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Larramendy",coverURL:"https://cdn.intechopen.com/books/images_new/923.jpg",editedByType:"Edited by",editors:[{id:"14764",title:"Dr.",name:"Marcelo L.",surname:"Larramendy",slug:"marcelo-l.-larramendy",fullName:"Marcelo L. Larramendy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"76153",title:"Faecoliths in Appendicitis: Does It Influence the Course and Treatment of the Disease in the Acute Setting?",doi:"10.5772/intechopen.97338",slug:"faecoliths-in-appendicitis-does-it-influence-the-course-and-treatment-of-the-disease-in-the-acute-se",body:'There are numerous theories with regards to the aetiology of acute appendicitis. These theories include genetic factors, environmental influences, luminal obstruction and infections. However, of all these theories, the debate between luminal obstruction with possible secondary infective process and primary infective causes has been the fiercest. With the latter raising more questions than answers.
Even though many infectious agents have been linked with acute appendicitis, quite a number of them are still unknown and this makes the understanding of the pathophysiology even more difficult [1, 2, 3]. In addition to the aforementioned, most organisms isolated from patients are typically normal colonic flora and that is in sharp contrast to the original postulation of the temporal and geographic distribution of organisms.
Luminal obstruction of the appendix results from a variety of causes and is associated with increased pressure within the lumen. Causes of appendiceal luminal obstruction include lymphoid hyperplasia due to inflammatory bowel disease or infections (commonly viruses), parasites, foreign bodies, neoplasms and faecoliths. The increased pressure results from continuous secretion and stagnation of fluids and mucus from the mucosal epithelial cells. This serves to provide a conducive milieu for intestinal flora to multiply and flourish. This multiplication leads to local increase in bacteria load, with its accompanying translocation and the subsequent inflammatory process which ensues, resulting in the formation of pus and a further increase in intraluminal pressure.
Appendiceal venous outflow obstruction occurs as the intraluminal pressure rises above the appendiceal venous pressure. A further increase in luminal pressure also impairs arterial blood flow to the appendix. The above-mentioned vascular compromise gives rise to a loss of epithelial integrity and wall ischaemia, which in addition to the luminal bacteria overgrowth, and rapid bacteria translocation are often complicated by peritonitis, perforation, gangrene of the appendix and/or peri-appendicular abscess with or without peritonitis.
Faecolith, also known as appendicolith, appendiceal calculi/enterolith or corpolith, is a combination of firm, dense stool and mineral or calcified deposits which usually has a laminar structure [4]. Although the formation of a faecolith is not clearly understood, there have been previous instances where foreign bodies and gallstones have been implicated [5, 6]. As a matter of fact, for a long time, there was a myth which seemed to have suggested that accidental swallowing of seeds could cause acute appendicitis.
Early on, faecoliths were noted to be one of the most common causes of acute appendicitis resulting from luminal obstruction. In the early 19th century Volz observed faecoliths to be a “pathognomonic agent” for typhlitis [7]. Later that century, Fitz revealed that in patients who presented with perforated appendicitis, 47% of them had hardened stools in the lumen of the appendix [8]. These findings raised enough suspicions which linked faecoliths to acute appendicitis and possibly its complicated forms. As a result, many other observations were published [9, 10, 11]. Most of these studies, however, remained experimental until Bowers conclusively showed in the late 1930s that obstruction by a faecolith was a major cause of acute appendicitis [12].
The other issue with respect to faecoliths in acute appendicitis has to do with its consistency. This has led to the suggestion that faecoliths should be classified based on consistency and calcium content due to their correlation with perforation. On the contrary, other authors have also suggested that even the softer form presents more commonly with appendicitis than the harder ones [13, 14].
In fact, the prevalence of faecoliths in the vermiform appendix has been recently reported to be 3% in a population study by Jones et al. [15]. In this study, the investigators observed an increased incidence in populations with increased intake of low-fibre diets. Other studies have shown higher prevalence in paediatric and young adult population, with increased male preponderance [16]. There are also reports of increased incidence of faecoliths among patients with a retrocaecal appendix, but these are yet to be substantiated.
