Dielectric properties of human body [26].
\r\n\tOver the years, the concept of maintenance became more comprehensive, reducing fault occurrence and increasing industrial system availability. Besides, reliability, safety, and criticality requirements were associated with the system or equipment under analysis. Maintenance strategies or schemes can be classified as corrective (run-to-break), preventive (time-based), and predictive (condition-based maintenance). Corrective maintenance is only performed after an occurrence of a fault. Therefore, it involves unexpected breakdowns, high costs, changes in the production chain, and it could lead to catastrophic events. Preventive maintenance and interventions occur based on a scheduled maintenance plan or the equipment's mean time between failures. Although it is more effective than corrective maintenance, unexpected failure may still occur by preventing most failures. Additionally, the process cost is still high, especially the costs associated with labor, inventory, and unnecessary replacement of equipment or components.
\r\n\tOn the other hand, predictive maintenance analyses the equipment condition so that a possible fault can still be identified at an early stage. Predictive maintenance aims to identify a machine anomaly so that it does not result in a fault. Such maintenance involves advanced monitoring, processing, and signal analysis techniques, which are generally performed non-invasively and, in many cases, in real-time. In the case of machines or processes, these techniques can be developed based on vibration, temperature, acoustic emission, or electrical current signal monitoring. It should be noted that monitoring such signals or parameters to verify the operating condition is called condition monitoring. Condition monitoring aims to observe the machine's current operational condition and predict its future condition, keeping it under a systematic analysis during its remaining life. In this sense, a fault condition can be detected and identified from systematic machine condition monitoring. A diagnosis procedure can be established, whereby properly investigating the fault symptoms and prognosis.
\r\n\t
\r\n\tThis book will aim to merge all these ideas in a single volume, aggregate new maintenance experiences, apply new techniques and approaches, and report field experiences to establish new maintenance processes and management paradigms.
\r\n\t
Imaging approaches for diagnosis of concealed metallic objects [1], such as on body weapon detection [2, 3] and metallic foreign objects (MFOs) detection in children [4], have received many attentions worldwide in recent years. Concealed weapon detection underneath human subjects’ clothing is an active research topic due to rapid screening of human subjects is urgent needed at some security sites, such as airports [1]. In 1995, the United States started the concealed weapon detection program [2] to detect concealed weapons from a standoff distance, especially when it is impossible to arrange the flow of people through a controlled procedure [3].
Various imaging techniques include infrared imaging [5, 6], passive millimeter-wave (MMW) imaging [7, 8, 9], active MMW imaging [10, 11], X-ray imaging [12, 13] and holographic imaging [14, 15, 16, 17] have been investigated for concealed metallic object detection. Recent studies have demonstrated that passive MMW imaging has the most potential to become a useful tool to identify concealed MFOs under clothing [18, 19], which has been investigated for various applications include security, military, surveillance and biomedical [20].
Passive MMW imaging sensor techniques offer the best near-term potential for providing a non-invasive method of observing metallic and plastic objects concealed underneath common clothing. However, MMW cameras alone cannot provide useful information about the detail and location of the individual being monitored. The passive MMW system can produce indoor and outdoor images in bad weather, such as smoke and fog [21]. It has been applied to scan human subjects moving in an unconstrained flow, however, the MMW image has poor quality due to low-level signals and system noise [5]. In order to improve the accuracy and specificity of MMW for diagnosing concealed MFOs, many researchers aimed to develop a new MMW approach such as imaging algorithm and implement system.
Holographic technique was first applied in microwave imaging in 1948 [22]. An interference pattern between reference wave and diffracted wave (created by an object) is recorded to produce a hologram that can be digitally stored. The holograms are reconstructed by numerically synthesizing the reference wave, which is well-known wave front reconstruction processing. The target object can be reconstructed from the measured reflections and holograms. Holographic approaches are very different from the conventional synthetic aperture radar imaging method particularly in imaging geometry and no field approximations are required for holographic, which have recently been applied in MMW for MFOs detection [14, 15]. Farhat and Guard [14] applied the holographic approach for concealed weapon detection, and this technique was dramatically improved by Collins et al. [15]. The concealed MFOs detection system aims at extracting features of MFOs and reconstructing the MFOs using the measured data. The image quality is often limited by low signal-to-noise ratio and long scan time. Existing MMW methods are multi-frequency approach, which reconstruct a 3D image from a sequence of 2D images that obtained at different frequencies. However, the multi-frequency MMW methods have difficulty in practical implementations and the broadband measurements also cause large noises.
This chapter demonstrates the feasibility of using a single frequency 3D holographic millimeter-wave (HMMW) imaging system and method to detect various small MFOs in inhomogeneous medium. A computer model is developed under MATLAB environment to validate the proposed theory and measurement system setups. The system contains a HMMW measurement model and various realistic models. Simulation and experimental validations are performed to evaluate the accuracy, effectiveness and performance of the proposed theory. The remainder of this chapter is organized as follows. Section 2 introduces the 3D HMMW measure system and imaging processing. Sections 3 and 4 present simulation and experimental performances. Section 5 gives discussion and conclusion of this study.
Figure 1 shows the proposed HMMW system for concealed metallic object detection. The system contains a RF generator (vector network analyzer, VNA) to illuminate microwave signals, a data acquisition unit consists of a single transmitter to transmit microwave signals into a target object and an array of receivers to measure scattered electric fields from the target object, a signal and imaging processor to analyze the measured signals which contains phase and amplitude information as well as reconstruct image of the target object using an imaging algorithm, and an image display unit to display the reconstructed image.
Experimental procedure.
During data collection, port one of the VNA generates millimeter waves to the object of interest and the backscattered electromagnetic fields from the object are recorded at each receiver in the detector array plane that is connected to the second port of VNA. The distance between the target object and the data acquisition unit is in far-field region. The recorded signals include phase and amplitude information, which are used to compute the complex visibility data for each possible pair of receivers. An image of the object can be reconstructed from recorded data using the HMMW algorithm.
In order to investigate the feasibility of using the 3D HMMW to detect concealed MFOs, 16 four-band patch antennas or waveguide antennas were simulated as both transmitters and detectors. Figure 2 shows the designed four-band patch antenna with length of 10.7 mm, width of 6.3 mm, and height of 0.254 mm. As shown in Figure 2(b) and (c), top layer and bottom layer of the proposed antenna contain 12 holes (0.15 mm in diameter) that aims to work in four broadband. The subtract material between the two layers of the antenna is RT/duriod6002 with dielectric property close to 1.
(a) Multiband patch antenna; (b) top layer of the designed antenna: (1) top antenna, (3) holes, (4 and 5) trumpet holes; (c) bottom layer of the antenna: (2) bottom antenna, (7) feed probe hole; (d) sideview of the antenna: (6) feed probe, (8) dielectric layer, (9) ground plate; (e) sensor array configuration.
The incident electric field from each transmitter is [23]:
Where
In far-field condition, the scattered electric field from the object can be computed as [24]:
Where
As shown in Figure 3, a point Q is located within a 3D object, the visibility for any two detectors located at
(a) Geometry of two detectors, (b) scattering characterization scheme from different receiving height 𝐻 [
Where * is the complex conjugate and < > denotes time average.
