chest pain and shortness of breath are common presenting symptoms of PSP and may be developed at rest or accelerated by any maneuver that increases intrathoracic pressure (Valsalva) [5, 13]. Other clinical findings in patients with pneumothorax include cough, ipsilateral hypoventilation, and nonspecific respiratory distress [4, 5].
Sample chest X-ray and thorax-computed tomography of our patients admitted with primary spontaneous pneumothorax from our archive are shown in Figures 1 and 2.
(a) A 16-year-old male patient presented to the emergency department with a sudden onset of chest pain and was diagnosed with spontaneous pneumothorax on the right side of his chest X-ray (free air in the thorax marked with a red arrow). (b) Film of the same patient after right side chest tube placement (inserted chest tube marked with blue arrow).
A 17-year-old male patient presented to the emergency department with the complaint of sudden onset of chest pain. (a) There was no pneumothorax in the anterior–posterior chest X-ray of the patient. (b) Minimal pneumothorax image on the left side in the thorax-computed tomography of the patient (free air in the thorax marked with red arrows).
Commonly known situations predisposing individuals to a secondary spontaneous pneumothorax (SSP) include primary lung disease as asthma, cystic fibrosis, interstitial emphysema, inflammatory/connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, juvenile idiopathic arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, sarcoidosis, Langerhans cell histiocytosis, α1-antitrypsin deficiency, Birt–Hogg–Dube syndrome, infections such as
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Types of pneumothoraces.
Primary lung disease: asthma, cystic fibrosis, interstitial emphysema | Infection: |
Inflammatory/connective tissue disease: Marfan syndrome, Ehlers-Danlos syndrome, juvenile idiopathic arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, sarcoidosis, Langerhans cell histiocytosis, α1-antitrypsin deficiency, Birt–Hogg–Dube syndrome | Malignancy—lymphoma, metastases |
Foreign body aspiration | Congenital malformation: congenital cystic adenomatoid malformation, congenital lobar emphysema |
The theorized mechanism is chronic airway inflammation that causes small airway obstructions and creates the pressure needed for air to escape into the pleural space. These conditions can make the lung pleura more susceptible to rupture and subsequent development of pneumothorax [15]. The most important symptom of SSP is dyspnea, tachypnea, and tachycardia.
Cystic fibrosis (CF) is a severe obstructive airways disease and one of the most common causes of secondary spontaneous pneumothorax. Pneumothorax is seen approximately 3.4% of all patients will suffer from CF during their lifetime and mostly occurs in adult patients [16, 17]. Cysts, blebs, and bullae are all commonly found in the lungs of CF patients, and these cause gas to accumulate in the small airways, resulting in a cystic appearance. The typical presentation is acute onset of chest pain and breathlessness, and the treatment decisions include the size of the pneumothorax, severity of disease, stability of the patient, and whether this is the first or a recurrent pneumothorax [16]. Pneumothorax due to cystic fibrosis can also be seen in the childhood age group and invasive surgeries may be required. A spontaneous pneumothorax chest X-ray film of a CF patient from our archive is shown in Figure 3a–f.
A 13-year-old male patient followed up with the diagnosis of cystic fibrosis was admitted to the emergency department with respiratory distress. Upon the presence of pneumothorax in the right upper lobe in the thorax in computed tomography (a, b) and the chest X-ray (c), a pig-tail catheter was placed in the right thorax (d). The child’s clinical condition did not improve and thoracotomy with pleurectomy was performed. The child was followed up with a chest tube after the operation (e), and has been covered and discharged (f).
The most frequent cause of iatrogenic pneumothorax is a transthoracic pulmonary biopsy, but it also may appear as a complication of many other procedures and caused by barotrauma secondary to mechanical ventilation [18, 19]. Iatrogenic pneumothorax is related to underlying lung disease along with high ventilatory settings [19]. The most common cause of iatrogenic pneumothorax is invasive diagnostic and therapeutic procedures, such as central venous access, thoracocentesis, thoracic surgery, or intubation [1]. Iatrogenic pneumothorax may also develop during cardiopulmonary resuscitation and tracheostomy.
