Primary and secondary sonographic features of acute appendicitis.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6498",leadTitle:null,fullTitle:"Mobile Computing - Technology and Applications",title:"Mobile Computing",subtitle:"Technology and Applications",reviewType:"peer-reviewed",abstract:"Nowadays, mobile communication services are penetrating into our society at an explosive growth rate. Applications in mobile devices offer limitations, restriction, and guidelines on how mobile software can be used in order to simplify the mobile usage. As smart phones and tablets are becoming the daily computing device of choice for young ages, it is expected that mobile applications and services should be as flexible, high quality, and secure as the desktop systems. In this book, latest trends in mobile computing will be discussed. In the first section, cloud computing topics will be discussed widely into four chapters to give information to the reader about topics such as challenges, services, edge computing, and distributed clouds needed to integrate this promising issue into the next generation.",isbn:"978-1-78923-223-3",printIsbn:"978-1-78923-222-6",pdfIsbn:"978-1-83881-504-2",doi:"10.5772/intechopen.70979",price:119,priceEur:129,priceUsd:155,slug:"mobile-computing-technology-and-applications",numberOfPages:122,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"ad8ae044b3a753dcd905348a5219549c",bookSignature:"Mutamed Khatib and Nael Salman",publishedDate:"May 30th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6498.jpg",numberOfDownloads:6669,numberOfWosCitations:8,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:11,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:25,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 21st 2017",dateEndSecondStepPublish:"October 12th 2017",dateEndThirdStepPublish:"December 11th 2017",dateEndFourthStepPublish:"March 1st 2018",dateEndFifthStepPublish:"April 30th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"22273",title:"Dr.",name:"Mutamed",middleName:null,surname:"Khatib",slug:"mutamed-khatib",fullName:"Mutamed Khatib",profilePictureURL:"https://mts.intechopen.com/storage/users/22273/images/system/22273.jpeg",biography:"Mutamed Khatib received his Ph.D. Degree in Wireless and Mobile Systems from USM in 2009. His research interests are in the field of mobile networks and coding. Since 2005, he worked as an instructor in the Engineering Faculty at Palestine Technical University (Kadoorie), Tulkarm – Palestine. He was the head of telecommunication department for two years, the dean of faculty of engineering for four years, and he is now the VP for academics, and is teaching advanced courses in telecommunications and coding as an Associate Professor. 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He is an assistant professor in computer engineering at Palestine Technical University–Kadoorie (PTUK). Currently, Dr. Salman is the Dean of Admission and Registration. Dr. Salman started his job as a lecturer at PTUK in 1996. From 2000 to 2007 he worked as an instructor at Cankaya University, Turkey. In January, 2007, Dr. Salman returned to PTUK and held several academic and administrative positions. Dr. Salman has a number of publications in various international journals and refereed conference proceedings. Dr. Salman also participated as an IT consultant in several TEMPUS, QIF funded projects. His research interests include the fields of Software Engineering, Software measurement, Web Application development, Network security, and Database systems.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"536",title:"Mobile Computing",slug:"communications-and-security-mobile-computing"}],chapters:[{id:"60665",title:"Taxonomy of Cloud Lock-in Challenges",doi:"10.5772/intechopen.74459",slug:"taxonomy-of-cloud-lock-in-challenges",totalDownloads:1146,totalCrossrefCites:3,totalDimensionsCites:5,hasAltmetrics:0,abstract:"This chapter reviews key concepts and terminologies needed for understanding the complexity of the vendor lock-in problem being investigated in this book. Firstly, we present aspects of cloud computing that contribute to vendor lock-in and briefly introduce existing results from cloud-related areas of computer science that contributes to understanding and tackling vendor lock-in. Secondly, we explore the literature on proprietary lock-in risks in cloud computing environments to identify its causes (i.e., restrictions), consequences, mitigations strategies, and related challenges faced by enterprise consumers migrating to cloud-based services. Then, we propose taxonomy of cloud lock-in perspectives based on reports of real experiences on migration to understand the overall cloud SaaS migration challenges. Finally, we narrow down to our perspective on cloud lock-in to three main perspectives which takes the use of sound techniques from IS research discipline and cloud-related literature into consideration, to improve the portability, security and interoperability of cloud (and on-premise) applications in hybrid environments. Collectively, the discussions presented herein, accordingly enables both academia and IT practitioners in the cloud computing community to get an overarching view of the process of combating application and data lock-in challenges, and security risks in the cloud.",signatures:"Justice Opara-Martins",downloadPdfUrl:"/chapter/pdf-download/60665",previewPdfUrl:"/chapter/pdf-preview/60665",authors:[{id:"222657",title:"Dr.",name:"Justice",surname:"Opara-Martins",slug:"justice-opara-martins",fullName:"Justice Opara-Martins"}],corrections:null},{id:"59721",title:"Integrating Cloud Computing with Next-Generation Telematics for Energy Sustainability in Vehicular Networks",doi:"10.5772/intechopen.74460",slug:"integrating-cloud-computing-with-next-generation-telematics-for-energy-sustainability-in-vehicular-n",totalDownloads:1148,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This research focuses on new approaches to enhance the economic viability of newer hybrid/electric vehicle technology utilizing a telematic and cloud computing framework. First, an economic foundation is proposed that rewards drivers for energy efficient driver behavior in units of energy based on a predefined standard. Next, a service model is presented that allows drivers to transfer information regarding their energy efficiency through a telematic and cloud computing network. Based on existing cloud computing technology and telematic standards, a network architecture is proposed to transfer this information to service integrators and content providers that can use this information to create vehicle energy resource management capabilities for vehicle users and fleet owners. Such an architecture would enable drivers or fleet owners to redeem energy units for monetary or promotional incentives, thereby realizing more economic value for the vehicle investment.",signatures:"Matthew Liotine",downloadPdfUrl:"/chapter/pdf-download/59721",previewPdfUrl:"/chapter/pdf-preview/59721",authors:[{id:"223643",title:"Dr.",name:"Matthew",surname:"Liotine",slug:"matthew-liotine",fullName:"Matthew Liotine"}],corrections:null},{id:"60315",title:"Mobile Services Meet Distributed Cloud: Benefits, Applications, and Challenges",doi:"10.5772/intechopen.75818",slug:"mobile-services-meet-distributed-cloud-benefits-applications-and-challenges",totalDownloads:1144,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"As the explosive growth of smart devices and enormous new applications, the variety of corresponding cloud services has been growing quickly. The conventional centralized cloud was faced with an overhead on backhaul links and high latency. Accordingly, a decentralized cloud paradigm including edge computing, mobile edge computing, cloudlet, and so on, was introduced to distribute cloud services to the edge network which located in proximity to mobile devices few years ago. However, this paradigm was not paid attention at that time since cloud technology and mobile network communication were immature to motivate mobile services. Recently, with the overwhelming growth of mobile communication technology and cloud technology, distributed cloud is emerging as a paradigm well equipped with technologies to support a broad range of mobile services. The 5G mobile communication technology provides high-speed data and low latency. Cloud services can be automatically deployed in the edge networks quickly and easily. Distributed cloud can prove itself to bring many benefits for mobile service such as reducing network latency, as well as computational and network overhead at the central cloud. Besides, we present some applications to emphasize the necessity of distributed cloud for mobile service and discuss further technical challenges in distributed cloud.",signatures:"Tien-Dung Nguyen, Yunkon Kim, Xuan-Qui Pham, Tri D.T. Nguyen\nand Eui-Nam Huh",downloadPdfUrl:"/chapter/pdf-download/60315",previewPdfUrl:"/chapter/pdf-preview/60315",authors:[{id:"17491",title:"Prof.",name:"Eui-Nam",surname:"Huh",slug:"eui-nam-huh",fullName:"Eui-Nam Huh"},{id:"226813",title:"Dr.",name:"Tien-Dung",surname:"Nguyen",slug:"tien-dung-nguyen",fullName:"Tien-Dung Nguyen"},{id:"239290",title:"Mr.",name:"Yunkon",surname:"Kim",slug:"yunkon-kim",fullName:"Yunkon Kim"},{id:"239291",title:"Mr.",name:"Xuan-Qui",surname:"Pham",slug:"xuan-qui-pham",fullName:"Xuan-Qui Pham"},{id:"239292",title:"Mr.",name:"Tri",surname:"Nguyen",slug:"tri-nguyen",fullName:"Tri Nguyen"}],corrections:null},{id:"60636",title:"Reliable Web Service Consumption Through Mobile Cloud Computing",doi:"10.5772/intechopen.74461",slug:"reliable-web-service-consumption-through-mobile-cloud-computing",totalDownloads:865,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The mobile intermittent wireless connectivity limits the evolution of the mobile landscape. Achieving web service reliability results in low communication overhead and correct retrieval of the appropriate state response. In this chapter, we discuss and analyze two approaches based on middleware approach, Reliable Service Architecture using Middleware (RSAM), and Reliable Approach using Middleware and WebSocket (RAMWS). These approaches achieve the reliability of web services consumed by mobile devices and propose an enhanced architecture that achieves the reliability under various conditions with minimum communication data overhead. In these experiments, we covered several cases to prove the achievement of reliability. Results also show that the request size was found to be constant, the response size is identical to the traditional architecture, and the increase in the consumption time was less than 5% with the different response sizes.",signatures:"Amr S. Abdelfattah, Tamer Abdelkader and EI-Sayed M. EI-Horbaty",downloadPdfUrl:"/chapter/pdf-download/60636",previewPdfUrl:"/chapter/pdf-preview/60636",authors:[{id:"222758",title:"Prof.",name:"El-Sayed M.",surname:"El-Horbaty",slug:"el-sayed-m.