From the discussions so far, it can therefore be concluded that the presence of faecoliths does not confirm a diagnosis of acute appendicitis without the presence of appendiceal wall inflammation involving the muscularis propria on histological assessment or peri-caecal inflammatory changes/appendiceal wall enhancement clinically. On this matter, there have been numerous conflicting reports on the relationship between the presence of faecoliths and appendicitis especially in different age groups [17, 18, 19]. There are reports by some authors that up to 49% appendices with luminal obstruction were normal on histological assessment. The same study also found that 49% of appendices with luminal obstruction had microscopic evidence of acute inflammation even though they looked normal macroscopically. Some of these studies initially led to the performance of an appendicectomy in asymptomatic patients with a faecolith by some surgeons. This practice, however, is currently controversial. At the moment, the widely accepted evidence is what Butler et al. [20] reported. They found faecoliths in 10% of patients, with 90% of them subsequently going on to develop appendicitis. The purpose of this chapter is however to look at the effect of faecoliths on the disease process of acute appendicitis.
The discussion on the role of faecoliths in appendicitis, in general, could be as old as the disease process itself and as result many theories have been postulated in times past. This chapter will be broken down into subheadings on important aspects of the role of faecoliths in acute appendicitis.
The incidence of faecoliths in population and patient studies have been generally discussed in previous paragraphs of this chapter. With the introduction of modern abdominal imaging modalities from plain abdominal radiography, ultrasound examination, computed tomography (CT) scan to magnetic resonance imaging, the association of faecoliths as an important cause of luminal obstruction in acute appendicitis have become very clear and recent data reports prevalence of about 20% in pathological specimens either with or without the presence of acute appendicitis.
Faecoliths are usually one the main causes of non-specific intermittent abdominal pain. In some cases, it even mimics genitourinary conditions such as urolithiasis. They are usually less than a centimeter in diameter and those that are more than two-centimeters are classified as giant faecoliths. Even though those greater than two-centimeters are considered uncommon, the largest ever recorded is 3.5 cm [21, 22].
A study by Ishiyama et al. [23] to investigate the significance of appendicoliths as an exacerbating factor of acute appendicitis using multivariate analysis resulted in very interesting findings. First of all, they were able to show that the presence of a faecolith is usually associated with more severe disease. In addition, the study identified a significant relationship between severe disease and size, and location of the faecolith. The larger the size and/or the more proximal the location in the vermiform appendix, the more likelihood of severe disease. The radiological characteristics of faecoliths associated with acute appendicitis were recently described by Khan [24]. He and his colleagues concluded that, in addition to a faecolith of 5 millimetres or more, multiple faecoliths were also identified to be an independent factor associated with acute appendicitis.
The diagnosis of acute appendicitis in a patient who presents with abdominal pain has markedly improved with the advent of numerous imaging modalities. In the presence of a faecolith, an abdominal plain radiography study alone can be considered as adequate when there is associated abdominal pain, with a specificity of 100% [25]. The use of CT scans in the assessment of patients suspected to have appendicitis has shown that the incidence of faecoliths is higher in the general population than previously reported. Two studies by Balthazar et al. and Rao et al. reports of incidence between 43 and 50% in predominantly adult patients diagnosed with acute appendicitis [26, 27]. In the paediatric population, Lowe and her friends showed that the incidence of faecoliths in patients with confirmed acute appendicitis was 65% [28]. This detection rate could be diminished by the administration of oral contrast. CT scans have been extensively used in the diagnosis of acute appendicitis.
At the time of writing this chapter, there was no study or literature dedicated to the diagnostic capabilities of ultrasound (US) scan in faecolith-related acute appendicitis. However, in general, the accuracy of US scan in the diagnosis of acute appendicitis is between 71–95% with sensitivity and specificity of 94.7% and 88.9% respectively when graded compression ultrasonography is done [29, 30]. Magnetic Resonance Imaging (MRI) has the advantage of no ionizing radiation exposure and the absence of nephrotoxic contrast agents. Availability and cost are among the main reasons why it is underutilised, although it has a sensitivity and specificity of 96.8% and 97.4% respectively. At the moment, there is very little data on its role and position in the workup of appendicitis, except in very special circumstances [31].