Although thoracic injuries occur less frequently in children than adults, thoracic trauma in children carries a 5% mortality [20, 21]. The most causes of trauma in pediatric patients are traffic accidents, followed by falling from heights, and bicycle accidents [22]. The greater flexibility of the thoracic cage in young children permits the anterior ribs to be compressed to meet the posterior ribs [23]. Because of the flexibility, pulmonary contusions are more common than rib fractures in children [23].
The most common injury in children with blunt thoracic trauma is pulmonary contusion and pneumothorax, which is observed as isolated injury in 30% of the cases [22].
Traumatic pneumothorax can be classified as small occult, tension, and open (Table 3). A small pneumothorax from blunt torso trauma is often asymptomatic, with more than half identified as being occult (defined as a pneumothorax observed on computed tomography scan of the chest, but not on chest radiograph) [22]. However, a large pneumothorax may cause clinical symptoms that overlap with those produced by lung parenchymal damage—tachypnea, distress, and decreased saturation [22]. A traumatic pneumothorax and contusion chest X-ray film of a patient from our archive is shown in Figure 4.
Open pneumothorax | Related to an open chest wall injury |
Occult pneumothorax | Small pneumothorax without clinical significance, typically seen in trauma |
Tension pneumothorax | Rapid accumulation of air within the thoracic cavity that leads to a reduction in central venous return as well as tamponade effect on cardiac output |
Characteristics of traumatic pneumothorax [14].
An 8-year-old male patient applied to the emergency department due to a traffic accident. (a) Pneumothorax in the right thorax and contusion in the left lung were detected in the chest X-ray (free air in the right thorax marked with red arrows and contusion has shown with yellow arrow). (b) Chest X-ray after tube placement in the patient’s right thorax (inserted chest tube marked with blue arrow).
When the mediastinum is displaced to the contralateral side with impairment of the venous return, the tension pneumothorax occurs and is more common in children [22]. The symptoms of tension pneumothorax are tachycardia, severe respiratory distress, and hypoxemia, with hypotension and tracheal deviation. Heartbeat is heard on the opposite side and the neck veins become dilated and severe cyanosis occurs. No chest X-ray is required to insert a chest tube in children with tension pneumothorax. The child’s symptoms improve dramatically with chest tube insertion.
Open pneumothorax is usually seen after penetrating injuries. This causes a collapse in the lung on the side of the trauma and ventilation failure in the other lung. The patient who develops open pneumothorax is cyanosed and has serious respiratory distress is present. In the treatment, the defect should be closed with a sterile gas.
Neonatal pneumothorax, with an incidence of 1–2% in newborns, is symptomatic in 0.08% of all live births and is reported as 5–7% in those with a birth weight of less than 1500 g, although it can reach 30% in those with an underlying lung problem and those who need mechanical ventilation comes out [10, 11]. The most common cause of this condition is barotrauma [13]. In addition, male gender and cesarean delivery are also considered among risk factors [11].
In order to inflate the lungs of a newborn baby when he is not breathing himself, mechanical ventilation with an average pressure of 50–80 cm H2O is required to overcome the high transpleural pressure. During this resuscitation, the air given into the lungs is distributed with an uneven pressure inside the lungs. As a result, some alveoli are ruptured and air passes from the peribronchial area to the mediastinum and pneumothorax develops [24]. A chest X-ray visualization from a newborn from our archive who needed resuscitation at 41-week postpartum and had pneumothorax on the right in the chest X-ray has been shown in Figure 5.
(a) Film of newborn who needed resuscitation at 41-week postpartum and had pneumothorax on the right in the chest X-ray (free air in the thorax marked with red arrows). (b) Film of the same newborn after right-side chest tube placement (inserted chest tube marked with blue arrow).
It most commonly occurs in the first three days and should be suspected in cases of sudden respiratory distress, decrease in oxygen saturation, inability to listen to breath sounds, or when ventilator parameters have to be increased.
It causes high mortality and morbidity, especially in premature babies and newborns with underlying lung parenchyma disease. Whatever the cause, neonatal pneumothorax needs to be treated very quickly because pneumothorax in neonates will lead to serious complications, including lung perforation, phrenic nerve palsy, chylothorax, and hemopericardium [11].