-el-horbaty",fullName:"El-Sayed M. El-Horbaty"},{id:"223952",title:"M.Sc.",name:"Amr",surname:"Elsayed",slug:"amr-elsayed",fullName:"Amr Elsayed"},{id:"224594",title:"Dr.",name:"Tamer",surname:"Abdelkader",slug:"tamer-abdelkader",fullName:"Tamer Abdelkader"}],corrections:null},{id:"60391",title:"Validating Activity-Based Travel Demand Models Using Mobile Phone Data",doi:"10.5772/intechopen.75810",slug:"validating-activity-based-travel-demand-models-using-mobile-phone-data",totalDownloads:944,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Activity-based travel demand models predict travel sequences on a day for each individual in a study region. These sequences serve as important input for travel demand estimate and forecast in the area. However, a reliable method to evaluate the generated sequences has been lacking, hampering further development and application of the models. In this chapter, we use travel behavioral information inferred from mobile phone data for such validation purposes. Our method is composed of three major steps. First, locations where a user made calls on a day are extracted from his/her mobile phone records, and these locations form a location trajectory. All the trajectories from the user across multiple days are then transformed into actual travel sequences. The sequences derived from all phone users are further classified into typical patterns which, along with their relative frequencies, define travel profiles. These profiles characterize current travel behavior in the study region and can thus be utilized for assessing sequences generated from activity-based models. By comparing the obtained profiles with statistics drawn from conventional travel surveys, the validation potential of the proposed method is demonstrated.",signatures:"Feng Liu, Ziyou Gao, Bin Jia, Xuedong Yan, Davy Janssens and Geert\nWets",downloadPdfUrl:"/chapter/pdf-download/60391",previewPdfUrl:"/chapter/pdf-preview/60391",authors:[{id:"55720",title:"Dr.",name:"Feng",surname:"Liu",slug:"feng-liu",fullName:"Feng Liu"},{id:"57852",title:"Prof.",name:"Geert",surname:"Wets",slug:"geert-wets",fullName:"Geert Wets"},{id:"206586",title:"Dr.",name:"Davy",surname:"Janssens",slug:"davy-janssens",fullName:"Davy Janssens"},{id:"239581",title:"Prof.",name:"Ziyou",surname:"Gao",slug:"ziyou-gao",fullName:"Ziyou Gao"},{id:"239582",title:"Prof.",name:"Bin",surname:"Jia",slug:"bin-jia",fullName:"Bin Jia"}],corrections:null},{id:"60121",title:"Adaptive Security Framework in Internet of Things (IoT) for Providing Mobile Cloud Computing",doi:"10.5772/intechopen.75190",slug:"adaptive-security-framework-in-internet-of-things-iot-for-providing-mobile-cloud-computing",totalDownloads:1422,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Internet of Things (IoT) has immense potential to change many of our daily activities, routines and behaviors. 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IoT is still highly not reliable in points of integration between how its devices are connected, that is, there is poor utilization of the existing IP security protocols. In this chapter, we propose a deep penetration method for the IoT connected set of devices, along with the mobile cloud. An architecture and testing framework for providing mobile cloud computing in the IoT that is based on the object security, power utilization, latency measures and packet loss rate is explained. Our solution is based on the use of existing security protocols between clients and the mobile hosts as well as a key management protocol between the individual mobile hosts implementing an out-of-band key exchange that is simple in practice, flexible and secure. We study the performance of this approach by evaluating a prototype implementation of our security framework. This chapter, in a preliminary manner, discusses the threats, hacks, misguided packets and over read sensor message. These packets are then translated by hardware and pushed through the web for later-on action or support. Our testing of a set of sensor-triggered scenario and setup clearly indicates the security threats from wireless connected small LAN environments and the overestimated sensor messages resulting from the initial set of the sensor readings, while we emphasize more on the security level of the web services serving the IoT-connected device. 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Shells form a wide range of structures, including bridge decks, retaining walls, slabs, tunnel linings, dams, etc. The concrete structure formworks are also designed using steel shells usually. Shells can be made using various materials such as prestressed or reinforced concrete, steel plates, and even fabrics. Although the analysis, design, and construction of shell structures are slightly more complex than other types of structures, in many cases, such as fuel tanks, decks, and some underground structures, the use of shells is inevitable. Also, from an architectural point of view, in many cases, no other type of structure can be as beautiful as structural shells. Therefore, this book has covered all matters related to the history, analysis, design, and construction of shell structures. Also, the design of shells against special loads such as earthquakes, blasting, and wind has been considered. Special shell structures such as pneumatic and fabric shells are also described in detail.
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Board member of some companies with about 60 books and the winner of 17 national/international awards with more than 30 years of experience in academic and industrial roles.",coeditorOneBiosketch:"Dr. Farzaneh Tahmoorian works as a lecturer at the Central Queensland University (CQU), Australia, and has broad work experience for over 10 years in many construction projects and projects related to road construction, waste management, landfills construction, etc. She is the recipient of various awards such as the Australian Postgraduate Award, Western Sydney Top-up Award, Award of Best Employee of Tehran Municipality, and the author of more than 20 books and book chapters.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"296316",title:"Dr.",name:"Saeed",middleName:null,surname:"Nemati",slug:"saeed-nemati",fullName:"Saeed Nemati",profilePictureURL:"https://mts.intechopen.com/storage/users/296316/images/system/296316.jpeg",biography:"Dr. Saeed Nemati (1969) is a professional writer, translator, editor, journalist, engineer, researcher, and inventor. He is a senior academic member at QIAU and executive director of the World Civil Engineering Information Centre. Dr. Nemati obtained his diploma in building and construction from TAFE Australia. He also received his B.Eng degree in civil engineering, M.Eng degree in environmental engineering, and PhD in infrastructure engineering from Tehran Polytechnic, Tarbiat Modares University (as a top student) and Western Sydney University, respectively. He has about 30 years of work experience in large infrastructure project management. Dr. Nemati is a full member of the Australia Society of Authors with many published ISI articles and books. In addition, he is the winner of 17 national and international awards in civil engineering. 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Dr. Tahmoorian is the recipient of various awards such as the Australian Postgraduate Award, Western Sydney Top-up Award, Award of Best Employee of Tehran Municipality, etc. Her research interests are in asphalt mix design, pavement engineering, road and transport engineering, waste management, and sustainability. 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Children have wide range of potential diagnosis, different from adults including congenital and acquired lesions. The causes of acute abdomen vary according to ages of the children. Since children are unable to give reliable history, have atypical presentations and accompanying extra-abdominal manifestations; evaluation and establishing the correct diagnosis is challenging.
Traditionally, pediatric abdominal ultrasound (US) examination focuses exclusively on parenchymal organs, putting less interest on the gastrointestinal tract [1]. However, recent US technologies and new transducers are able to perform a detailed examination with great contrast resolution of each section of the digestive system in pediatric age because of their smaller body size and less impaired by gas content and adipose tissues. The other well-known advantages of US, particularly its lack of ionizing radiation, easy access, low-cost and without need of patient preparation, makes this imaging modality an ideal one for the evaluation of pediatric population in the emergency settings. Currently in many places, US is the first line of imaging over computed tomography (CT) and radiography for patients with acute abdominal pain. The main role of diagnostic imaging with US and color Doppler in the emergency is to determine whether the acute abdomen is due to a surgically or medically treatable disease, even though the exact pathology has not been diagnosed.
This chapter presents the basic aspects of US for evaluating the pediatric GI tract, including techniques, equipment, patient preparation and the anatomy. Then indications and sonographic findings of frequently encountered acute non-traumatic GI diseases in neonates, infants and children are highlighted with some exemplary cases. Acute traumatic GI tract injuries, oncologic emergencies, acute abdomen due to hepatobiliary or urogenital diseases are beyond the scope of this chapter.
New generation ultrasound equipment including the wide spectrum frequency probes provides high quality images of the gastrointestinal system, adjacent mesentery and related structures. Children’s small body habitus and the presence of less fat tissue in the abdominal wall enable examination with high frequency transducers. Therefore US is increasingly used as the initial and follow-up study for investigating gastrointestinal tract pathologies in children and it is sufficient for the radiological diagnosis in majority of cases.
The contrast resolution of an US probe is dependent on the frequency, the velocity of sound in tissue and the number of cycles in the US pulse [2]. Depending on the age and size of the patient, a large convex-array (1–5 MHz) or smaller convex-array transducer (5–8 MHz) is a good option for beginning the examination for overview of the entire abdomen [3]. Following initial overview, a detailed analysis of the bowel wall and adjacent structures should be evaluated with a high frequency (10–18 MHz) linear-array transducer [1]. Tissue harmonic imaging is newly developed imaging software to increase resolution of the superficial parts of the field-of-view. It should be used to improve the delineation of bowel wall layers [2]. While evaluating anxious children in the acute setting, dynamic range should be lowered and the number of foci should be reduced to increase frame rate [4]. To demonstrate peristalsis, normal or abnormal motility, and motion of air bubbles in perforation or necrotizing enterocolitis; extended field-of-view can be helpful and cine clips should be recorded [5].
Doppler US evaluation is essential in GI system imaging, especially when looking at inflammatory diseases or neoplastic conditions. Doppler should be performed with a low wall filter and pulse repetition frequency should be adjusted as low as possible to prevent aliasing [6]. Power Doppler is a good method to overcome motion artifact in uncooperative children. As there are modern equipment and software, newer vascular imaging techniques, such as B-flow and superb microvascular imaging are brought into use by different vendors which are able to assess smaller vessels in the bowel wall [4].
US elastography is an emerging US technique to assess the stiffness of a tissue [5]. There are some studies in the literature regarding the usage of elastography for GI tract diseases, particularly in inflammatory conditions [7, 8]. The bowel is a hollow viscus with a lumen containing gas and fecal contents. The anatomy of the bowel is not ideal for US elastography as solid organs (e.g. liver or kidney). However, bowel wall thickening due to inflammation or tumor often reduces motility and luminal contents that enable to perform US elastography more reliable [2]. Some studies suggest using US elastography in inflammatory bowel disease to differentiate inflammatory and fibrotic stenosis [9, 10].
Contrast enhanced US (CEUS) can be used to evaluate bowel wall vascularity and perfusion in real time [5]. It is performed after the intravenous injection of microbubbles that resonate and give rise to more intensely reflected signals [2]. Enhancement pattern, contrast quantification at peak intensity and dynamic contrast enhancement can be analyzed with CEUS [11, 12]. Enhancement pattern following bolus injection is used as a qualitative parameter. For example, patients with absent bowel wall enhancement can be separated from those with detected enhancement [2]. It can also be used in patients with complicated GI disorders when trying to differentiate a phlegmon from an abscess [13].