Literature on what role and effect faecoliths have on clinical scoring systems in acute appendicitis was very scanty to come by and therefore this chapter cannot provide a comment on that currently. Nonetheless, some studies, like that of Ishiyama and colleagues as mentioned in the previous paragraph have observed severe disease presentations in patient with faecoliths compared to those without.
In addition, faecoliths have been known to be more frequently associated with perforations and abscess formation [32]. Flum et al. found that the presence of faecoliths was identified to be a significant contributor of post treatment complications and adverse effects in patients who received antibiotics alone compared with those who had surgery. They also realised that though the perforation rate was high in patients initially treated with antibiotics, this high rate was attributable to patients with a faecolith. They reported about a 3-fold rise in perforations among the faecolith group. This, however, did not lead to a higher rate of extensive resections in the antibiotic group. Looking at the group that had appendicectomy done as initial treatment, there was not much difference in the perforation rate between patients with faecoliths and those without.
As a result, the finding of an appendicolith may be sufficient evidence to perform an appendectomy in patients earmarked for conservative management, given the higher rate of perforation at the time of failure of antibiotic treatment. This position is so explicitly stated in the recommendations made in the Jerusalem guidelines of 2020 and seems to be consistent with what Von and his friends found. It is however the author’s strong believe that every patient’s situation should be uniquely assessed, and a tailored treatment advocated with the patient’s express consent of course.
In the management of acute uncomplicated appendicitis using laparoscopy, Finnerty et al. [33] showed that age, presence of diabetes, raised BMI, presence of imaging confirmed complicated appendicitis, male gender and ethnicity were independent predictor of failure in laparoscopic management of acute uncomplicated appendicitis. At the moment, there is no evidence to support which method of treatment is best in the presence of faecolith in acute uncomplicated appendicitis, even though current evidence favours laparoscopy in the management of uncomplicated acute appendicitis generally. The presence of faecolith has been shown to have significant effect on therapeutic interventions and therefore the treating surgeon must be informed about the presence of faecolith for certain considerations to be taken into account. For instance, there have been several studies and case reports to show that dropped faecolith is a major contributor of post interventional morbidity with increased incidence of pelvic abscesses especially after laparoscopic appendicectomy.
The results from the CODA trial showed a noninferiority in managing patient with acute appendicitis conservatively with antibiotics in terms of 30-day post treatment health status, which was the primary outcome of the study. At 90-day post treatment, 29% of patients in the antibiotic arm had undergone appendicectomy. When a subgroup analysis was done, the number of patients with faecolith who required appendicectomy in the antibiotic group was almost twice patients without faecolith in the same subgroup. Even though all these are evolving areas of controversy, the surgeon’s awareness of the presence of faecolith is key to enable adequate decision making and planning for possible retrieval of faecolith if so needed [32, 34, 35].
The Gridiron incision, also known as McBurney’s incision, is the most commonly used open method in the management of acute uncomplicated appendicitis. In addition to this type of incision offering a minimally invasive and direct access to the diseased appendix, it provide good cosmesis and in lean (healthy BMI) patients, it is usually comparable to laparoscopic technique in terms of access, time of surgery, hospital stay and cosmetic advantage. In situations of delayed presentation or complications, McBurney’s technique becomes extremely challenging and, in such situations, larger laparotomy incisions are made with accompanied extensive bowel resection in some cases. The most common extensive bowel resection in acute appendicitis is ileocaecectomy with or without primary anastomosis of bowel. Recent evidence suggests that appendiceal mass, non-visualization of appendix, delayed admission, and CRP are strong predictors of extensive resection in acute appendicitis [36]. Additionally, faecolith was also identified as a preoperative predictor of extensive resection for acute appendicitis. Other preoperative predictors of extensive resection found in these studies included age, ascites, and extraluminal air. The role of faecolith in predicting the possibility of extensive resection obviously require further robust research but should not be underestimated.
Consensus on routine interval appendicectomy after conservative management of acute appendicitis is another highly debated subtopic in acute appendicitis. As a principle, surgeons are more inclined to do routine interval appendicectomy especially in patients in their mid-forties and above as there is an increased risk of malignancy in this groups. However, one can question the essence of this practice especially when there are very accurate diagnostic imaging modalities available to assist with confirming the presence of a tumour. While some have argued for routine interval appendicectomy when a faecolith is involved because of its possible association with increase recurrence rate, others have suggested otherwise as there have not been adequate evidence to support this idea especially when patients remained asymptomatic [37, 38].