Catamenial pneumothorax (CP) is a form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax, and endometriosis lung nodules, as well as some exceptional presentations [25]. The most common extrapelvic manifestation of endometriosis is thoracic endometriosis and often presents as catamenial pneumothorax [10]. Most commonly occurs in women aged 30–40 years, but has been diagnosed in young girls as early as 10 years of age and postmenopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis [25].
CP is a rare and important condition of recurrent pneumothoraces, which occurs within 48–72 h from the onset of menses [11]. The pathophysiology is not completely understood but it is treated with hormonal therapies [11].
The diagnosis of pneumothorax can be made by physical examination or imaging studies including chest X-ray, ultrasonography, and computed tomography (CT) scan [19]. A conventional chest X-ray is a typical imaging examination used to confirm the diagnosis of pneumothorax and a CT scan may be validated to show smaller pneumothoraces. CT scan is commonly accepted as the gold standard in pneumothorax diagnosis [1]. Dotson et al. proposed that detection of blebs/bullae on the CT scan may be predictive of recurrence of PSP, especially bilaterally pneumothoraces [5]. There are multiple methods for calculating pneumothorax sizes like Light, Rhea, and Collins for adults, but these methods are not appropriate for the childhood age group [5, 26, 27].
Dahmarde et al. suggested that ultrasound is accurate and reliable for newborn pneumothoraces [28]. Ultrasound can result in timely diagnoses specifically in neonatal pneumothorax and facilitates the therapy process; lack of ionizing radiation and easy operation are the benefits of this imaging technique.
The treatment options are changing by age, size, and the type of pneumothorax in childhood. There are no standardized guidelines for therapeutic interventions for children with pneumothorax; however, early identification and appropriate management can reduce morbidity and mortality.
While the size of the pneumothorax can be calculated by various methods in adults, there is no method that can be applied to children yet. Although minimal pneumothoraxes that do not cause clinical problems can be followed conservatively, most patients require drainage, and a thorax tube is inserted. Nonoperative treatment methods are monitoring with supplemental oxygen (100% high-flow) or needle aspiration. Surgical treatment methods range from the insertion of a chest tube to more invasive interventions such as video-assisted thoracoscopic surgery (VATS) or thoracotomy, including resections, pleurodesis, or bullectomy [10]. Surgical indications for pneumothorax are resistant and prolonged air leak (>4 days), persistent and recurrent pneumothorax, large pneumothorax, first pneumothorax with a history of pneumothorax in the other lung, and bilateral pneumothorax [10, 11]. Chest tube placement should be the first choice in patients with surgical indication, and then, open or closed surgical techniques should be planned according to the child’s clinic. Although the VATS procedure is easily used in the childhood age group, thoracotomy with resections, pleurodesis, or bullectomy may be preferred or needed in cases with severe air leak and recurrent pneumothorax [29].
Pleural catheters are tools that are placed in the fourth, fifth, or sixth intercostal space in generally anterior or midaxillary line with Seldinger technique and placed to water seal in children. In newborns, the catheters are usually placed from the second or third midclavicular line with again Seldinger technique and placed to water seal. The chest tube sizes are changing from the patient’s size and age. The guide for chest tube selection for pneumothorax for children patients is summarized in Table 4 [4].
Children weight (kg) | Tube size (French) |
---|---|
<3 | 8–10 |
3–8 | 10–12 |
8–15 | 12–16 |
16–40 | 16–20 |
>40 | 20–24 |
Guide for chest tube selection for pneumothorax [4].
The aim of surgical treatment is to resect of blebs and bullae and pleurodesis to prevent recurrences. VATS procedure is performed with good results in children with PSP and as the gold standard for surgical management of PSP by using various surgical instruments from 1 to 3 incisions of approximately 1.5–2 cm, which are opened on the chest with the help of a video [29, 30]. Blebs and bullae due to pneumothorax are removed with VATS with the help of staples. Pleurodesis ensures that the parietal and visceral pleura sheets stick together. Pleurodesis can be performed by using pleurectomy, pleural abrasion, or chemicals [31].
