\r\n\tThe fifth topic is “complications and drug side effects in the treatment of pigmentation disorders”. These include drug allergies, hyper- and hypopigmentation, persistent skin depigmentation, scars, skin burns, and the potential for skin cancer and skin lymphoma. The last topic is called “coping and support along with skin pigmentation diseases”. Increase the quality of life, psychotherapy, team therapy, and asking for understanding and support from family members.
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1. Introduction
Supply chain is a research area which has attracted the attention of many researchers for more than 20 years (Mehrjerdi, 2009) due to costs and time involved in managing materials, information and financial flows from the point of origin to the point of consumption. The simplest definition of the supply chain suggests (Waters, 2003) that it consists of series of activities and companies that move materials through on their journey from initial suppliers to final customers. On that journey each company somehow is adding value to the product. However, due to an increasing competition on the market and due to more demanding and more sophisticated customers, the picture of supply chain is getting more complicated. If we take into consideration that many companies have crossed their borders and have included some geographically separate operations into their supply chain, it is very difficult to successfully integrate and to manage all related activities. In the praxis, it is normally that every company is working for its own benefit resulting in duplicating effort and reducing productivity, lowering efficiency, higher costs and decreasing the level of customer services. However, environmental uncertainty expressed through shortening product life cycle, expanding product proliferation, and more demanding customers requires from companies to coordinate production processes across company borders, to tackle problems from the viewpoint of the whole organization, and to look for the greatest benefit of all chain members.
Namely, organizations’ opportunities for value enhancement and cost reduction are clearer when they look beyond their own operations. Supply Chain Management is built on the principles of partnerships, the development and use of the connections that exists between the links of the chain to provide information that will increase the efficiency of all members in the chain (Helms et al., 2000). If it is successfully developed over a period of time, those partnerships lead to collaboration. In other words, collaboration is focused on relationship between all supply chain members and it requires the availability of integrated information and the high level of motivation and trust as well. There are two dimensions of collaboration that may exist in the supply chain: vertical collaboration between suppliers and customers, and horizontal collaboration between competitors and other supply chain actors.
This chapter focuses on the vertical collaboration which is more common and easier to implement than horizontal collaboration. The chapter is structured as follows. It will begin with the theoretical background where the insight into definitions of collaboration in the supply chain, types of collaboration, motives for implementing it, benefits of its usage, the discussion about the necessary prerequisite, and limitations for the successful collaboration between supply chain partners are given. In order to illustrate what needs to be done to synchronize all supply chain activities and to establish successful integration among suppliers and their customers (i.e. retailers and wholesalers), the results of the research study among Croatian companies are shown.
2. Theoretical background
Ayers and Odegaard (2008) argue that there are many definitions of supply chain, depending on the viewpoint of the author of the definition. According to them, common viewpoints define supply chain as the procurement only, distribution, or as a collection of information system applications. On the other side, Ayers (2006) gives more precise definition of supply chain as the product life-cycle processes comprising physical, information, financial, and knowledge flows whose purpose is to satisfy end-user requirements with physical products and services from multiple, and linked suppliers. If we consider the number of business entities which are involved in above mentioned activities and processes, it is obvious that there are potential areas for cost increasing and profitability decreasing. However, in today’s competitive market, supply chain should efficiently integrate suppliers, manufacturers, warehouses, and stores so that merchandise is produced and distributed at the right quantities, to the right locations, and at the right time in order to minimize system wide costs while satisfying service-level requirements (Simchi-Levi et al., 2004). All companies along the supply chain - suppliers, transport companies, warehousing, etc. – have the same goal: to satisfy the customer. They move toward the traditional view where each company is focused on its own business objectives disrupting the flow of materials, goods and information and increasing costs. Thus, they co-operate in the chain looking for a more efficient flow of materials through the chain, for faster deliveries, and reduction of stock levels, for quick response to customer changing demands, etc.