To conclude, the role of faecoliths in causing acute appendicitis, and not just the disease but the worse form of it cannot be underestimated. Its ability to accelerate complications in the disease process and in addition cause significant headaches for surgeons and patients cannot be in dispute. The several contrasting opinions with regards to what to do with it confirms how complicated the situation is. It is the author’s firm opinion that more focused research should be done on this subject. Also, a lot of commendations should go to the designers and authors of the CODA trial who have thrown more light on this subgroup of patients.
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They were derived from erbium-doped fiber amplifiers, which are still important component for telecommunications. Since discovery, fiber laser has become a natural choice for many uses, primarily because of the physical characteristics of fiber waveguide structure. Their rapid progress may show how excellent they really are. Although fiber lasers are today widely used in various research and industrial areas, one of the most meaningful applications of fiber laser technology has been through its use in medicine. A wide variety of wavelengths generated by fiber lasers as well as the diversity of physical mechanisms employed in pulse generation also additionally underpins the flexibility of fiber laser technology. This study is devoted to background technology of fiber lasers in the light of medical applications. Basic physics and theories of optical fibers and their important properties are introduced.",book:{id:"6467",slug:"optical-amplifiers-a-few-different-dimensions",title:"Optical Amplifiers",fullTitle:"Optical Amplifiers - A Few Different Dimensions"},signatures:"Amira Tandirovic Gursel",authors:[{id:"240070",title:"Dr.",name:"Amira",middleName:null,surname:"Tandirovic Gursel",slug:"amira-tandirovic-gursel",fullName:"Amira Tandirovic Gursel"}]}],mostDownloadedChaptersLast30Days:[{id:"63129",title:"Laser Ablation Technique for Synthesis of Metal Nanoparticle in Liquid",slug:"laser-ablation-technique-for-synthesis-of-metal-nanoparticle-in-liquid",totalDownloads:2550,totalCrossrefCites:8,totalDimensionsCites:25,abstract:"Recently, the synthesis and application of metal and ceramic nanoparticle are significant subject in science and engineering. 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The analytical performance of such techniques, challenges related to calibration, and strategies to improve sensitivity are discussed. In addition, the processes involved in data acquisition and imaging for acquiring the elemental spatial distribution are highlighted, and some representative examples in environmental, biological, medical, and forensic researches are presented.",book:{id:"10481",slug:"practical-applications-of-laser-ablation",title:"Practical Applications of Laser Ablation",fullTitle:"Practical Applications of Laser Ablation"},signatures:"Renata S. Amais, Danielle S. Francischini, Pedro S. Moreau and Marco A.Z. Arruda",authors:[{id:"327464",title:"Prof.",name:"Marco A.Z.",middleName:null,surname:"Arruda",slug:"marco-a.z.-arruda",fullName:"Marco A.Z. 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Moreau"}]},{id:"59750",title:"Quantum Dot-Semiconductor Optical Amplifiers (QD-SOA): Dynamics and Applications",slug:"quantum-dot-semiconductor-optical-amplifiers-qd-soa-dynamics-and-applications",totalDownloads:1356,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Quantum dot-semiconductor optical amplifiers (QD-SOA) attracted strong interest for applications in optical communications and in all-optical signal processing due to their high operation rate, strong nonlinearity, small gain recovery time of about few picoseconds, broadband gain, low injection current and low noise figure (NF). In this chapter, we present the theoretical investigation of the gain recovery time acceleration in DQ SOA; the specific features of the cross gain modulation (XGM) in QD-SOA; the influence of the optical injection on the dynamics of QD-SOA based on the QD in a well (QDWELL) structure. We describe the following applications of QD-SOA: the all-optical ultra-wideband (UWB) pulse generation based on the Mach-Zehnder interferometer (MZI) with a QD-SOA; the ultra-fast all-optical signal processor based on QD-SOA-MZI; the ultra-fast all-optical memory based on QD-SOA. The contents of the chapter are mainly based on the original results.",book:{id:"6467",slug:"optical-amplifiers-a-few-different-dimensions",title:"Optical Amplifiers",fullTitle:"Optical Amplifiers - A Few Different Dimensions"},signatures:"Yossef Ben Ezra and Boris I. Lembrikov",authors:[{id:"2302",title:"Prof.",name:"Yossef",middleName:null,surname:"Ben-Ezra",slug:"yossef-ben-ezra",fullName:"Yossef Ben-Ezra"},{id:"2359",title:"Dr.",name:"Boris I.",middleName:"I.",surname:"Lembrikov",slug:"boris-i.