The total visibility data can be computed as:
Define the object intensity distribution at position
All detectors are located on the same plane, thus, define the line integral as:
Where
A 2D image is obtained by using inversion Fast Fourier Transformation:
The 2D image difference between each two 2D images is computed by differentiating 2D images when the sensor array plane is placed at different heights (H):
Where
A 3D image can be reconstructed by acquiring the measured 2D intensity distributions when the sensor array plane is placed at different vertical locations, and computing a sequence of 2D images,
A numerical system was developed under MATLAB environment to investigate the proposed theory and system for diagnosing concealed MFOs. An array of 16 open-ended waveguide antennas with one element for transmitter and others for receivers. The target object was located at
(a) Model I, (b) Model II, (c) Model III, (d) Model IV, (e) Model V (
Model I was made of two metallic spheres (10 mm in diameter,
To investigate the feasibility of on body conceded weapon detection using the proposed imaging method, a Model V includes human phantom was developed using published dielectric properties of various tissues, and a series of simulations were carried out on a personal computer by the developed computer model. Figure 4(e) shows the Model V, where the multimedia dielectric object (cylinder) was located at z = 0 mm and it was assumed to be fully contained in a rectangle imaging domain with length 100 cm. This multimedia object simulates human body (contains skin, skull and fat), clothing and metallic object. The scale values of the published dielectric properties of real tissues were applied (see Table 1).
No | Region | Dielectric properties | Scale value of dielectric properties | ||
---|---|---|---|---|---|
A4 | Skin | 41 | 4 | 0.5125 | 0.4 |
A5 | Skull | 25 | 2 | 0.31 | 0.2 |
A6 | Fat | 5 | 0.4 | 0.06 | 0.04 |
Dielectric properties of human body [26].
Figure 5 shows the reconstructed images of Model I at different frequencies in water. Both cylindrical box and two metallic objects are clearly identified in the frequency range of 20–25 GHz, but only metallic object is identified when frequency out of this range.
Reconstructed images of Model I with operating frequency of (a) 19 GHz, (b) 20 GHz, (c) 21 GHz, (d) 22 GHz, (e) 23 GHz, (f) 24 GHz, (g) 25 GHz, (h) 26 GHz.
Figure 6 shows the reconstructed images of Model II when the two objects located at different distance with frequency of 23 GHz in free-space. Results show that two small wood spheres are successfully identified when the distance between the two items great than 3 mm.
Reconstructed images of Model II when the distance between two wood spheres is: (a) 0 mm, (b) 1 mm, (c) 2 mm, (d) 3 mm, (e) 4 mm, (f) 5 mm, (g) 6 mm, (h) 7 mm.
Figure 7 shows the 3D reconstructed images of Model III and Model IV when the sensor array plane moved from
(a) 3D reconstructed image of Model III, (b) 3D reconstructed image of Model IV.
To simulate on body weapon detection using the HMMW approach, the image measuring system was set-up in free-space with operating of frequency at 96 GHz, a 16-element antenna array plane was placed at the bottom of the model with a distance of 65 cm. A small four-band patch RF antenna was designed as transmitter and receiver and it was simulated using HFSS software with operating frequency of 50–120 GHz. Figure 8 shows the return loss of the four-band patch antenna, which has the ability to receive good result at 96–116 GHz.
Simulated S11 value of the designed 4-band patch antenna.
Figure 9 shows the 2D reconstructed images of Model V at operating frequency of 96 GHz. The rectangle imaging region contains the dielectric object (human model with clothing) and the steel stainless object. Simulation result demonstrates that the metallic object underneath wof human model’s clothing has been successfully imaged, and structures of the tested human model are clearly identified with operation frequency of 96 GHz. Color bar plots signal energy on a linear scale, normalized to the maximum in the image space and values below 0.1 are rendered as blue.
Reconstructed 2D image of Model V.
An experimental study was conducted to evaluate the 3D HMMW system for concealed MFO detection (see Figure 10). A concealed steel ball (10 mm in diameter) embedded in a plastic box (
(a) HMMW measurement setup; (b) sensor array; (c) target object.
Figure 11 shows the 2D and 3D reconstructed images of the concealed metallic steel ball. The steel ball is clearly identified in the reconstructed images with correct location, shape and size.
(a) 2D reconstructed image of concealed steel ball, (b) 3D reconstructed image of concealed steel ball.
This chapter investigated the 3D HMMW method for various concealed objects detection and the theory has been evaluated through numerical and experimental validations. It was found that various small concealed metallic and wood objects with different sizes and locations can be identified in the reconstructed HMMW images. Results showed that the proposed HMMW has the potential for investigating characterization and structure of concealed objects. The potential applications of the 3D HMMW include on body weapon detection and packed food quality control.
The author gratefully acknowledges the financial supports from the National Natural Science Foundation of China (Grant No. 61701159, JZ2017GJQN1131), the Natural Science Foundation of Anhui Province (Grant No. 101413246, JZ2017AKZR0129), the Foundation for Oversea Master Project from the Ministry of Education of the People’s Republic of China (Grant No. 2160311028), and the start-up funding from the Hefei University of Technology (Grant No. 407037164).
The author declares no conflict of interest.
Empyema is a common clinical problem to both pulmonary physicians and thoracic surgeons. It affected 65,000 patients annually in the US [1]. Thanks to the advent of antibiotics and continuous advancement of minimally invasive procedures, most acute empyema patients can now receive tube thoracostomy and/or video-assisted thoracoscopic surgeries (VATS) to alleviate the infection with good recovery [2]. Empyema, also known to be pleural empyema or thoracic empyema, is defined as infection in the pleural cavity. The most common scenario is that the patient has a prior or ongoing pneumonia which the infection has extended to the lung surface, causing a series of inflammation and infection response on the visceral pleura and therefore parietal pleura. The products of the infection then accumulate in the pleural space resulting in empyema. Some patients would develop pleuritic pain which they easily mistake it as muscle strains or sprains, so they tend to overlook the real problem and lead to delay diagnosis. There are also a lot of other reasons that can eventually cause empyema, such as trauma, invasive procedures (including thoracic operation), liver abscess, spinal abscess, mediastinitis (because in the vicinity of an infection source) or being transmitted through hematogenous route.
According to American Thoracic Society classification, empyema is divided into three stages (Table 1) [3, 4]. In the early stage of pleural cavity infection, some fibrin would develop in this avascular space along with some body fluid. It is often recognized as parapneumonic pleural effusion. At this exudative phase, most fluid in the pleural cavity can be drained by a chest tube. If the infectious process continues and the fluid accumulates, the fluid will become thicker with more fibrin deposition. This second stage is often characterized by loculated pleural effusion which makes it difficult to drain all effusion in different areas with a single chest tube. Patients with this true empyema stage often require surgical intervention to deloculate the effusion for complete drainage. Fibrinolytic agent is another option for non-surgical candidate. When the disease progresses, more and more fibrin pile up and the fluid becomes denser and denser. A thick peel will form to cover all contact surfaces, including lung, inner chest wall, diaphragm, and mediastinum. This final stage of empyema, organizing phase, will restrict lung expansion and hence reduce lung compliance. More aggressive treatment modalities should always be considered to avoid long-term lung function impairment.