Accordingly, they have to overcome typical supply chain and move towards collaborative supply chain.
Collaboration is defined as two or more companies sharing the responsibility of exchanging common planning, management, execution, and performance measurement information (Anthony, 2000).
Lambert et al. (1996) summarised three key factors that contribute to a successful partnership in the supply chain, such as: 1) drivers (the compelling reasons for forming partnerships, such as cost reduction, better customer services, etc.), 2) facilitators (the supportive corporate factors that encourage partnerships, such as similar management style, compatibility of operations, etc.); and 3) components (the join activities and operations used to build and sustain the relationship, such as communication channels, investments, etc.).
Supply chain costs that include production, inventory, distribution, marketing and selling costs are often cited in the literature as major factors influencing the implementation of supply chain collaboration (Saha, 2004). The supply chain environment with large number of root causes for costs is possible calls for collaboration between supply chain partners. Ayers and Odegaard (2008) state that majority of waste examples in the supply chain can be tracked to one or more of root causes: 1) variability root cause which includes anything in the supply chain that creates uncertainty in operations (missed deliveries, demand fluctuations, poor quality material, etc.); 2) product design cost which includes wrong decisions related to material choices, component obsolescence, suppliers, etc.; 3) insufficient information sharing which implies failures to provide or/and to manage information; 4) weak links which relates to poor relationships between supply chain members; and 5) unintended consequences which may result in cost raising practices somewhere in the chain. Therefore, the need for supply chain collaboration is obvious, as it provides (Waters, 2003): improved performance (due to more accurate forecasts, better planning, higher productivity of resources, rational priorities), improved material flow, better customer services with shorter lead times and faster deliveries, standardised procedures, becoming routine and well-practices with less duplication on effort and information, and so on.
vertical collaboration which includes collaboration between suppliers and customers,
horizontal collaboration which includes collaboration with competitors and other supply chain actors, e.g. in sharing manufacturing capacity.
Vertical collaboration is more common and easier to implement than horizontal collaboration, but they are not exclusive ones. Supply chains that achieve both vertical and horizontal collaboration would gain significant business benefit.
3. Understanding the reasons and preconditions for vertical supply chain collaboration
It is widely approved that collaboration and partnering between firms is an increasingly common approach for enterprises to discover and to sustain shared competitive advantages (Mentzer, 1999). However, the implementation of this concept does not provide benefits to enterprises involved in the flow of materials between suppliers and customers, yet it leads to the win-win-win situation with focus on consumers.
Collaboration is the result of a joint effort of the supplier and the retailer to attain mutual benefit and it does not happen overnight. Therefore, some preconditions for successful vertical collaboration should be obtained (Deloitte, 2008):
financial conditions - trade terms relating to cost reduction and joint profitability,
relationship characteristics – personal relationships, mutual trust, interdependency and commitment,
compatibility of strategies - jointly developing goals and strategies,
effective negotiations – efficiently use the negotiating time and active participation during negotiations,
quality of account management – account managers need to have the relevant facts and figures to hand, and to be well aware how their company performs.
The greatest value derived from better supplier-buyer relationships is more satisfied customer, because when chain members begin to collaborate to solve possible problems and pitfalls in the chain, and to improve service, the customer is the final winner.
Christopher (1996) summarizes situation on the market by saying that “supply chains compete, not companies”, because the opportunity to reduce costs and to enhance customer value is the basis of the interface between supply chain members. However, there are some difficulties to achieve efficient supply chain collaboration. Many organisations simply do not trust other members of the supply chain and they are reluctant to share information (Waters, 2003). Traditional business relationships, which have been built on open market negotiations, need time to convert to a trust-based win-win situation in a supply chain (Mangan et al., 2008). Figure 1 shows “step-by-step journey” needed for the development of collaboration.
Figure 1.