Lewit et al. suggested that nonoperative methods are not suitable for the treatment of pneumothorax and mentioned a decreased recurrence rate in those undergoing surgical treatment at initial presentation in the childhood age group [32]. Also, Lopez et al. have observed decreased median total length of stay and decreased recurrence rate in the surgical group compared with the initial non-VATS group in children [11].
On the other hand, Brown et al. discussed whether conservative management is an acceptable alternative to nonconservative procedures and found that conservative management of primary spontaneous pneumothorax was similar to interventional management, with a lower risk of significant adverse events [33].
The general approach is chest X-ray negative and CT scan positive pneumothoraces do not require invasive methods and they can be followed conservatively [23]. However, since childhood is a wide range, a pneumothorax that looks small may even be mortal for a newborn premature baby. Although thoracic tube insertion is a minor surgical procedure, every procedure has surgical stress, especially for neonatal intensive care patients. Therefore, every child with pneumothorax for whom a follow-up decision is made requires very special close follow-up. Likewise, close follow-up of a child patient with a chest tube placed should be very important in terms of possible complications.
The most common complications of pneumothorax seen in childhood are air leak, tension pneumothorax, pneumomediastinum, subcutaneous emphysema, hemothorax, and very rarely Horner’s syndrome. If the air leak is continued within 48 hours of pneumothorax treatment, it may become resistant. Therefore, a second chest tube or even VATS or thoracotomy may be required for persistent air leakage, depending on the age of the child or the etiology of the pneumothorax [3].
In conclusion, the etiology and management vary according to age and type of pneumothorax in the childhood age group, and this is a life-threatening special condition that requires urgent intervention and special follow-up.
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\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.
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\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.
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\n\nCroatian version of Terms and Conditions available here
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CO2 capture, utilisation and storage (CCUS) is considered a means to deliver low carbon energy, decarbonising industries, power plants and facilitates the net removal of CO2 from the atmosphere. The stages involved include CO2 capture, transport of the captured CO2, utilisation and secure storage of the captured CO2. This chapter reports the use of eggshell and seashells biomaterials as an adsorbent to separate CO2 from other gases generated by power plants and industrial processes. The capture of carbon dioxide by adsorption is based on the ability of a material to preferentially adsorb or carbonate CO2 over other gases. In light of this, calcined eggshell and seashells biomaterial rich in calcium carbonate from which calcium oxide (94%) can be obtained have demonstrated a strong affinity for CO2. These biomaterials are abundant and low-cost alternative to zeolite, activated carbon and molecular sieve carbon. The mechanism of CO2 capture by eggshell and seashells derived CaO adsorbent comprises of a series of carbonation-calcination reactions (CCR): calcium oxide (CaO) reacts with CO2 resulting in calcium carbonate (CaCO3), which releases pure CO2 stream upon calcinations for sequestration or utilisation, and as a consequence, the biomaterial is regenerated. Findings reveal that these biomaterials can hold up to eight times its own weight of CO2 from flue gas stream. It was also found that the combination of 2 M acetic acid and water pretreatment improved the reactivity and capture capacity of the biomaterial for successive regeneration over four cycle’s usage. Unlike activated carbon, these biomaterials are considered stable for high-temperature adsorption through carbonation.",book:{id:"8509",slug:"carbon-capture",title:"Carbon Capture",fullTitle:"Carbon Capture"},signatures:"Abarasi Hart and Helen Onyeaka",authors:[{id:"326770",title:"Dr.",name:"Helen",middleName:null,surname:"Onyeaka",slug:"helen-onyeaka",fullName:"Helen Onyeaka"},{id:"327022",title:"Dr.",name:"Abarasi",middleName:null,surname:"Hart",slug:"abarasi-hart",fullName:"Abarasi Hart"}]},{id:"73496",doi:"10.5772/intechopen.93893",title:"COVID-19: A Learning Opportunity to Improve Environmental Sustainability",slug:"covid-19-a-learning-opportunity-to-improve-environmental-sustainability",totalDownloads:676,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"In just a few months, COVID-19 transformed from a dangerous regional health threat into a widespread global pandemic and economic disaster. Thus the world is expecting a great recession once again. The rapid spread of COVID-19 has had far-reaching consequences for people’s daily lives in