Pre-test likelihood of CAD in symptomatic patients according to age and sex.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"3823",leadTitle:null,fullTitle:"Epilepsy Topics",title:"Epilepsy Topics",subtitle:null,reviewType:"peer-reviewed",abstract:"An international group of recognised experts has contributed to this volume to discuss a variety of topics on epilepsy. 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El-Shemy",coverURL:"https://cdn.intechopen.com/books/images_new/5612.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"54719",title:"Prof.",name:"Hany",middleName:null,surname:"El-Shemy",slug:"hany-el-shemy",fullName:"Hany El-Shemy"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"193281",title:"Dr.",name:"Fatiha",middleName:null,surname:"Brahmi",fullName:"Fatiha Brahmi",slug:"fatiha-brahmi",email:"fatiha.brahmi@univ-bejaia.dz",position:null,institution:{name:"University of Béjaïa",institutionURL:null,country:{name:"Algeria"}}},{id:"199693",title:"Prof.",name:"Khodir",middleName:null,surname:"Madani",fullName:"Khodir Madani",slug:"khodir-madani",email:"madani28dz@yahoo.fr",position:null,institution:null},{id:"199694",title:"Prof.",name:"Pierre",middleName:null,surname:"Duez",fullName:"Pierre Duez",slug:"pierre-duez",email:"pduez@umons.be",position:null,institution:null},{id:"203738",title:"Prof.",name:"Mohamed",middleName:null,surname:"Chibane",fullName:"Mohamed Chibane",slug:"mohamed-chibane",email:"chibanem@yahoo.fr",position:null,institution:null}]},book:{id:"5612",title:"Aromatic and Medicinal Plants",subtitle:"Back to Nature",fullTitle:"Aromatic and Medicinal Plants - Back to Nature",slug:"aromatic-and-medicinal-plants-back-to-nature",publishedDate:"March 15th 2017",bookSignature:"Hany A. 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\r\n\r\n\tThis book will entail design, development, and industrial applications of new and novel dyes and pigments from wide areas of organic and inorganic chemistry along with biological sciences. Besides, this book will comprise recent design and development on organic molecules and their metal-complexes towards the detection of biologically and environmentally concerned cations, anions, neutral molecules via chromogenic, fluorometric, and electrochemical signaling responses using UV/vis, emission, and electrochemical techniques. Further, the advancements in the bio-chromophores for detection of biologically vital as well as harmful ions and molecules using colorimetric changes via UV/vis technique, fluorimetric signaling through emission technique, and electrochemical changes by cyclic voltammetry (CV), LSV, etc. will also be included in this book.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"4aca0af0356d8d31fa8621859a68db8f",bookSignature:"Dr. Rampal Pandey",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10572.jpg",keywords:"Organic Probes, Metal-Complex Probes, Nano-Probes, Fluorometric Readout, Electrochemical Response, Environmentally Concerned Analytes, Bio-Chromophores, Biomolecular Detection, Multichannel Signaling Response, Absorption, Emission, Electrochemical",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 17th 2020",dateEndSecondStepPublish:"December 15th 2020",dateEndThirdStepPublish:"February 13th 2021",dateEndFourthStepPublish:"May 4th 2021",dateEndFifthStepPublish:"July 3rd 2021",remainingDaysToSecondStep:"a year",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"A leading young researcher in the chromophore, MOF, and soft material research, Appointed Associate Dean at NIT Uttarakhand, received Presidents Inspire Teacher Award, published quality international papers, registred patents, developed MOOC and e-PG Pathshala contents.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338234",title:"Assistant Prof.",name:"Rampal",middleName:null,surname:"Pandey",slug:"rampal-pandey",fullName:"Rampal Pandey",profilePictureURL:"https://mts.intechopen.com/storage/users/338234/images/system/338234.jpg",biography:"Dr. Rampal Pandey currently works as Senior Assistant Professor and Associate Dean (Faculty Welfare) at the Department of Chemistry, NIT Uttarakhand. He is an active researcher in the field of Supramolecular Chemistry, Porous functional materials, Inorganic and Organometalic Chemistry. He has been recognized as the President's Inspired Teacher, International Outstanding Scientist, and DST-INSPIRE Faculty. He is a member of the American Chemical Society (ACS), Royal Society of Chemistry (RSC), Chemical Research Society of India (CRSI), Society of Material Chemistry of India (SMC), Solar Energy Society of India (SESI), and Indian Society of Chemists & Biologists (ISCB). Dr. Pandey has over 45 internationally reputed publications, 2 Patents in chemical sensing, and over 10 invited talks in person. He is Section Editor (Inorganic Chemistry) of Current Indian Science (Bentham Science), Guest Editor-Frontiers in Chemistry, reviewers of many international journals, Coordinator for MOOC programs, and has organized several conferences and workshops.",institutionString:"National Institute of Technology Uttarakhand",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"8",title:"Chemistry",slug:"chemistry"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"252211",firstName:"Sara",lastName:"Debeuc",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/252211/images/7239_n.png",email:"sara.d@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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While scan times and consecutively temporal resolution, enhanced rapidly it has become a more accurate noninvasive imaging method for cardiac morphology. The first attempts in using CT to visualize coronary arteries have been made in the early 1980s and were followed by the back then newly emerging electron beam computed tomography (EBCT), which already had scan times lower than 100 ms [1]. Clinical relevance of the coronary CT angiography (cCTA) increased distinctly with the introduction of multi detector CT (MDCT) in the late 1990s—initially with four parallel detectors, the launch of the 64-slice MDCT generation enabled cCTA to become established in routine clinical practice [2, 3]. Nowadays, there are systems with up to 320-slices in clinical use, providing even lower scan times and a very high spatial resolution. Another landmark development was the introduction of the dual-source CT (DSCT) technology. DSCT contains of two tubes and detectors arranged in a 90° angle, also resulting in a higher temporal resolution due to the halved rotation time. The dual-energy CT (DECT) scans allow two different tube voltages, resulting in a significant lower radiation exposure for the patient [4]. As spatial and temporal resolution achieved remarkable dimensions, recent technologic improvement emphasized particularly the reduction of radiation dose on the one hand (see Section 3.1) [5], and the expansion of cCTA on additionally functional and morphological aspects, e.g., plaque characterization, myocardial perfusion imaging, or even CT-based fractional flow reserve (CT-FFR).