US examination of GI system must involve a systematic approach. While evaluating large bowel, the transducer is applied to the right iliac fossa to identify the cecum. Afterwards, colon can be followed through the ascending colon, transverse colon, descending colon, sigmoid colon and finally the rectum. Since the rectum is visualized behind the bladder, filled bladder is better to evaluate rectum and sigmoid colon. Longitudinal placement of the transducer is often better to identify the haustrations of colon segments [2]. The examination of the small intestine begins with the identification of ileocecal valve and the terminal ileum at the right iliac fossa. The examiner should identify the appendix, often inferior to the terminal ileum and follow the ileum as far as possible. Tracking the whole small bowel is generally not possible, therefore the abdomen should be scanned cranially and caudally parallel scans covering the whole abdominal area. The scanning approach may differ according to clinical scenario. For surgical disorders or trauma, a faster and a targeted approach are preferred, whereas for general and nonspecific complaints, more detailed examination can be performed.
Graded compression is a simple, essential and effective technique to push away gas filled bowel segments or intraabdominal fat [3, 4]. It decreases the distance between the transducer and target organ and enables to reach deeper with high frequency transducers. Although it was introduced for the diagnosis of acute appendicitis by Puylaert [14], now it has been performed for detection of bowel thickening and compressibility, and for specific diseases such as diverticulitis and colonic polyps [15, 16].
As a general principle, no preparation of the patient is required to perform gastrointestinal US, particularly in the emergency setting. However, to decrease the amount of food and gas in the gut, and to examine the gallbladder and biliary tree, a fasting period of 3 hours in newborn and 5 hours in children is recommended [1]. Physical activity also reduces the splanchnic flow, therefore patients should avoid from extensive activity before the examination [2]. Since the cold gel is one of the major complaints of children, gel warmer to warm the coupling gel can be used. If the infants or neonates are anxious and reluctant to be scanned; examiner can sit them on their mother’s lap, get her lie down on the couch along with the child.
For stomach and pyloric examination, oral fluid intake or fluid ingestion via nasogastric tube is useful [4]. The distention of colon with anechoic fluid (water) ingestion, or with oral administration of hyperosmotic solutions allows the detailed examination of the haustration of colonic wall and adjacent structure [2]. The scanning of small intestine following the ingestion of iso-osmolar polyethylene glycol (PEG) solution is called US enterography or small intestine contrast US (SICUS). Since the PEG solution is non-absorbable in the small bowel, retained fluid distends the intestine and induces the wall contractility. The PEG solution moves distally and distends whole loops of the entire small bowel. Following PEG ingestion, small bowel lumen diameter > 30 mm and wall thickness > 3 mm is abnormal [17].
Before beginning a US examination, examiner should be familiar with the abdominal symptoms, clinical presentations and laboratory findings of acute GI diseases. The most common presentations are pain, vomiting, diarrhea, fever, hematochezia and melena. Although some diseases have peculiar clinical findings, majority of cases have non-specific symptoms and clinical appearances [3]. US is generally suggested as the first line imaging modality in children with acute abdomen. Most common indications for gastrointestinal US in children are acute appendicitis, intussusception, hernia, hypertrophic pyloric stenosis, inflammatory bowel disease, and volvulus. Further indications involve necrotizing enterocolitis, duplication cysts, malrotation of the bowel [4]. Also US is widely performed for the disease of other intraabdominal structures such as mesenteric lymphadenitis, lymphoid hyperplasia of the appendix, infectious enterocolitis, omental infarct, epiploic appendagitis, specific inflammations such as tuberculosis, colitis with hemolytic uraemic syndrome and Henoch-Schönlein purpura [4]. The recent COVID-19 pandemic associated multisystem inflammatory syndrome in children (MIS-C) can also manifest with gastrointestinal system dysfunction which has been also a novel US indication since 2020 [18].
Major challenges of US is based on its operator-dependency and reproducibility [5]. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) suggests to set standards of training and education curriculum for GI system US to provide high quality performance in clinical practice [2]. According to EFSUMB recommendations; the operator should be able to recognize the normal anatomy of small intestine and large bowel initially. Following recognizing normal appearance of normal GI tract, the investigator should be able to perform a complete scanning of the gut; evaluation for focal or diffuse diseases, the presence of diverticular disease and its complications (perforation and obstruction), the peritoneal cavity, the mesentery, and the omentum for the inflammatory, infectious or malignant diseases [2].
There are other challenging factors related to the patient such as noncollaboration, obesity and interposition of large amount of gas [5]. Particularly retroperitoneal, paraaortic and retroduodenal areas are often danger zones that are not well delineated on US. If the graded compression technique is ineffective to eliminate gas interposition and US findings are unremarkable; intravenous contrast enhanced CT should be performed in patients with acute abdominal pain, especially if there is suspicion of gut perforation.
While examining normal anatomy of GI structures; position, size, wall thickness and stratification should be evaluated. Many GI disorders appear as bowel wall thickening but normal bowel wall thickness may vary depending on peristalsis and the degree of distention [3]. Recent studies with high frequency transducers suggest that both normal small and large bowel wall thickness should be <2 mm when distended [19]. The exceptions are the pylor/duodenal bulbus and rectum wall which should be < 3 mm and < 4 mm respectively [20]. If the measurements were made from collapsed bowel wall, it should be reported since the wall of collapsed bowel is shown as thicker [2].
When examined with high frequency transducers, five sonographic layers of the bowel wall can be seen. When imaging the anterior wall (closer to transducer); the innermost echogenic layer is called as the mucosa-lumen interface which is not a part of actual GI wall. The second hypoechoic layer correspond to the deep mucosa, the third hyperechoic layer is submucosa which is most prominent in the colon [3]. The muscularis propria is the hypoechoic fourth layer which is most pronounced in the stomach. The outermost hyperechoic layer is the interface between muscularis and serosa. As the interface are hyperechoic and located distal to the real tissue, correspondence of histology and US layers are slightly different in the dorsal wall [2]. Therefore, evaluation of the layers should be made from the anterior bowel wall in diffuse inflammatory diseases. Bowel wall thickness measurement should be made perpendicular to the wall from innermost to the outermost echogenic layers [2].
The small intestine has three segments. The duodenum passes into the jejunum at the ligament of Treitz located in the left upper quadrant. The jejunum is often located in the left upper quadrant and usually collapsed with prominent folds, also known as valvula conniventes. They decrease and shorten from jejunum to ileum and best demonstrated at the fluid filled loops [2]. The ileum is located at the right lower quadrant and frequently involves fluid in normal patients. Sometimes cecum may be located intraperitoneal in variable positions even at the left lower quadrant of abdomen. The cecum and ileocecal valve is important landmarks to identify appendix which is usually below to the ileocecal valve. Although appendix is typically seen over the iliopsoas muscle medial to the cecum, lateral elevation or retrocecal course are not infrequent [2]. The normal appendix can be visualized in about 70% of healthy children with graded compression and it may increase depending on the experience of examiner and the resolution of transducer [21].
Acute appendicitis accounts for 80% of all abdominal surgical emergencies in pediatric population [22]. It is most frequently seen in second decade and is rare in children under two years of age, probably due to the funnel shape of appendix in infancy, which reduces the possibility of obstruction [23, 24]. Possible predisposing factors include lymphoid hyperplasia (due to past viral infection), dehydration, and low dietary intake of fiber [24]. Although the typical clinical presentation is acute onset of abdominal pain that may occur in the periumbilical area, radiating to the right lower quadrant, one-third of children have atypical clinical findings and symptoms, especially younger ones [23]. Other clinical signs are; fever, elevated acute phase reactants, nausea, vomiting and leg pain. Diarrhea is not present unless there is perforation and peritonitis, more frequently occurs in young children and confused with gastroenteritis [24]. Following clinical assessment and laboratory findings, imaging is the third component while evaluating the patients with suspected appendicitis. The routine US examination in suspected appendicitis reduces the negative appendectomies 50% and decreases the surgical complications and costs [25].
In patients with localized pain, transducer is applied to the point of maximum tenderness or pain. Self-localization facilitates the scanning, especially in patients with an aberrantly located appendix, and reduces the time of examination. If the patient cannot localize the pain or uncooperative; systematic evaluation starts in transvers plane to identify ascending colon. Lowermost part of the ascending colon is the cecal pole and medial to the cecum ileocecal valve can be demonstrated. The most common origin of the appendix is 2–3 cm below to the ileocecal valve [26]. Pressure is gradually increased to displace gas and fecal materials in the cecal lumen to adduct appendix to the transducer. In obese children, a left oblique body position or an upward graded compression technique may be useful to displace the fat tissue of the abdominal wall [27]. Anatomical variations require a systematic approach to evaluate appendix and experience plays an important role in examination. There are several US features to distinguish between normal and inflamed appendix which are valid for both children and adults (Table 1) [25, 26, 28, 29].
Primary US findings of acute appendicitis | Secondary US findings of acute appendicitis (adjacent structures) |
---|---|
Maximum outer diameter > 6 (6–8 mm indicates borderzone) | Hyperechoic periappendiceal fat tissue |
Maximum tenderness over the thickened appendix | Complex fluid collection (pericecal abscess) |
Incompressibility of the inflamed appendix | Mesenteric / pericecal lymphadenopathy |
Appendicolith (fecalith) within the appendix lumen | Periappendiceal reactive fluid |
Hypervascularity in color Doppler in uncomplicated cases | |
Loss of stratification and normal appearance of appendix wall in gangrenous appendicitis |
Primary and secondary sonographic features of acute appendicitis.