Stage | Phase | Characteristics | Status of Lung Parenchyma | Treatment |
---|---|---|---|---|
I | Exudative (Acute) | Pleural membrane thickening Fibrin deposition Presence of exudative fluid | Compliant Reexpansion possible with evacuation of fluid | Thoracentesis Closed-tube thoracostomy |
II | Fibrinopurulent | Extensive fibrin deposition Pleural fluid becomes turbid or purulent Presence of loculated empyema | Partial compliance Lung entrapment due to fibrin deposition | Closed-tube thoracostomy with/ without fibrinolytics VATS Thoracotomy |
III | Organized (Chronic) | Fibroblast in growth Thickened pus Granulation tissue replacement of the pleural space | No compliance Lung completely entrapped by fibrous peel | VATS (decortication) Thoracotomy (decortication) Open window thoracostomy |
Since empyema equals to infected pleural cavity, the primary goal is to treat the infection. There are a few recognized treatment principles to such disease. First, sterilization of the pleural space. Second, adequate drainage. Third, optimizing lung expansion and reducing potential pleural space. These principles will be explained in detail below.
Just like treating other infectious disease, removal of pus or necrotic tissue and antibiotics therapy are the two key components to successful treatment. In empyema, sterilization targets not only the pleural space but also the original infection source, such as pneumonia or liver abscess. To select effective antibiotics, obtaining cultures are important so that adjustment can be made according to susceptibility test after empirical antibiotics. Other effective ways to lower the pathogen colonization in the pleural cavity are removal of the infectious debri and irrigation. These procedures, debridement and irrigation, are often carried out during the surgery, either through VATS or thoracotomy. Although some doctors believe irrigation may result in unstable hemodynamics as capillary permeability increases due to transient bacteremia, the author thinks it is reasonable to do so as it is easier and faster to achieve sterilization. If the patient’s blood pressure drops during the surgery, it is suggested to irrigate the pleural cavity with some diluted epinephrine with cautious monitoring. Since the patient’s capillary permeability may increase, it is possible that the patient would develop tachycardia and hypertension if the medication is well-absorbed by the pleura.
Unlike airway, pleural cavity is a closed space. The fluid should be drained adequately to avoid further or repeated infection. A chest tube is sufficient for simple parapneumonic pleural effusion (stage I empyema) while complicated pleural effusion (stage II empyema) or organizing empyema (stage III empyema) often requires surgical intervention and a chest tube(s) after the surgery for adequate drainage.
When the empyema reaches to its final stage --- organizing stage, the lung would become completely trapped and therefore poorly expanded. This not only leads to restrictive lung (impaired lung function), but also leaves a potential dead space in the pleural cavity. This space would possibly result in repeated infection. Therefore, the initial treatment goal of empyema should also include best pleural apposition to prevent chronicity. To achieve this, remove “peels” from the lung and other pleural surfaces. This surgical procedure is known as “Decortication.” As long as it is feasible, removing all debri and resuming patients’ optimal pulmonary function are always recommended. However, there could be exceptions that the lung fails to fill the pleural cavity. If this is the case, other measures should be taken to reduce the potential pleural space.
From a thoracic surgeon’s point of view towards managing empyema, it is always “the earlier the easier.” In an acute setting of empyema (stage I or II), most patients can be cured by tube thoracostomy or VATS [2]. This further emphasizes the fact that early diagnosis and early aggressive treatment to prevent chronicity are crucial. In addition, the choice of first intervention is important as well. According to the literature, failure of the first attempted procedure was an independent predictor of death [5]. As a result, operation is the most successful initial procedure in this study. More and more studies demonstrated good outcomes of early surgical intervention treating complex empyema [5, 6]. Furthermore, VATS decortication is found to be superior to open surgery in the management of primary empyema [7]. In the author’s hospital, empyema is a surgical disease. Once the diagnosis is made, almost all patients need surgical consult for further treatment planning. All surgeons tacitly agree that VATS is the gold standard procedure to treat acute empyema in the author’s institution.
There are still certain patients who will eventually continue to have the infection and enter to a chronic phase. Several causes of chronic empyema include delayed diagnosis, retained hematoma in the pleural cavity, bronchopleural fistula with continuous airway secretion spillage, a large potential pleural space (e.g. post lung resectional empyema) which is prone to have repeated infection, and the patient is too ill to receive definite treatment at the initial acute phase. Among all the causes, the author thinks that retained hematoma in the pleural cavity is the most preventable cause of chronic empyema. Blood clots are perfect culture medium for bacteria, so it is important to avoid too much oozing when one performs VATS debridement and decortication on empyema patients, especially those who have liver cirrhosis, end stage renal disease, or other bleeding tendency. Adequate hemostasis and diluted epinephrine irrigation are helpful to prevent retained hematoma. If retained hematoma still happens, at least it is detectable from the drainage fluid. The drained fluid would be bloody initially then turned to dark brown and remained in this color without turning to light yellow. As one recognizes the sign of retained hematoma in the pleural cavity, it is often required to do another operation to remove all the blood clots to prevent chronic empyema.
In this section, the focus will be solely on the treatment options of chronic empyema and to which treatment principles that each option fits in.
When dealing with empyema, following the above mentioned three treatment principles is the key to success. Although the principles are the same in different stages, treatment strategies may vary, especially in the chronic stage. Treating chronic empyema is more complicated, more unpredictable, and therefore more challenging. It may require staged operations, different surgical approaches, and there is no standardized option. Before establishing treatment plan for chronic empyema patients, comprehensive understanding between each option is necessary.
Decortication can be done either through VATS or thoracotomy. It is basically surgeon’s preference. During the same surgery, debridement is also done so that non-viable tissue and debri are removed to achieve “cleaning” in the pleural cavity. In stage III empyema, the lung is always restricted by thickened “cortex,” so freeing the lung by decortication can optimize lung expansion and reduce the potential pleural space. Choosing proper surgical instruments accelerates the procedure. In the author’s experience, Roberts artery forceps or long Kelly forceps are best tools to separate the lung from the overlying “cortex.” This separation process can be done sometimes with the operated lung ventilating so that the correct pleural plane is evident. If pleural apposition still cannot be achieved after decortication, make sure to check the lung surface again. There may be some remnant peel from the multi-layered peel that restricts lung expansion. Sometimes the peel is extremely thick and firm. Using a scalpel cautiously to slit through the peel will aid in removal.
*Fitting in the treatment principles sterilization of the pleural cavity and reducing potential pleural space by optimizing lung expansion.
To optimize lung expansion, there are several other ways, but none are as effective as decortication.
Some of these patients are ventilator dependent while others are not. If they still require ventilator support, it is acceptable to increase positive end-expiratory pressure (PEEP) a little, by 1 or 2 cmH2O, to further expand the lung. If patients can be weaned off from ventilator successfully after the operation, a strategical management option is to delay extubation time by 0.5 to 1 day. This may also allow the lung to further expand.
*Fitting in the treatment principle reducing potential pleural space by optimizing lung expansion.
Positive airway pressure expands the lung from internal while negative pleural pressure provides a tractive force externally. A suction pressure of −20 cmH2O is usually recommended with a traditional chest drainage system. Other modality that can create negative pressure in the pleural cavity is Vacuum-assisted closure (VAC) therapy. (see 4.4).
*Fitting in the treatment principles drainage and reducing potential pleural space by optimizing lung expansion.
OWT was first described by Robinson in 1916 and then revised by Leo Eloesser in 1935 which was also called Eloesser flap thoracostomy window [8]. However, the most adopted OWT is modified by Symbas and coworkers in 1971 as modified Eloesser flap [9].