-lembrikov",fullName:"Boris I. Lembrikov"}]},{id:"73390",title:"Laser Machining",slug:"laser-machining",totalDownloads:544,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The increasing demands of materials with superior properties are given priority by most of the industries in recent years due to their higher performance levels. Machining of hard materials is a challenging task since it involves higher cutting forces and rapid tool wear. This leads to complexity in shaping these difficult-to machine materials such as advanced composite and ceramics. There have been many alternative techniques developed to overcome the shortcomings of conventional machining processes. Laser beam machining (LBM) is one of the advanced noncontact machining processes that employ monochromatic light with high frequency for machining using thermal energy. The highly energized photos are focused on a material cause heating, melting and vaporizes the material which is effectively used to remove unwanted portion of a material. Due to higher coherency of laser beam, materials can be machined very precisely than conventional machining processes. Generally, the laser-based material processing is suitable for a brittle type of material with minimum conductivity. However, this laser machining can be used for all kinds of materials in most cases. This chapter provides the principle of laser and its types, mechanism of material removal using laser, applications, advantages, and limitations of LBM.",book:{id:"10481",slug:"practical-applications-of-laser-ablation",title:"Practical Applications of Laser Ablation",fullTitle:"Practical Applications of Laser Ablation"},signatures:"Natarajan Jeyaprakash, Che-Hua Yang and Manickam Bhuvanesh Kumar",authors:[{id:"32620",title:"Prof.",name:"Che-Hua",middleName:null,surname:"Yang",slug:"che-hua-yang",fullName:"Che-Hua Yang"},{id:"319416",title:"Dr.",name:"Jeyaprakash",middleName:null,surname:"Natarajan",slug:"jeyaprakash-natarajan",fullName:"Jeyaprakash Natarajan"},{id:"329306",title:"Dr.",name:"Bhuvanesh Kumar",middleName:null,surname:"M",slug:"bhuvanesh-kumar-m",fullName:"Bhuvanesh Kumar M"}]},{id:"63522",title:"Nonlinear Optical Response of Noble Metal Nanoparticles",slug:"nonlinear-optical-response-of-noble-metal-nanoparticles",totalDownloads:1420,totalCrossrefCites:2,totalDimensionsCites:6,abstract:"The special nonlinear optical response of noble metal nanoparticles (MNPs) when exposed to intense laser radiation has induced novel applications in nonlinear spectroscopy, optoelectronics, and optical switchers and limiters. In this chapter, recent results on the nonlinear optical properties of MNPs (including gold, silver, palladium, and platinum) have been discussed. Some specific optical nonlinear properties, such as nonlinear refraction, saturable absorption and reverse saturable absorption, two-photon absorption, and optical limiting, for femtosecond, picosecond, and nanosecond laser pulses, have been covered.",book:{id:"7349",slug:"laser-technology-and-its-applications",title:"Laser Technology and its Applications",fullTitle:"Laser Technology and its Applications"},signatures:"Yachen Gao and Deigui Kong",authors:null}],onlineFirstChaptersFilter:{topicId:"226",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261",scope:"Modern physiology requires a comprehensive understanding of the integration of tissues and organs throughout the mammalian body, including the cooperation between structure and function at the cellular and molecular levels governed by gene and protein expression. While a daunting task, learning is facilitated by identifying common and effective signaling pathways mediated by a variety of factors employed by nature to preserve and sustain homeostatic life. \r\nAs a leading example, the cellular interaction between intracellular concentration of Ca+2 increases, and changes in plasma membrane potential is integral for coordinating blood flow, governing the exocytosis of neurotransmitters, and modulating gene expression and cell effector secretory functions. Furthermore, in this manner, understanding the systemic interaction between the cardiovascular