The inflamed appendix is shown as a fluid-filled non-compressible distended aperistaltic tubular structure with a blind end (Figure 1). In the axial plane, it has a target appearance with thickened echogenic mucosal interface and hypoechoic muscular wall. Appearance of an appendicolith, which is an echogenic focus with a posterior acoustic shadowing, is supportive finding for the diagnosis (Figure 1C) [23]. However, intraluminal air is also echogenic and can mimic appendicolith (Figure 1D). A heterogeneous mass around appendix representing phlegmon, and a walled-off fluid collection representing abscess are often the signs of complicated appendicitis and perforation [23]. Complicated appendicitis can occur either as a gangrenous appendicitis (focal or diffuse necrosis of the wall) or as a perforation. There is continuous transition from phlegmonous uncomplicated to gangrenous appendicitis during the disease course. The most important indicator of gangrenous appendicitis is the loss of normal hyperechoic mucosa-lumen interface [30]. Other ancillary finding is the lack of vascularity on color Doppler. The rate of perforation following acute appendicitis is around 60% for a 3-year-old child, 50% for a 5-year-old child, and this incidence reduces with increasing age, because of limited ability to communicate and define complaints in little ones [31]. Moreover, small children are more prone to peritonitis and abscess formation, rather than phlegmon, following perforation due to underdeveloped omentum which confines purulent material [24].
Three different cases with acute appendicitis. Ultrasound images of an 8-year-old boy demonstrate longitudinal (A) and transverse (B) section of inflamed appendix (arrow) with a diameter of 8.7 mm, and hyperechoic inflamed periappendiceal fat tissue. Ultrasound image of a 9-year-old boy (C) shows appendicolith (dashed arrow) within the appendix lumen, fluid level (asterisk) and dilatation distal to the obstruction. Ultrasound image of a 5-year-old girl (D) demonstrates inflamed appendix with a diameter of 8.6 mm and periappendiceal reactive fluid. Despite the inflammation, lumen is filled with air seen as echogenicity with dirty posterior shadow (thin arrows).
Non-visualization of the appendix is an important problem while evaluating appendicitis. The major reason for false-negative scanning is inexperience examiner in GI US. Other challenging situations are retrocecal or pelvic position of appendix, thick abdominal fat tissue in very obese patients, or focal appendicitis confined to distal tip that account for 5% of cases [25]. Thus, the entire appendix should be delineated clearly [32]. In perforated appendicitis, an abscess may be misinterpreted as a gas-containing bowel loop. In these cases, indirect signs of appendicitis should be scrutinized around cecum [33].
Recent publications confirm the mild forms of appendicitis which is spontaneously resolved under antibiotic therapy without need for surgery [34]. Unfortunately, there are not any reliable criteria to differentiate mild courses on US that probably not require surgery [25]. Other pitfalls that lead to a false-positive diagnosis of acute appendicitis are; incorrect identification of the terminal ileum as inflamed appendix, Meckel’s diverticulitis, cecal diverticulitis, dilated Fallopian tube or gonadal vein thrombosis [25]. Contrarily, appendiceal thickening can occur by other conditions such as Crohn’s disease, infectious enterocolitis, peritonitis, ascites and appendiceal tumors such as mucocele, cystadenoma or carcinoid [25].
Over the last decades, the sensitivity of US for the diagnosis of appendicitis has reached to 95%, with specificity above 90% [23, 35, 36]. The accuracy of US is currently equivalent to CT and magnetic resonance imaging (MRI), even more accurate particularly in small children with less intraabdominal fat tissue. Point-of-care ultrasonography (POCUS) is increasingly done by emergency physicians for the diagnosis of appendicitis, but US is a highly operator dependent tool that requires experience and sufficient equipment. Consequently, adequate equipment, structured training program and quality control should be provided before clinical application. Consistent preoperative use of US for right lower quadrant pain can decrease the additional CT/MRI examinations to a low fraction [35, 37]. When initial US is inconclusive, second US following an observation period, or an additional MRI or CT examination can be considered. In children, MRI should be performed if possible to support the ALARA (radiation as low as reasonably achievable) principle. Some guidelines recommend several scoring systems for US to diagnose acute appendicitis [38]. Since these scoring systems roughly estimate the likelihood and do not prove appendicitis, they are not obligatory to use in routine practice [25].
Hypertrophic pyloric stenosis (HPS) is the most common cause of surgery in vomiting infants due to the failure of relaxation of the pyloric sphincter of stomach [39]. The disease usually appears between 2nd and 12th week of life and commonly affects white males [2, 39]. The typical complaint is non-bilious, projecting vomiting by a previously healthy infant after feeding. HPS is not an actual emergency unless severe dehydration or excessive electrolyte loss occur. HPS can be palpated as a pyloric mass in the epigastrium on physical examination (olive sign) [22]. Preoperative US is the gold standard radiologic modality for the diagnosis of HPS with sensitivity, specificity and accuracy of approximately 100% if adequate equipment is provided [40].
The US scanning begins with placing the baby in a supine or right lateral decubitus position. A high-frequency (10–18 MHz), linear-array transducer should be applied from sub-xiphoid area to the right paramedian area to search for pylorus [1]. If adequate fluid is not present in the stomach, breast feeding or oral sugar contained water can be given in order to displace the air in the stomach and to see the passage of the fluid [41]. Normal position of the pylorus can be demonstrated between the liver and the head of the pancreas, medial to the gallbladder. If abundant air present in the gastric antrum, the patient should be moved into the right lateral decubitus position, to displace air into the fundus and to move pylorus anteriorly [3]. To confirm the HPS, pyloric canal length and thickness of the pyloric muscle should be measured [1]. Pyloric muscle thickness > 3 mm, canal length > 17 mm, and antero-posterior diameter of pylorus >12 mm confirm the diagnosis of HPS with high accuracy (Figure 2) [1, 3, 22]. By the way, pylorus is a dynamic structure and muscle thickness may change due to peristalsis during a real-time US examination. Therefore, imaging for a sufficient time is needed to exclude pylorospasm from HPS, which is a transient phenomenon [41]. Other ancillary findings to diagnose HPS are the prolapsed mucosa into the gastric antrum (antral nipple or cervix sign) and trapped fluid within the crevices of mucosa. The main reason of false-negative result is the overdistention of stomach that moves antra-pyloric canal posteriorly [3]. To overcome this issue, gastric content can be aspirated via nasogastric or orogastric tube.
(A) Normal appearance of pylor in a 25-day-old baby and (B) hypertrophic pyloric stenosis in a 30-day-old boy. Hypertrophic pylor (arrows) is thicker and longer than normal (dashed arrows) that does not permit the passage of gastric content into the duodenum.
Intussusception is the penetration of the bowel segment, either the small intestine or colon, into the distal lumen and propulsion as luminal content. It is the most common etiology of small bowel obstruction in infants, with a reported incidence of 56 cases per 100,000 hospitalizations per year in the United States [24]. More than 90% of cases present in the first two years after birth and peak age between 3 and 9 months [1, 3, 22]. Depending on the localization, there are two subtypes; ileo-cecal (or ileocolic) comprises 90% of cases and ileo-ileal occurs in about 10% [42]. The most common symptoms are recurrent abdominal pain, vomiting and currant jelly stool. Additionally, previous episodes of infection in the upper respiratory tract or gastroenteritis may occur in the patient’s clinical history. Most common localization of ileocecal intussusception is the subhepatic region, followed by upper abdominal midline and left upper quadrant [3]. It consists of three bowel segments; the inner prolapsing and returning limbs of the bowel are terminal ileum (called as intussusceptum) and attached mesentery and lymph nodes is dragged between these limbs [3, 39]. Outermost bowel receiving intussusceptum is the colon (called as intussuscipiens). Due to the compromised vascular supply, the thickest ileal segment is the returning limb of the ileum [3].
The diagnostic accuracy of US have verified with the several studies with a sensitivity of 97–100% and a specificity of 88–100% [24]. Thus, US has become as the primary modality of choice, replacing the contrast enema, in patients with suspected intussusception. Transverse section of intussusception appears as an oval or round mass with concentric rings and hypoechoic rim, described as ‘doughnut’ or ‘target’ configuration on US [1]. The crescentic shaped, hyperechoic, mesenteric fat can be seen in the center of the mass (called as ‘the crescent in doughnut sign’) (Figure 3A and B). The longitudinal appearance of intussusception is called as ‘pseudo-kidney’ or ‘sandwich’ sign (Figure 3C). On color Doppler US, double rings sign between the layers can be seen (Figure 3B) and absence of blood flow may indicate ischemia or irreducibility [22]. US can also be performed safely and accurately to monitor the hydrostatic reduction. Successful hydrostatic reduction rates are approximately 80% with a very few complication rates (2.7%to 4.26%) [24]. Some findings on US are useful to predict the success of enema or hydrostatic reduction such as; reduced vascular flow, thickened outer wall (>10 mm), trapped fluid and/or large (>1 cm short axis) lymph nodes within the intussusceptum [1, 3]. The appearance of intramural or subserosal air, manifested as echogenic foci, indicates the risk of necrosis and perforation, for those enema/hydrostatic reduction is contraindicated [1].
A 5-month-old boy with intussusception. (A) Transverse section demonstrates “target sign” composed of intussusceptum (thin arrow), intussuscipiens (thick arrow) and a lymph node (dashed arrow) within the trapped mesenteric fat tissue. (B) Doppler shows swirling of arteries and veins within intussusception. (C) Longitudinal section shows typical “sandwich” or “pseudokidney” sign (arrows).
The US can identify pathologic lead points in approximately two third of cases, particularly in older age group [43]. Similarly pathologic lead points may occur in younger than expected age group as < 3 months of age [24]. Common lead points are; Meckel’s diverticulum, duplication cyst, lymphoma or polyp. Cystic fibrosis, Henoch-Schonlein purpura, or polyposis syndrome may cause recurrent intussusceptions. Lead points or underlying disease should be searched elaborately in a patient with unusual age, abnormal localization of intussusception, recurrent disease and long duration of symptoms [3].
Small bowel intussusception comprises 10% of cases and is usually transient and asymptomatic. Common locations are the periumbilical area, left upper or lower quadrant of the abdomen. Most cases are due to small bowel hyperperistalsis. They are usually smaller than ileocecal intussusception (<1 cm diameter) and involve shorter bowel segment. If small bowel intussusception is persistent and symptomatic or involving longer segment (>3.5 cm), the patient should be scrutinized carefully to identify pathological lead point [3].
