Variables related to the drug, organism and technique used in antifungal testing.
\r\n\tVarious disciplines characterize the constituent components comprising mechatronics, which include physical systems modeling, sensors and actuators, signals and systems, computers and logic systems, and software and data acquisition.
\r\n\tMany new MEMS and Nanotechnology applications will emerge, expanding beyond that which is currently identified or known. Here are a few applications of current interest: new phenomena are addressed nowadays in science and technology.
\r\n\tIn this book, we will deal with physical systems modeling., discuss the physical phenomena involved, the adequate methodology to deal with them, and report a selection of papers recently published for possible applications for MEMS and Nanotechnology.
\r\n\r\n\tIn summary, Nano- and micro-electromechanical systems (NEMS/MEMS) are useful for applications ranging from: The design of MEMS accelerometers, gyroscopes, electrostatic actuators, and microresonators; Interfacial engineering for NEMS/MEMS; Biosensors, magnetic biochips, in vitro diagnostics, cell sorting, magnetic nanoparticles, spin electronic materials and sensors, magnetic inductive heads, and magnetic integrated inductors and transformer’s; Flexible substrates for electronics, sensors, and energy conversion platforms; Nanofabrication and nanopatterning technologies, including self-assembly for device fabrication.
\r\n\t
The diseases in plants can be reduced with chemical control, in the case of plant fungi illness can be controlled using fungicides. Chemical fungicides are toxic substances that are used to prevent growth or kill fungi harmful to plants, animals or humans. Their use presents many environmental problems such as: the development of resistance to insecticides in pest populations, the resurgence of the populations treated, chemical waste accumulation, risks and legal complications, destruction of beneficial species. Moreover, it is need to be taking in consideration high cost of fumigants, equipment, labor work and material. Thus, to minimize an environmental damage it is very important to substitute chemical control by the biological control.
Biocontrol means to use natural enemies or their metabolites against pathogens causing diseases. This method provides a decrease of pathogenic microorganisms’ population. The main advantages are: little or no adverse side effects to the other biological systems different from pathogenic microorganisms; rare resistance of pathogenic forms to biological control; not harmful to environment; the favorable relation cost
A fungal disease can be described as polycyclic whether the causative agent is capable of producing spores and re-infect plants during a growing season or monocyclic when the causative agent must wait for a new season. This classification applies to regions with four seasons where pathogens must produce specific structures to survive the winter. Phytopathogenic fungi can also be distinguished by the types of produced spores and the method by which they penetrate into the plant. Once the pathogen has penetrated, it produces a haustorium and grows inside the plant (biotrophic power), or kills target cells and feeds on dead tissue (necrotrophic power). The identification of pathogens is performed based on the signs and symptoms of the disease. Signs refer to the observation of some of the structures of the pathogen (such as sporulation). Symptoms are secondary evidence produced by the plant where a pathogen is present (such as wilting leaves).
The fungal cell wall contains different chemical constituents such as polysaccharides, proteins, chitin and other substances. The cell wall formation varies among species, also varies with age of the fungus, since substances may be present in young hyphae, disappear in the older or deposit other materials to mask the presence of initial constituents. Also the composition of the medium, the pH and temperature influence composition of fungi walls.
Enzymes such exo-1,3- β -D-glucosidase (laminarinase; EC 3.2.1.6) and β -N-acetyl-D-glucosaminidase (chitinase; EC 3.2.1.14) are hydrolytic enzymes produced by
The use of mycolytic enzymes as antifungal treatments in the protection of some commercially important crops is promising. Nevertheless, the application of enzyme
The objectives of this study are: to describe the bioluminescence assay approach for detection of mycolytic activity of biocatalysts (chitinase and laminarinase) using
Fungal growth inhibition could be measured by different methods, which are affected by several
Organism specific factors | Drug specific factor | Variables that influence results |
Variable growth characteristics Pleomorphism (in yeasts) Type of Metabolism (aerobic or anaerobic) Medium, pH and incubation temperature can affect growth and pleomorphism | Limited aqueous solubility of some agents Partial inhibition of growth over a wide concentration range giving trailing end points Buffer and pH effects on activity Interaction with media components and buffer | Inoculum Medium formulation and pH Agar versus broth Type of buffer Temperature and duration of incubation Minimal inhibitory concentration (MIC) end point criteria |
Variables related to the drug, organism and technique used in antifungal testing.
Broth dilution test was established as the standard reference for antifungal susceptibility testing, serving as the basis for comparison, for the development of novel tools for antifungal susceptibility testing (Rex et al., 2008 a; Rex et al., 2008 b). These alternative methods require correlation with MIC results in broth dilution one. At first, National Committee for Clinical Laboratory Standards (NCCLS) recommended broth macrodilution methods, but broth microdilution tests were later determined, having the same effect (Espinel-Ingroff et al., 1992). The methodology is useful for testing common filamentous fungi or yeasts, including the dermatophytes. The fungi encompass
NCCLS, now Clinical and Laboratory Standard Institute (CLSI), recommended some alternative methodologies to the conventional broth dilution tests to probe yeasts and molds susceptibility, which provide reproducible results: YeastOne, Alamar Blue, MTT–test, E-test and Disc diffusion.
Disk diffusion testing is a simple and economic alternative to broth dilution tests. It has been probed with yeasts inhibition. Furthermore there have been identified parameters for testing the antifungal effect over filamentous fungi to five agents (amphotericin B, caspofungin, itraconazole, posaconazole, and voriconazole) by this method (Diekema et al., 2003). Results are provided between 8 to 24 hours, quicker than broth dilution test and the use of nonsupplemented Mueller-Hinton agar instead supplemented one should make this method more available to conventional laboratories at a less cost. There is a good correlation between minimal inhibitory concentration (MIC) and diameter of inhibition in disk diffusion testing.
The E-test (stable agar gradient method) is an alternative procedure to test antifungal susceptibility of yeast (Espinel-Ingroff et al., 1996) and molds (Espinel-Ingroff et al., 2001; Szekely et al., 1999). The method is based on a combination of the concepts of dilution and diffusion tests. It quantifies antifungal susceptibility directly as MIC values, like dilution methods. E-test also consists of a predefined and continuous concentration gradient, making this methodology more precise than conventional procedures based on discontinuous two-fold serial dilutions, and it is not affected by antifungal agent properties (such as molecular weight, diffusion characteristics and aqueous solubility) or by different growth rates of fungus as disk diffusion testing (AB BIODIS, 2000). This method involves placing a plastic strip containing a gradient of an antifungal agent on the surface of an inoculated agar plate (plates are inoculated with a suspension of yeast or mold, turbidity equal to 0.5 McFarland standard (1 McFarland standard for
MICs determination can be facilitated for a method which quantifies the hyphal growth of filamentous fungi and overcomes observer bias, which can be getting by colorimetric methods based on the measurement of metabolic activity. Alternative methods use different colorimetric growth indicators and they take at least 24 h before reading. The commercially available YeastOne (Trek Diagnostics Systems) consists of a microtiter plate with dried antifungal drugs (Table 2). Every well includes an oxidation-reduction indicator (Alamar Blue) that changes from blue to pink in the presence of microbial growth. The first well to show a change from pink (growth) to purple or blue (growth inhibition) is recorded as the MIC. Easy set-up procedures eliminate time-consuming broth dilution alternative and results are ready after 24 hours of incubation. Several multicenter studies found good correlation between microbroth dilution and Alamar Blue colorimetric susceptibility tests among
Another preliminary colorimetric test used for filamentous fungi and yeast isolates utilized the yellow tetrazolium salt dye 3-(4,5-dimethyl-2-thiazyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT). This salt is cut by dehydrogenases to form its purple formazan derivative, which can be measured spectrophotometrically at 550 nm (Levitz & Diamond, 1985). All living and metabolically active fungi can cleave MTT. This method has demonstrated a good agreement with MICs of standard broth dilution tests for the fungal inhibition test of yeasts (Clancy & Nguyen, 1997) and some molds (Meletiadis et al., 2000). Initial inoculum and the dye MTT are incubated for 48 h or more to get results.
The methods described above require a long time to perform. Thus, the development of the faster methods for antifungal activity detection is obvious.
Antifungal agents and its dilution range on a YeastOne plate.
Due to conventional antifungal methods need long periods of time to evaluate inhibitory effect of the antifungal compounds, a research focused in the development of a faster and reliable technique using luciferase catalyzed bioluminescent reaction for detection of ATP released from the cells destroyed by mycolytic compounds was carried out in our laboratory.
The luciferase catalyzed reaction allows to selective ATP detection (Ansehn & Nilsson, 1984)). However, ATP of dead cells is very unstable metabolite due to ATPases activity, which in this case catalyzes its hydrolysis. To improve detection of ATP released from dead fungal cells, there were applied vanadate ions as inhibitor of a wide spectrum of ATP-ases (Angelis & Gobbetti, 2004). Assay was carried out testing the susceptibility of
Firstly, vanadate concentration that doesn’t affect fungi’s viability has been determined by evaluation of the
The effect of the mycolitic agents on extracellular and intracellular ATP levels in the presence and absence of vanadate (applied at 0.75 mM) was evaluated (Fig. 1). These assays were performed using enzymes at 20 µg/ml (Cano et al., 2008) and syringomycin E at 2 µg/ml (Espinel-Ingroff et al., 1995) as final concentrations. Results confirm the hypothesis that vanadate addition leads to keep ATP of dead cells due to ATPases inhibition. The increase of extracellular ATP could be considered as the measurable parameter that demonstrates the effect of mycolytic antifungal compounds because it has linear correlation with the CFU (colony forming unit) change rate (Fig. 2).
Intracellular ATP (ATPint) and extracellular ATP (ATPext) detected after 120 min of incubation with antifungal biochemical compounds applied to
The decline of intracellular ATP occurs simultaneously with the decrease of fungus viability: the CFU concentration remained constant in the absence of biofungicides, and decreased in their presence. This parameter also may be indicative to measure the inhibitory effect of antifungal compounds. According to the relationship between the CFU/ml and ATP concentration (Fig. 2), is defined that each CFU of
Selection of change in intracellular ATP level as indicative parameter of antifungal effect is confirmed by results of kinetic study performed with different concentrations of the tested substances (Fig. 3). The increase of biofungicides concentration leads to greater decrease of intracellular ATP level as well as fungus viability, i.e. a good correlation is observed.
The obtained results led to conclusion that the bioluminescent assay may be considered as the fast and reliable method to antifungal activity evaluation.