and nervous systems has become more important than ever as human populations' life prolongation, aging and mechanisms of cellular oxidative signaling are utilised for sustaining life. \r\nAltogether, physiological research enables our identification of distinct and precise points of transition from health to the development of multimorbidity throughout the inevitable aging disorders (e.g., diabetes, hypertension, chronic kidney disease, heart failure, peptic ulcer, inflammatory bowel disease, age-related macular degeneration, cancer). With consideration of all organ systems (e.g., brain, heart, lung, gut, skeletal and smooth muscle, liver, pancreas, kidney, eye) and the interactions thereof, this Physiology Series will address the goals of resolving (1) Aging physiology and chronic disease progression (2) Examination of key cellular pathways as they relate to calcium, oxidative stress, and electrical signaling, and (3) how changes in plasma membrane produced by lipid peroxidation products can affect aging physiology, covering new research in the area of cell, human, plant and animal physiology.",coverUrl:"https://cdn.intechopen.com/series/covers/10.jpg",latestPublicationDate:"May 14th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,editor:{id:"35854",title:"Prof.",name:"Tomasz",middleName:null,surname:"Brzozowski",slug:"tomasz-brzozowski",fullName:"Tomasz Brzozowski",profilePictureURL:"https://mts.intechopen.com/storage/users/35854/images/system/35854.jpg",biography:"Prof. Dr. Thomas Brzozowski works as a professor of Human Physiology and is currently Chairman at the Department of Physiology and is V-Dean of the Medical Faculty at Jagiellonian University Medical College, Cracow, Poland. His primary area of interest is physiology and pathophysiology of the gastrointestinal (GI) tract, with the major focus on the mechanism of GI mucosal defense, protection, and ulcer healing. He was a postdoctoral NIH fellow at the University of California and the Gastroenterology VA Medical Center, Irvine, Long Beach, CA, USA, and at the Gastroenterology Clinics Erlangen-Nuremberg and Munster in Germany. He has published 290 original articles in some of the most prestigious scientific journals and seven book chapters on the pathophysiology of the GI tract, gastroprotection, ulcer healing, drug therapy of peptic ulcers, hormonal regulation of the gut, and inflammatory bowel disease.",institutionString:null,institution:{name:"Jagiellonian University",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"10",title:"Animal Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",isOpenForSubmission:!0,editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},{id:"11",title:"Cell Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",isOpenForSubmission:!0,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},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",isOpenForSubmission:!0,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}}},{id:"13",title:"Plant Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/13.jpg",isOpenForSubmission:!0,editor:{id:"332229",title:"Prof.",name:"Jen-Tsung",middleName:null,surname:"Chen",slug:"jen-tsung-chen",fullName:"Jen-Tsung Chen",profilePictureURL:"https://mts.intechopen.com/storage/users/332229/images/system/332229.png",biography:"Dr. Jen-Tsung Chen is currently a professor at the National University of Kaohsiung, Taiwan. He teaches cell biology, genomics, proteomics, medicinal plant biotechnology, and plant tissue culture. Dr. Chen\\'s research interests include bioactive compounds, chromatography techniques, in vitro culture, medicinal plants, phytochemicals, and plant biotechnology. He has published more than ninety scientific papers and serves as an editorial board member for Plant Methods, Biomolecules, and International Journal of Molecular Sciences.",institutionString:"National University of Kaohsiung",institution:{name:"National University of Kaohsiung",institutionURL:null,country:{name:"Taiwan"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:43,paginationItems:[{id:"81796",title:"Apoptosis-Related Diseases and Peroxisomes",doi:"10.5772/intechopen.105052",signatures:"Meimei Wang, Yakun Liu, Ni Chen, Juan Wang and Ye Zhao",slug:"apoptosis-related-diseases-and-peroxisomes",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"The Metabolic Role of Peroxisome in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/10837.