\nDespite its many advantages, cCTA is only one out of many clinically approved methods to examine coronary arteries. Although there are notable technical developments in evaluating functional parameters as well [6–8], the current indication is predominantly the investigation of anatomical and morphological vessel characteristics. Especially in the exclusion of coronary artery disease (CAD), cCTA plays a decisive role [9–11]. Patients presenting with symptoms of CAD and low-to-intermediate risk patients undergo rapid evaluation of their coronary arteries. To estimate the suitable method for the individual patient, pre-test risk-stratification calculation plays a key role. For this purpose, Diamond-Forrester (Table 1) [12] and Genders (Table 2) [13] are well-established charts to obtain a pre-test probability of CAD based on age, sex, and chest pain constellation. However, further established cardiovascular risk factors such as smoking, dyslipidemia, hypertension, diabetes, and family history of cardiac diseases should be considered in the risk stratification as well. Depending on the individual risk constellation, cCTA may be the suitable modality in low-to-intermediate risk patients, as for high-risk patients, invasive coronary angiography remains still the gold standard, as recommended by the ESC/AHA/ACC guidelines [9, 10]. Due to the three-dimensional visualization that can be constructed by cCTA, it can also be even used in planning and evaluating coronary artery bypass grafts (CABG) and detecting in-stent restenosis (ISR).
\ncCTA is excellent in visualizing coronary morphology and has emerged to an appropriate method of ruling out obstructive CAD. But by cCTA alone, the pathophysiological relevance of a detected CAD remains often unclear. Despite the remarkable advancements regarding functional parameters as for example perfusion imaging achieved by new DECT approaches, many conventional cCTAs show a rather moderate specificity regarding the functional assessment of cCTA measured stenosis. The methodical approach, as proposed by the SCCT guidelines for the interpretation and reporting of cCTA, consists of a systematic inspection of each coronary segment in multiple planes, the contemplation of image quality and artifacts and finally the evaluation of the respective lesions in regard of morphology, composition, and stenosis severity. A modified version of the well-established 1975 American Heart Association (AHA) model is used to refer to the certain segments [14]. Coronary abnormalities, plaque description or insufficient interpretability due to artifacts should be mentioned. Following this, a qualitative assessment for each segment is obtained and should be reported according to Table 3. Subsequently, a quantitative assessment of the stenosis severity is performed; the findings should be reported according to Table 4.
\n\n | Non-anginal chest pain | \nAtypical angina | \nTypical angina | |||
---|---|---|---|---|---|---|
Age | \nMen | \nWomen | \nMen | \nWomen | \nMen | \nWomen |
5.2 ± 0.8 | \n0.8 ± 0.3 | \n21.8 ± 2.4 | \n4.2 ± 1.3 | \n69.7 ± 3.2 | \n25.8 ± 6.6 | |
14.1 ± 1.3 | \n2.8 ± 0.7 | \n46.1 ± 1.8 | \n13.3 ± 2.9 | \n87.3 ± 1.0 | \n55.2 ± 6.5 | |
21.5 ± 1.7 | \n8.4 ± 1.2 | \n58.9 ± 1.5 | \n32.4 ± 3.0 | \n92.0 ± 0.6 | \n79.4 ± 2.4 | |
28.1 ± 1.9 | \n18.6 ± 1.9 | \n67.1 ± 1.3 | \n54.4 ± 2.4 | \n94.3 ± 0.4 | \n90.6 ± 1.0 |
Pre-test likelihood of CAD in symptomatic patients according to age and sex.
Each value represents the percentage ± 1 standard deviation. Adapted from Diamond et al. [12].
\n | Non-anginal chest pain | \nAtypical angina | \nTypical angina | |||
---|---|---|---|---|---|---|
Age | \nMen | \nWomen | \nMen | \nWomen | \nMen | \nWomen |
17.7 | \n5.3 | \n28.9 | \n9.6 | \n59.1 | \n27.5 | |
24.8 | \n8.0 | \n38.4 | \n14.0 | \n68.9 | \n36.7 | |
33.6 | \n11.7 | \n48.9 | \n20.0 | \n77.3 | \n47.1 | |
43.7 | \n16.9 | \n59.4 | \n27.7 | \n83.9 | \n57.7 | |
54.4 | \n23.8 | \n69.2 | \n37.0 | \n88.9 | \n67.7 | |
64.6 | \n32.3 | \n77.5 | \n47.4 | \n92.5 | \n76.3 |
Updated pre-test likelihood of CAD in symptomatic patients according to age and sex.
Adapted from Genders et al. [13].
0 | \nNormal | \nAbsence of plaque and no luminal stenosis |
1 | \nMinimal | \nPlaque with negligible impact on lumen |
2 | \nMild | \nPlaque with mild narrowing of the lumen |
3 | \nModerate | \nPlaque with moderate stenosis that may be of hemodynamic significance |
4 | \nSevere | \nPlaque with probable flow limiting disease |
5 | \nOccluded | \n
Descriptors of qualitative stenosis severity.
According to SCCT guidelines.
0 | \nNormal | \nAbsence of plaque and no luminal stenosis |
1 | \nMinimal | \nPlaque with <25% stenosis |
2 | \nMild | \n25–49% stenosis |
3 | \nModerate | \n50–69% stenosis |
4 | \nSevere | \n70–99% stenosis |
5 | \nOccluded | \n100% stenosis |
Descriptors of quantitative stenosis severity.
According to SCCT guidelines.
It has to be mentioned that these classifications are founded on morphological features only and, based on these findings, conclusions about functional or ischemic insufficiencies are not to be inferred.