The journey from open market negotiations to collaboration (Spekman et al., 1998)
Additionally, supply chain characterizes different activities, different organisations, different skills, geographical dispersion, etc., and it is very difficult to create a successful linkage within a supply network. Generally, a chain is constructed as hybrid network between independent companies (Reese, 2004) and it is intended that the companies involved in such a network work together. The efficiency of the whole supply chain of independent companies is based on a close cooperation of all chain members. Traditional customer and purchase orders are replaced with collaborative demand/order forecasts and an automated replenishment order flow (Friedman & Belkin, 2003)
Relationship between supply chain members leads to some benefits for the chain members and for the final customers as well. Some of the most important benefits are:
improved communication and information sharing,
elimination of activities that waste time or do not add value,
balanced operations and lower stocks,
more accurate forecasts and better planning,
improved material flow,
better customer service, with shorter lead times and faster deliveries,
more flexible organisations reacting faster to changing conditions, etc.
Collaboration is very often recognized as an information sharing directed to sharing of production and inventory data, market places for buying and selling, and production planning along the supply chain (Ayers & Odegaard, 2008). It is widely discussed that the information technology revolution and the exchange of information are the foundation of the collaboration (Pooler et al., 2004). Mentzer, Foggin and Golicic (2000) found out that supply chain executives believed that advanced technology was essential to the success of collaborative supply chain relationships. Information technology enables collaboration by providing the necessary tools that make collaboration feasible and by supporting collaborative interorganizational relationships (Esper & Williams, 2003). However, information technology in and of itself is not enough to lead to successful collaboration (Mentzer, et al., 2000) because human factor lies behind everything. Namely, only well-educated employers, that know how to use information technology, will provide true benefits of information system.
Lapide et al. (2002) describe collaboration as a three-stage process which begins with simpler form of information sharing that are relatively easy to automate, and finishes with joint decision making and win-win partnerships across network.
Partnership that derives from supply chain collaboration could become a source of innovation. New process technologies entail collaboration because they require installation of technical capabilities all along the retail supply chain.
The development of the relationship between trading partners can be divided into three levels:
Initial level of collaboration, where chain members exchange information mostly to complete day-to-day transactions,
Cooperative collaboration, where chain members have simultaneous access to information needed,
Cognitive collaboration, where chain members share information to jointly gain knowledge in order to joint decision making.
Retailers make effort to build longer-term and better relationships with their suppliers. There have also been changes in the style and the technology of supplier-retailer interactions. The fact is that the larger retailers have sought to extend their control over the supply chain and move away from the use of the wholesaler (Gilbert, 2003). The size of market share gives large retailers power over suppliers to negotiate prices and to absorb the role of the former wholesale intermediary, while ensuring the quality and service of product to the customer.
Collaboration provides a number of potential opportunities for vertical supply chain collaboration on the downstream as well as on the upstream side of the supply chain (Barratt, 2004). On the downstream side of the supply chain we can find: customer relationship management (CRM), collaborative demand planning with collaborative forecasting, demand replenishment, and shared distribution. On the upstream side of the supply, there are: supplier relationship management, supplier planning and production scheduling, collaborative design, and collaborative transportation.
4. Vertical collaboration methods
It is generally accepted that the main purpose of the retailer is to satisfy consumers better than its competitors. In order to achieve this purpose, retailers have to provide an assortment of “right goods to the right places at the right time for the least cost” (Kotler & Kevin Lane, 2006). In the past, retailers have used a large number of suppliers and they were competing against each other for individual order. The current trend is to reduce the number of suppliers and to develop long-term relationships with a small number of them. Each supplier has different capabilities and retailer select them based on a supplier selection software package. They follow some of assessment criteria in four main areas, together with the kind indicators that would determine the likelihood of a supplier meeting these criteria (Varley, 2003) such as:
product range and quality with the quality and variety of products available, where the retailer assesses the supplier’s production specialisation and flexibility, design capability, technical capability, etc.,
prices of products and discounts available for large quantities and for rapid payment, where the retailer assesses the supplier’s financial stability, willingness to negotiate, scale economies, etc.,
delivery in accordance with the retailer’s specification in terms of timing, quantities and product variety,
service by which a supplier is adding value to the retailer, where the retailer assess the supplier’s speed of new product introduction, its handling of queries and complaints, etc.