Correlation between ΔCFU/ml and extracellular ΔATP to estimate the ATP quantity on a CFU of
The effect of chitnase and laminarinase (Sigma, USA) on
Kinetics of intracellular ATP (left) and
After immobilization, antifungal properties of these preparations were compared with free enzymes on wheat HGF. This experiment was carried out under controlled conditions (on an environmental chamber at 21ºC). Five grams of wheat seeds were used for each test. Seeds were irrigated with 20 ml of nutritious solution per day and inoculated with 10 4\n\t\t\t\t
0 60 90 120 180 | 0 38.87 62.71 65.7 66.48 | 0 0.017 0.018 0.02 0.019 | 0 31.5 35.26 82.76 83.75 | 0 0.13 0.14 0.17 0.14 |
Kinetics of chitinase and laminarinase immobilization.
38.23 | 5.74 | 19.33 | 5.5 x 105 | |
39.63 | 6.07 | 19.66 | 2.8 x 106 | |
49.86 | 5.85 | 20.33 | 8 x 104 | |
47.33 | 5.7 | 20.16 | 1.5 x 106 | |
62.5 | 5.5 | 24.5 | 6 x 104 | |
50.06 | 5.2 | 24.3 | 1 x 104 |
Effect of chitinase and laminarinase free and immobilized on seaweed bagasse in HGF characteristics.
Table 4 shows that treatments with chitinase and laminarinase immobilized were effective to inhibit
Thus, with immobilized chitinase and laminarinase on seaweed bagasse led to better control of phytopathogenic fungi under HGF system.
Liposomes are vesicles of colloidal dimensions and spherical shape, with a membrane composed of a lipid bilayer in which (phospho) lipid bilayer sequesters part of the solvent (Lasic, 1995). Liposomes were discovered in 1961 by Alec D. Bangham who was studying phospholipids and blood clotting, and since then they became very versatile tools in biology, biochemistry and medicine.
Due to their chemical composition, structure and small size, liposomes exhibit several properties which may be useful in various applications (Table 5). The most important properties include bilayer phase behavior, its mechanical properties and permeability, charge density, presence of surface bound or grafted polymers, or attachment of special ligands. Additionally liposomes exhibit many special biological characteristics, including specific interactions with biological membranes and various cells (Lasic, 1995).
Liposomes are broadly classified by their structure, composition and size (Table 6). The size, lamellarity (unilamellar or multilamellar) and lipid composition of the bilayers influence
Use | Application area | Reference |
Containing drugs or markers. As a model, tool, or reagent in the basic studies of cell interactions. Recognition processes. | Pharmacology and medicine | Lasic, 1995 |
Used to improve the therapeutic efficacy of the encapsulated drug molecules. Site specific targeting. | Pharmacokinetics and biodistribution | Lasic, 1995 |
As carriers of nystatin and amphotericin | Pharmacology | Yamskov |
Antimicrobial effect of liposome-encapsulated polymyxin B. formulations against a | Microbiology | McAllister |
To yield better correlations with partitioning and solvation of ketoprofen. | Pharmacology | Lozano & Martínez, 2006 |
To deliver exogenous genetic material intra cellularly via fusion with the cell | Pharmacology | Ravichandiran |
The antimicrobial and antiviral activity of liposomes as carriers of essential oils. | Microbiology | Martin |
Drug delivery systems such antifungal, local anesthetics and Retinoids. | Pharmacology | Granda & Diduk, 1996 |
Encapsulation of chitinase and laminarinase on soya lecithin liposomes against | Biotechnology | Joublanc |
Applications of liposomes in different science areas.
many of the important properties like the fluidity, permeability, stability and structure, these can be controlled and customized to serve specific needs. The properties are also influenced by external parameters like the temperature, ionic strength and the presence of certain molecules nearby.
Liposomes are under investigation both as models for biological membranes and as carriers for various bioactive agents such as drugs, diagnostic and genetic materials, and vaccines. The thermodynamics of molecules transfer can be studied by measuring the partition coefficient as a function of temperature. Such data were used for the prediction of absorption, membrane permeability, and
To obtain liposomes, different phospholipids may be applied such soya lecithin, which is the popular and commercial name for a naturally occurring mixture of phospholipids (also called phosphatides or phosphoglycerides). Different soya lecithin samples vary in color from light tan to dark reddish brown. Lecithin is the gummy material contained in crude vegetable oils and removed by degumming. Soybeans are by far the most important source of commercial lecithin and lecithin is the most important by-product of the soy oil processing industry because of its many applications in foods and industrial products. Three main phospholipids in this mixture called "commercial soy lecithin" are 33.0% of phosphatidylcholine (also called "pure" or "chemical" lecithin to distinguish it from the natural mixture), 14.1% of phosphatidylethanolamine (popularly called "cephalin"), and 16.8% of phosphatidylinositols (also called inositol phosphatides) as well as 0.4% of phosphatidylserine. Commercial soy lecithin also typically contains unrefined soy oil as well as additives insoluble in organic solvents (Beare- Rogers et al. 1992).
* Multilamellar: Spherically concentric multilamellar (many bilayers) structures. * Unilamellar: Spherical concentric unilamellar (one bilayer) structures. | |
Composition | * Phospholipids, cholesterol, phosphatidylethanolamine, free fatty acids, divalent cations. * Conventional, pH-sensitive, cationic, immune and long-circulating. |
* Small unilamellar 20-50 * Large unilamellar, 200-1000 * Multilamellar, 400-3500 |
Classification of liposomas according to structure, composition and size.
Liposomes are widely used to deliver drugs for cancer and other diseases, as well as physiologically active substances in cosmetic products. Their application for immobilization of mycolytic enzymes such as chitinase and laminarinase, and the effect of microencapsulation on their antifungal properties are studied by our scientific group.
Liposomes were prepared similar to Bangham method (1993). This resulted in the formation of multilamellar vesicles (MLVs), which was verified by microscopy according to Ávila et al. 2003. The molal partition coefficients (Ko/w), were calculated by Lozano & Martínez (2006) reported method. The standard free energy of transfer (ΔGwo), from aqueous media to organic system was calculated in agreement Ávila & Martínez (2003) approach. The temperature dependence of partitioning (van’t Hoff method) was employed to obtain data on the enthalpy of transfer (ΔHwo). The entropy of transfer (ΔSwo) was quantified by means equation ΔSwo = (ΔH wo - ΔG wo )/ T, and van’t Hoff linearization.
The \'partition\' means, in this case, that the enzyme is distributed between two phases in a dynamic equilibrium. It is a heterogeneous equilibrium since the \'solute\' is distributed between two distinct phases: water and liposomes lipids. As the evidence confirming the distribution process of the enzyme might be considered the decrease of its concentration in aqueous phase after liposome formation related to the partition process between these two phases. Fig. 4 shows the temperature dependence of the partition coefficients for laminarinase and chitinase in studied systems. The Ko/w values diminish with rising temperature in chitinase contained systems and increase for laminarinase microencapsulation (Fig. 4). The partition coefficients of enzymes laminarinase and chitinase (Ko/w) are greater than 1 indicating affinity of enzymes for microencapsulation in liposomes. However, the mechanisms of microencapsulation are different for each enzyme that may be related with differences of their primary structure and amount of lipophilic nature aminoacids (Nobe et al., 2004
).The thermodynamic functions related to the transfer of laminarinase and chitinase from aqueous media to soya lecithin liposomes are summarize in Table 7. In both cases values of ΔG wo at 25 °C are similar and negative. This indicates the preference of each enzyme for the organic phase confirming that enzyme transfer from aqueous media to organic system is spontaneous.
The enthalpic changes imply to energetic requirements and the entropic changes the molecular randomness (increase or decrease in the molecular disorder), resulting in the net transfer of enzyme from water to organic phase. The ΔS wo values defined for chitinase and laminarinase microencapsulation in soy lecithin liposomes are differed to the sign: positive for laminarinase immobilization and negative for chitinase microencapsulation (Table 7). The enthalpy of chitinase transfer (ΔH wo) is negative and that of laminarinase is positive. Therefore, the process is exothermic and endothermic, respectively. Negative enthalpy indicates the presence of significant interaction between molecules of chitinase and soya lecithin phospholipids. Phospholipids can establish hydrogen bonding as donor or acceptor of hydrogen (Ávila & Martínez, 2003). On the other hand, after a certain number of enzyme molecules have migrated from the aqueous to the liposome organic phase, the original cavities occupied by the protein in the aqueous phase now are occupied by water molecules. This event is accompanied by release of energy due to water-water interactions. However, depending on enzyme\'s molecular structure, it is also necessary to keep in mind that the water molecules can organize around the enzyme hydrophobic aminoacids (hydrophobic hydration). This event is accompanied by an intake of energy in addition to a local entropy increase which is related to the separation of some water molecules.
Table 7 shows that for the laminarinase, transfer processes from water to lecithin liposomes were endothermic, and imply high increments in the system net entropy. The entropies of transfer (ΔS wo) are positive only for laminarinase contained system. The increase in entropy at the transfer of laminarinase to lecithin liposomes is possibly due to the disorder produced in the hydrophobic core of the lipid layers during separating the phospholipids hydrophobic tails to accommodate the protein molecules in liposomes. The obtained results indicate that the transfer of laminarinase is entropy driven due to positive value of entropy, while chitinase transfer is enthalpy driven due to its negative value.
Thus, laminarinase and chitinase microencapsulation performed by means of thermodynamically different mechanism that might be taken in account for process optimization.
Partition coefficients of enzymes (laminarinase and chitinase) in soya lecithin liposomes system as a function of temperature (±0.1 °C), in molality (± standard deviation).
Enzyme, mg/Ml | Laminarinase at 0.01 mg/mL | Chitinase at 0.01 mg/Ml |
ΔGw(o, kJ/mol | -8.4 | -8.3 |
Δ Hw(o, kJ/mol | 19.4 | -39.3 |
ΔS w(o, J/(mol x K) from equation | 93.4 | -103.9 |
Free energy, enthalpy and entropy for the transfer of enzymes (laminarinase and chitinase) from aqueous media to soya lecithin liposomes.
The liposomes number were measure by optical light microscopy (40X) immediately after their preparation and each tenth day during their storage at 4° and 25°C (Ávila et al., 2003).
The enzyme presence and rising temperature for liposome formation led to decrease in their number and storage stability over long period of time (Table 8). In the presence of chitinase significant decreasing was observed in twentieth day under both storage temperatures and disappearance at 40th and 30th days, respectively for 4° and 25°C. The number chitinase contained liposomes obtained at 25°C (Table 8) was significantly lower than number of liposomes at the same temperature without enzymes or in the presence of laminarinase (Table 8) that seems to relate to a different interaction mechanisms. In the presence of laminarinase the concentration was similar to quantified in the system without enzymes at 4°C and it was greater than detected at 25°C. Significant decreasing was observed in 10th and 20th day and disappearance after 50 and 30 days, respectively, for 4° and 25°C. In this case, at 25°C liposomes number did not decrease as drastically as in liposomes without enzymes. Effects of enzymes on the stability of liposomes could be related to the interaction of proteins and lipids, which in the case of chitinase destabilized the liposomes, while laminarinase stabilized them for short periods of interaction followed by destabilization.