This procedure, an open drainage method, is often saved as the last resort to treat chronic empyema, especially when the pleural infection is difficult to be managed by debridement and decortication. It is also a treatment option for critically ill patients who are too weak to receive decortication. As the name presents itself, OWT is to create a window through the patient’s chest so serial dressing changes are feasible to clean the infected pleural cavity and therefore alleviate the septic condition. The advantage of OWT is that it is proved to be safe and effective [10]. On the other hand, it affects the patient’s appearance and may cause chronic pain after chest wall resection. Some of the patients will need another surgery to close up the wound.
*Fitting in the treatment principles sterilization of the pleural cavity and drainage.
The most common use of OWT is modified Eloesser flap [11]. The window is usually created at the basal part of the hemithorax where most of the infected material accumulates (Figure 1). After confirming the chest CT image, an inverted U-shaped incision is made at this area. Electrocautery is used for dissection till the rib cage. In order to create a sufficient window, two or three ribs need to be resected. Then, the tongue-shaped muscular-cutaneous flap is folded inward and sutured to the diaphragm (Figure 2). The remaining wound edge is sutured to the pleura so that the window can be maintained for a period of time without spontaneous closure. It is also imperative that the window is large enough for the convenience of frequent wet packings. Another key point that must be mentioned is the timing of OWT creation. From the Massera et al. study [12], immediate OWT requires lesser time for the resolution of empyema comparing to the delayed OWT after prolonged chest tube drainage. As a result, the median OWT closure time (between performing and closing of OWT) of immediate OWT was 8 months shorter than that of delayed OWT. The timing of attempted closure should be carefully decided by the surgeon after a thorough evaluation of the empyema patient’s condition. This includes free from recurrent disease, good recovery of the pleural cavity with coverage by healthy granulation tissue, the patient’s general condition, and to a lesser degree by the normalization of inflammatory parameters [12, 13]. Methods of OWT closure please see 4.6.2 below.
OWT. An OWT on the patient’s left-side chest wall.
Coronal view of the Eloesser flap window. Demonstrating the supposition of the skin surface of the inferiorly based soft tissue flap to the diaphragmatic surface. (Adapted from Denlinger [
VAC is a negative pressure wound therapy that is widely used in acute and extended open wounds. The first case report of intrathoracic VAC therapy was published in 2006 [14]. Varker et al. managed a postlobectomy empyema patient with VAC device successfully after open debridement of the empyema cavity. In the next following decade, with the popularity of VAC therapy, it was proved that it is safe and efficient to fight against all kinds of intrathoracic infections [13, 15, 16, 17].
VAC device is able to create a negative pressure wound environment that promotes wound healing by reducing edema, promoting granulation tissue formation and perfusion, and removing exudate and infectious material. As to treating chronic empyema, it is a useful tool to apply on an open wound such as an OWT after debridement of the pleural cavity (Figure 3). In the setting of intrathoracic VAC usage, it may reduce the duration and frequency of dressing changes necessary for spontaneous chest closure or a space filling procedure, reducing patient’s discomfort, and resolving the infectious process faster [18]. When compared with conventional management of OWT, VAC therapy accelerates wound healing and helps re-expansion of residual lung parenchyma in patients with OWT [19]. In selected patients, applying Mini-VAC procedure can even avoid OWT by insertion of the ALEXIS (Applied Medical, Rancho Santa Margarita, CA, USA) wound retractor to create a similar window effect without resecting the ribs which preserves the chest wall integrity and avoids the consequences that OWT can cause (Figure 4) [20]. However, the biggest disadvantage of this device is that it is not suitable for everyone. VAC device should be used cautiously or be avoided on patients with bleeding tendency, presence of malignancy, or unstable hemodynamics. Because VAC creates a negative pressure environment, it may lead to continuous bleeding, promote cancer growth, or deteriorate hypotension. The reason why hypotension may develop is probably due to the negative pressure effect intrathoracically causing decreased cardiac output. Thus, intrathoracic application in older patients must be monitored closely and should be avoided on patients with poor cardiac function.
Intrathoracic VAC therapy. VAC therapy is applied through the patient’s OWT.
Mini-VAC procedure. VAC therapy is applied through the ALEXIS wound retractor which creates a similar window effect without resecting the ribs.
*Fitting in the treatment principles drainage and reducing potential pleural space by optimizing lung expansion.
VAC therapy is designed to be applied on open wounds. To treat chronic empyema with VAC, an open chest wound or an OWT must be created during the surgical intervention. Some authors advocate leaving the thoracotomy wound open directly after the operation [13, 14] while others create an OWT to make dressing changes easier [17, 18, 19]. It is reasonable to decide on an individual basis depending on the size and depth of the residual pleural space. A large and deep residual pleural space is preferred for OWT. The advantage of OWT is that the chest will stay open for a longer period because of the inverted skin flap compared to just leaving the thoracotomy wound open. OWT would avoid the skin from healing before complete eradication of the infected pleural cavity. It is contraindicated to apply VAC on a dirty wound with necrotic tissue that has yet to be debrided. After adequate debridement in the pleural cavity, VAC sponges (GranuFoam) are inserted in the residual pleural space to fill the entire cavity. Placing the sponges directly in contact with exposed blood vessels, anastomotic sites, organs, or nerves are prohibited, except for the lungs. According to the literature [13, 21] and the author’s personal experiences, VAC dressing can be safely applied directly on the visceral pleura or lung parenchyma without any complications. The negative pressure can be set at -50 mmHg from the start, and gradually increased to -125 mmHg if the patient does not have any discomfort. The dressing change should be done at least twice a week, and it can be performed at the bedside. During the VAC therapy period, the skin covered by the dressing should be well protected to prevent skin maceration problems. If negative pressure fails to be maintained due to significant air leak caused by bronchopleural fistula (BPF), combining a one-way valve may solve this issue [21].
When dealing with postpneumonectomy empyema (PPE), VAC therapy should be used carefully, especially for patients who develop the complication shortly after the initial surgery. This is because negative pressure would shift the mediastinum which may cause heart or great vessels herniation leading to obstructive shock or even cardiac arrest. On the contrary, if PPE is developed at a later stage, such events will not happen as the mediastinal shift has already completed and the patient’s body has compensated it well.
There are two scenarios where chronic empyema patients would need an empyema tube for long-term drainage. One is that the patient is too unstable and fragile to receive general anesthesia and adequate surgical intervention. To alleviate the septic condition, empyema tube (tube thoracostomy) can be placed to decrease the burden of infection until definite treatment can be initiated. Another scenario is that the chronic empyema is somehow localized in a small area without systemic infection. It is either a tube thoracostomy left after previous surgical intervention or a new chest tube inserted into this localized area for drainage if the patient is not a surgical candidate.
In the author’s opinion, this treatment option is only reserved for those who are not able to receive other definite treatment because of the low success rate, and not all infected materials can be drained adequately. However, if adequate drainage can be achieved, the tube may be slowly retracted over a period of weeks to months while the infected space heals behind it [3].
*Fitting in the treatment principle drainage.
Clagett procedure was first described by Clagett and Geraci in 1963 [22]. It is a method that obliterate the pleural cavity with antibiotic solution. As a precondition of the procedure, there must be no BPF and the pleural cavity should be sterilized by debridement and irrigation. In other words, if the patient has BPF and primary repair is impossible, Clagett procedure is not suitable for the patient. Nonetheless, this procedure has a good overall success rate in selected patients (no BPF at the time of the procedure), range from 81–100% [12, 23, 24, 25]. Those who fail from the procedure are mainly due to persistent or recurrent BPF.