\nDue to the limited spatial resolution of the first electronic beam CT, it was initially not possible to visualize of the stented lumen and an indirect approach was applied to assess the stent patency. For this reason, contrast density was measured distally to the stent and compared with the density pattern proximal to the stented segment, in the aorta or the left ventricle, while stent patency was assumed when the contrast enhancement matched [15].
\nWith the introduction of 64-slice scanners, a high negative predictive value could be reached for the evaluation of in-stent restenosis, while the positive predictive value is still rather worse as demonstrated by meta-analysis [16, 17]. However, there are specific technical limitations such as blooming caused by metal artifacts resulting in an underestimation of the stent lumen.
\nThe value of cCTA in the assessment of coronary artery bypass graft (CABG) and native coronary arteries after bypass graft surgery continues to grow with advances in CT technology [18, 19]. The improvement of spatial resolution allows the cardiovascular radiologist and cardiac surgeon to evaluate the patency of CAGB in a rapid and noninvasive manner [20]. The major advantage of cCTA over invasive angiography is the ability to simultaneously evaluate for alternate postoperative complications like malposition, kinking, or pericardial effusion.
\nThe main benefit of cCTA is its noninvasive character. Although invasive coronary angiography (ICA) is an approved and secure procedure, it still involves the possibility of serious complications such as bleeding, stroke, or coronary dissection [6]. In comparison, the risks of cCTA, such as extravasation or allergic reaction to the contrast agent are less severe and common. As previously mentioned, cCTA is able to rule out CAD with excellent sensitivity and negative predictive value, both up to 99% in several studies [9, 21, 22]. Therefore, a preceding cCTA can reduce the share of unnecessarily performed ICA [11]. On the other hand, currently, the moderate specificity of cCTA causes a following ICA to validate the findings [9]. Recent developments seek to solve this issue. Further limitations result from technical conditions of computed tomography:
\nAlthough the temporal resolution has achieved levels below 80 ms, it is still necessary for the patient to maintain a heart frequency under 70 beats per minute to obtain a sufficient image quality. This might be accomplished using beta-blockers, but not all patients are suitable for auxiliary agents. Regarding patients who are unable to follow breathing orders, but especially patients with cardiac arrhythmias, prospectively electrocardiogram (ECG)-triggered images are prone to artifacts. New approaches in ECG triggering seek to react flexibly to arrhythmia but have to be implemented in the clinical routine. Retrospectively ECG-gated image acquisition is less interference-prone, but is along going with higher radiation doses. ECG-dependent dose reduction is required. Furthermore, a high coronary calcification or iatrogenic metallic material may lead to so-called blooming or streak artifacts, which tend to over-estimate the severity of stenoses [23, 24]. A better temporal resolution, acquired e.g., by using DSCT allows reduction of blooming artifacts. Radiation dose represents another important disbenefit of cCTA, which is explained later in detail.
\nSince its introduction into clinical use, a constantly mentioned point of criticism of cCTA is the radiation the patient is exposed to. While referring to this topic, one should distinguish the terms “radiation exposure,” which describes the radiation emitted by the X-ray source, and “radiation dose,” which indicates the amount of radiation absorbed by the patient [25]. The early concerns were not unjustified, as the novel scanners with 16 or 64 slices showed radiation doses above 10 mSv, even up to 21 mSv [26, 27], and radiation resulting of CT examinations make up a large share of the populations radiation exposure [28]. But subsequently, a substantial reduction of the applied radiation doses was achieved by different approaches: cCTA images are usually acquired using retrospective ECG gating, which requires a lower pitch and a longer duration, resulting in higher doses than prospective ECG triggering. Dose reduction is acceived using ECG gating or implementation of suitable ECG-triggering protocols. The first option is realized through ECG-dependent tube current modulation. The best image quality is obtained in the late-diastolic phase of the heart cycle; therefore, the tube current can be decreased in the remaining phase, resulting in a radiation dose lowered up to 50% [29, 30]. Under certain circumstances, it is possible to perform cCTA by prospective ECG triggering and sequential scanning. Patients with a low and stable heart rhythm and without an indication for functional testing are qualified for this technique in line with SCCT guidelines [31]. This attempt could reduce the radiation dose to 70–80% [29, 32]. Both options are optimal if either a scanner with 256 or more slices or a DSCT is used. Furthermore, use of DSCT enables further decrease due to its higher pitch rates at higher heart rates, since multisegment reconstruction is not necessary [33, 34]. Additional reduction is accomplished by a tube voltage of 100 kV or even 80 kV instead of the usual 120 kV, which can be performed depending on the patient’s body mass [30, 31]. The image postprocessing technique of iterative reconstruction (chapter 3.2) also contributes to reduction of radiation dose. With all these measures taken into consideration, cCTA reached radiation doses lower than 4 mSv, therefore being in the range of the average yearly background radiation dose, in certain conditions even in submillisievert range [35, 36].
\nNowadays, two methods of image reconstruction are in use, analytical filtered back projection (FBP) and iterative reconstruction (IR). The initially used technique was indeed the more complex IR [37], but soon its use was limited by the computational power of erstwhile processors. The method was displaced by FBP, which still is the most widely used technique nowadays.
\nIn FBP, the measured intensity is described as an integral function, and the reconstruction data is obtained through solution of the resulting equations, which is called back projection. Additionally, a filter component compensates low-pass signals. If a higher spatial resolution is required, the filter can be adjusted accordingly. However, this adaptation of the filter causes a higher image noise, since image sharpness and image noise are proportional [38].
\nIR seeks to solve this problem, and since nowadays, not only CT hardware but also software underwent enormous advances, complex computational operations are more and more available. Iterative reconstruction accomplishes the back projection through the comparison of two components; a simulated first image estimation on the one hand and the actual measured projection on the other hand. Both images are automatically compared and, in case of discrepancy, the estimation is altered and another comparison is made until a default condition is achieved [38]. The underlying complex mathematical algorithms are propriety of the respective companies. Not only was IR able to break the correlation between image noise and spatial resolution, but it does so while simultaneously reducing the applied radiation dose up to 40–70%, while maintaining or even increasing subjective image quality and diagnostic accuracy [39–42].