Enzyme concentration (mg/mL) | Temperature (°C) | Time (days) | |||||||
0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | ||
Liposomes/Ml | |||||||||
Without enzyme | 4 | 9 E+09 | 9 E+09 | 9 E+09 | 9 E+09 | 6 E+09 | 5 E+09 | 5 E+09 | 5 E+09 |
25 | 6 E+09 | 8 E+08 | 6 E+08 | 9 E+07 | 7 E+06 | 5 E+06 | 5 E+06 | 4 E+06 | |
Chitinase 0.005 | 4 | 4.63 E+09 | 4.81 E+09 | 2.76 E+09 | 2.78 E+09 | n.d. | n.d. | n.d. | n.d. |
25 | 6.83 E+06 | 6.08 E+06 | 2 E+06 | n.d. | n.d. | n.d. | n.d. | n.d. | |
Chitinase 0.01 | 4 | 2.88 E+09 | 2.43 E+09 | 2.12 E+09 | 1.68 E+09 | n.d. | n.d. | n.d. | n.d. |
25 | 3 E+06 | 3.17 E+06 | 1.25 E+06 | n.d. | n.d. | n.d. | n.d. | n.d. | |
Laminarinase 0.005 | 4 | 8.65 E+09 | 8.68 E+09 | 7.75 E+09 | 2.22 E+09 | 2.17 E+07 | n.d. | n.d. | n.d. |
25 | 7.1 E+09 | 5.53 E+09 | 5.83 E+08 | n.d. | n.d. | n.d. | n.d. | n.d. | |
Laminarinase 0.01 | 4 | 8.44 E+09 | 8.68 E+09 | 9.02 E+09 | 1.67 E+09 | 3.17 E+07 | n.d. | n.d. | n.d. |
25 | 6.3 E+09 | 5.4 E+09 | 4.9 E+08 | n.d. | n.d. | n.d. | n.d. | n.d. |
Liposome storage stability at 4°C and 25°C
There are two aspects that affect stability of liposome systems: 1) the liposome component may degrade by hydrolysis and oxidation; chemical changes in the layer-forming molecules may affect physical stability; e.g., if phospholipids lose one of their acyl chains (turn into their lysoforms), the liposome structure is affected; and 2) the physical structure of the liposomes may be affected by changes within the lipid-layer, aggregation, or fusion. The storage stability may be increased by the use of purified phospholipids (Bangham, 1993; Ávila et al., 2003). Thus, the soya lecithin liposomes are sensible to the enzyme presence and are better stored at low temperature.
Chitinase activity was quantitatively determined by colorimetric measuring the nitrophenyl group of p-nitrophenyl-β-D-N-acetyl-glucosamide served as substrate, as described previously by Li et al. (2004). The laminarinase (β-1, 3-glucanase) activity was measured according to the method of Singh (1999) using laminarine from
Chitinase and laminarinase activity during storage at 4°C for microencapsulated in liposomes and free enzyme using at 0.01 mg/mL.
Results described activity of free and encapsulated chitinase and laminarinase during their storage at 4°C are shown in Fig. 5. Microencapsulated enzymes are less active than free enzymes, possibly due to encapsulation effect (Fig. 5). In the presence of liposome the chitinase activity was twice less than free enzyme, while laminarinase was significantly less active after encapsulation. The lower activity is related to partly enzyme encapsulation. The enzyme concentration is less in microencapsulated form than in free form.
Moreover, Chaize (2004) reports that once encapsulated, the enzymes have encountered another problem. The permeability barrier of the lipid membrane drastically diminishes the activity of the enzyme trapped in the liposome by reducing the entrance rate of the substrate molecules and then reducing the substrate concentration inside the liposome. It could be the reason for decreasing of chitinase and laminarinase activity after their microencapsulation.
Microencapsulated enzymes lost activity slower than free enzymes. Thus, immobilization of laminarinase and chitinase led to increase the enzymes stability.
The inhibitory effects of free and microencapsulated chitinase and laminarinase were estimated by using the radial growth inhibition assay as described previously by Prapagdee et al. (2007). Fungal growth inhibition was expressed as the percentage of radial growth inhibition relative to the control assay. The means and standard deviations of all obtained results were calculated. Data were analyzed by one-way analysis of variance (ANOVA). Significant differences (p ≤ 0.05) between the means were determined by the Duncan multiple range tests (Bewick et al., 2004).
Previously we reported that chitinase and laminarinase from
The concentration (spores/ml) was decreased in comparison with one detected in the presence of liposomes without enzyme. Conidia concentration decrease was greater in the presence of free enzymes that related to their higher activity and greater growth inhibition.
However, the growth of
Use of free or microencapsulated laminarinase and chitinase at 0.01 mg/mL allows at least double decrease of chemical fungicide concentration to obtaining complete inhibition of fungal growth. It can be useful in agriculture practice to reduce levels of chemical fungicides. Thus, the results demonstrate a synergistic effect on the
All tubes were inoculated with
It has been demonstrated that the enzymes addition led to decrease of the fungus proliferation that was expressed in lower values of CFU/(g of soil). Free and immobilized laminarinase significantly controlled the fungus viability only at 10 or 20 µg/mL, while chitinase applied at 5 µg/mL also provoked the inhibitory effect. The effect was greater with microencapsulated chitinase than free enzyme, while it was not observed in the case of laminarinase. The results obtained in assays carried out in soil demonstrate fungistatic effect (an inhibiting effect upon the growth and reproduction of fungi without its total destruction) which is more pronounced in the presence of higher enzyme concentrations.
The low fungistatic effect also was demonstrated in assay carried out with liposomes without enzymes that demonstrated the lecithin capacity to inhibit conidia germination. The difference between free and microencapsulated enzyme activities decreased during the assay, possibly due to greater storage stability of enzymes immobilized in soya lecithin liposomes. The relative activity of microencapsulated enzymes was superior to free enzymes. It may be considered as higher enzymatic stability under storage in the soil. Microencapsulation of chitinase and laminarinase protects the protein active structure from these inactivation factors.
The synergic effect to control fungus viability was demonstrated. A mixture of chitinases and - 1,3-glucanase was significantly more effective against phytopathogenic fungus than either of these enzymes used individually.
With thiabendazole applied at 12.5 µg/mL the fungicide effect was observed, while at 6 µg/mL the effect was lower. The enzyme addition led to greater inhibition of
Microencapsulated laminarinase and chitinase were applied in the soil under greenhouse condition against
Three different treatments included encapsulated enzymes were applied: the mixture of laminarinase and chtinase at 10 µg/g of soil and 5 µg/ g of soil, respectively; immobilized laminarinase at 10 µg/g of soil with thiabendazole at 6 µg/g of soil, and immobilized chitinase at 10 µg/g of soil in the presence of thiabendazole at the same concentration. The assays with thiabendazole at 12.5 µg/g of soil and with liposomes without enzyme were carried out. Two controls inoculated and not inoculated with
Tomato seedlings (
The group of plants grown on the substrate infected with
Obtained results demonstrated that application of all treatments contained enzymes or chemical fungicide led to control of CFU/(g of soil). The best results were obtained with thiabendazole at 12.5 µg/(g of soil) and at 6 µg/(g of soil) in the presence of chitinase microencapsulated in liposomes at 10 µg/mL. With three other treatments, a similar effect to fungus viability was observed. The CFU/(g of soil) measurements were significantly greater in the untreated infected pots than in the pots with applied treatments, although the increase of CFU/(g of soil) was observed in all cases. The activity maintained at the initial level for the first 14 days followed by its decrease for the next two weeks.
The growth of plants under treatments contained enzymes and/or liposomes with and without thiabendazole was greater than in the case of non-treated and non-infected control. The lowest growth was detected on the infected group without treatments that indicated positive effect of microencapsulated enzymes applied in different treatments to control of phytopathogenic fungus
To determine antifungal activity of biochemical micolytic compounds, the bioluminescent assay may be considered as the fast and reliable method of its evaluation.
It can be concluded that immobilization of chitinase and laminarinase can be a good alternative for enzyme stabilization. Mycolitic enzymes immobilized on seaweed bagasse can be used for the control of phytopathogenic fungi in HGF system.
Chitinase and laminarinase have affinity to soya lecithin liposomes. The findings on the thermodynamic properties of enzymes microencapsulation on liposomes can be considered for process optimization in future studies and applications. Stability of enzyme preparations was increased. Finally, the possibility of using of mycolytic enzymes immobilized in liposomes for the control of some pathogens was confirmed. This finding may provide the alternative means of reducing the dependency on synthetic chemical fungicides. The synergistic effect on viability of
The authors would like to thank SEP–CONACYT 2006-57118 project for the financial support.
This chapter aims to provide an overview of the transdisciplinary work of the Neurosurgeon, Neuroanesthesiologist and Neuropsychologist before, during and after the resection of a neoplasm in eloquent areas with the patient conscious under the 3A anesthesia modality (asleep, awake, asleep). The diagnostic approach and the logistics to carry out this procedure and achieve better results will be shown.
At present there is growing evidence regarding the benefits of surgery in awake patients, with application in the treatment of epilepsy, abnormal movements and neurooncological surgery [1]. The benefits of awake craniotomy are increased lesion removal, with improved survival benefit, whilst minimizing damage to eloquent cortex and resulting postoperative neurological dysfunction. Other advantages include a shorter hospitalization time, hence reduced cost of care, and a decreased incidence of postoperative complications [2, 3]. This approach has allowed to achieve a higher degree of resection with less morbidity and a higher quality of life [2, 3].
Throughout the history of neurosurgery it is known from archeological findings that therapeutic trepanation has existed since the Neolithic period between 8,000–500 BC, this type of treatment was performed for headaches, fractures, localized cranial deformity, mental changes, infections or seizures [4].
The earliest descriptions in the modern era of neurosurgery date back to descriptions in the treatment of epilepsy in the 17th century. However, the most identifiable antecedent dates back to the beginning of the last century with Penfield’s descriptions in the 1920s of intractable epilepsy surgery in awake patients and later in 1937 with the exposure of the intraoperative electrical stimulation technique used for the treatment of epileptogenic foci close to the language area [5, 6].