Introducing a supplier rating system for measuring mentioned criteria, a retailer has the opportunity to rationale its supply base. Furthermore, a retailer facilitates communication and develops closer relationships with suppliers. They tend to retain their autonomy yet move the business together by forming supply “partnership”. Table 1 summarizes the transactional vs the partnership approach characteristics in retail supply.
Transactional approach
Partnerships approach
short term or one-off many suppliers and buyers disloyalty and lack of commitment low switching costs, little or no investment made in relationships loose or no procedures exchange centred on single person in firm changes in customer/supplier make little difference
long term and on-going few suppliers and buyers loyalty and commitment high switching costs, significant investments will have been made in the partnership strict procedural guidelines many people and departments involved in exchanges change in customer/supplier causes disruption
Table 1.
Transactional vs partnership approach (Varley, 2003)
A time progresses, those partnerships lead to collaboration and to higher level of operational efficiency. In this new collaborative environment each supplier gains a share of the total orders based on their ability to deliver the order on time and to specifications (Mangan, 2008). However, rather than searching for new suppliers, retailers are more likely to increase business with the existing supply base, which has already made some changes in order to adapt their products and services to retailers. Some initiatives that will improve retailer-supplier relationships are shown in Table 2.
Companies that want to build holistic relationships with selected suppliers across the chain raise their revenue and lower costs (Booz & Company, 2009). There is a wide spectrum of possible collaborative measures that can improve efficiency, raise revenues, and cut costs for both retailers and their suppliers (Table 3).
The supplier’s understanding of the retailer’s target customer and the brand image that the retailer is trying to build. Detailed feedback on sales from the retailer to the supplier. Co-operation and co-ordination in marketing activities. Sharing of information on relevant consumer and product/market trends. Commitment of businesses to one another, including combined forward planning, store space dedicated to supplier’s ranges, provision of point of purchase materials and fixtures for the retailer, retailer involvement in product development. System integration to facilitate information sharing, including sales data, stock and delivery information. An understanding of the retailer’s quality standard requirements, including product quality and compliance on delivery and administration.
Table 2.
What can improve relationships between retailer and its supplier? (Varley, 2003)
Revenue/margin enhancement
Process improvement
Cost reduction
Increasing penetration of core products Building multiyear strategies to grow/build the category Managing/reallocating shelf space and products Driving consumer convenience and impulse shopping Collaborating more closely with private labels
Launching new products collaboratively Improving effectiveness of marketing efforts Jointly improving promotion planning and management Practicing life-cycle management Utilizing POS data and improving on-shelf availability Improving demand forecasting
Decreasing shortage Enhancing distribution efficiency Redesigning display operating model Optimizing the role of merchandisers Reducing returns Improving efficiency through supply chain improvements
5. Limitations to vertical supply chain collaboration
Supply chain collaboration has proven difficult to implement (Sabath & Fontanella, 2002) due to a number of elements necessary to support collaboration such as (Barratt, 2004):
Trust –defined as a willingness to rely on an exchange partner in whom one has confidence (Moorman et al., 1992). Trend of private labels and raising retailers’ ability to manage them may cause the lack of trust between the manufacturer and the retailer, because premium-brand manufacturers introducing new products and concepts are afraid that their ideas will be taken over and used by retailers for their private-label products (Deloitte, 2008).
Mutuality –reflected through mutual benefits and risk sharing among chain members.
Information sharing - relied on the transparency and quality of information flows between buyers and suppliers. However, there has been an over-reliance on technology in trying to implement it (McCarthy & Golocic, 2002).