\nThe first attempts in evaluating atherosclerotic plaques via CT have already been made 1985 [43], but this approach did not gain acceptance due to insufficient resolution and image quality. Nowadays, with a spatial resolution up to 400 μm, noninvasive detection and characterization of atherosclerotic lesion and plaque characteristics can be performed by current CT scanners. Although intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide even higher spatial resolutions up to 80 and 20 μm, respectively [44], and therefore are the reference standard, cCTA yields the advantage of its noninvasive character. This technique enables an evaluation and characterization of the individual plaque extent and composition in patients without the clear indication for invasive measures. Recent studies have shown the ability of cCTA to perform on a high level in comparison with earlier mentioned reference standards, thus making cCTA a promising noninvasive method in identifying high-risk atherosclerotic coronary plaques [45–47]. Plaque characterization is essential in risk stratification in patients with suspected or diagnosed CAD or ACS, hereby it is important to distinguish the terms “stable” and “vulnerable” plaque (Figure 2). The hazard in stable plaques, consisting mainly of calcifications, lies in their subsequent obstruction of vessel lumen, associated with hemodynamic insufficiency, whereas vulnerable plaques tend to rupture and can lead to occlusion of the affected vessel through the thrombogenic lesion [48]. The finding that major adverse cardiac events (MACEs) are a consequence of the hemodynamically insignificant vulnerable plaques in more of two-thirds has been already made in the end of the last century [49, 50], but only now it is possible to detect morphological correlates
59-year-old female with known hypertension presenting with chest pain. (I) cCTA show several moderate stenoses of the LAD (arrows).
cCTA shows stenotic noncalcified plaque of the LAD.
Due to high sensitivity and negative predictive value [54, 55], cCTA is at present an accepted diagnostic tool in detecting CAD in patients with low pretest probability [9]. However, the major limitation of cCTA remains in its low specificity and positive predictive value and the missing correlation of detected lesions and their physiological significance [56–58].
\nChallenge for novel diagnostic methods is to provide data about the anatomical and functional assessment of coronary stenosis. Myocardial perfusion derived from computed tomography (CTMP) is a recent instrument in diagnosis of ischemia. Compared to other functional tests, CTMP offers the substantial advantage that it is performed during ordinary cCTA. CTMP is a “one-stop shop” approach to close the gap between anatomical and functional assessment within a single imaging and could additionally limit false-positive results of cCTA [6].
\nUnderlying principles of CTMP is the distribution and enhancement of iodinated contrast agent within the myocardium. The iodinated contrast agent is used as an indicator for myocardial blood flow and myocardial blood volume, based on the principles of the indicator-dilution theory. Myocardial areas with reduced amounts of contrast agent are indicating perfusion defects [59].
\nLike other functional imaging methods, ordinary acquisition of CTMP consists of three sequences: a rest acquisition, an acquisition under pharmacological stress, and an acquisition of late enhancement. This approach is used to evaluate the reversibility of the ischemia [6].
\nAdenosine is used during the pharmacological stress acquisition for dilation of the coronary arteries with a dose ratio of 140 μg kg−1 min−1. This leads to a decrease of the perfusion pressure. However, compensatory dilatation of obstructed arteries is limited. Reversible ischemia is the result of decreased perfusion reserves within these vessels. This pathophysiological phenomenon is called the “steal-effect.” After 2–3 min of continuous administration of adenosine with monitoring of ECG, pulse oximetry, and blood pressure, iodinated contrast agent is injected and image acquisition starts [6]. Beyond the application of iodinated contrast agent during rest and stress acquisition and adenosine during stress acquisition, beta blockers, and nitrates were administered immediately before the examination to avoid motion artifacts and to improve image quality [59]. Contraindication (e.g., contrast agent allergy, severe COPD, severe aortic valve stenosis) should be taken into consideration regarding suitability of the patient. After 5–10 min of administration of contrast agent, a delayed acquisition can provide information about nonviable myocardium [6]. Myocardial areas of ischemia or infarction are described based on the American Heart Association segmental model [14].
\nRegarding comparability of studies and deeper understanding, it should be noted that there is a static myocardial blood pool imaging method during first pass and apart from it a dynamic myocardial perfusion method over several time points of myocardial iodine distribution. Development in computed tomography offers with dual-energy CT a further static perfusion method. For example, differences between these techniques apply on the direct assessment of quantitative perfusion parameters or radiation exposure [6, 60].
\nRadiation dose of a comprehensive protocol containing rest, stress, delayed enhancement, and calcium scoring have generally been reported in the range of 12–14 mSv. This is comparable to the radiation dose during SPECT examination [6]. Modified protocols in research contain considerably lower radiation. Feuchtner et al. achieved high accuracy (sensitivity 96%, specificity 88%, PPV 93%, and NPV 94%) in a stress approach and reported radiation dose of 2.5 mSv for cCTA and perfusion imaging with pharmacological stress [61]. Radiation doses for CTMP can be expected to decrease further, as radiation doses <1 mSv on cCTA studies are still state of the art [61].
\nAs mentioned in the introduction of this chapter, CT myocardial perfusion offers additional functional data of the myocardial blood supply. In contrast, ordinary cCTA only provides anatomical evaluation of the heart. Combined cCTA plus CTMP provides incremental diagnostic value compared with cCTA alone to assess the status of the myocardial blood supply and for the detection of significant coronary stenosis [6, 57, 58].
\nCompared with other functional noninvasive methods such as single photon emission computed tomography (SPECT) or cardiac magnetic resonance perfusion imaging (cMRI), CTMP is a recent technology.
\nSPECT is a nuclear imaging technique with tracer substances, such as thallium-201 or technetium-99. Myocardial enhancement of this tracer differs in damaged myocardium. A rotating gamma camera enables three-dimensional tomographic reconstruction [6]. According to current guidelines of the American Heart Association and American College of Cardiology, SPECT is used for the diagnosis of CAD, risk stratification, myocardial viability, and left ventricular function [62]. Rest and stress SPECT acquisitions allow evaluation of ischemic reversibility.