*Fitting in the treatment principle reducing potential pleural space.
After confirming that there is no active BPF in the pleural cavity or it is firmly closed, antibiotic fluid can be instilled to fill the remaining pleural cavity after it is fully cleansed. DAB solution (gentamicin 80 mg/L, neomycin 500 mg/L, and polymyxin B 100 mg/L) is one of the antibiotic solution choices [23]. The combination of the fluid can be chosen according to the microbiological findings [26].
Tissue flap transposition technique is frequently used in chronic empyema patients for the purpose of either closure of the BPF or OWT, and/or obliteration of the residual pleural space. It can also be used for the prophylactic reinforcement of a bronchial stump after major lung resection to avoid BPF formation. Because the flap tissue is full of mesenchymal cells, it can promote granulation tissue growing under good circulation and secure the bronchial stump as a backup layer. A bulky muscle flap is extremely helpful to reduce the residual pleural space while a smaller residual space only requires a smaller tissue flap. However, not every patient is medically fit for long-hour flap surgery especially the critically ill. A successful flap reconstructive surgery is determined by a well-perfused flap which is highly dependent on patients’ stable hemodynamics.
*Fitting in the treatment principle reducing potential pleural space.
Tissue flaps commonly used in chronic empyema are latissimus dorsi (LD) muscle flap (Figure 5), serratus anterior (SA) muscle flap, pectoralis major (PM) muscle flap, intercostal muscle flap, pedicled omental flap, and other free flaps. LD is the largest muscle among all chest wall muscles. Therefore, it is an ideal option for pleural cavity obliteration. However, if the patient has received a standard posterolateral thoracotomy previously, this muscle may have been compromised and hence not suitable. PM flap is another good alternative for it is the second largest chest wall muscles. Because of its anatomy and orientation, PM flap is particularly useful to obliterate the apical residual pleural space [3, 27]. Although SA flap and intercostal muscle flap are relatively small compared to LD and PM flaps, they can be sufficient to help accelerate BPF healing as long as the pedicle is healthy. Omental flap is another option if no chest wall muscle is available [28]. However, entering the peritoneal cavity may potentially spread the infection and complicate the situation. Sometimes the remaining pleural space is too big that only by combining two flaps will fill the space [27]. Free flap may also be considered in highly selected patients.
LD muscle flap. Harvest of the LD muscle flap to reinforce the PPE BPF closure.
Thoracoplasty has a long history in the field of thoracic surgery. It was first described by Estlander in the late 19th century when tuberculosis was a troublesome pandemic without medical cure [29]. The original concept of this surgery is to collapse the chest wall to minimize the cavitary pleural space caused by mycobacterium. To achieve this goal, multiple ribs are resected resulting in loss of rigid chest wall configuration and therefore obliteration of the infected pleural space. Although it is an effective way to fill the potential pleural space, this procedure can cause significant morbidity, including chronic pain, chest wall deformity, thoracic spine scoliosis, limited ipsilateral shoulder range of motion, and finally resulting in poor quality of life.
*Fitting in the treatment principle reducing potential pleural space.
Thoracoplasty can be classified into three types, full, extended, and tailored thoracoplasty. Full thoracoplasty is defined as removing first 11 ribs to collapse the whole hemithorax. Extended thoracoplasty, on the other hand, is removing 7 to 9 ribs while tailored thoracoplasty is removing fewer than 5 ribs at certain area [30]. Resection of 7 ribs can lead to approximately 50% reduction of the pleural space, and resection of 5 ribs results in 25% reduction (Figure 6) [31]. The key to a successful thoracoplasty is complete resection of the targeted ribs which means from the transverse process of the thoracic spine posteriorly to the costosternal joint anteriorly. In the modern era, this procedure is seldom conducted alone. Combining with muscle flap transposition is an effective alternative so that chest wall deformity can be less significant [32, 33].
Thoracoplasty. Complete resection of the 4 right upper ribs. (Adapted from Lewis and Wolfe [
Managing chronic empyema is art. There is no standardized option. Knowing the different measures in depth and applying each principle with these measures will certainly increase the success rate of treatment. Making a customized treatment plan according to the patient’s physical condition, complications, and special requirements cannot be emphasized enough. There are special circumstances which will be introduced below for better understanding of how to put the different treatment options in use.
The main issue contributed by post-resectional empyema is that the residual pleural space is often large. The treatment strategy therefore should be emphasized on how to fill the space. If post-lobectomy empyema occurs in a delayed setting, the size of the residual pleural space would not be a concern because the pleural cavity should have been remodeled by diaphragm elevation, mediastinum shifting, and narrowing of the intercostal space over time. However, if post-resectional empyema happens in an acute phase when the remodeling has not been completed yet, different filling procedures should always be considered. For instance, if a patient who is medically fit for surgery develops a post-lobectomy empyema in a delayed phase, VATS or thoracotomy debridement and decortication are usually amenable to solving the problem.
Post-pneumonectomy empyema (PPE) is notorious for its high morbidity and mortality rate [12]. It is a challenging situation clinically, especially when BPF is present (Figure 7). According to the literature [12, 25, 30], approximately 65 to 84% PPE patients have BPF. Closure of the BPF is imperative or else spillage from the infected cavity into the airway can cause pneumonia or even acute respiratory distress syndrome (ARDS). On the other hand, the secretion from the airway would also leak into the pleural space continuously and contaminate the cavity. After closing the BPF, as per treatment of other empyema, sterilization of the cavity with debridement, irrigation, parenteral antibiotics, and adequate drainage, the most important is effective obliteration of the remaining pleural space. Since the BPF is often failed by primary suture alone, covering the stump with pedicled muscle flap ensures secondary healing as well and obliteration the pleural space at the same time. For example, if a debilitated patient suffers from severe sepsis caused by late onset right-sided PPE with BPF, it is reasonable to lay out a staged surgical plan. First, do a tube thoracostomy and forbid the patient to lie in a left decubitus position to protect the contralateral lung. This first stage is for drainage and lung protection. Second, perform simple debridement, OWT, and primary BPF repair added on a buttressed intercostal muscle flap. Instead of frequent dressing changes after OWT, VAC therapy can be initiated under the circumstance without any contraindication. VAC dressings can be changed at least twice a week. After a period of aggressive treatment plus appropriate nutritional support, successful BPF closure, a clean pleural cavity covered with healthy granulation tissue, and improved physical status of the patient can be expected. The second stage is for sterilization of the pleural space and open drainage. The third stage is purely for filling. Choose an appropriate procedure, such as Clagett procedure, to obliterate the pleural cavity.
PPE with BPFs. (A) from the thoracoscopic view of the BPFs (B) from the bronchoscopic view of the BPFs.
As mentioned in the last paragraph, BPF connects the bronchus to the pleural cavity leading to infection burden and possible respiratory distress. Life threatening events, such as ARDS or septic shock, must be managed as top priority. Successful closure of the BPF may prevent those critical situations from happening. As long as the patient’s physical condition is suitable for intervention, attempts to close the BPF should be carried out as early as possible.