Communication and understanding – related to the importance of clear and broad lines of communication in the whole chain that will contribute to faster information sharing between supply chain partners.
Openness and honesty – resulted in high level of trust, respect and commitment.
Collaboration is not just about developing closer relationships between supply chain members, but also needs to identify with whom to collaborate with. Sabath and Fontanella (2002) suggest that the problem in the efficient implementation of supply chain collaboration is a great failure to differentiate between whom to collaborate with. Therefore, another problem in the collaboration appears and is related to a lack of trust between trading partners (Ireland & Bruce, 2000). Gattorna (2003) propose “segmentation” approach in the context of successful collaboration. This segmentation approach should be conducted on the downstream as well as on the upstream side of the supply chain. Namely, company has to segment its suppliers and customers and to intensify its relationships with a small number of strategically important customers and suppliers. Barratt (2004) argue that if customers can be segmented by way of their buying behaviour and service needs, then separate supply chains can be designed to meet the specific needs of the various customer segments. Moreover, suppliers could be segmented according to their abilities and requirements to service the segmented supply chain (Barratt, 2004). Additionally, one of these segments may be appropriate for a collaborative approach, whereas more distinctive approach may be suitable for other segments.
Booz and Company (2009) found main limitations of retailer-supplier partnerships and collaboration in the traditional retailers’ tension to view their value purely as a means of extracting lower prices or promotional support from their suppliers. It should be noted that such maintaining of relationships often caused low in-store availability. Restricted communication like that eliminates the possibility of partnerships which can put the negotiation level and to add value to the whole supply chain.
Friedman and Belkin (2003) point out that order forecasts are the key preconditions for the integration and the coordination of supply chain processes of partners in the chain, but also that sharing demand forecasts alone cannot optimize manufacturing flexibility or enable a make-to-order manufacturing process.
6. The research on the level of vertical collaboration in the supply chain
For the purpose of this chapter, a research study examining the level of collaboration between retailers and their suppliers, tools necessary to establish successful relationship between them, benefits and/or problems raised from the partnership between those two sides, years of the partnership between retailers and their major suppliers, etc. on the Croatian market was conducted. But for the purpose of better understanding of the environment where the research was carried out, the main characteristics of Croatian retailing should be presented.
6.1. An outline of retailing in Croatia
The retail industry is a significant part of the Croatian national economy. It generates EUR 15,329 mil. in revenue and employs 145,472 persons which accounts for almost 10% of the total active workforce (own calculation based on data in RCCBS First release, 23rd September, 2009.) Croatian market is dominated by a limited number of multiple-outlet retailers. The Croatian retailing counts 37,353 outlets of various formats (RCCBS First release, 23rd September, 2009). Nowadays, among the main characteristics of Croatian retailing are concentration, internationalization and consolidation, with 71.4% of the market held by 15 retailers (compared to 16.6% of the market held by 10 retailers in 2002). On the first place, with 25.8 per cent market share domestic retailer, Konzum is the market leader. It has been followed by international chain stores such as: Schwartz Group (Germany) with Kaufland stores and Lidl stores; Rewe Group (Germany) with Billa stores; Spar (Austria); Ipercoop (Italy) and Mercator (Slovenia). Renko (2008) and Knezevic (2003) note that international retailers have introduced new standards and know-how to the domestic market, including new technology, a more customer-focused orientation, and an environment-friendly approach.
6.2. Questionnaire design
The questionnaire consisted of three parts. Part I relates to the domain of the strategic integration construct, dependence, flexibility, relationship quality, continuity expectation, and supply chain collaboration tools. 31 items are created based on Cassivi (2006), Johnson (1999) and Morgan and Hunt (1994). The respondents indicated their level of agreement on a 5-point Likert scale with strongly disagree (1) and strongly agree (5) as the anchors.