\nCardiac magnetic resonance imaging (cMRI) offers anatomical information and a variety of functional aspects, such as assessment of myocardial perfusion during rest and stress acquisition and myocardial viability. SPECT has lower temporal and spatial resolution than cMRI [6]. The large CE-MARC trial led to higher sensitivity with cMRI than with SPECT and postulated cost-effectiveness and more use of this method [63, 64]. Patients with devices such as cardiac pacemakers or internal cardiac defibrillator (ICD) are often associated with great effort, regarding cMRI requirements. For patients with a tendency to claustrophobia, cMRI is potentially not the adequate examination due to long acquisition time [65]. On the other hand, cMRI is advantageous because of no ionizing radiation.
\nCT myocardial perfusion or other functional techniques are not reasonable in each clinical question compared to ordinary cCTA for ruling out CAD. In a situation of acute chest pain in a patient with low pretest probability of CAD, an extensive stress examination (irrespective of the imaging technique) is potentially not indicated due to prolonged examination. The availability in case of short-term request of such a comprehensive examination represents a further doubtful aspect in the clinical setting. However, CT myocardial perfusion has the potential to overcome these obstacles.
\nMyocardial perfusion derived from computed tomography is a growing diagnostic method that provides a comprehensive evaluation of coronary artery disease along with functional assessment of the myocardium with promising findings in current clinical studies. Combining cCTA with CTMP significantly improves specificity and positive predictive value [57, 58].
\nThe multicentre DECIDE-Gold trial [66] might contribute in establishment myocardial perfusion within the clinical setting. Focus of current research is, e.g., the order and general need of all three sequences in times of modern dual energy computed tomography scanners. Meinel et al. postulates a dual energy rest-stress approach as protocol of choice. Furthermore, he achieves excellent sensitivity and specificity in a rest-only approach [67]. This would represent substantial advantage for the patient. Functional situation of myocardial blood supply could be derived simultaneously from ordinary coronary computed tomography angiography within the same examination, without additional radiation, drugs or prolonged examination.
\nCT myocardial perfusion imaging offers great potential to reclassify findings in cCTA and to evaluate the myocardial blood supply [68]. Regarding risk of invasive coronary angiography [69], an initial noninvasive diagnostic selection would be desirable to reduce invasive angiograms, showing no obstructive CAD. Addition of CTMP to cCTA holds highly promising potential to adopt this role and to establish CT as a single imaging examination for comprehensive evaluation of CAD and direct assessment of myocardial ischemia in one examination (Figure 1).
\nThe invasive measurement of the fractional flow reserve is currently the accepted reference standard to determine, whether a coronary stenosis is hemodynamically relevant and is therefore implemented in the guidelines [70]. The FAME study has proved that FFR guided coronary revascularization is associated with reduced rates of death, myocardial infarction or target vessel revascularization [71]. In clinical routine, the use of invasive FFR is associated with risks and complications such a severe bleeding, arrhythmia, stroke, and coronary dissections depending on the experience of the interventional cardiologist [72].
\nNovel technologies have been developed to calculate noninvasive FFR from routine cCTA datasets using computational fluid dynamics. The main advantage of this technology is the markly improvement of specificity and positive predictive value compared to standard cCTA, without additional stress medication, image protocols, and radiation exposure (Table 5). While the first studies concentrated on the general feasibility and diagnostic performance, further clinical studies validated the cost-effectiveness. The PLATFORM-study showed that the numbers of patients without anatomically obstructive CAD (
\n | Koo et al. (DISCOVER-FLOW) [77] | \nMin et al. (DeFACTO) [78] | \nNørgaard et al. (NXT-Trial) [79] | \nRenker et al. [80] | \nCoenen et al. [81] |
---|---|---|---|---|---|
159 | \n407 | \n484 | \n67 | \n189 | |
66/159 [25] (41.5%) | \n150/407 [26] (36.9%) | \n235/484 (48.6%) | \n39/67 (58.2%) | \n144/189 (76.2%) | |
87.9 (76.7–95.0) [91.4 (81.0–97.1)] | \n80 (73–86) [N.A.] | \n84 (75–89) [83 (74–89)] | \n85 (62–97) [90 (68–98)] | \n87.5 (78.2–93.8) [81.3 (71.0–89.1)] | |
82.2 (73.3–89.1) [39.6 (30.0–49.8)] | \n61 (54–67) [N.A.] | \n86 (82–89) [60 (56–65)] | \n85 (72–94) [34 (21–49)] | \n65.1 (55.4–74.0] [37.6 (28.5–47.4)] | |
73.9 (61.9–83.7) [46.5 (37.1–56.1)] | \n56 (49–62) [N.A.] | \n61 (53–69) [33 (27–39)] | \n71 (49–87) [37 (23–52)] | \n64.8 (55.0–73.8)] [48.9 (40.1–57.7)] | |
92.2 (84.6–96.8] [88.9 (75.9–96.3)] | \n84 (78–89) [N.A.] | \n95 (93–97) [92 (88–95)] | \n93 (81–98) [89 (65–98)] | \n87.7 (78.5–93.9) [73.2 (59.7–84.2)] | |
84.3 (77.7–90.0) [58.5 (50.4–66.2)] | \nN.A. [N.A.] | \n86 (83–89) [65 (61–69)] | \nN.A. [N.A.] | \n74.6 (68.4–80.8) [56.1 (49.0–63.2)] | |
0.90 (N.A.) [0.75 (N.A.)] (p = 0.001) | \nN.A. [N.A.] | \n0.93 (0.91–0.95) [0.79 (0.74–0.84)] (p <0.001) | \n0.92 (N.A.) [0.72(N.A.)] (p <0.005) | \n0.83 (N.A.) [0.64 (N.A.)] (p <0.001) |
Diagnostic accuracy of CT-FFR and cCTA compared to invasive FFR as the reference standard on a per vessel (n = 1306) basis.