Intestinal malrotaton is not an infrequent phenomenon with a prevalence of 0,2–0,5% of live births. While the most patients are asymptomatic, 3–8% of malrotated bowel is symptomatic in the first year of life with bilious vomiting, pain and malabsorption [1]. The normal midgut rotates 2700 counterclockwise in utero around the axis of superior mesenteric artery (SMA). Incomplete rotation of bowel during fetal period results in short mesenteric root, abnormal positioning of duodeno-jejunal junction and ileocecal valve and close proximity of duodenum and cecum [3]. Twisting of malrotated small bowel around its mesentery may cause obstruction and volvulus, an emergent situation that requires prompt surgical intervention [44].
The well-known sonographic finding of intestinal malrotation is the inversion of the SMA and superior mesenteric vein (SMV). Patients should be lay supine while US evaluation and transducer applied at the upper midline to recognize SMA at its point of origin on the abdominal aorta [1]. SMV can also be identified tracing from the main portal vein to the midline after giving branch of splenic vein. Normally, the SMV is found on the right side or anterior to the SMA. If SMV located ventrally or left to the SMA, it is an abnormal location, which raises suspicion but do not always indicate malrotation [3]. For evaluating duodenum and to see the passage or beak sign of acute volvulus, oral water instillation may be useful. In suspected malrotation patients, when US findings are abnormal or inconclusive, an upper GI study should be performed, as a gold standard, to confirm the diagnosis [45].
Midgut volvulus is a fatal complication of malrotation, and 90% of cases occur in the first year of life, even %75 of cases occur in the first month. The typical sonographic feature of volvulus is the ‘whirlpool sign’, which is the swirling of SMV and its tributaries around the SMA in clockwise direction, best appreciated on color Doppler. Associated US findings of malrotation are proximal duodenal dilatation with distal tapering, duodenal wall thickening (> 2 mm), fixed midline bowel, intraabdominal free fluid, dilatation of the distal SMV and increased resistive index on SMA [3, 39].
Off-midline scanning due to inappropriate position of the transducer may demonstrate SMV and SMA as an abnormal relation which is the most common cause of the false-positive diagnosis of malrotation. Another reason for false-positive diagnosis is the ‘whirlpool’ sign occurs due to normal counterclockwise rotation. False-negative diagnosis may also be observed due to severe abdominal distension, abdominal guarding, abundant bowel gas, and/or an inexperienced operator. If there is strong clinical suspicion, an emergency upper GI study should be performed to clarify the diagnosis [3].
Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal emergencies of neonates, usually affecting the terminal ileum and ascending colon [22]. Although it affects primarily preterm babies, NEC can also be seen in term infants. The clinical presentation ranges from feeding intolerance, abdominal distention, emesis, diarrhea, rectal bleeding to more severe systemic findings including respiratory failure and fulminant shock [41]. Bowel necrosis occurs in NEC without any precise cause, which compromises the mucosal integrity [6]. Pathogenic organisms become dominant in the gut flora, leading to the pneumatosis intestinalis, which subsequently leads to portal venous gas and consequently leads to perforation and pneumoperitoneum. While the disease progresses, both early and late clinical signs and laboratory tests are often non-specific for diagnosis of NEC, therefore imaging plays crucial role for accurate diagnosis.
Radiographs are still primary modality of choice for evaluation of neonates suspected of having NEC [46]. Plain abdominal radiographs demonstrate pneumatosis, increased thickness of bowel wall, free intraperitoneal air and portal venous air [22, 46]. The role of US has been increasingly appreciated, owing to its higher sensitivity than plain films in the detection of early changes such as wall thickening, intestinal pneumatosis, portal venous air and disturbed bowel wall perfusion on color Doppler [5, 46]. Recent publications stated that diagnostic performance of US for detecting NEC is accurate with sensitivity of 100% and specificity of 90%. However, role of US in the follow-up of NEC is uncertain [6].
In the early phase of the disease, US can show the bowel wall thickening due to inflammation. Whereas, bowel wall thinning (<1 mm) may occur as it becomes necrotic and progresses toward perforation [47]. Similarly, Color Doppler may display hyperemia in the early stages due to inflammation, and avascular wall in the advanced disease with bowel wall necrosis [6]. Pneumatosis intestinalis is seen as punctate or granular echogenic foci with ‘dirty’ posterior acoustic shadowing or linear echogenic ring within the bowel wall. The gas bubbles create twinkling artifact on color Doppler which is useful in equivocal cases. To differentiate intramural gas from intraluminal air, nondependent bowel wall should be evaluated. Moreover, true pneumatosis would not change with the motion of the patient, whereas intraluminal air is freely mobile. Placing the patient in multiple positions may be useful to observe movement of the air. For the detection of pneumatosis, US is more sensitive than plain radiography [48].
Portal venous gas manifests on US as the presence of curvilinear or punctate mobile echogenic foci within the portal venous system. It is commonly seen in the neonates after umbilical catheterization, and may occur in different neonatal diseases. Therefore, in the absence of pneumatosis intestinalis, other etiologies should be considered rather than NEC. In the case of NEC, fluid-filled dilated bowel, complex hyperechoic intraperitoneal free fluid, focal fluid collections are suggestive of perforation and have been correlated with a poor clinical outcome [47, 49]. Evaluation of bowel peristalsis by real-time examination is an important component of US in infants with suspected NEC, because necrotic or inflamed bowel segments have decreased or absent motility [6]. US may also be considered in the follow-up to decide the appropriate time to restore oral feeding and to evaluate post-enterocolitis stenosis [5].
Inflammatory bowel disease (IBD) is a general term that covers a series of acute and non-acute diseases which do not require surgical treatment, ranging from self-limiting focal disorders to the debilitating and/or chronic diseases [1]. Diagnosis can be challenging due to nonspecific or atypical clinical presentation with extra-intestinal manifestations. US is useful in the diagnosis of IBD, especially in children by assessing bowel wall, peristalsis and surrounding mesentery with high-frequency transducers. Moreover, color Doppler increases the diagnostic accuracy and estimates the disease activity by showing vascularity. Presence of extra-intestinal complications such as abscess, fistula can also be evaluated with US.
While evaluating IBD, the thickening of the bowel wall can be divided into two categories according to US appearance [1]. ‘Layered thickening’ is shown as hyperechoic and organized wall thickening corresponds to mucosal inflammation with indirect involvement of submucosa. Whereas ‘non-layered thickening’ characterized by the loss of normal structure seen as a diffuse hypoechoic thickening without any reflective echoes. Based on the thickening type and localization, possible diagnoses are presented in Table 2.
Ileum involvement | Colon involvement | |
---|---|---|
Layered thickening | Infectious ileitis (Campylobacter or salmonella) | Infectious colitis (E.Coli, salmonella, shigella) |
Early Crohn disease | Chronic intestinal infectious disease (CIID) | |
Non-layered thickening | Henoch-Schönlein Purpura | Ischemic colitis prodromal of hemolytic uremic syndrome (HUS) |
Tuberculosis ileitis | Advanced IBD (ulcerative colitis or Crohn disease) | |
Protein-losing enteropathy, Celiac disease | Pseudomembranous colitis | |
Advanced Crohn disease | Neutropenic colitis |
Sonographic pattern and location of common inflammatory bowel diseases.
Crohn disease is the most common IBD that requires frequent imaging because of its extensive involvement of GI tract, and phases of exacerbations and remissions [1, 6]. It is characterized as a chronic transmural inflammation of an unknown cause and can affect any part of GI tract. In 20% of cases, the disease first becomes symptomatic during childhood [39]. Although, the role in the diagnostic algorithm is emerging, bowel US in its current form cannot replace with CT or MRI but can provide complementary information in the evaluation of disease. The diagnostic performance of US for identifying lesions of Crohn disease has sensitivity of 75–94% and specificity of 67–100% [6]. The primary imaging features of Crohn disease are bowel wall thickening and loss of stratification. Affected segments are non-compressible, hypoperistaltic and have hypoechoic wall with a minimal thickness of >3 mm [6, 39]. The hallmark of active disease is increased vascularity of thickened bowel wall segments (> 5 mm) with 88% specificity and 95% positive predictive value [49]. Moreover, SMA flow volume is higher but resistive index is lower with active disease [6]. Remarkable extramural manifestations that can be seen on US include thickened, hyperechoic mesentery (‘creeping fat’ sign) and enlarged mesenteric lymph nodes (Figure 4). Strictures, fistula, phlegmon and abscess are common complications of Crohn disease that can be depicted on US but requires further evaluation with CT or MRI. On US strictures are identified in 70–79% of cases as a narrowed bowel segment accompanying dilatation and hyperperistalsis at the proximal part [6]. Fistulas are less common in children than adults, and US is not a reliable modality to depict fistulas with the sensitivity of 31–87% in different publications [50]. An abscess can be delineated with US as an irregular thick-walled aperistaltic fluid collection including internal echoes and sometimes air. The sensitivity of US for the diagnosis of abscessranges from 83–91% [51]. An abscess may mimic a bowel loop, but bowel segments are thin-walled and peristalsis of bowel can be seen on real-time imaging.
An active Crohn’s disease in an 11-year-old girl. Longitudinal (A) and transverse (B) section of inflamed bowel segments demonstrates layered wall thickening, increased echogenicity and prominent thickening of mesenteric fat tissue.
Henoch-Schönlein Purpura (HSP) is the most common pediatric vasculitis that frequently involve GI tract [3, 39]. The pathogenesis of the disease originated from the thrombosis of small vessels, which in turn can cause ischemia of the small bowel [39]. Bowel wall thickening and edema can be seen on US in 50–60% of cases [52]. Although typical skin lesions are the hallmark of the disease, bowel wall thickening in duodenum and proximal small bowel may occur before the appearance of skin lesions. However, HSP can affect any segment of the bowel. The most common US feature is diffuse circumferential bowel wall thickening (Figure 5). Focal intramural hemorrhage can be revealed as a hyperechoic lesion in the mucosa or submucosa. With intramural hematoma, bowel wall thickening may increase up to 9–10 mm and multiple skip lesions can be demonstrated [3]. In HSP patients with obstructive symptoms such as vomiting or hemorrhagic stool, one or more intussusception can be seen with intramural hematoma as a lead point [53]. In the active stage of the disease, hypervascularity on color Doppler imaging may present. Other less common vasculitides involving the bowel may also occur with a variable presentation but similar findings on US.