It was not until 1970 that the intraoperative cortical mapping technique began to be used for the resection of neoplastic lesions by Whitaker and Ojemann, who perfected the technique and published the first series that demonstrated the usefulness of this technique, describing it as safe, simple and adequately tolerated by most patients [5, 6, 7]. Later, in the last decade of the 20th century, Berger began to treat infiltrating neoplasms in eloquent cortical areas, improving the cortical mapping technique with the posterior publication of his experience [5, 8, 9]. Finally, in recent decades, new neuroanatomical studies and the popularization of the cortical mapping technique have led to a better understanding of the cortical and subcortical anatomy, improving the technique and prognosis of patients with infiltrating CNS lesions [10, 11].
For centuries there has been an incessant search to associate specific neurological functions with specific areas of the nervous system. At the beginning of the 19th century, explanatory models of functional neuroanatomy were built. The first to develop a model was Franz Joseph Gall (1776–1832) and his disciple Spurzheim. Dr. Gall is the founder of phrenology, based on the interpretation of the different neurological functions, on the basis that the greater development of a certain function resulted in hypertrophy of a specific brain region and that this hypertrophy conditioned a variation in the external configuration of the skull. This ability of the nervous system to “hypertrophy”, erroneously in the past, is now one of the main properties of the central nervous system used by modern radiology, such as the BOLD effect (increased blood supply to an area that is developing functional activity) or PET (increased glucose metabolism) [12, 13].
Walter Moxon (1836–1886) published the first cases that exposed the principle of hemispheric lateralization, associating the right hemiplegia with aphasia and, therefore, breaking the principle of hemispheric symmetry and locating language in the dominant left hemisphere. Later, Paul Broca presented the case of Monsieur Leborgne a patient suffering from septic gangrene in the lower limb. He was admitted to the Salpetriere hospital in Paris with a clinical presentation described by Broca as “expressive aphemia”, that is, he did not present facial motor deficit or comprehension problems, but the patient was unable to articulate words. An autopsy study identified the lesion in the posterior part of the lower left frontal gyrus. Pierre Marie (1853–1940), reexamined the brain of M. Leborgne, despite confirming the anatomical - functional association made by Broca 50 years earlier, he also concluded that the lesion was not limited to Broca’s area only, but it extended subcortically to the striatum and posterior to the angular gyrus [12, 13, 14].
Carl Wernicke in 1874 gave name and anatomical location to sensory aphasia that he located in the primary auditory cortex, in the posterior part of the superior left temporal gyrus. Decades later Theodore Meynert (1833–1892) was the first to associate auditory aphasia with the posterior part of the superior left temporal gyrus. Wernicke not only correlated the types of aphasia with different areas, but also established the term conduction aphasia (inability to repeat words) for those syndromes of disconnection between the sensory and motor areas of language, associated with the lesion of the arcuate fascicle (AF) [13, 15].
Geschwind succeeded in introducing one more level into the theory of language: the fundamental idea of networking and interconnection of the central nervous system. There are some basic Broca - Wernicke nodes and their main connection, which is the arcuate fascicle, but they do not work in isolation [16].
Damasio published the implication of the associative areas of the left medial frontal gyrus and the premotor area when performing tasks of understand words when related to animals, tools, or people. Also the implication of the inferotemporal cortex in the assimilation of the semantic concept of language, regardless of the stimulus pathway through which the word, visual (reading) or auditory information arrives, the precise implication of the dominant temporal pole in the memory-language association with the name of famous faces or places. He also characterized the difference between the pure primary auditory cortex in the transverse gyrus of Heschl and the posterior temporal area in T1 proper language, establishing the high regional cortical specialization for language understanding and he introduced the participation of the right hemisphere in the assimilation of concepts [17, 18].
Once the historical review of the intraoperative cortical mapping has been carried out, it is important to emphasize that it is an evolving paradigm. Nowadays the vision of functions dependent on a specific anatomical cortical site has given way to a new dynamic and integrative paradigm with structural and functional connectivity and reciprocal influence, in this manner a lesion in a given site does not affect only one function, but the system as a whole [19, 20]. For this reason, pre-surgical functional studies are not superior to intraoperative mapping.
Although it is accepted that the mapping should be directed towards the area where the lesion is located, the wide anatomical and functional variability between individuals, limitations in presurgical neuroimaging, and functional modifications caused by the tumor must be considered [21, 22]. Usually, the evaluation of 8 main domains is accepted, which are adapted to the location of the lesion, activity of each patient and the evaluation of the benefit of a broad resection against the loss of functionality/neuroplasticity [20, 22]:
Movement.
Somatosensory function.
Visual Function.
Vestibular/auditory function.
Language (spontaneous, nominate, understand, repeat, read, write).
Higher functions (calculation, memory, attention, cognitive control, judgment).
Spatial orientation.
State of consciousness (Table 1
Function | Cortical Areas | Subcortical pathways |
---|---|---|
Motor function | Central region, SMA, premotor cortex | Pyramidal pathways (corona radiata, internal capsule, mesencephalic peduncles) |
Somatosensory | Central region (primary and secondary somatosensory areas), insula | Thalamocortical pathways |
Oral language | ||
Ventral semantic stream | Posterior temporal regions, orbitofrontal and dorsolateral prefrontal areas (dorsal and ventral) | Inferior occipital fasciculus |
Dorsal phonological stream | Posterosuperior temporal cortex, inferior frontal gyrus | Direct SLF (arcuate fasciculus) |
Articulatory loop | Supramarginalis gyrus, ventral premotor cortex | Indirect SLF III (lateral, anterior) |
Speech production | Dominant anterior insula (articulatory planning), ventral premotor cortex, primary sensorimotor area of the mouth | Operculo-insular fibers, descending pathways from the ventral premotor cortex, pyramidal tract and lentiform nucleus. |
Writing | Inferior and superior parietal lobules, insula, second and third frontal convolutions, SMA | SLF |
Reading | Visual cortex, visual object (word) form area | Inferior longitudinal fasciculus |
Visuospatial cognition | ||
Visual | Temporo-parieto-occipital junction, visual cortex | Optic radiations |
Spatial awareness | Right supramarginal gyrus, right superior temporal cortex | Right SLF |
Vestibular | Right inferior parietal cortex, posterior insula, superior temporal cortex | Right SLF |
Higher cognitive / executive functions | ||
Language switching | Left inferior frontal gyrus, posterosuperior temporal area | SLF |
Working memory | Inferior frontal gyrus, dorsal premotor cortex, supramarginal gyrus | SLF |
Syntactic processing | Left inferior frontal gyrus, left inferior temporal gyrus | SLF |
Judgment, decision making, understanding | Left dominant prefrontal cortex, Left posterior temporal cortex. | Inferior occipitofrontal fasciculus |
Selection, inhibition, attention | SMA, cingulum, frontal eye fields. | Subcallosal medialis fasciculus, head of the caudate nucleus |
Cortical and subcortical structures involved in major brain functions as detected by direct cerebral stimulation.
SLF: superior longitudinal fasciculus.
SMA: supplementary motor area.
The cortical mapping must be adapted in each patient, according to location of the lesion. The following paragraphs review the main tasks and effects of cortical stimulation.
The main functions to evaluate correspond to the motor paradigm, which traditionally has an anatomical correlate in the primary motor cortex in the precentral gyrus, and surrounding subcortical regions, therefore it is necessary to map this area to avoid contralateral paresis or plegia. Corona radiata is considered the posterior subcortical limit of a frontal lesion resection. Cortical mapping is performed by asking the patient to perform movements while stimulating the specific area with respect to the Penfield homunculus, which will lead to its inhibition, or in a patient at rest the stimulation will cause involuntary movement [21, 22]
It is the most widely used technique in awake patient surgery to delimit essential brain regions for some functions such as movement and language. It consists of the administration of an electric current in milli-amperes directly on the cerebral cortex (authors recommend bipolar stimulation, short train, 1 ms duration and 200 Hz frequency, with 5-20 mA intensity) in order to cause depolarization of a group of neurons belonging to a cerebral system to produce a positive symptom (such as a muscle contraction) or negative (such as the arrest during number counting).
Thanks to this technique, the organization of the representation of the body in the cerebral cortex was described by the eminent neurosurgeon Wilder Penfield in the 1950s and later important contributions were made on the organization of language in the brain by George Ojemann.
Among the most important advantages is the speed with which a wide region of the cerebral cortex can be mapped, in cases where the neoplasm delimited in the cortex can be observed, the edges of the lesion can be delimited. In the same way, it is possible to stimulate subcortically in the white matter.
Among the most important limitations is the little time available to carry out a cognitive task. For example, it is ideal to explore the denomination since the electrical stimulus can be administered immediately after asking the patient for the name of an object represented in a slide (several seconds), however it would not be possible to administer an electrical stimulus during the elaboration of a narration (Figures 1–3).
Cortical stimulation with bipolar.
Use of cortical stimulation guided by navigation.
Cortical stimulation using various contacts.
The cortex of the inferior and middle frontal gyri, when stimulated, causes impairment in writing.
Regarding the frontal subcortical mapping, these fasciculi are evaluated by counting, naming, and reading tasks, the main tracts to evaluate in this area are:
Executive functions, working memory, attention, control, judgment and decision-making, functions related to perisylvian and prefrontal areas are also evaluated.
The primary somatosensory cortex is located posterior to the primary motor cortex and, if necessary, it is possible to resect it without significant alterations in the sensory function, since other association areas can supply its function. However, the thalamocortical radiation must be preserved, representing the anterior limit of resection of parietal lesions [22, 23, 24].
The cortical region of the inferior parietal lobe, the supramarginal and angular gyrus, affect language in the dominant hemisphere and spatial awareness in the non-dominant hemisphere. Writing and calculation tests should be done to avoid iatrogenic Gertsman’s syndrome. In the subcortical region of the dominant inferior parietal lobe (Geschwind territory), there are continuity of the pathways that communicate Broca’s area (inferior frontal cortex) with Wernicke’s area (posterior temporal cortex), the AF and SLF, therefore the stimulation of these areas can cause paraphasia and alteration in the production of language [22, 25].
In the temporal cortex, the main function to identify is language, especially in lesions of the dominant hemisphere. The posterior limit of a temporal pole resection is the arcuate fasciculus, which when stimulated causes paraphasia. Other temporal cortical and subcortical functions are visual recognition and dependent language, which is assessed with picture recognition. Likewise, temporary optic radiation should be evaluated in periventricular lesions in this region, in order to avoid postsurgical hemianopia [23].
The primary visual cortex is the main area to be explored, which when stimulated can produce phosphenes, blurred vision, visual hallucinations, and scotomas. Regarding the subcortical mapping, the final portion of the IFOF can produce alteration in the recognition and conceptualization of objects, so semantic paraphasia can be found [22, 23].