CT-FFR <0.80 (95% CI) und cCTA stenosis ≥50% (95% CI) [in brackets] were defined as cut-off values. AUC, area under the curve; cCTA, coronary CT-angiography; CT-FFR, CT-based FFR; FFR, Fractional flow reserve; N.A., not available; NPV, negative predictive value; PPV, positive predictive value.
There are the first head-to-head comparisons of CT-FFR compared stress CT myocardial perfusion (CTP) in patients with CAD with a per-vessel specificity of was 66% for cCTA, 77% for CT-FFR, and 91% for CTP, respectively, while the diagnostic performance of cCTA alone was significantly improved by combination with CT-FFR or CTP [74]. Meta-analysis shows that CT-FFR can act in the context of other myocardial perfusion modalities as a potential gatekeeper for invasive revascularization (Table 6) in patients with suspected or known CAD using invasive FFR as the reference standard [75]. Due to time-consuming off-site calculation and transfer of the datasets to external core laboratory the clinical impact is limited. Thus, a novel solution for physician-driven CT-FFR derivation using regular on-site workstations was developed. This CT-FFR algorithm applies reduced-order models for more expeditious calculation, but is currently not commercially available [76].
\n\n | CT-FFR | \nCT-perfusion | \nSPECT | \nPET | \nMRT |
---|---|---|---|---|---|
714 | \n1074 | \n924 | \n870 | \n1830 | |
0.83 (0.79–0.87) | \n0.78 (0.72–0.82) | \n0.61 (0.56–0.66) | \n0.83 (0.77–0.88) | \n0.87 (0.84–0.90) | |
0.77 (0.74–0.80) | \n0.86 (0.83–0.88) | \n0.84 (0.81–0.87) | \n0.89 (0.86–0.91) | \n0.91 (0.89–0.92) | |
3.76 (2.17–6.54) | \n5.74 (3.48–9.46) | \n3.76 (2.74–5.16) | \n7.43 (5.03–10.99) | \n8.27 (4.93–13.87) | |
0.23 (0.16–0.35) | \n0.22 (0.12–0.39) | \n0.47 (0.37–0.59) | \n0.15 (0.05–0.44) | \n0.16 (0.13–0.21) | |
N.A. | \n0.91 (0.86–0.96) | \n0.83 (0.67–0.98) | \n0.95 (0.91–0.99) | \n0.95 (0.93–0.97) |
Diagnostic accuracy of CT-FFR and other non-invasive modalities compared to invasive FFR.
Currently, CT-FFR is an interesting and sophisticated approach to identify functionally significant CAD in a noninvasive way. However, this promising technique is still in development and searching for its clinical application, and further evidence studies are necessary before CT-FFR is implemented for clinical use.
\nCardiovascular diseases (CVDs) are the major cause of death globally, which takes an estimated 17.9 million lives per year based on the World Health Organization (WHO) statistics. Especially, arrhythmia has a strong clinical correlation with sudden cardiac death (SCD) [1]. The irregular heart rhythm called arrhythmia can mainly be divided into two main types: tachycardia arrhythmia and bradycardia arrhythmia. As shown in Figure 1, the tachycardia and bradycardia arrhythmia represent the heart beats too fast and slow, respectively. The physical treatment for tachycardia and bradycardia syndrome required a regulator to suppress the abnormal heart rhythm. The implantable cardiac pacemaker is commonly applied in the cardiac modulation that generates the electrical stimulation pulse to regulate the heart’s sinoatrial node, thus obtaining the normal rhythm.
Heart rhythm is divided into normal rhythm, tachycardia arrhythmia, and bradycardia arrhythmia.
As shown in Figure 2, the cardiac pacemaker would be activated once the heart detector measures the abnormal cardiac rhythm. Thus, the stable operation of a cardiac pacemaker is important for adverse patients, thus providing prompt treatment in arrhythmia.
Schematic of the detection and treatment system for cardiac arrhythmia.
Epilepsy is a neurological disorder that can induce the brain activities abnormal, causing seizures and further loss of awareness suddenly [2, 3, 4]. According to WHO statistics, epilepsy is a chronic non-communicable brain disease that affects humans of all ages, around 50 million globally, becoming one of the most common neurological diseases worldwide. The risk in the death probability of epilepsy patients is up to three times higher than healthy people. In epilepsy diagnosis, Electroencephalogram (EEG) is the most common non-invasive approach to record the brain’s electrical activity and identify the measured signals, whether it is epilepsy or not [5]. In addition, the imaging-based diagnosis of computed tomography (CT) [6], positron emission tomography (PET) [7], and MRI [8] can help further examining brain-tumor-induced epilepsy. In epilepsy treatment, an vagus nerve stimulator is the common physical approach implanted near the left chest area, as shown in Figure 3. The electrode is attached around the vagus nerve in the neck to generates the electrical pulses to the brain via the vagus nerve. The delay time more than 10 minutes from seizure onset would increase mortality, which emphasizes the importance of timely treatment and time and medical emergency [9]. Therefore, high reliability is crucial for vagus nerve stimulation (VNS) during incidental neurological disease. Moreover, VNS is also widely applied in significant disease treatment, including cardiac function [10], depression [11], anxiety [12], Parkinson’s disease [13], and Alzheimer’s disease [14].
Schematic of vagus nerve stimulation and its installations.
The electromagnetic interference (EMI) in the implantable medical device can be produced by the external source with the combined electric and magnetic fields [10, 15], as shown in Figure 4. EMI is due to radiation that can be through the air from many possible sources (Table 1) in our daily life [17, 18, 19, 20], including the common consumer device such as mobile phones, radio frequency identification (RFID) based systems, and microwaves. Moreover, the medical procedure-induced EMI is a critical concern. For example, dental equipment and magnetic resonance imaging (MRI) can generate EMI. In particular, the MRI equipment can cause a strong EMI that is very hard to guard against. The MRI machine can produce an intense magnetic field of about two or three teslas that are dangerous to any electronic device. The electromagnetic susceptibility (EMS) is frequently used to define immunity for EMI, which implies the degree of electronic system malfunctions under varying levels of EMI. Therefore, electromagnetic compatibility (EMC) in implantable medical devices such as cardiac pacemakers and vagus nerve stimulators is important to sustain the stable and normal function to treat accidental cardiac issues because humans are always surrounded by electrical equipment [21, 22].