almost all parts of the world. Climate change and biodiversity depletion have now reached global boundaries; thus, human activity has surpassed Earth’s capacities. Earth capacities can be explained in terms of extreme climate change. This chapter is intended to investigate the link between the outbreak of Covid-19 and its effect on environmental and society. The discussion reveals that environmental pollution is minimized as a result of global lockdown. Furthermore, our review also shows that in terms of environment, Covid-19 provide an opportunity to transform our polluted economy toward the green economy through adoption of renewable energy sources and green practices in our businesses.",book:{id:"8509",slug:"carbon-capture",title:"Carbon Capture",fullTitle:"Carbon Capture"},signatures:"Syed Abdul Rehman Khan, Laeeq Razzak Janjua and Zhang Yu",authors:[{id:"254664",title:"Prof.",name:"Syed Abdul Rehman",middleName:null,surname:"Khan",slug:"syed-abdul-rehman-khan",fullName:"Syed Abdul Rehman Khan"},{id:"300373",title:"Dr.",name:"Zhang",middleName:null,surname:"Yu",slug:"zhang-yu",fullName:"Zhang Yu"},{id:"328959",title:"Dr.",name:"Laeeq Razzak",middleName:null,surname:"Janjua",slug:"laeeq-razzak-janjua",fullName:"Laeeq Razzak Janjua"}]}],mostDownloadedChaptersLast30Days:[{id:"74218",title:"Energy-Efficient Landscape Design",slug:"energy-efficient-landscape-design",totalDownloads:676,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Buildings that are carefully designed using passive strategies for natural ventilation and day lighting reduces our dependency on electrical energy meanwhile ensuring thermal comfort inside the building. 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Then it introduces the new traffic analysis method especially for its traffic congestion analysis and its parameters. 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Secondly, we calculate there megalopolises to obtain the vulnerability of each city in 2018 Sex index. The results show that the central cities and economically underdeveloped cities of the three megalopolises are relatively vulnerable areas in the urban agglomerations, and areas have low sensitivity and high response. Finally, policy suggestions for megalopolis are given to improve the adaptive capacity of tackling climate change. 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Kendrekar, MSc, MBA, Ph.D., is currently a visiting scientist at the Lipid Nanostructure Laboratory, University of Central Lancashire, England. He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. His present research includes organic synthesis, drug discovery and development, biochemistry, nanoscience, and nanotechnology.",institutionString:"Visiting Scientist at Lipid Nanostructures Laboratory, Centre for Smart Materials, School of Natural Sciences, University of Central Lancashire",institution:null},{id:"428125",title:"Dr.",name:"Vinayak",middleName:null,surname:"Adimule",slug:"vinayak-adimule",fullName:"Vinayak Adimule",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428125/images/system/428125.jpg",biography:"Dr. Vinayak Adimule, MSc, Ph.D., is a professor and dean of R&D, Angadi Institute of Technology and Management, India. He has 15 years of research experience as a senior research scientist and associate research scientist in R&D organizations. He has published more than fifty research articles as well as several book chapters. He has two Indian patents and two international patents to his credit. Dr. Adimule has attended, chaired, and presented papers at national and international conferences. He is a guest editor for Topics in Catalysis and other journals. He is also an editorial board member, life member, and associate member for many international societies and research institutions. His research interests include nanoelectronics, material chemistry, artificial intelligence, sensors and actuators, bio-nanomaterials, and medicinal chemistry.",institutionString:"Angadi Institute of Technology and Management",institution:null},{id:"284317",title:"Prof.",name:"Kantharaju",middleName:null,surname:"Kamanna",slug:"kantharaju-kamanna",fullName:"Kantharaju Kamanna",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284317/images/21050_n.jpg",biography:"Prof. K. Kantharaju has received Bachelor of science (PCM), master of science (Organic Chemistry) and Doctor of Philosophy in Chemistry from Bangalore University. He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. 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She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. 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His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"22",type:"subseries",title:"Applied Intelligence",keywords:"Machine Learning, Intelligence Algorithms, Data Science, Artificial Intelligence, Applications on Applied Intelligence",scope:"This field is the key in the current industrial revolution (Industry 4.0), where the new models and developments are based on the knowledge generation on applied intelligence. 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