The insular cortex and its corresponding subcortical tracts are considered unresectable, since they represent an important anatomical seat of essential functions of sensory, motor, limbic, vestibular and language integration. It is explored using a picture naming test [22, 26].
In a report, Ius et al., were able to identify sites considered unresectable after cortical mapping and resection of the lesion; in the dominant hemisphere the primary sensory and motor areas for the upper and lower extremities, the ventral premotor cortex, Wernicke’s area in the posterior part of the superior temporal gyrus, and the supramarginal and angular gyrus; while in the non-dominant hemisphere the primary motor and sensory cortex and the angular gyrus. In certain cases it was possible to excise the rest of the association areas under the principle of maximum resection without greatly affecting the function [20, 21, 22]. Likewise, regarding the tracts, the following were considered unresectable: the cortico-spinal tract, posterior limit in patients with frontal lesion; thalamic-cortical radiations, anterior limit in patients with parietal lesions; the stratum sagittale, medial border of temporo-parietal lesions; anterior part of IFOF and perisylvian network [21, 22].
In general, neoplastic intracranial lesions can displace or invade brain structures. The first group of lesions are not usually candidates for awake resection, since the symptoms are produced by the effect of mass on the cortex and tracts, but their resection does not involve functional areas. Unlike the second group of neoplasms that can infiltrate or even originate in functional areas, and whose resection without the appropriate quality of life approach, can have unacceptable consequences for the functioning of patients. Also, since the patient should be comfortable as much as possible for resection of the lesions, the awake and cortical mapping approaches usually involve convexity or superficial, intra-axial, supratentorial lesions [1, 27].
In a review of several reported series of awake cortical mapping, gliomas are the neoplasms that are most frequently approached by this technique, up to 60%. High-grade astrocytomas such as OMS GIV glioblastoma is the most frequent glioma reported, followed by oligodendrogliomas, oligoastrocytomas, and low-grade astrocytomas [2, 28, 29]. The second group in frequency are brain metastases, mainly pulmonary and mammary origin. Finally, non-neoplastic lesions such as cavernous angiomas are usually reported as accessible lesions using this technique [30].
Although it is true that all the lesions described in the previous paragraph benefit from a wide resection, at present special emphasis has been placed in low-grade gliomas since these are lesions that usually occur in young adults, and it migrates through white matter tracts at an average rate of 4 mm/year [23, 31]. This raises new paradigms in which a supramarginal resection has been proposed even at the cost of function, hoping that brain plasticity in young patients improves the prognosis and quality of life in the long term [32].
The main criteria that are considered in neurosurgery to determine that a patient is considered for this type of procedure can be consulted in Figure 4 in the form of a flow chart. Some of the most important criteria will be mentioned below according to the purpose of this chapter:
The lesion should be located intra-axial (typical of the brain parenchyma), in a brain region that implies a high risk of post-surgical neurological and/or cognitive alterations. Generally, cortical and/or subcortical sensorimotor and periinsular regions of the dominant hemisphere. However, other “highly specialized areas” should be considered according to the profession of each patient.
In relation to the radiological characteristics of the tumor, ideally with little cerebral edema, without significant midline deviation.
Degree of malignancy. Previously it was considered that the tumor should be low grade (histologically) since having a good survival prognosis, the benefit of keeping it neurologically intact was essential However, nowadays it is currently considered that it should also for patients with a high-grade, to promote quality of life.
Patient can decide to accept the procedure and agree to collaborate once he knows the type of surgery that is proposed.
Patient with no history of anxiety or impulsivity disorder because these may be exacerbated during surgery (e.g. refusing to cooperate or presenting psychogenic symptoms that make evaluation difficult) (Table 2
Diagram showing the flow of neurosurgical conditions that must be considered to determine that a patient is a candidate for awake surgery (red line). Patient admitted to neurosurgery, from the outpatient or emergency department with an intra-axial lesion, located in a highly specialized area. Candidate for structural, functional and tractography MRI. Neuropsychological assessment confirmed the possibility of surgery with a conscious patient. Surgery is scheduled with a navigation method for resection of the lesion.
Prior Concerns | Current Solutions |
---|---|
Significant mass effect (>2-cm midline shift) despite preoperative diuretics & steroid | Staged internal debulking (asleep) using functional imaging (MEG/MSI) followed by reoperation w/ awake mapping or LMA |
Obese patient (BMI >30)/obstructive apnea | LMA before & after mapping (limits subcortical mapping during resection if LMA is used) |
Psychiatric history/emotional instability | Treated mood disorders no longer a contraindication |
Age (yrs) | |
>10 | Awake |
<10 | 2-stage procedure w/ implanted grid |
Intraop seizures | Iced Ringers solution, propofol IV 6 inches from vein |
Smoker | Cough suppressants w/ or w/o light sedation |
Intraop nausea | Preop medication w/ antiemetic drugs (ondansetron hydrochloride, scopolamine) & high-dose dexamethasone (10 mg) |
Reop (dural scar) | Focused craniotomy w/ negative mapping is acceptable |
Severely impaired preoperative function* | Attempt to improve function w/ up to 5 days of preoperative high-dose steroids w/ or w/o diuretics |
Tumor location presumed to be w/in functional cortical or subcortical pathways on preop imaging | The decision to offer surgery is not made based on preop anatomical or functional imaging (attempt is always made to map, identify, & preserve functional sites). |
Relative contraindications and solutions for awake craniotomy patients.
Motor function <2/5 or baseline naming/reading errors.
BMI = body mass index; IV = intravenous; MEG = magnetoencephalography; MSI = magnetic source imaging.
Once the patient has been selected for resection of the lesion with cortical mapping, extension studies should be carried out to bring us more evidence regarding the patient and their environment through neuropsychological and neuro-anesthesiology assessment. In addition, to plan the intraoperative mapping, it is advisable to perform:
Diffusion tensor tractography (DTI): identifies the main tracts of white fibers (corticospinal, superior longitudinal fasciculus, arcuate fasciculus, uncinate fasciculus, inferior orbitofrontal fasciculus, optic pathways) their location and infiltration or displace. However, the variability between imaging and the effect of medical treatment on the injury and associated vasogenic edema must be taken into consideration.
Functional MRI: it helps to locate functional cortical areas through dependent sequences of blood oxygenation, which detects the increase in cerebral perfusion to certain areas when specific tasks are performed. The most studied paradigms are motor, sensory and speech
The functional Magnetic Resonance images are based on the changes in the oxygen levels in the blood related to an activity by the subject. It is an indirect measure of brain functionality since the equipment detects changes in signal intensity caused by vascular changes (demand for oxygen supply through the blood). Since the construction of the images depends on the use of complex mathematical algorithms, it is not possible to completely eliminate the noise sources that may occur, causing false positives, that is, activations in some brain region that are not real. In the same way, false positives can occur due to the pathology of the brain tissue itself due to the pathological vasculature.
It is currently one of the most common methods in cognitive neurosciences due to its safety in healthy subjects.
Figure 5 shows motor paradigm during evaluation of a patient with a supratentorial glioma.
Functional MRI with motor paradigm.
Other functional extension studies such as positron emission tomography (PET) or magnetoencephalography allow planning the procedure but none of them is superior to intraoperative cortical mapping, which is considered the gold standard.
Benefits of awake craniotomy are greater resection of the lesion, with improvement in survival, while the damage to the eloquent cortex, which generates postoperative neurological dysfunction, is minimized. Other advantages include shorter hospitalization times, hence a reduction in care costs, and a decrease in the incidence of postoperative complications.
The term “awake craniotomy” is misleading as the patient is not fully awake during the entire procedure. The most painful moments of surgery require different levels of sedation or anesthesia, nonetheless, patient is fully awake while mapping or during resection [33].
A very important aspect in an awake craniotomy is the adequate selection and full preparation of the patient by a multidisciplinary team in order to avoid intraoperative failures [34].
All patients should have consultations with the neurosurgeon and neuroanesthesiologist to assess whether the patient is a good candidate for this technique (
Patient refusal Inability to lay still for any length of time Inability to co-operate, for example confusion Mental retardation Anticipated difficult intubation Obstructive sleep apnea Children <10 years |
Patient cough Learning difficulties Inability to lay flat Patient anxiety Language barriers Obese patients |
Anesthetic contraindications.
Preoperative evaluation includes getting detailed information from the patient, in turn the patient must know what to expect and know the risks inherent to anesthesia. Usually this includes verbal and written informed consent [34, 35].
Pre-operative consultations provide an invaluable opportunity for the multidisciplinary team to create a rapport with the patient and therefore encourage trust.
The layout of the operating room and the position of the patient must be taken into account. The ability to communicate with the patient must be maintained at all times and access to the patient during adverse events is of equal importance.
As in every surgery, the operating table should be as comfortable as possible, since the patient is going to be lying in the same position for several hours. The operating room temperature should be comfortable for the patient, and the number of people should be minimized to reduce unnecessary noise and reduce patient anxiety [36].
The position of the patient is determined by the location of the lesion. (Figure 6) This is usually a lateral or supine position, in the case of occipital lesions and evaluation of the visual cortex, a sitting position may be used. In either position, it’s important that when patient is fully awake during mapping, he can see and communicate with the neuroanesthesiologist or neuropsychologist. Sterile drapes used should not invade the patient’s face, as this may cause claustrophobia and difficulty in communicating [37].
Position of the patient and the evaluator during the surgical procedure to carry out the neuropsychological and movement evaluation.
The choice of the anesthetic agent even within a preferred anesthetic technique varies, but the general principles are common to all of them; the need to maximize patient comfort, prevention of nausea and vomiting that may increase intracranial pressure, the need for hemodynamic stability, and the use of short-acting drugs that allow acute control of the patient’s level of consciousness.
Premedication is not common, but reflux prophylaxis should be considered, patients should continue their prescribed medication such as steroids, antiepileptic drugs, or antihypertensives. Prophylactic antibiotics and usually one or more antiemetics are administered in every patient before the incision. The most common options are ondansetron and dexamethasone. Dexamethasone can also be used to diminish brain edema during the operation.
Standard anesthetic monitoring is used. Depth of anesthesia monitors, for example Bispectral Index Monitoring (BIS™), are sometimes used to reduce the dose of anesthetic agents administered and thus time required for patient emergence and cortical mapping cooperation [37, 38].
Capnography under general anesthesia is considered basic monitoring, but carbon dioxide monitoring for sedated or awake patients during mapping is also a common practice. Although carbon dioxide levels may be inaccurate, it is used to confirm ventilation [39].
A large-bore intravenous access is obtained and most neuroanesthesiologist place also an arterial line, usually sedated or asleep. The use of other forms of monitoring is variable.