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81723",title:"Peroxisomal Modulation as Therapeutic Alternative for Tackling Multiple Cancers",doi:"10.5772/intechopen.104873",signatures:"Shazia Usmani, Shadma Wahab, Abdul Hafeez, Shabana Khatoon and Syed Misbahul Hasan",slug:"peroxisomal-modulation-as-therapeutic-alternative-for-tackling-multiple-cancers",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"The Metabolic Role of Peroxisome in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/10837.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81638",title:"Aging and Neuropsychiatric Disease: A General Overview of Prevalence and Trends",doi:"10.5772/intechopen.103102",signatures:"Jelena Milić",slug:"aging-and-neuropsychiatric-disease-a-general-overview-of-prevalence-and-trends",totalDownloads:14,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81566",title:"New and Emerging Technologies for Integrative Ambulatory Autonomic Assessment and Intervention as a Catalyst in the Synergy of Remote Geocoded Biosensing, Algorithmic Networked Cloud Computing, Deep Learning, and Regenerative/Biomic Medicine: Further Real",doi:"10.5772/intechopen.104092",signatures:"Robert L. Drury",slug:"new-and-emerging-technologies-for-integrative-ambulatory-autonomic-assessment-and-intervention-as-a-",totalDownloads:9,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Autonomic Nervous System - Special Interest Topics",coverURL:"https://cdn.intechopen.com/books/images_new/10835.jpg",subseries:{id:"12",title:"Human Physiology"}}}]},overviewPagePublishedBooks:{paginationCount:11,paginationItems:[{type:"book",id:"7264",title:"Calcium and Signal Transduction",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7264.jpg",slug:"calcium-and-signal-transduction",publishedDate:"October 24th 2018",editedByType:"Edited by",bookSignature:"John N. Buchholz and Erik J. Behringer",hash:"e373a3d1123dbd45fddf75d90e3e7c38",volumeInSeries:1,fullTitle:"Calcium and Signal Transduction",editors:[{id:"89438",title:"Dr.",name:"John N.",middleName:null,surname:"Buchholz",slug:"john-n.-buchholz",fullName:"John N. Buchholz",profilePictureURL:"https://mts.intechopen.com/storage/users/89438/images/6463_n.jpg",biography:"Full Professor and Vice Chair, Division of Pharmacology, Loma Linda University, School of Medicine. He received his B.S. Degree in Biology at La Sierra University, Riverside California (1980) and a PhD in Pharmacology from Loma Linda University School of Medicine (1988). Post-Doctoral Fellow at University of California, Irvine, College of Medicine 1989-1992 with a focus on autonomic nerve function in blood vessels and the impact of aging on the function of these nerves and overall blood vessel function. Twenty years of research funding and served on NIH R01 review panels, Editor-In-Chief of Edorium Journal of Aging Research. Serves as a peer reviewer for biomedical journals. Military Reserve Officer serving with the 100 Support Command, 100 Troop Command, 40 Infantry Division, CA National Guard.",institutionString:null,institution:{name:"Loma Linda University",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"6925",title:"Endoplasmic Reticulum",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6925.jpg",slug:"endoplasmic-reticulum",publishedDate:"April 17th 2019",editedByType:"Edited by",bookSignature:"Angel Català",hash:"a9e90d2dbdbc46128dfe7dac9f87c6b4",volumeInSeries:2,fullTitle:"Endoplasmic Reticulum",editors:[{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}}]},{type:"book",id:"6924",title:"Adenosine Triphosphate in Health and Disease",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6924.jpg",slug:"adenosine-triphosphate-in-health-and-disease",publishedDate:"April 24th 2019",editedByType:"Edited by",bookSignature:"Gyula Mozsik",hash:"04106c232a3c68fec07ba7cf00d2522d",volumeInSeries:3,fullTitle:"Adenosine Triphosphate in Health and Disease",editors:[{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. 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He\nreceived a short-term scholarship to carry out his post-doctoral\nstudies abroad, from Japan International Cooperation Agency\n(JICA), in coordination with the Egyptian government. Dr.\nShalaby speaks fluent English and his native Arabic. He has 77\ninternationally published research papers, has attended 15 international conferences, and has contributed to 18 international books and chapters.\nDr. Shalaby works as a reviewer on over one hundred international journals and is\non the editorial board of more than twenty-five international journals. 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