An 8 year-old-girl with Henoch-Schönlein Purpura. (A) Ultrasound shows diffuse thickening of the intestinal wall (arrow). (B) Color Doppler demonstrates increased vascularity. Gray scale ultrasound from another part of abdomen (C) reveals hyperechoic mesenteric fat tissue (dashed arrows).
Bacterial enterocolitis can occur by a wide variety of pathogens, including
Neutropenic colitis, also known as typhilitis, is a necrotizing inflammatory process of cecum and terminal ileum usually seen in severe neutropenic and immunocompromised patients [39]. The typical US features are asymmetric, prominent wall thickening, with decreased echogenicity and loss of layering due to transmural inflammation. Echogenic foci can be seen in the bowel wall caused by circumscriptive hemorrhages or intramural air suggestive of anaerobic infection [55]. In thyphilitis, increased wall thickness may have correlation with a worse prognosis of the disease [41].
Pseudomembranous colitis is caused by the superinfection with
Mesenteric lymphadenitis is a benign, self-limiting inflammatory condition that affects the mesenteric lymph nodes, more frequently pericecal ones. It may either occur as a primary inflammatory disease or may arise secondarily due to an abdominal disease. Clinically, this condition is commonly mistaken for appendicitis, since the symptoms are quite similar [22]. As the lymph node enlargement is the only finding on US, the diagnosis is made by excluding other possible etiologies of abdominal pain.
Various nomograms for normal ranges of mesenteric lymph node size have been reported and short axis of > 5 mm for lymph nodes are very common in healthy children [3]. Simanovsky et al. [56] suggested that, in the setting of normal appendix, cluster of > 3 lymph nodes with short axis of > 10 mm should be diagnosed as mesenteric lymphadenopathy. Enlarged lymph nodes are often oval and perinodal fat tissue may appear hyperechoic (Figure 6). A preserved fatty hilum is seen as a hyperechoic area at the center with vascular pedicle on color Doppler imaging. If the shape of enlarged lymph nodes is round rather than being oval, cortex is eccentrically thickened and there is loss of fatty hilum, neoplastic process should be suspected [3].
Ultrasound (A,B) and color Doppler ultrasound (C) of the right lower quadrant of a 5-year-old girl diagnosed as mesenteric lymphadenitis. There are enlarged lymph nodes anterior to the iliac vessels. Color Doppler (C) demonstrates vascular supply from hilum of the lymph node.
Epiploic appendagitis is the inflammation of epiploic appendages arise from the serosal surface of the large bowel. Torsion of the appendages results in venous occlusion, ischemia and inflammation [39]. Although predominantly encountered in adults, it is also described in children and should be kept in mind in the differential diagnosis of acute appendicitis because the treatment is supportive rather than surgery. Characteristic US feature is hyperechoic, fixed non-compressible oval mass-like lesion at the anti-mesenteric side of the bowel. CT is generally needed to confirm the exact diagnosis [57].
Omental infarction is a rare cause of acute abdomen in children, even though 15% of all omental infarct cases occur in the pediatric population [3]. As the patients are commonly present with right-sided abdominal pain, it mimics appendicitis. However, associated nausea and vomiting is less frequent than appendicitis [24]. Predisposing factors include obesity, strenuous activity, coagulopathy and history of trauma to the affected region. The characteristic US feature is an ovoid or triangular hyperechoic mass located between the abdominal wall and the bowel, frequently in the right upper quadrant (Figure 7) [3]. In some cases, avascular hypoechoic tubular structure can be seen corresponds to a twisted vein. Although, some centers recommend conservative treatment, others prefer surgery to remove the necrotic tissue [24].
Ultrasound image (A) of an 11-year-old boy demonstrates thickened hyperechoic mass (asterisk) with indistinct border beneath the anterior abdominal wall. Intravenous contrast enhanced axial CT (B) and sagittal reconstructed image (C) shows hyperdense omentum (white circles), hyperdense dot at the center of lesion (arrows). The dot can be followed on the contiguous images as a linear tortuous hyperdense structure consistent with twisted vein. Surgical removal of necrotic tissue confirmed the diagnosis of omental infarct.
In the setting of a groin mass or swelling, possible diagnoses are hernia, fluid collection, enlarged lymph nodes, and cryptorchidism, and for those US can be performed to differentiate. The most common type of inguinal hernia in children is the indirect inguinal hernia in which hernia sac protrude into the inguinal canal [41]. Inguinal hernia is more common in preterm neonates and more frequently occurs on the right side because the right processus vaginalis closes later than the left. One-third of all infants with hernias become symptomatic before 6 months after birth, and males are affected more than females with a ratio of 6:1 [58]. Hernia sac frequently includes fluid in the processus vaginalis with or without bowel loops and other abdominal structures such as omentum, testes, ovaries, bladder and fallopian tubes. If hernia sac contains intestine and other abdominal structures; possibility of spontaneous regression reduces and incarceration risk increases. Hence, early diagnosis and surgery is very important in order to prevent complications and possible damage to the ipsilateral testis [6, 58].
The diagnostic accuracy of US to detect inguinal hernia is 97% in surgically confirmed cases with the sensitivity of 92.7% and the specificity of 92.7% [6]. Internal inguinal canal diameter > 4 mm is 95% diagnostic for indirect inguinal hernia. Real-time imaging on US is the biggest advantage among other modalities, with the patient performing a Valsalva maneuver (or provoke to cry in infants or babies) in both supine and upright views that enlarge the hernia sac and protrude through the inguinal canal with increased intraabdominal pressure. US can also be able to reveal peristalsis of herniated bowel segment with dynamic scan. Large inguinal hernias may lead to testicular ischemia by compressing the gonadal vessels within the inguinal canal [59]. Therefore, ipsilateral testis should be evaluated with US and color Doppler to assess intratesticular blood flow in the setting of inguinal hernia. While, evaluating a patient with an inguinal hernia, US should be performed to both inguinal canals because a clinically occult contralateral hernia can be found in 88% of cases [58].
Incarceration is a remarkable complication of indirect inguinal hernia and occurs with a frequency of 31% in children [58]. The most common incarcerated contents of hernia sac are the bowel, ovaries, and fallopian tubes. An incarcerated inguinal hernia may gradually progress to a strangulation, in which vascular supply is compromised and the necrosis of incarcerated contents occur. On US, incarcerated bowel shows circumferential thickening of the wall, aperistalsis, fluid level in the herniated loop, free fluid in the hernia sac and intraabdominal bowel dilatation (Figure 8). Incarcerated or strangulated hernias may not demonstrate clear continuity with abdominal bowel loops. Color Doppler may demonstrate absent vascularity in the hernia sac as a late finding of strangulation [41]. The presence of peristaltic activity in the herniated bowel loop is strong evidence against strangulation.
Ultrasound of an indirect inguinal hernia of an 8-week-old baby (A,B,C). Along with bowel, blind ending appendix (arrow) is herniated into the inguinal canal, called as Amyand hernia. (B) There is some fluid (dashed arrow) within the hernia sac and (C) transverse section of distal appendix is seen at the same level with penile shaft (asterisk).
Coins are the most common foreign material ingested, and most of them are not able to reach intraabdominal GI tract [41]. Two-third of those is located at the level of cricopharyngeus muscle that requires urgent endoscopic removal. In the radiologic evaluation of the ingested foreign body, plain radiographs are frequently the modality of choice. Nevertheless, all foreign bodies are not visible on plain films, depending on composition of the material and location within the body. US may provide additional information about the foreign bodies trapped in the intraabdominal GI tract [60]. However, diagnostic performance of US to detect intraabdominal foreign body is not known to date. Most of the foreign bodies in bowel appear as fixed, hyperechoic structure that often demonstrate posterior acoustic shadowing with a cleaner shadow than bowel gas [6]. Linear, high frequency transducers should be used with graded compression to evaluate intraluminal contents. Administration of 200–300 mL of oral water before the examination may facilitate the detection of foreign bodies within the stomach [41].
A bezoar consists of ingested foreign objects that cluster within the GI tract. The most common types are trichobezoars (composed of hair) and phytobezoars (composed of greengrocer fibers) and they usually accumulate in the stomach [39]. Sometimes enlarged bezoars reach to the small bowel and cause obstruction. Prior history of gastric surgery is an important predisposing factor to develop bezoar due to delayed gastric emptying [41]. On US, regardless of the originated fiber, bezoar is shown as an intraluminal mass with hyperechoic arc-like (curved or “inverted U” shape) anterior surface and prominent acoustic shadowing (Figure 9). Color Doppler can be used as a supportive modality which demonstrates ‘twinkling artifact’ behind the hyperechoic surface [39]. Bowel obstruction and proximal dilatation may be revealed as associated features.
A 12-year-old girl with a history of compulsive trichophagia disorder. Upper abdomen sonography with convex-array transducer (A) and linear-array transducer (B), demonstrates curvilinear echogenicities beneath the anterior wall of the stomach (arrow) and duodenum (dashed arrow) with clear, marked black posterior shadow. On endoscopy (C), trichobezoar was removed from her stomach and proximal duodenum.
While evaluating the etiology of acute abdominal pain in pediatric patients, US should be the initial imaging modality, as US is sufficient to diagnose several diseases that cause abdominal pain, far beyond only appendicitis and intussusception. Even if the underlying cause has not been identified, US will show indirect signs that indicate the need for a surgical exploration or provide supplemental information for CT and MRI. Therefore, it is crucial to be aware of the full potential of targeted bowel US with proper selection of the transducers, optimal positioning and the application of graded compression technique. Good quality examination requires experience, training, time and attention to perform a detailed evaluation of as many bowel loops as possible, minding their morphological features and their functional characteristics. Radiologists should be familiar with the sonographic appearance of both the normal and abnormal GI tract in order to provide the optimal treatment options for pediatric patients with acute abdominal diseases.
I thank Dr. Fatma Demirbas (Diyarbakır Children’s Hospital) for providing endoscopic image of the trichobezoar case.