There are several ways to manage BPF, either bronchoscopically or surgically. Treatment choices mainly depend on patients’ clinical status, duration before the development of BPF, and number and size of the BPF [30]. An algorithm for treatment of BPF at the European Oncologic Institute [34] (Figure 8) was created according to these principles. If the BPF occurs in an early setting (<14 days after surgery), surgical repair of the bronchial stump is always encouraged. In a delayed setting (>14 days after surgery), bronchoscopic application with sealants, fibrin glue, silver nitrate, coils, endobronchial stents, Endobronchial Watanabe Spigot, or atrial septal defect occluder device [35, 36, 37, 38] can be used for small BPF size <8 mm or for patients who are physically unfit for surgery. As for BPF size >8 mm, patients who are fit for surgery, patients who had failure from other treatment strategies, surgical intervention is unavoidable. In addition to primary closure of the bronchial stump, muscle flap transposition to cover the sutured stump provides a good environment for secondary healing which may increase the success rate of closure. If the BPF is deemed to be closed during the operation, Clagett procedure may be considered after thorough cleansing of the infected pleural cavity. Since continuous spillage from the BPF may occur, therefore OWT is often a treatment option to enable frequent dressing changes to eliminate the infection.
Management of PPE BPF: EOI algorithm. (Adapted from Mazzella et al. [
At times, malignant pleural effusion can be infected either through hematogenous or direct inoculation by invasive procedures. The treatment principles are essentially the same. Sterilization of the pleural cavity and adequate drainage are not difficult to achieve. Since the pleura tumor cells cannot be eradicated immediately by surgical procedures or medical treatment, it is almost impossible to fully expand the lung via decortication and therefore a possible residual pleural space which can cause repeated infection. Under this circumstance, a thorough decortication is not practical because tumor cells are prone to bleed and cause the underneath lung tissue to be more fragile. Too much “peeling” will lead to excessive bleeding resulting in hematoma retention and causing the lung to tear. To weigh the benefits and risks of surgical intervention is crucial since the patient’s life expectancy may be limited. From the author’s personal experience, debridement, irrigation, and limited decortication followed by a tube thoracostomy are sufficient to treat the infected pleural cavity.
Although some surgical measures for chronic empyema originated from treating tuberculous (TB) empyema [8, 29], such as Eloesser flap thoracostomy window and thoracoplasty, these intensive procedures are now rarely used to treat TB empyema. It is not that TB empyema patients do not need invasive procedures, but it is that most of these patients can be managed by tube thoracostomy or VATS debridement with decortication. When it comes to uncontrolled TB empyema with initial treatment attempt failure, more aggressive modalities should be considered which are the same as treating other bacterial chronic empyema.
Double lumen endotracheal tube intubation is frequently seen in thoracic surgery for lung isolation. It can be an adjunct to help with BPF treatment after pneumonectomy if the patient still requires ventilator support or to protect the remaining lung from fistular spillage. Application of this device would help ventilate the remaining side of the lung and leave the fistular side of the hemithorax unventilated to accelerate fistular healing. However, the diameter of the double lumen tube is certainly greater than the single lumen tube which would make the patient feel uncomfortable if not sedated. Another frequently encountered issue is that the left-sided tube tip would slide outward easily, and this malposition may cause failure of lung isolation. Although the whole diameter of the double lumen is greater than the single lumen tube, each individual double lumen tube diameter is smaller. This would make it difficult to clean the airway by suction as the suction tip may not always reach to the proper depth. As a result, airway hygiene may become a serious issue if the tube is placed in the bronchus for a long time.
With the development of modern medicine and minimally invasive technology, the role of both bronchoscopic and thoracoscopic (VATS) procedures have become increasingly important replacing some of the traditional surgeries in treating chronic empyema. More studies should focus on solving existing issues like, Mini-VAC replacing OWT completely, customized device to help repairing BPF, and 3D bioprinting assisting BPF closure. The author believes that chronic empyema management is still evolving, and look forward to less traumatic ways of approach with better outcome in the future.
Treating chronic empyema and BPF are certainly clinical challenges that thoracic surgeons would encounter from time to time. It is necessary to thoroughly comprehend each treatment option and some management key points of different situations. With the development of modern technology, more treatment modalities can be anticipated.
The author has nothing to declare.
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Spiess",coverURL:"https://cdn.intechopen.com/books/images_new/1845.jpg",editedByType:"Edited by",editors:[{id:"64476",title:"Dr.",name:"Philippe E.",middleName:null,surname:"Spiess",slug:"philippe-e.-spiess",fullName:"Philippe E. Spiess"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1985",title:"Prostate Cancer",subtitle:"Original Scientific Reports and Case Studies",isOpenForSubmission:!1,hash:"51d83bcaa97cb41331a0e6cc466f237f",slug:"prostate-cancer-original-scientific-reports-and-case-studies",bookSignature:"Philippe E. Spiess",coverURL:"https://cdn.intechopen.com/books/images_new/1985.jpg",editedByType:"Edited by",editors:[{id:"64476",title:"Dr.",name:"Philippe E.",middleName:null,surname:"Spiess",slug:"philippe-e.-spiess",fullName:"Philippe E. Spiess"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:12,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"27324",doi:"10.5772/28281",title:"Hemocyanins in the Immunotherapy of Superficial Bladder Cancer",slug:"hemocyanins-in-the-immunotherapy-of-superficial-bladder-cancer",totalDownloads:2109,totalCrossrefCites:7,totalDimensionsCites:13,abstract:null,book:{id:"559",slug:"bladder-cancer-from-basic-science-to-robotic-surgery",title:"Bladder Cancer",fullTitle:"Bladder Cancer - From Basic Science to Robotic Surgery"},signatures:"Sergio Arancibia, Fabián Salazar and María Inés Becker",authors:[{id:"73351",title:"PhD.",name:"Maria",middleName:"Ines",surname:"Becker",slug:"maria-becker",fullName:"Maria Becker"},{id:"73365",title:"Dr",name:"Sergio",middleName:null,surname:"Arancibia",slug:"sergio-arancibia",fullName:"Sergio Arancibia"},{id:"73366",title:"MSc",name:"Fabian",middleName:"Alberto",surname:"Salazar",slug:"fabian-salazar",fullName:"Fabian Salazar"}]},{id:"26808",doi:"10.5772/22156",title:"Science and Affordability of Cancer Drugs and Radiotherapy in the World - Win-Win Scenarios",slug:"science-and-affordability-of-cancer-drugs-and-radiotherapy-in-the-world",totalDownloads:2641,totalCrossrefCites:4,totalDimensionsCites:10,abstract:null,book:{id:"1312",slug:"advances-in-cancer-management",title:"Advances in Cancer Management",fullTitle:"Advances in Cancer Management"},signatures:"Ahmed Elzawawy",authors:[{id:"46527",title:"Prof.",name:"Ahmed",middleName:null,surname:"Elzawawy",slug:"ahmed-elzawawy",fullName:"Ahmed Elzawawy"}]},{id:"62783",doi:"10.5772/intechopen.79726",title:"Biomarkers for Diagnosis and Prognosis of Prostate