There is not a recognized consensus on the best anesthetic approach for awake craniotomy. This is because neuroanesthesiologists vary the technique depending on neurosurgeon’s preferences, pathology, duration of the surgery and patient’s factors.
There are two dominant anesthetic approaches to solving this problem: monitored anesthetic care (MAC) and asleep-awake-asleep (AAA).
The goal of the MAC approach is to decrease the sedative dose to avoid an abrupt transition from sleep to awakening, which can lead to hypoactive or hyperactive delirium upon emergence and to decrease the reliability of mapping. MAC technique for awake craniotomy involves spontaneous ventilation and low doses of sedative drugs [38].
The AAA technique involves induction of general anesthesia and control of the airway with a supraglottic device such as laryngeal mask airway (LMA) or intubation. When neurocognitive testing and intraoperative mapping need to be started, anesthetic drugs are reduced or stopped, and the device is removed from the airway. Once resection of the lesion is complete, return to general anesthesia and reintroduction of the airway device is done. Advantages of this technique include the ability to control ventilation and thus control carbon dioxide concentrations and prevent airway obstruction and hypoventilation. It also facilitates a greater anesthetic depth during the most painful moments of surgery. Anesthetic drugs used for this technique are varied, but propofol and remifentanil TCI are the most common, followed by the use of a volatile anesthetic and remifentanil infusion. The use of dexmedetomidine has also been reported with this technique, and it’s generally used during the awake stage of surgery and closure [39].
The cornerstone of awake craniotomy analgesia is regional scalp block along with infiltration of the incision line. A scalp block also provides hemodynamic stability and decreases the stress response to painful stimuli [40].
The scalp block technique includes infiltration of local anesthetic into seven nerves on each side. This is an anatomical block and not just a ring block. A ring block will require large volumes of local anesthetic, increase the risk of toxicity, and will not provide deep anesthesia to the temporal fascia.
Most neuroanesthesiologist place a bilateral scalp block before pinning of the head with Mayfield skull clamp. Occasionally, a scalp blocker is not applied and relies on local anesthetic infiltration by the surgeon.
The total dose of local anesthetic with and without epinephrine must be calculated individually for each patient. Studies have shown that the rise in plasma concentration of levobupivacaine and ropivacaine is faster compared to other local anesthetics and similar in all patients. Despite the quick rise in plasma levels, there were no signs of cardiovascular or central nervous system toxicity. The use of bupivacaine, levobupivacaine, and ropivacaine in varying concentrations with and without epinephrine has been described for use in a blockage of the scalp. The addition of epinephrine, usually 1: 200,000, increases the total amount of local anesthetic that can be used, decreases localized bleeding, and maximizes duration. However, systemic absorption may cause tachycardia and hypertension, and intraarterial injection into the superficial temporal artery is possible when the auriculotemporal nerve is blocked [37].
Awake craniotomy is generally a well-tolerated procedure with a low conversion rate to general anesthesia and a low complication rate. One of the most common complications is intolerance of the patient to the procedure, often due to urinary catheter or prolonged positioning and intraoperative seizures.
Seizures, focal or generalized, are more likely to occur during cortical mapping. The frequency of seizures during awake craniotomy ranges widely from 2.9–54%. These are treated by irrigating the brain tissue with ice-cold saline, they usually stop with this treatment, but sometimes benzodiazepines, antiepileptic drugs or re-sedation with airway control are required [41].
The efficacy of prevention of intraoperative seizures with anticonvulsants remains doubtful. The latest systematic review on this topic revealed no benefit of prophylaxis. However, it should be noted that most of seizure prevention trials are based on the use of phenytoin or valproate. On the other hand, there are new data that support the superiority of levetiracetam in the prophylaxis of seizures. However, there are insufficient data to recommend its routine use in awake craniotomy.
An emergency plan for airway control must be in place at all times and this can be challenging as the patient’s head is fixed on the clamp and often away from the ventilator. Options include insertion of an LMA which may be easier than endotracheal intubation.
Once resection is complete, patient may be re-sedated or re-anesthetized with reattachment of the airway device, even if in the lateral position. Dura, bone flap, and scalp are then closed, pins are removed, and patient is awakened.
If remifentanil has been used, it can be given at low infusion rates to aid for a “soft” awakening and prevent coughing.
It is imperative that close neurological monitoring continues as postoperative hematomas may develop, especially in the first 6 h after operating. This may require an urgent evacuation of the clot.
After scalp block has worn off, systemic pain relief is used. The use of postoperative pain relief can be decreased in patients who have received a scalp block. Regular paracetamol and opioids are used.
Some generalities of intraoperative neuropsychological evaluation will be mentioned in the light of new neurocognitive technological and theoretical tools that allow us to carry out current forms of evaluation, always outlined based on the objectives of the surgical plan of the transdisciplinary group of the treating physician, as well as the type of tumor, location and extension.
The selection of the methodology for the intraoperative neuropsychological evaluation is described in detail in accordance with the current literature on a recent vision of Functional Neurosurgery in brain tumors called hodology [19], which implies a radical change to the classical view on a rigid and exclusively cortical cerebral organization of brain functions. (
This term refers to a current vision in functional neurosurgery in which the classic trend of localize functions in the cerebral cortex is changed by a concept called hodological mechanism (from the Greek hodos, path or path) related to the cognitive alteration caused by affection in anatomical connectivity rather than a lesion in the cerebral cortex.
This approach conceives the Central Nervous System as a comprehensive system integrated by a plastic network made up of functional cortical epicenters connected by short and long fibers of white matter. Thus, brain functions are the result of the confluence of parallel information pathways, dynamically modulated in a widely distributed, interactive and multimodal circuit.
This view is of great relevance, especially in brain tumor neurosurgery due to the brain plasticity that is induced by the neoplasm itself. This phenomenon makes the dissociation between anatomy and functional delimitation especially valid, that is, to determine anatomically an area (for example the precentral gyrus) does not guarantee that it functionally corresponds to motor regions. This new perspective opens the possibility of contemplating the performance of surgical procedures in regions that were previously considered inoperable. Broca’s area is an example of this new vision, since if it is considered inoperable, different brain mapping techniques such as cortical electrical stimulation can currently be used to functionally delimit this region through naming tasks. Broca’s area is also a good example to show the brain plasticity that the hodological approach considers, since we frequently observe neoplasms in these regions with a patient without deficit (dynamic, not rigid system), and it is well known that in order to presents an alteration compatible with Broca’s aphasia, the lesion must include cortical and subcortical regions (cortical epicenters and connectome), since a lesion limited only to the cerebral cortex corresponding to Brodmann’s area 44 and 45 is associated with a transitory alteration less severe.
Transoperatively evaluating a cognitive domain with all the theoretical complexity that we currently have can take a long time, bringing an apparent contradiction, since on the one hand we require time to assess details of the domains, however, during surgical procedures with the patient awake, only they have several seconds and in some cases minutes. This leads to apparently unrelated cognitive areas that will be evident in the postoperative period. To exemplify this, we can take the case of the famous patient HM, one of the best known cases in the history of modern neurosciences who was operated awake during the bilateral resection of hippocampal structures in 1953. At that time, it was only considered important to explore the understanding and expression of language, without considering the exploration of other cognitive domains, resulting in the tragic history of memory loss that we all know. Without devaluing the merit of surgery in the context of the time, this story teaches us that it is essential to carry out a broader neuropsychological evaluation in terms of cognitive domains, apparently little related to the intervened brain region, so that the consideration of the activities to perform during the intraoperative is essential in order to optimize the time and tasks to be performed.
Among the most important neuropsychological criteria is that the patient wishes to cooperate and his neurological and psychological condition allows it, that is, the patient must understand why the suggestion of this surgery modality so that he openly expresses that he wants awake modality, knowing that it can be stressful to a certain extent and that your participation is essential. A second important criterion is not to present alterations that may obstruct the intraoperative neuropsychological evaluation. In this sense, the patient could find conditions that allow him to have a functional daily life, however, it may be that for the surgical procedure it is not suitable, for example a tumor in prefrontal regions that could affect uninhibited behavior. This could be dangerous because the integrity of the patient could be compromised by refusing to participate during surgery. Another example could be the difficulty in understanding long sentences or marked slowness when carrying out the instructions. These examples show that, even though the patient understands the importance of the procedure and shows the willingness to cooperate, it should be considered, since in the last example it could be determined that it would be enough to be able to carry out the monitoring of gross motor aspects, so it could be done.
An important aspect is to know, through anxiety, depression and impulsivity scales, the degree that the patient can manifest in the face of stress, since the procedure can facilitate the appearance of behaviors that could hardly be observed in daily life.
In our experience, awake surgery involves a series of stages prior to the intraoperative that the patient must undergo to guarantee a greater chance of success. That is, if it is true that success depends largely on what happens in the operating room, it is also true that a lot has to do with the preparation of the patient, the collection of neuropsychological and psychological data, and in some cases the family dynamics before the surgery, as it must be remembered that patient participation is essential, so that an inadequate preparation (eg, lack of understanding of the purpose of the procedure) could turn into limited cooperation and vulnerable to fatigue due to the small discomforts that could present.
In the same way, follow-up is important to guide the family and the patient about neuropsychological or personality changes that may occur, some of them may require neuropsychological intervention or orientation to primary caregivers.
The entire conventional neuropsychological clinical interview is conducted paying attention to traits or probable personality disorders, how to manage stress in the daily life and impulse management. It should be remembered that surgery can represent a time of stress in which the patient can behave differently from the way they do it in their daily life (explain with appropriate psychological terms that it can be psychologically unstructured), in addition to the use of medications that they could contribute for that moment. (If you are in stress, you can request to be put to sleep or decide not to cooperate, making the procedure considerably more difficult).
A conventional neuropsychological evaluation is performed. In brain tumors, large batteries are used in terms of functions, e.g. The Comprehensive Neuropsychological Exploration Program Test Barcelona completes and complementary tests.
One of the purposes is to detect qualitatively and quantitatively. All this to detect obvious or subtle alterations that the neoplasm is already causing and think about the possibility that these alterations are highlighted.
Psychological approach in which the patient’s real expectations and fantasies must be detected. Anxiety and depression must be identified. Follow-up is encouraged for the next stages, gives an overview of what might happen if the tumor is malignant or non-malignant. This stage is mixed with the Psychological intervention and the intervention plan must begin here.
Other aspects that influence this stage are:
the carving explanation of the procedure, beginning, end, when waking up, when sleeping, when to sedate it, activities to perform, activities to perform, possible discomfort, procedure simulation, stereotactic frame simulation. As far as possible, visit the operating room from the outside, explanation of a video of a patient with a similar tumor.