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According to a survey, 63% of deaths due to cancer are reported from developing countries. There are different conventional treatment modalities that are available to treat and manage cancer. However, new cancer treatment options are being explored continuously as over 60% of all current experimental trials worldwide are focusing on tumor cure. The success of treatment depends upon the type of cancer, locality of tumor, and its stage of progression. Surgery, radiation-based surgical knives, chemotherapy, and radiotherapy are some of the traditional and most widely used treatment options. Some of the modern modalities include hormone-based therapy, anti-angiogenic modalities, stem cell therapies, and dendritic cell-based immunotherapy. This chapter discusses different traditional and novel treatment modalities to combat different types of cancer.",book:{id:"6313",slug:"neoplasm",title:"Neoplasm",fullTitle:"Neoplasm"},signatures:"Zaigham Abbas and Sakina Rehman",authors:[{id:"214546",title:"Dr.",name:"Zaigham",middleName:null,surname:"Abbas",slug:"zaigham-abbas",fullName:"Zaigham Abbas"}]},{id:"64178",doi:"10.5772/intechopen.81517",title:"Zebrafish (Danio rerio) as a Model Organism",slug:"zebrafish-em-danio-rerio-em-as-a-model-organism",totalDownloads:2802,totalCrossrefCites:4,totalDimensionsCites:26,abstract:"Animals as model organisms, the silent sentinels, stand watch over the environmental health of the world. These are non-human animal species which can be used to understand specific biological processes and to obtain informations which can provide an insight into working of other organisms. Among the model organisms, the zebrafish (Danio rerio) is one of the best leading models to study developmental biology, cancer, toxicology, drug discovery, and molecular genetics. In addition, the zebrafish is increasingly used as a genetic model organism for aquaculture species and in toxicogenomics and also to generate zebrafish disease models for application in human biomedicines. 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HER2 gene amplification and receptor overexpression, which occur in 15–20% of breast cancer patients, are important markers for poor prognosis. Moreover, HER2-positive status is considered a predictive marker of response to HER2 inhibitors including trastuzumab and lapatinib. Therefore, reliable HER2 determination is essential to determine the eligibility of breast cancer patients to targeted anti-HER2 therapies. In this chapter, we aim to illustrate important aspects of the HER2 receptor as well as the molecular consequences of its aberrant constitutive activation in breast cancer. In addition, we will present the methods that can be used for the evaluation of HER2 status at different levels (protein, RNA, and DNA level) in clinical practice.",book:{id:"6813",slug:"cancer-prognosis",title:"Cancer Prognosis",fullTitle:"Cancer Prognosis"},signatures:"Daniela Furrer, Claudie Paquet, Simon Jacob and Caroline Diorio",authors:null},{id:"67964",doi:"10.5772/intechopen.87963",title:"Protein Tyrosine Phosphatases in Tumor Progression and Metastasis: Promoter or Protection?",slug:"protein-tyrosine-phosphatases-in-tumor-progression-and-metastasis-promoter-or-protection-",totalDownloads:946,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"Reversible phosphorylation of proteins, executed by kinases and phosphatases, is the major posttranslational protein modification in eukaryotic cells, causing them to become activated or deactivated. This intracellular event represents a critical regulatory mechanism of several signaling pathways and can be related to a broad number of diseases, including cancer. Few decades ago, protein tyrosine phosphatases (PTPs) were considered as tumor suppressors. However, nowadays, accumulating evidence demonstrates that a misregulation of PTP activities plays a crucial and decisive role in cancer progression and metastasis. In this chapter, we will focus on the molecular aspects that support the crucial role of PTPs in cancer and in turn make them promising for prediction, monitoring, and rational appropriate therapy selection of individual patients.",book:{id:"8002",slug:"tumor-progression-and-metastasis",title:"Tumor Progression and Metastasis",fullTitle:"Tumor Progression and Metastasis"},signatures:"Carmen V. Ferreira-Halder, Stefano Piatto Clerici, Alessandra V. 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These tiny extracellular vesicles, once thought to be “garbage bags for cells,” carry a wide variety of molecules of cellular origin, including proteins, lipids, and RNAs, that are selectively incorporated during the formation of exosomes. Exosomes are now known to play a central role in several important biological processes such as cellular communication, intercellular transfer of bioactive molecules, and immune modulation. Recent advances in the field have shown that a number of animal viruses can exploit the exosomal pathway by incorporating specific cellular or viral factors within exosomes, in order to modulate the cellular microenvironment and influence downstream processes such as host immunity and virus spread. In this chapter, we provide an overview of our current understanding of exosome biogenesis and how this normal physiological process is hijacked by some pathogenic viruses. Viral components that appear to be selectively incorporated into exosomes and the potential role of these exosomes in viral pathogenesis are discussed. Identifying viral signatures in exosomes and their mode of action is fundamental for any future diagnostic and therapeutic strategies for viral infections.",book:{id:"5793",slug:"novel-implications-of-exosomes-in-diagnosis-and-treatment-of-cancer-and-infectious-diseases",title:"Novel Implications of Exosomes in Diagnosis and Treatment of Cancer and Infectious Diseases",fullTitle:"Novel Implications of Exosomes in Diagnosis and Treatment of Cancer and Infectious Diseases"},signatures:"Gulfaraz Khan, Waqar Ahmed and Pretty S. 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However, new cancer treatment options are being explored continuously as over 60% of all current experimental trials worldwide are focusing on tumor cure. The success of treatment depends upon the type of cancer, locality of tumor, and its stage of progression. Surgery, radiation-based surgical knives, chemotherapy, and radiotherapy are some of the traditional and most widely used treatment options. Some of the modern modalities include hormone-based therapy, anti-angiogenic modalities, stem cell therapies, and dendritic cell-based immunotherapy. This chapter discusses different traditional and novel treatment modalities to combat different types of cancer.",book:{id:"6313",slug:"neoplasm",title:"Neoplasm",fullTitle:"Neoplasm"},signatures:"Zaigham Abbas and Sakina Rehman",authors:[{id:"214546",title:"Dr.",name:"Zaigham",middleName:null,surname:"Abbas",slug:"zaigham-abbas",fullName:"Zaigham Abbas"}]},{id:"64178",title:"Zebrafish (Danio rerio) as a Model Organism",slug:"zebrafish-em-danio-rerio-em-as-a-model-organism",totalDownloads:2801,totalCrossrefCites:4,totalDimensionsCites:26,abstract:"Animals as model organisms, the silent sentinels, stand watch over the environmental health of the world. These are non-human animal species which can be used to understand specific biological processes and to obtain informations which can provide an insight into working of other organisms. Among the model organisms, the zebrafish (Danio rerio) is one of the best leading models to study developmental biology, cancer, toxicology, drug discovery, and molecular genetics. In addition, the zebrafish is increasingly used as a genetic model organism for aquaculture species and in toxicogenomics and also to generate zebrafish disease models for application in human biomedicines. 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This provides the need for type of tools which could detect cancer at early stages so that survival rate could be augmented. There are various diagnostic ways to identify cancer, but in each case, there are always circumstances to compromise on the sensitivity. In this framework, a new and more advanced approach of diagnosis for cancer is microRNA (miRNA). miRNAs are conserved regions among humans and animals, and their synthesis takes place in the nucleus and cytoplasm. There are several types of microRNAs that could be upregulated and downregulated in various cancers. A cancer cell could be identified by measurement of the expression pattern of miRNA. By examining the expression level for different types of cancers, miRNA can be used as biomarker for early detection of cancer in human beings.",book:{id:"9172",slug:"current-cancer-treatment",title:"Current Cancer Treatment",fullTitle:"Current Cancer Treatment"},signatures:"Ayesha Siddiqua, Sumaira Kousar, Amer Jamil, Riaz Tabassum, Tariq Mehmood and Nusrat Shafiq",authors:null},{id:"63685",title:"A Molecular Link between the Circadian Clock, DNA Damage Responses, and Oncogene Activation",slug:"a-molecular-link-between-the-circadian-clock-dna-damage-responses-and-oncogene-activation",totalDownloads:1405,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Circadian clocks enhance the efficiency and survival of living things by organizing their behavior and body functions. There has been a long history of research seeking a link between circadian clock and tumorigenesis. Studies of animal models and human tumor samples have revealed that the dysregulation of circadian clocks is an important endogenous factor causing mammalian cancer development. The core circadian clock regulators have been implicated in the control of both the cell cycle and DNA damage responses (DDR). Conversely, several intracellular signaling cascades that play important roles in regulation of the cell cycle and the DDR also contribute to circadian clock regulation. This review describes selected regulatory aspects of circadian clocks, providing evidence of a molecular link of the circadian clocks with cellular DDR.",book:{id:"7281",slug:"oncogenes-and-carcinogenesis",title:"Oncogenes and Carcinogenesis",fullTitle:"Oncogenes and Carcinogenesis"},signatures:"Yoshimi Okamoto-Uchida, Junko Izawa and Jun Hirayama",authors:[{id:"246364",title:"Prof.",name:"Jun",middleName:null,surname:"Hirayama",slug:"jun-hirayama",fullName:"Jun Hirayama"}]},{id:"67447",title:"Molecular Pathogenesis of Oral Squamous Cell Carcinoma",slug:"molecular-pathogenesis-of-oral-squamous-cell-carcinoma",totalDownloads:3824,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Oral carcinogenesis is a molecular and histological multistage process featuring genetic and phenotypic molecular markers which involves enhanced function of several protooncogenes, oncogenes and/or the deactivation of tumor suppressor genes, resulting in the over activity of growth factors and its cell surface receptors, which could enhance messenger signaling intracellularly, and/or leads to the increased production of transcription factors. Alone oncogenes are not responsible for carcinogenesis, genes having tumor suppressor activity, leads to a phenotypic change in cell which is responsible for increased cell proliferation, loss of cellular cohesion, and the ability to infiltrate local tissue and spread to distant sites. Understanding the molecular interplay of both onco and tumor genes will allow more accurate diagnosis and assessment of prognosis, which might lead the way for novel approaches to treatment.",book:{id:"8211",slug:"squamous-cell-carcinoma-hallmark-and-treatment-modalities",title:"Squamous Cell Carcinoma",fullTitle:"Squamous Cell Carcinoma - Hallmark and Treatment Modalities"},signatures:"Anshi Jain",authors:[{id:"280692",title:"Dr.",name:"Anshi",middleName:null,surname:"Jain",slug:"anshi-jain",fullName:"Anshi Jain"}]}],onlineFirstChaptersFilter:{topicId:"428",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82682",title:"Soft Tissue Tumors: Molecular Pathology and Diagnosis",slug:"soft-tissue-tumors-molecular-pathology-and-diagnosis",totalDownloads:10,totalDimensionsCites:0,doi:"10.5772/intechopen.104096",abstract:"Tumors of mesenchymal origin, also called soft tissue tumors, include tumor from muscle, fat, fibrous tissue, vessels and nerves, which are a group of heterogeneous neoplasms, and accounts for about 1% of all malignant tumors. They are uncommon tumors in routine practice, with complex tumorigenesis. Due to the recent advance in molecular pathology, we got a major achievement in the understanding of these tumors at the gene level, which makes the diagnosis and prognosis of this type of tumor more accurate and comfortable. This chapter will cover some molecular pathology and diagnosis of soft tissue and bone tumors.",book:{id:"11316",title:"Advances in Soft Tissue Tumors",coverURL:"https://cdn.intechopen.com/books/images_new/11316.jpg"},signatures:"Frank Y. Shan, Huanwen Wu, Dingrong Zhong, Di Ai, Riyam Zreik and Jason H. 