EMI in medical devices from external sources with time-varying electrical and magnetic fields such as base station, radar, mobile device, and microwave oven [
Home environment |
Mobile phone (RF) |
Microwave oven (Microwave) |
Remote controller (RF) |
Refrigerator (ELF) |
Electric razor (ELF) |
Outdoor environment |
Radar (Microwave) |
Base station (Microwave) |
High voltage power lines (ELF) |
Medical environment |
Magnetic resonance image machine (RF) |
Radio-based therapy (RF) |
Ionizing-based radiation therapy (X-ray) |
Defibrillation (ELF) |
Lithotripsy (ELF) |
Industrial environment |
Transformer (ELF) |
High voltage power lines (ELF) |
Electric motor (ELF) |
Radiofrequency identification (RF) |
EMI sources from home, outdoor, medical, and industrial environments.
The EMI shield is designed to decrease the electromagnetic (EM) wave transmission using a shield to increase the reflection or absorption of EM wave incident at the interfaces between different mediums. As shown in Figure 5, the electric and magnetic fields of EM waves are perpendicular to each component and the EM propagation direction, which can be expressed as phasor form [23], according to Eqs. (1) and (2). Where γ, α, β are the propagation, attenuation, phase constants of the medium, respectively; E0 and H0 are the amplitude of the electric and magnetic fields.
Time-varying EM waves and the propagation, transmission, and reflection of the EM waves in different mediums.
The EM wave propagates at the interface of two different mediums that induce reflection due to impedance mismatching. The reflection coefficient (R12) and transmission coefficient (T12) at the interface between two mediums can be determined, according to Eqs. (3) and (4). Ei, Er, η1, η2 represent incident, reflected electric fields, impedances in Medium 1 and Medium 2, respectively. The impedance in the medium can be defined by a ratio of electric field and magnetic field, which is related to the permittivity (ε), permeability (μ), and conductivity (σ), according to Eq. (5).
The time-domain electric field can be rewritten as Eq. (6), according to Eq. (1).
When the EM wave propagates in the conductive shield (loss medium) at a time of zero, the expression between the distance and amplitude of the electric field can be obtained, according to (7).
Figure 6 demonstrates the EM wave propagation in the conductive shield. The skin depth (δ) can be defined as that penetration distance at which the intensity of the electric field attenuates to 1/e of the original incident wave intensity. According to the Eqs. (8) and (9), the skin depth (δ) is the reciprocal of attenuation constant (α), which is related to the EM operating frequency, permeability (μ), and conductivity (σ) in the medium [10].
Schematic of skin depth of EM waves using the shield.
Thus, conductivity and permeability in shielding design play an important role in EM wave absorption enhancement, thus increasing the overall EMI shielding effectiveness.
However, the implantable medical device is not a fully closed system that must require the openings of the shield to interact with external equipment such as body sensing devices for signal transmit or receive. In some cases, the external controlled magnetic fields or electrical signals can be utilized to externally modulate the stimulation protocol of implantable medical devices according to patients’ clinical requirements. So, the selective filtering of EMI waves is important for implantable medical devices to classify the noise and external signals. Thus, the EMI filter was provided in the following subsection to promote the EMC applications in implantable medical devices.
The filter implementation is also a strategy for EMI elimination in medical devices [24, 25, 26, 27]. For example, the typical ranges of P, R, T waves in ECG are 20 to 40 Hz, 18 to 50 Hz, and 0 to 10 Hz [28], as shown in Table 2.
Frequency (Hz) | Signal amplitude (mV) | |
---|---|---|
T-waves | 0–10 | 3.5 |
R-waves | 18–50 | 30 |
P-waves | 20–40 | 4.5 |
Muscle signals | 30–200 | 3.5 |
Significant frequency bandwidth of ECG waveform [28].
Filtering can be divided into active and passive modes. Active filters consist of several operational amplifiers and passive elements such as capacitors and resistors. [29, 30, 31, 32]. The active filters are applied in wide applications owing to excellent filter performance. However, the active filters need a power source to sustain the operations. Moreover, the upper frequency of active filters may be limited. Thus, the active filter is not suitable for EMI filtering in implantable medical devices. The active filter can perform programmatical filtering for the received signals, thus separating the signal from noise. However, programmatical computation requires a high-cost and complex circuit with larger power consumption to sustain the processing functions. Because the implantable devices aim to sustain life, such devices are not expected to remove or insert frequently because of extremely high costs for device failure.
Moreover, it is not easy to replace it if the devices fail due to the high risk of surgery. The concern regarding the surgery risk, which makes battery life issues more important. Owing to the battery requirements of implantable medical devices, the minimization of filters’ power is crucial to prolong the implantable device lifespan.
The capacitor-based passive filter is frequently used for most high-frequency noise in the surrounding ambient for the filter design regarding implantable medical devices. Capacitors can filter EMI noise utilizing absorption and smoothing of electromagnetic noise. The high-frequency noise attenuates as quickly as charging and discharging the capacitor-based filter. Absorbing such EMI noise to the ground will neutralize or prevent specific frequencies from passing through the circuit, as shown in Figure 7.
Filter implementation for removing the time-varying electric and magnetic fields.
The discoidal capacitor and feedthrough capacitor array were commonly utilized in the practical applications of medical devices, which deliver high-density performance with low-volume packaging [33, 34, 35], as shown in Figure 8.
The feedthrough capacitor array and discoidal capacitor for the implantable medical device.