Cancer",slug:"biomarkers-for-diagnosis-and-prognosis-of-prostate-cancer",totalDownloads:2138,totalCrossrefCites:4,totalDimensionsCites:8,abstract:"Since its discovery, elevated prostate-specific antigen (PSA) has been the measurement to indicate possibility of prostate cancer, as well as biochemical recurrence following treatment. Although PSA has led to decrease in prostate cancer–related mortalities, PSA is a nonspecific prostate cancer biomarker reflective of other prostate-related conditions such as benign prostatic hyperplasia (BPH), resulting in a high false-positive rate. This has led to overtreatment of men with clinically insignificant disease. While most prostate cancer patients have slowly progressive disease and should be treated conservatively, roughly 10% of patients will progress to have metastatic disease, of which the majority of prostate cancer deaths can be attributed. Stratifying these patients based on prognosis so that they may benefit from aggressive treatment is critical to their survival. Biomarkers for prostate cancer diagnosis and subsequent prognostic screening have significantly advanced this field. Here, we review some of the current blood, tissue, and urine biomarker tools used to measure an array of molecules including DNA, RNA, protein, or even epigenetic modifications. Utilizing the technologies described here, as well as looking to the future, correct early identification of prostate cancer with powerful prognostic value is much closer than ever before.",book:{id:"7126",slug:"prostatectomy",title:"Prostatectomy",fullTitle:"Prostatectomy"},signatures:"Meghan A. Rice and Tanya Stoyanova",authors:null},{id:"51256",doi:"10.5772/63965",title:"Pathogenesis of Human Papillomavirus – Immunological Responses to HPV Infection",slug:"pathogenesis-of-human-papillomavirus-immunological-responses-to-hpv-infection",totalDownloads:2150,totalCrossrefCites:3,totalDimensionsCites:8,abstract:"Papillomavirus is an oncogenic virus which infects mucosal and cutaneous epithelia where it induces benign hyperproliferative lesions. Few studies have been conducted on the causative factors associated with the development of cancer. Infections by high-risk human papillomaviruses (HPVs) have been implicated as causative agents in a variety of cancers such as anogenital, and head and neck cancers. HPVs appear to have evolved mechanisms resulting in escape from host immune surveillance and delay of resolution of infection. The HPV E5 oncoprotein is one of the possible effectors that allows the virus to escape from host immune system through the downregulation of surface classical major histocompatibility complex class I (MHC I) and not the nonclassical MHC I. Lack of classical MHC I in infected cells expressing E5 would allow evasion of cytotoxic T lymphocytes (CTLs) killing and thus establishment and persistence of viral infection.",book:{id:"5256",slug:"human-papillomavirus-research-in-a-global-perspective",title:"Human Papillomavirus",fullTitle:"Human Papillomavirus - Research in a Global Perspective"},signatures:"G. Hossein Ashrafi and Nadia Aziz Salman",authors:[{id:"180711",title:"Dr.",name:"Hossein",middleName:null,surname:"Ashrafi",slug:"hossein-ashrafi",fullName:"Hossein Ashrafi"},{id:"185528",title:"Dr.",name:"Nadia",middleName:null,surname:"Aziz Salman",slug:"nadia-aziz-salman",fullName:"Nadia Aziz Salman"}]},{id:"50425",doi:"10.5772/62833",title:"The Involvement of Epigenetic Mechanisms in HPV‐Induced Cervical Cancer",slug:"the-involvement-of-epigenetic-mechanisms-in-hpv-induced-cervical-cancer",totalDownloads:1654,totalCrossrefCites:2,totalDimensionsCites:7,abstract:"High‐risk human papillomavirus (HPV) genotypes infection associates with cervical dysplasia and carcinogenesis. hr‐HPV transforming potential is based on E6 and E7 viral oncoproteins actions on cellular proteins. A persistent infection with hr‐HPV leads to progression from precursor lesions to invasive cervical cancer inducing changes in host genome and epigenome. Pathogenesis and development of cancer associated with both genetic and epigenetic defects alter transcriptional program. An important role for malignant transformation in HPV‐induced cervical cancer is played by epigenetic changes that occur in both viral and host genome. Furthermore, there are observations demonstrating that oncogenic viruses, once they integrated into host genome, become susceptible to epigenetic alterations made by host machinery. Epigenetic regulation of viral gene expression is an important factor in HPV‐associated disease. Gene expression control is complex and involves epigenetic changes: DNA methylation, histone modification, and non‐coding RNAs activity. Persistent infection with hr‐HPV can cause viral DNA integration into host genome attracting defense mechanisms such as methylation machinery. In this chapter, we aim to review HPV infection role in chromatin modification/remodeling and the impact of HPV infection on non‐coding RNAs in cervix oncogenesis. The reversible nature of epigenetic alterations provides new opportunities in the development of therapeutic agents targeting epigenetic modification in oncogenesis.",book:{id:"5256",slug:"human-papillomavirus-research-in-a-global-perspective",title:"Human Papillomavirus",fullTitle:"Human Papillomavirus - Research in a Global Perspective"},signatures:"Adriana Plesa, Iulia V. Iancu, Anca Botezatu, Irina Huica, Mihai\nStoian and Gabriela Anton",authors:[{id:"80114",title:"Dr.",name:"Gabriela",middleName:null,surname:"Anton",slug:"gabriela-anton",fullName:"Gabriela Anton"},{id:"88744",title:"Dr.",name:"Anca",middleName:null,surname:"Botezatu",slug:"anca-botezatu",fullName:"Anca Botezatu"},{id:"167968",title:"Dr.",name:"Adriana",middleName:null,surname:"Plesa",slug:"adriana-plesa",fullName:"Adriana Plesa"},{id:"185918",title:"Dr.",name:"Iulia V.",middleName:null,surname:"Iancu",slug:"iulia-v.-iancu",fullName:"Iulia V. Iancu"},{id:"185919",title:"Dr.",name:"Irina",middleName:null,surname:"Huica",slug:"irina-huica",fullName:"Irina Huica"},{id:"185920",title:"Dr.",name:"Mihai",middleName:null,surname:"Stoian",slug:"mihai-stoian",fullName:"Mihai Stoian"}]}],mostDownloadedChaptersLast30Days:[{id:"44311",title:"Molecular Tools for Detection Human Papillomavirus",slug:"molecular-tools-for-detection-human-papillomavirus",totalDownloads:2467,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"3395",slug:"human-papillomavirus-and-related-diseases-from-bench-to-bedside-a-diagnostic-and-preventive-perspective",title:"Human Papillomavirus and Related Diseases",fullTitle:"Human Papillomavirus and Related Diseases From Bench to Bedside A Diagnostic and Preventive Perspective"},signatures:"Angela Adamski da Silva Reis, Daniela de Melo e Silva, Cláudio\nCarlos da Silva and Aparecido Divino da Cruz",authors:[{id:"68829",title:"Dr.",name:"Angela",middleName:"Adamski Da Silva",surname:"Reis",slug:"angela-reis",fullName:"Angela Reis"},{id:"121027",title:"Dr.",name:"Aparecido Divino",middleName:null,surname:"Da Cruz",slug:"aparecido-divino-da-cruz",fullName:"Aparecido Divino Da Cruz"},{id:"161255",title:"Prof.",name:"Daniela De Melo",middleName:null,surname:"Silva",slug:"daniela-de-melo-silva",fullName:"Daniela De Melo Silva"},{id:"166363",title:"Prof.",name:"Cláudio Carlos",middleName:null,surname:"Da Silva",slug:"claudio-carlos-da-silva",fullName:"Cláudio Carlos Da Silva"}]},{id:"62729",title:"Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies",slug:"preventing-erectile-dysfunction-after-radical-prostatectomy-nerve-sparing-techniques-penile-rehabili",totalDownloads:2023,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Post-operative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre- and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile rehabilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy.",book:{id:"7126",slug:"prostatectomy",title:"Prostatectomy",fullTitle:"Prostatectomy"},signatures:"Michael