This gives you a lot of neuropsychological material to ask questions during surgery, e.g. If so, a description of the coffee harvest can already be requested (since he is involved in the process in his place of origin). This constitutes a great deal of material to use in assessing spontaneous language.
Activities are designed according to the neuropsychological profile and the surgical plan. This stage can be better understood in the section on the intraoperative neuropsychological evaluation plan.
Ecological evaluation plan, what the patient requires for her daily life.
Neuropsychological rehabilitation and orientation to the family on apparently permanent and transitory alterations, including personality changes.
Follow-up at 6 months and 1 year. Figure 7.
General diagram (timeline) of the transdisciplinary treatment and location of the intraoperative neuropsychological evaluation. The steps prior to the neuropsychological assessment represented by interconnected circles represent the independence of each step, but the close relationship between them. CH: Clinical History, Pre-NP: Preoperative Neuropsychological Evaluation, PE: Psychoeducation, Inter Psicol - Psychological Intervention, Post: Postoperative neuropsychological follow-up, Rehab: Neuropsychological rehabilitation.
The most important objective of this surgical modality is the cognitive preservation and neurological function of the patient and at the same time achieving the greatest amount of tumor resection, that is, the removal of the greatest amount of brain tumor with the least amount of sequelae. This is especially valid for those patients who have a low-grade tumor with an adequate prognosis for life, recently also for those with a tumor with a higher grade of malignancy that will limit survival to several months. In both cases, the amount of pathological tissue that can be removed is of vital importance since the success of the rest of the complementary postsurgical treatments such as radio or chemotherapy depends largely on this.
The most serious intra-surgical complications include seizures, respiratory depression, air embolism, cerebral edema, and the cardiac trigeminal reflex. The total reported complication rate is about 16.5%, and in 6.4% of patients it is not possible to complete the mapping procedure.
The main causes of failure are the appearance of seizures and the loss of cooperation of the patient due to severe drowsiness, agitation, or the development of mixed dysphasia. Failed craniotomies are associated with a lower incidence of gross total resections, greater speech impairment after the procedure, and a longer hospital stay.
The application of awake craniotomy has continually evolved. The key to the success of this procedure is to pay attention to each of the components, such as careful patient selection, prior psychological preparation, building a solid relationship, ensuring the solid position of the patient, optimal regional anesthesia, the correct selection of agents and anesthetic technique, preparation and timely management of crises, and constant communication between group members.
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Research continuously innovates to develop efficient and cheap methods to sustain clean water for developing countries. Developing nations are a broad term that includes countries that are less industrialised and have lower per capita income levels than developed countries. This chapter will discuss clean water for drinking water purposes. Pollution concerns of water in developing countries will be categorised in terms of physical, chemical and biological pollutants such as turbidity, organic matter and bacteria. Natural and anthropogenic pollution concerns linking with seasonal factors will be outlined. The multi-barrier approach to drinking water treatment will be discussed. Abstraction points used will be researched. Water treatment systems, medium- to small-scale approaches, will be discussed. The processes involved in removing the contaminants including physical processes such as sedimentation, filtration such as slow-sand filtration, coagulation and flocculation, and disinfectant processes such as chlorination will be reviewed. Other important methods including solar disinfection, hybrid filtration methods and arsenic removal technologies using innovative solid phase materials will be included in this chapter. Rainwater harvesting technologies are reviewed. Safe storage options for treated water are outlined. Challenges of water treatment in rural and urban areas will be outlined.",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",title:"The Relevance of Hygiene to Health in Developing Countries",fullTitle:"The Relevance of Hygiene to Health in Developing Countries"},signatures:"Josephine Treacy",authors:[{id:"238173",title:"Dr.",name:"Josephine",middleName:null,surname:"Treacy",slug:"josephine-treacy",fullName:"Josephine Treacy"}]},{id:"63322",doi:"10.5772/intechopen.80355",title:"Challenges to Hygiene Improvement in Developing Countries",slug:"challenges-to-hygiene-improvement-in-developing-countries",totalDownloads:2647,totalCrossrefCites:8,totalDimensionsCites:15,abstract:"Hygiene is defined as conditions or practices conducive to maintaining health and preventing disease. Hygiene has been shown to reduce diarrheal diseases and assist to improve social outcomes in the community. Improving hygiene faces several problems especially in countries with low income per capita of population. Currently, many developing countries already struggle to cope with consistent water shortages and rapid urbanization causing more pressure to limited resources which in turn result in poor hygienic practices in the communities. The common types of hygiene include personal hygiene, water hygiene, food hygiene, and hygiene during waste handling. Different nongovernmental and governmental organizations face different challenges in achieving high levels of hygiene in communities. Some of these challenges include poverty, lack of political commitment, lack of full community participation, inadequate gender inclusion, inadequate data, lack of coordination among actors, and behavioral issues. To reduce these challenges, several measures have been proposed including community empowerment, pushing for equitable access to hygiene needs, advocating for political commitment, promoting gender equity, and enhancing youth involvement.",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",title:"The Relevance of Hygiene to Health in Developing Countries",fullTitle:"The Relevance of Hygiene to Health in Developing Countries"},signatures:"Save Kumwenda",authors:[{id:"233913",title:"Mr.",name:"Save",middleName:null,surname:"Kumwenda",slug:"save-kumwenda",fullName:"Save Kumwenda"}]},{id:"52475",doi:"10.5772/65462",title:"Teenage Pregnancies: A Worldwide Social and Medical Problem",slug:"teenage-pregnancies-a-worldwide-social-and-medical-problem",totalDownloads:8239,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"Teenage pregnancies and teenage motherhood are a cause for concern worldwide. From a historical point of view, teenage pregnancies are nothing new. For much of human history, it was absolutely common that girls married during their late adolescence and experienced first birth during their second decade of life. This kind of reproductive behavior was socially desired and considered as normal. Nowadays, however, the prevention of teenage pregnancies and teenage motherhood is a priority for public health in nearly all developed and increasingly in developing countries. For a long time, teenage pregnancies were associated with severe medical problems; however, most of data supporting this viewpoint have been collected some decades ago and reflect mainly the situation of per se socially disadvantaged teenage mothers. According to more recent studies, teenage pregnancies are not per se risky ones. A clear risk group are extremely young teenage mothers (younger than 15 years) who are confronted with various medical risks, such as preeclampsia, preterm labor, and small for gestational age newborns but also marked social disadvantage, such as poverty, unemployment, low educational level, and single parenting. In the present study, the prevalence and outcome of teenage pregnancies in Austria are focused on.",book:{id:"5392",slug:"an-analysis-of-contemporary-social-welfare-issues",title:"An Analysis of Contemporary Social Welfare Issues",fullTitle:"An Analysis of Contemporary Social Welfare Issues"},signatures:"Sylvia Kirchengast",authors:[{id:"188289",title:"Prof.",name:"Sylvia",middleName:null,surname:"Kirchengast",slug:"sylvia-kirchengast",fullName:"Sylvia Kirchengast"}]},{id:"75646",doi:"10.5772/intechopen.96039",title:"Neurological Complications in COVID-19: Implications on International Health Security and Possible Interventions of Phytochemicals",slug:"neurological-complications-in-covid-19-implications-on-international-health-security-and-possible-in",totalDownloads:266,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Global health security or international health security (IHS) includes any natural or man-made phenomenon that challenged human health and well-being including emerging infectious diseases such as the current global pandemic: COVID-19. Since the sudden outburst of COVID-19 pandemic in 2019, many COVID-19 patients have exhibited neurological symptoms and signs. Till now, there is no known effective established drug against the highly contagious COVID-19 infection despite the frightening associated mortality rate. This chapter aims to present the mechanism of action of coronavirus-2 (SARS-CoV-2), the clinical neurological manifestations displayed by COVID-19 patients, impact on the global health system and present phytochemicals with neuroprotective ability that can offer beneficial effects against COVID-19 mediated neuropathology. Reports from COVID-19 clinical studies, case reports, and other related literature were evaluated. Neurological complications of COVID-19 include anosmia, acute cerebrovascular disease, acute disseminated post-infectious encephalomyelitis, encephalitis, etc. Also, SARS-CoV-2 соuld be a neurotropic vіruѕ due to its iѕоlаtіоn from сеrеbrоѕріnаl fluіd. Multірlе nеurоlоgісаl dаmаgе displayed by COVID-19 patients might be due to hyperinflammation associated with SARS-CoV-2 infections. Kolaviron, resveratrol, vernodalin, vernodalol, and apigenin are natural phytochemicals with proven anti-inflammatory and therapeutic properties that could extenuate the adverse effects of COVID-19. The phytochemicals have been documented to suppress JNK and MAPK pathways which are essential in the pathogenesis of COVID-19. They also showed significant inhibitory activities against SARS-CoV-2 main protease. Taken together, these phytochemicals may offer neuroprotective benefits against COVID-19 mediated neuropathology and suppress the burden of the pandemic on IHS.",book:{id:"10624",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-2",title:"Contemporary Developments and Perspectives in International Health Security",fullTitle:"Contemporary Developments and Perspectives in International Health Security - Volume 2"},signatures:"Johnson Olaleye Oladele, Oluwaseun Titilope Oladele, Oyedotun M. Oyeleke and Adenike T. Oladiji",authors:[{id:"335880",title:"Dr.",name:"Johnson Olaleye",middleName:null,surname:"Oladele",slug:"johnson-olaleye-oladele",fullName:"Johnson Olaleye Oladele"},{id:"342648",title:"Mrs.",name:"Oluwaseun Titilope",middleName:null,surname:"Oladele",slug:"oluwaseun-titilope-oladele",fullName:"Oluwaseun Titilope Oladele"},{id:"342649",title:"Prof.",name:"Adenike T.",middleName:null,surname:"Oladiji",slug:"adenike-t.-oladiji",fullName:"Adenike T. Oladiji"},{id:"346531",title:"Dr.",name:"Oyedotun M.",middleName:null,surname:"Oyeleke",slug:"oyedotun-m.