The circular-shaped discoidal capacitor is one of the most common constructions for feed-through-style EMI filters. Circular capacitors outside and inside diameters serve as connection points for the case and the lead and serve as the capacitor poles. Moreover, several discoidal capacitors can be assembled to integrate as a capacitor array on a single piece of ceramic [36]. Such assembly offers the highest filter performance within the limited physical dimension. Thus, the feedthrough capacitor array provides the merits of the miniature dimension and lightweight within a high-density implantable device [37].
However, a feedthrough filter will have a double impact on battery life. First, a minimal amount of current always flows between the plates of the charging capacitor. Since one capacitor is processing the signal and the other capacitor is grounded, the leakage current will drain the battery over time. A strong dielectric with an appropriate thickness can resist this current flow, thereby significantly reducing battery consumption. Besides, filter design in implantable medical devices is to minimize the loss of expected signals. The filter’s insertion loss implies how much a signal will be lost or reduced for each frequency. An excellent filter requires a lower insertion loss for signal frequencies and a higher insertion loss for noise frequencies. Some energy in the expected signal will attenuate in internal resistance and inductance of the filter, which implies that the implantable battery needs optimize in the power design. Thus, an optimized design can suppress the energy loss. The less power dissipated in the battery, which extends battery life and improves effectiveness.
This chapter has demonstrated the EMC methodology for implantable medical devices. A common effective EMI removal approach was provided by EMI shielding and filtering. Such EMC design in implantable medical devices can resist EMI day-to-day exposure to ensure the stable and reliable operation in implantable medical devices such as cardiac pacemakers and vagus nerve stimulators.
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However, it is difficult to find them manually because of disturbing factors such as baseline wander and high-frequency noise. In this chapter, we propose a method based on variational autoencoder to distinguish these distortions automatically and efficiently. We test our method on three ECG datasets from Physionet by adding some tiny artificial distortions. 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Furthermore, the research will suggest two algorithms to calculate the 67 measurements with precision; assuming that the algorithms output will be used as guideline to human body modelers in simulation, gaming, plastic surgery, as well as the world of biometrics or wherever human body measurements and calculations is needed like prosthetic limbs, spatial design, and machine learning of human biometrics. Furthermore, building proportional models creates visual harmony in measurements and visual parity model. Hence, the chapter facilitates and explains for the human modeler the process of human modeling from within an algorithm. This research is an expanded work based on two published conference papers listed in the references section.",book:{id:"6563",slug:"machine-learning-and-biometrics",title:"Machine Learning and Biometrics",fullTitle:"Machine Learning and Biometrics"},signatures:"Evon Abu-Taieh and Hamed S. 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One of the primary data analysis tasks for gene expression studies involves data-mining techniques such as clustering and classification. Clustering, which is an unsupervised learning technique, has been widely used as a computational tool to facilitate our understanding of gene functions and regulations involved in a biological process. Cluster analysis aims to group the large number of genes present in a sample of gene expression profile data, such that similar or related genes are in same clusters, and different or unrelated genes are in distinct ones. Classification on the other hand can be used for grouping samples based on their expression profile. There are many clustering and classification algorithms that can be applied in gene expression experiments, the most widely used are hierarchical clustering, k-means clustering and model-based clustering that depend on a model to sort out the number of clusters. Depending on the data structure, a fitting clustering method must be used. In this chapter, we present a state of art of clustering algorithms and statistical approaches for grouping similar gene expression profiles that can be applied to RNA-seq data analysis and software tools dedicated to these methods. In addition, we discuss challenges in cluster analysis, and compare the performance of height commonly used clustering methods on four different public datasets from recount2.",book:{id:"8734",slug:"applications-of-pattern-recognition",title:"Applications of Pattern Recognition",fullTitle:"Applications of Pattern Recognition"},signatures:"Ismail Jamail and Ahmed Moussa",authors:[{id:"322618",title:"Ph.D.",name:"Ismail",middleName:null,surname:"Jamail",slug:"ismail-jamail",fullName:"Ismail Jamail"},{id:"322619",title:"Dr.",name:"Ahmed",middleName:null,surname:"Moussa",slug:"ahmed-moussa",fullName:"Ahmed Moussa"}]},{id:"62526",title:"Introductory Chapter: Machine Learning and Biometrics",slug:"introductory-chapter-machine-learning-and-biometrics",totalDownloads:1131,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"6563",slug:"machine-learning-and-biometrics",title:"Machine Learning and Biometrics",fullTitle:"Machine Learning and Biometrics"},signatures:"Jucheng Yang, Yarui Chen, Chuanlei Zhang, Dong Sun Park and\nSook Yoon",authors:[{id:"220565",title:"Dr.",name:"Jucheng",middleName:null,surname:"Yang",slug:"jucheng-yang",fullName:"Jucheng Yang"}]},{id:"73909",title:"Incomplete Data Analysis",slug:"incomplete-data-analysis",totalDownloads:306,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"This chapter discusses missing-value problems from the perspective of machine learning. Missing values frequently occur during data acquisition. When a dataset contains missing values, nonvectorial data are generated. This subsequently causes a serious problem in pattern recognition models because nonvectorial data need further data wrangling before models are built. In view of such, this chapter reviews the methodologies of related works and examines their empirical effectiveness. At present, a great deal of effort has been devoted in this field, and those works can be roughly divided into two types — Multiple imputation and single imputation, where the latter can be further classified into subcategories. They include deletion, fixed-value replacement, K-Nearest Neighbors, regression, tree-based algorithms, and latent component-based approaches. In this chapter, those approaches are introduced and commented. 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He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. 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He\nreceived a short-term scholarship to carry out his post-doctoral\nstudies abroad, from Japan International Cooperation Agency\n(JICA), in coordination with the Egyptian government. Dr.\nShalaby speaks fluent English and his native Arabic. He has 77\ninternationally published research papers, has attended 15 international conferences, and has contributed to 18 international books and chapters.\nDr. Shalaby works as a reviewer on over one hundred international journals and is\non the editorial board of more than twenty-five international journals. 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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. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. 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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