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Existing epidemiological data confirm the role of the components of the metabolic syndrome, namely obesity, hypercholesterolemia, diabetes, and hyperinsulinemia, in the development and/or progression of prostate cancer. Although the exact mechanisms underlying the relationship between metabolic syndrome and prostate cancer remain largely unknown, it has been shown that various \\"in vitro\\" and animal experiments with models of the metabolic syndrome contribute to survival, mitogenesis, metastasis, and treatment resistance pathways through various adaptive reactions, such as intracellular steroidogenesis and lipogenesis. Although the exact biopathophysiological mechanisms between metabolic syndrome and prostate cancer have yet to be studied, drugs that target specific components of the metabolic syndrome have also provided evidence for the relationship between metabolic syndrome, its components, and prostate cancer. The appearance of “in vitro” results and molecular genetic research data will bring us closer to using this knowledge to determine specific ways of cancer-specific survival and improve treatment outcomes in patients with this disease.',book:{id:"11316",title:"Advances in Soft Tissue Tumors",coverURL:"https://cdn.intechopen.com/books/images_new/11316.jpg"},signatures:"Maxim N. Peshkov, Galina P. Peshkova and Igor V. Reshetov"},{id:"82080",title:"The Clinical Usefulness of Prostate Cancer Biomarkers: Current and Future Directions",slug:"the-clinical-usefulness-of-prostate-cancer-biomarkers-current-and-future-directions",totalDownloads:16,totalDimensionsCites:0,doi:"10.5772/intechopen.103172",abstract:"Worldwide, prostate cancer (PCa) is the leading cause of morbidity and cancer-related mortality in men. The pathogenesis of PCa is complex and involves abnormal genetic changes, abrogation of cell growth with heterogeneous progression and predictive subgroups. In the last two decades there have been the exploration and development of molecular and genetic biomarkers for PCa due to limitations of traditional serum biomarkers such as prostate specific antigen (PSA) in screening and diagnosis. These biomarkers could possibly differentiate between PCa and benign prostatic hyperplasia (BPH) patients, and healthy controls as well as assist with prognosis, risk stratification and clinical decision-making. Such molecular biomarkers include serum (PHI and 4K score), urine (PCA3 and SelectMDx), and tumor tissue (Oncoytype DX, Decipher and Prolarix). microRNAs (miRNAs) deregulation where there is increased or decreased expression levels, constitute prospective non-invasive molecular biomarkers for the diagnosis and prognosis of PCa. There are also other emerging molecular biomarkers such as exosomal miRNAs and proteins that are in various stages of development and clinical research. This review is intended to provide a wide-ranging appraisal of the literature on current and emerging PCa biomarkers with robust evidence to afford their application in clinical research and by extension routine clinical practice.",book:{id:"10661",title:"Cancer Bioinformatics",coverURL:"https://cdn.intechopen.com/books/images_new/10661.jpg"},signatures:"Donovan McGrowder, Lennox Anderson-Jackson, Lowell Dilworth, Shada Mohansingh, Melisa Anderson Cross, Sophia Bryan, Fabian Miller, Cameil Wilson-Clarke, Chukwuemeka Nwokocha, Ruby Alexander-Lindo and Shelly McFarlane"},{id:"81809",title:"Imaging of Benign Soft-Tissue Tumors",slug:"imaging-of-benign-soft-tissue-tumors",totalDownloads:17,totalDimensionsCites:0,doi:"10.5772/intechopen.104320",abstract:"Soft-tissue tumors account for less than 4% of all tumors in adult patients and 7–10% of all tumors in pediatric age group. The majority of these tumors are benign in nature (more than 99%). Different imaging modalities play a significant role in the diagnosis, treatment, and follow-up of these tumors. In this chapter, we will try to cover the imaging appearances of different benign soft-tissue tumors and to demonstrate the differentiation features. In addition, we will demonstrate a systematic approach for the characterization of soft-tissue masses based on different imaging appearances.",book:{id:"11316",title:"Advances in Soft Tissue Tumors",coverURL:"https://cdn.intechopen.com/books/images_new/11316.jpg"},signatures:"Ahmed D. Abdulwahab"},{id:"80160",title:"Soft-Tissue Tumors of the Head and Neck Region",slug:"soft-tissue-tumors-of-the-head-and-neck-region",totalDownloads:27,totalDimensionsCites:0,doi:"10.5772/intechopen.102026",abstract:"Fibroblastic and myofibroblastic neoplasms in the head and neck region are a rare group of tumors ranging from benign lesions to malignant lesions. Due to the difficult anatomy of the head and neck region, even neoplasms without metastatic potential can pose significant therapeutic challenges in this region. In this section, the most common soft-tissue neoplasms in the head and neck region will be discussed.",book:{id:"11316",title:"Advances in Soft Tissue Tumors",coverURL:"https://cdn.intechopen.com/books/images_new/11316.jpg"},signatures:"Ahmet Baki"}],onlineFirstChaptersTotal:12},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:333,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. 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He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. 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His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. 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Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:6,paginationItems:[{id:"82526",title:"Deep Multiagent Reinforcement Learning Methods Addressing the Scalability Challenge",doi:"10.5772/intechopen.105627",signatures:"Theocharis Kravaris and George A. 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He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:null,institution:null},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"417317",title:"Mrs.",name:"Chiedza",middleName:null,surname:"Elvina Mashiri",slug:"chiedza-elvina-mashiri",fullName:"Chiedza Elvina Mashiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"352140",title:"Dr.",name:"Edina",middleName:null,surname:"Chandiwana",slug:"edina-chandiwana",fullName:"Edina Chandiwana",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"342259",title:"B.Sc.",name:"Leonard",middleName:null,surname:"Mushunje",slug:"leonard-mushunje",fullName:"Leonard Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"347042",title:"Mr.",name:"Maxwell",middleName:null,surname:"Mashasha",slug:"maxwell-mashasha",fullName:"Maxwell Mashasha",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"2941",title:"Dr.",name:"Alberto J.",middleName:"Jorge",surname:"Rosales-Silva",slug:"alberto-j.-rosales-silva",fullName:"Alberto J. Rosales-Silva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"437913",title:"Dr.",name:"Guillermo",middleName:null,surname:"Urriolagoitia-Sosa",slug:"guillermo-urriolagoitia-sosa",fullName:"Guillermo Urriolagoitia-Sosa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"435126",title:"Prof.",name:"Joaquim",middleName:null,surname:"José de Castro Ferreira",slug:"joaquim-jose-de-castro-ferreira",fullName:"Joaquim José de Castro Ferreira",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"437899",title:"MSc.",name:"Miguel Angel",middleName:null,surname:"Ángel Castillo-Martínez",slug:"miguel-angel-angel-castillo-martinez",fullName:"Miguel Angel Ángel Castillo-Martínez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"289955",title:"Dr.",name:"Raja",middleName:null,surname:"Kishor Duggirala",slug:"raja-kishor-duggirala",fullName:"Raja Kishor Duggirala",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jawaharlal Nehru Technological University, Hyderabad",country:{name:"India"}}}]}},subseries:{item:{id:"11",type:"subseries",title:"Cell Physiology",keywords:"Neurodevelopment and Neurodevelopmental Disease, Free Radicals, Tumor Metastasis, Antioxidants, Essential Fatty Acids, Melatonin, Lipid Peroxidation Products and Aging Physiology",scope:"\r\n\tThe integration of tissues and organs throughout the mammalian body, as well as the expression, structure, and function of molecular and cellular components, is essential for modern physiology. The following concerns will be addressed in this Cell Physiology subject, which will consider all organ systems (e.g., brain, heart, lung, liver; gut, kidney, eye) and their interactions: (1) Neurodevelopment and Neurodevelopmental Disease (2) Free Radicals (3) Tumor Metastasis (4) Antioxidants (5) Essential Fatty Acids (6) Melatonin and (7) Lipid Peroxidation Products and Aging Physiology.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11407,editor:{id:"133493",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/133493/images/3091_n.jpg",biography:"Prof. Dr. Angel Catalá \r\nShort Biography Angel Catalá was born in Rodeo (San Juan, Argentina). He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of Osijek",institutionURL:null,country:{name:"Croatia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"79615",title:"Dr.",name:"Robson",middleName:null,surname:"Faria",slug:"robson-faria",fullName:"Robson Faria",profilePictureURL:"https://mts.intechopen.com/storage/users/79615/images/system/79615.png",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",slug:"valerie-chappe",fullName:"Valerie Chappe",profilePictureURL:"https://mts.intechopen.com/storage/users/84459/images/system/84459.jpg",institutionString:null,institution:{name:"Dalhousie University",institutionURL:null,country:{name:"Canada"}}}]},onlineFirstChapters:{paginationCount:18,paginationItems:[{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - 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