-oyeleke",fullName:"Oyedotun M. Oyeleke"}]},{id:"63191",doi:"10.5772/intechopen.80392",title:"Household Water Handling Practices in the Arid and Semi-Arid Lands in Kenya",slug:"household-water-handling-practices-in-the-arid-and-semi-arid-lands-in-kenya",totalDownloads:994,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Utilisation of water from unimproved water sources coupled with inadequate access to sanitation can adversely affect human health. This study undertaken from November 2014 to March, 2015 sought to assess the household water handling practices and relate them to the prevalent diseases in Baringo Central and South, Kenya. A Household sanitary survey was conducted and questionnaires were administered to 100 household heads within the study area. The data was analysed using descriptive and inferential statistics. The results indicated that 72% of the households (n = 100) collected water for cooking and drinking from the water pans. Only 34% of the households treated water commonly using boiling (19%), filtration with cloth (2%), chlorine (11%) before using it for drinking. There was a positive correlation between methods used in accessing water from drinking water storage containers and water related diseases prevalent in the study area (p < 0.05). Household drinking water in the study area did not meet the WHO drinking water quality guidelines mainly due to poor handling practices at the household level. There is a need to promote water, sanitation and hygiene campaigns in the study area to prevent water related diseases at the household level.",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",title:"The Relevance of Hygiene to Health in Developing Countries",fullTitle:"The Relevance of Hygiene to Health in Developing Countries"},signatures:"Edith J. Kurui, George M. Ogendi, Wilkister N. Moturi\nand Dishon O. Nyawanga",authors:[{id:"78236",title:"Dr.",name:"Wilkister",middleName:null,surname:"Moturi",slug:"wilkister-moturi",fullName:"Wilkister Moturi"},{id:"234029",title:"M.Sc.",name:"Edith",middleName:"Jepchirchir",surname:"Kurui",slug:"edith-kurui",fullName:"Edith Kurui"},{id:"247927",title:"Dr.",name:"George",middleName:null,surname:"Ogendi",slug:"george-ogendi",fullName:"George Ogendi"},{id:"247930",title:"Mr.",name:"Dishon",middleName:null,surname:"Nyawanga",slug:"dishon-nyawanga",fullName:"Dishon Nyawanga"}]}],mostDownloadedChaptersLast30Days:[{id:"52475",title:"Teenage Pregnancies: A Worldwide Social and Medical Problem",slug:"teenage-pregnancies-a-worldwide-social-and-medical-problem",totalDownloads:8225,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"Teenage pregnancies and teenage motherhood are a cause for concern worldwide. From a historical point of view, teenage pregnancies are nothing new. For much of human history, it was absolutely common that girls married during their late adolescence and experienced first birth during their second decade of life. This kind of reproductive behavior was socially desired and considered as normal. Nowadays, however, the prevention of teenage pregnancies and teenage motherhood is a priority for public health in nearly all developed and increasingly in developing countries. For a long time, teenage pregnancies were associated with severe medical problems; however, most of data supporting this viewpoint have been collected some decades ago and reflect mainly the situation of per se socially disadvantaged teenage mothers. According to more recent studies, teenage pregnancies are not per se risky ones. A clear risk group are extremely young teenage mothers (younger than 15 years) who are confronted with various medical risks, such as preeclampsia, preterm labor, and small for gestational age newborns but also marked social disadvantage, such as poverty, unemployment, low educational level, and single parenting. In the present study, the prevalence and outcome of teenage pregnancies in Austria are focused on.",book:{id:"5392",slug:"an-analysis-of-contemporary-social-welfare-issues",title:"An Analysis of Contemporary Social Welfare Issues",fullTitle:"An Analysis of Contemporary Social Welfare Issues"},signatures:"Sylvia Kirchengast",authors:[{id:"188289",title:"Prof.",name:"Sylvia",middleName:null,surname:"Kirchengast",slug:"sylvia-kirchengast",fullName:"Sylvia Kirchengast"}]},{id:"73634",title:"Supply Chain Management and Restart of Economy in Post COVID-19",slug:"supply-chain-management-and-restart-of-economy-in-post-covid-19",totalDownloads:741,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"The increase in World Trade has led to significant growth in world GDP over last 100 years particularly. Supply chains have become the major enablers of world trade and the world is connected through supply chains. Any disruptions in any part of the world has led to disruptions in supply chains and economic recessions. Crisis like Tsunamis, earthquakes, 911 terror attacks, epidemics/pandemics like COVID-19 etc. have affected the businesses worldwide. COVID-19 pandemic has precipitated economic crisis due to disruption of supply chains and suppressed demand for many products and services worldwide. International Monetary Fund (IMF) has projected global economic growth to be negative 4.9%. This economic crisis has resulted in substantial erosion of market capitalization across the globe. The impact of COVID-19 is very significant on both health of the people and economy worldwide. Almost all businesses and governments are trying its best to save people from health and economic crisis. This requires rebuilding of supply chains through appropriate configuration with reliable sources of supply, collaboration, manufacturing and distribution of goods and services. Sectors like essential items, pharmaceutical, e-commerce have started early recovery of economy. However, other sectors require suitable interventions from government, business organizations in their policies and practices and use of digital technologies for economic recovery.",book:{id:"10624",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-2",title:"Contemporary Developments and Perspectives in International Health Security",fullTitle:"Contemporary Developments and Perspectives in International Health Security - Volume 2"},signatures:"Venkataramanaiah Saddikuti, Sagar Galwankar and Akilesh Sai Saddikuti Venkat",authors:[{id:"292211",title:"Associate Prof.",name:"Venkataramanaiah",middleName:null,surname:"Saddikuti",slug:"venkataramanaiah-saddikuti",fullName:"Venkataramanaiah Saddikuti"},{id:"293168",title:"Dr.",name:"Sagar C.",middleName:null,surname:"Galwankar",slug:"sagar-c.-galwankar",fullName:"Sagar C. Galwankar"},{id:"321650",title:"Mr.",name:"Akilesh Sai",middleName:null,surname:"S V",slug:"akilesh-sai-s-v",fullName:"Akilesh Sai S V"}]},{id:"63707",title:"Drinking Water Treatment and Challenges in Developing Countries",slug:"drinking-water-treatment-and-challenges-in-developing-countries",totalDownloads:7979,totalCrossrefCites:13,totalDimensionsCites:24,abstract:"Safe drinking water remains inaccessible to many humans in the developing countries. Research continuously innovates to develop efficient and cheap methods to sustain clean water for developing countries. Developing nations are a broad term that includes countries that are less industrialised and have lower per capita income levels than developed countries. This chapter will discuss clean water for drinking water purposes. Pollution concerns of water in developing countries will be categorised in terms of physical, chemical and biological pollutants such as turbidity, organic matter and bacteria. Natural and anthropogenic pollution concerns linking with seasonal factors will be outlined. The multi-barrier approach to drinking water treatment will be discussed. Abstraction points used will be researched. Water treatment systems, medium- to small-scale approaches, will be discussed. The processes involved in removing the contaminants including physical processes such as sedimentation, filtration such as slow-sand filtration, coagulation and flocculation, and disinfectant processes such as chlorination will be reviewed. Other important methods including solar disinfection, hybrid filtration methods and arsenic removal technologies using innovative solid phase materials will be included in this chapter. Rainwater harvesting technologies are reviewed. Safe storage options for treated water are outlined. Challenges of water treatment in rural and urban areas will be outlined.",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",title:"The Relevance of Hygiene to Health in Developing Countries",fullTitle:"The Relevance of Hygiene to Health in Developing Countries"},signatures:"Josephine Treacy",authors:[{id:"238173",title:"Dr.",name:"Josephine",middleName:null,surname:"Treacy",slug:"josephine-treacy",fullName:"Josephine Treacy"}]},{id:"74995",title:"Death Penalty: A Human Rights Issue for South Africa",slug:"death-penalty-a-human-rights-issue-for-south-africa",totalDownloads:624,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In South Africa, the death penalty has been repealed just after the arrival of democracy in 1994. At present, due to numerous daily murders, especially farm murders, this issue is being debated once again seriously – by ordinary citizens, politicians, theologians, and others. In the media, in particular, it gets a lot of attention and in view of the extent of violent crime in our country, the reinstatement of the death penalty is again supported by many. The death penalty as such will always be contentious because it is about the reasoned termination of someone’s life – which is a radical act. Between 2009 and 2013 I did research on the death penalty in South African prisons (the first of its kind as far as we could determine), in all 9 our country’s provinces. The content of this study, gathered from 467 convicted murderers, and several other core aspects of why the reinstatement of the death penalty particularly in South Africa, should not be an option, will be discussed with reference to supporting international and authoritative research.",book:{id:"9537",slug:"human-rights-in-the-contemporary-world",title:"Human Rights in the Contemporary World",fullTitle:"Human Rights in the Contemporary World"},signatures:"Chris Jones",authors:[{id:"274281",title:"Dr.",name:"Chris",middleName:null,surname:"Jones",slug:"chris-jones",fullName:"Chris Jones"}]},{id:"63322",title:"Challenges to Hygiene Improvement in Developing Countries",slug:"challenges-to-hygiene-improvement-in-developing-countries",totalDownloads:2642,totalCrossrefCites:8,totalDimensionsCites:14,abstract:"Hygiene is defined as conditions or practices conducive to maintaining health and preventing disease. Hygiene has been shown to reduce diarrheal diseases and assist to improve social outcomes in the community. Improving hygiene faces several problems especially in countries with low income per capita of population. Currently, many developing countries already struggle to cope with consistent water shortages and rapid urbanization causing more pressure to limited resources which in turn result in poor hygienic practices in the communities. The common types of hygiene include personal hygiene, water hygiene, food hygiene, and hygiene during waste handling. Different nongovernmental and governmental organizations face different challenges in achieving high levels of hygiene in communities. Some of these challenges include poverty, lack of political commitment, lack of full community participation, inadequate gender inclusion, inadequate data, lack of coordination among actors, and behavioral issues. To reduce these challenges, several measures have been proposed including community empowerment, pushing for equitable access to hygiene needs, advocating for political commitment, promoting gender equity, and enhancing youth involvement.",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",title:"The Relevance of Hygiene to Health in Developing Countries",fullTitle:"The Relevance of Hygiene to Health in Developing Countries"},signatures:"Save Kumwenda",authors:[{id:"233913",title:"Mr.",name:"Save",middleName:null,surname:"Kumwenda",slug:"save-kumwenda",fullName:"Save Kumwenda"}]}],onlineFirstChaptersFilter:{topicId:"277",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:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:10,paginationItems:[{id:"82380",title:"Evolution of Parasitism and Pathogenic Adaptations in Certain Medically Important Fungi",doi:"10.5772/intechopen.105206",signatures:"Gokul Shankar Sabesan, Ranjit Singh AJA, Ranjith Mehenderkar and Basanta Kumar Mohanty",slug:"evolution-of-parasitism-and-pathogenic-adaptations-in-certain-medically-important-fungi",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fungal Infectious Diseases - Annual Volume 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11400.jpg",subseries:{id:"4",title:"Fungal Infectious Diseases"}}},{id:"82367",title:"Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in an HIV Hyperendemic Area of KwaZulu-Natal, South Africa",doi:"10.5772/intechopen.105547",signatures:"Adenike O. 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He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. 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He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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