Whalen",authors:null},{id:"62783",title:"Biomarkers for Diagnosis and Prognosis of Prostate Cancer",slug:"biomarkers-for-diagnosis-and-prognosis-of-prostate-cancer",totalDownloads:2138,totalCrossrefCites:4,totalDimensionsCites:8,abstract:"Since its discovery, elevated prostate-specific antigen (PSA) has been the measurement to indicate possibility of prostate cancer, as well as biochemical recurrence following treatment. Although PSA has led to decrease in prostate cancer–related mortalities, PSA is a nonspecific prostate cancer biomarker reflective of other prostate-related conditions such as benign prostatic hyperplasia (BPH), resulting in a high false-positive rate. This has led to overtreatment of men with clinically insignificant disease. While most prostate cancer patients have slowly progressive disease and should be treated conservatively, roughly 10% of patients will progress to have metastatic disease, of which the majority of prostate cancer deaths can be attributed. Stratifying these patients based on prognosis so that they may benefit from aggressive treatment is critical to their survival. Biomarkers for prostate cancer diagnosis and subsequent prognostic screening have significantly advanced this field. Here, we review some of the current blood, tissue, and urine biomarker tools used to measure an array of molecules including DNA, RNA, protein, or even epigenetic modifications. Utilizing the technologies described here, as well as looking to the future, correct early identification of prostate cancer with powerful prognostic value is much closer than ever before.",book:{id:"7126",slug:"prostatectomy",title:"Prostatectomy",fullTitle:"Prostatectomy"},signatures:"Meghan A. Rice and Tanya Stoyanova",authors:null},{id:"41843",title:"The Role of E-Cadherin-Catenin Complex in Prostate Cancer Progression",slug:"the-role-of-e-cadherin-catenin-complex-in-prostate-cancer-progression",totalDownloads:2453,totalCrossrefCites:0,totalDimensionsCites:1,abstract:null,book:{id:"3274",slug:"advances-in-prostate-cancer",title:"Advances in Prostate Cancer",fullTitle:"Advances in Prostate Cancer"},signatures:"Anuradha K. Murali and James S. Norris",authors:[{id:"158306",title:"Prof.",name:"James",middleName:null,surname:"Norris",slug:"james-norris",fullName:"James Norris"}]},{id:"42652",title:"Surgical and Oncological Results of Treatment of Metastases of Renal Cell Carcinoma to the Contralateral Adrenal Gland",slug:"surgical-and-oncological-results-of-treatment-of-metastases-of-renal-cell-carcinoma-to-the-contralat",totalDownloads:1772,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"3441",slug:"renal-tumor",title:"Renal Tumor",fullTitle:"Renal Tumor"},signatures:"Archil Chkhotua, Laurent Managadze and Ambrosi Pertia",authors:[{id:"66478",title:"Prof.",name:"Archil",middleName:null,surname:"Chkhotua",slug:"archil-chkhotua",fullName:"Archil Chkhotua"}]}],onlineFirstChaptersFilter:{topicId:"1079",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 15th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:48,paginationItems:[{id:"81799",title:"Cross Talk of Purinergic and Immune Signaling: Implication in Inflammatory and Pathogenic Diseases",doi:"10.5772/intechopen.104978",signatures:"Richa Rai",slug:"cross-talk-of-purinergic-and-immune-signaling-implication-in-inflammatory-and-pathogenic-diseases",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81764",title:"Involvement of the Purinergic System in Cell Death in Models of Retinopathies",doi:"10.5772/intechopen.103935",signatures:"Douglas Penaforte Cruz, Marinna Garcia Repossi and Lucianne Fragel Madeira",slug:"involvement-of-the-purinergic-system-in-cell-death-in-models-of-retinopathies",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"81681",title:"Immunomodulatory Effects of a M2-Conditioned Medium (PRS® CK STORM): Theory on the Possible Complex Mechanism of Action through Anti-Inflammatory Modulation of the TLR System and the Purinergic System",doi:"10.5772/intechopen.104486",signatures:"Juan Pedro Lapuente",slug:"immunomodulatory-effects-of-a-m2-conditioned-medium-prs-ck-storm-theory-on-the-possible-complex-mech",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}}]},overviewPagePublishedBooks:{paginationCount:27,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. 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She is also the Global Harmonization Initiative (GHI) Ambassador to Sri Lanka.",institutionString:"Australian College of Business & Technology",institution:null}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. 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He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
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Dr. Rahman was also adjunctly attached with Kanazawa University, Japan (Visiting Research Professor, Dec 2014 to Mar 2015; JSPS Postdoctoral Research Fellow, Apr 2012 to Mar 2014), and Tokyo Institute of Technology, Japan (TokyoTech-UNESCO Research Fellow, Oct 2004–Sep 2005). \nHe received his Ph.D. degree in Environmental Analytical Chemistry from Kanazawa University, Japan (2011). He also achieved a Diploma in Environment from the Tokyo Institute of Technology, Japan (2005). Besides, he has an M.Sc. degree in Applied Chemistry and a B.Sc. degree in Chemistry, all from the University of Chittagong, Bangladesh. \nDr. Rahman’s research interest includes the study of the fate and behavior of environmental pollutants in the biosphere; design of low energy and low burden environmental improvement (remediation) technology; implementation of sustainable waste management practices for treatment, handling, reuse, and ultimate residual disposition of solid wastes; nature and type of interactions in organic liquid mixtures for process engineering design applications.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",slug:"zinnat-ara-begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",biography:"Zinnat A. 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David Pan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSEI9QAO/Profile_Picture_1623656213532",institutionString:null,institution:{name:"University of Alabama in Huntsville",institutionURL:null,country:{name:"United States of America"}}},{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",fullName:"Yves Rybarczyk",profilePictureURL:"https://mts.intechopen.com/storage/users/72920/images/system/72920.jpeg",institutionString:"Dalarna University, Faculty of Data and Information Sciences",institution:{name:"Dalarna University",institutionURL:null,country:{name:"Sweden"}}}]},{id:"27",title:"Multi-Agent Systems",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",annualVolume:11423,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"275140",title:"Dr.",name:"Dinh Hoa",middleName:null,surname:"Nguyen",fullName:"Dinh Hoa Nguyen",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRbnKQAS/Profile_Picture_1622204093453",institutionString:null,institution:{name:"Kyushu University",institutionURL:null,country:{name:"Japan"}}},{id:"20259",title:"Dr.",name:"Hongbin",middleName:null,surname:"Ma",fullName:"Hongbin Ma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRhDJQA0/Profile_Picture_2022-05-02T08:25:21.jpg",institutionString:null,institution:{name:"Beijing Institute of Technology",institutionURL:null,country:{name:"China"}}},{id:"28640",title:"Prof.",name:"Yasushi",middleName:null,surname:"Kambayashi",fullName:"Yasushi Kambayashi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYOQxQAO/Profile_Picture_1625660525470",institutionString:null,institution:{name:"Nippon Institute of Technology",institutionURL:null,country:{name:"Japan"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/416628",hash:"",query:{},params:{id:"416628"},fullPath:"/profiles/416628",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()