Part II of the questionnaire consists of 6 statements related to performance of the company. Statements were adopted from the study of Johnson (1999). A 7-point Likert format (1=much poorer than expected and 7= much better than expected) was used to assess the level of commitments of retail managers to the statements relating to effects of partnerships with suppliers. Here, respondents were asked to evaluate their firm’s performance on sales, information flows, customer’s satisfaction level, time reduction, business flexibility and inventory level which arose as the result of the supply chain collaboration. Part III of the questionnaire required some information on the companies in the sample, such as assortment, number of employees, number of suppliers, number of key suppliers, the length of the cooperation with key suppliers, etc.
6.3. Sampling procedure
50 Croatian retailers with different assortment were included in the sample. There were no special criteria in selecting the retailer, but the respondents were chosen based on their specialized knowledge of and experience with supply chain relationships, and their role in the procurement or sales activities carried out in the supply chain. The method used in this study was an e-mail based structured questionnaire. The companies chosen were retail companies dealing with food and non-food assortment. Similar to Coltman (2007) pre-survey telephone calls were made at each participant to identify whether they would be prepared to participate in the survey or whether they could provide contact details for the most appropriate person in the firm. The research was conducted in the period February – March 2011.
A total of 50 completed questionnaires were received, but three questionnaires were eliminated due to a large number of unanswered questions. The collected data were analyzed using SPSS. Except from descriptive statistics calculations, testing the reliability with Cronbach\'s Alpha coefficient was conducted. Before using items for further analysis, the reliability testing was conducted. The value of 0.81 for statements related to relationship quality, supply chain collaboration tools, dependence, etc. and the value of 0.86 for statements related to the performance of the company as the result of the collaboration with key suppliers suggested very good internal consistency reliability for all scales used in this research (the recommended standard of 0.7 has been suggested by Nunnally (1978) and 1.00 respresents perferct reliability). Since data were not normally distributed, a significance of the findings and the level of collaboration between retailers and their suppliers were was explored using Spearman correlation coefficient.
6.4. The findings
The structure of the sample cannot indicate a satisfactory level of representativeness as the majority of responding firms are large companies with more than 500 employees (32.1 per cent of the sample) and small companies with 10-50 employees (21.4 per cent of the sample). There are mostly retail companies (57.1%), but the rest of the sample consists of companies that are involved in retail and wholesale business (42.9 per cent of responding firms). The analysis of the number of suppliers reveals that half of the sample operates with more than 200 suppliers. Among them, the largest percentage of the sample (35.7 per cent) has got 5-10 key suppliers on average and 10-20 years of relationships with their key suppliers (67.9 per cent of the sample).
The mean scores for the degree of collaboration items (from 4.25 to 4.50) are very high (on the scale from 1 to 5) suggesting that respondents are aware of the importance of collaborating with their major suppliers. The largest percentage of respondents (49 per cent) identified direct procurement (forwarding of purchase orders to pre-qualified suppliers) as the most important supply chain collaboration tool. Mean scores for the collaboration planning items (from 3.90 to 4.36) suggest that respondents highly evaluate the possibility to exchange the forecast information provided by the supplier and to improve innovativeness. Table 4 reveals main benefits of the collaboration between retailers and the suppliers. Table 4 shows that the positive impact on output measures, such as sale, has the highest average score.
Item
Mean
St.dev.
the collaboration has a positive impact on resource measures the collaboration has a positive impact on output measures the collaboration has a positive impact on on flexibility measures the collaboration has a positive impact on the firm\'s market share the collaboration has a positive impact on the market share of major supplier\'s products
4.18 4.39 4.11 3.86 4.36
0.819 0.951 0.737 0.832 1.079
Table 4.
Vertical collaboration main advantages
However, the mean scores for flexibility and dependence are moderate to low. Dependence and flexibility scales were adopted from Johnson (1999). Dependence was measured with items based on replaceability, for example “if we could not buy our stock from our present major supplier, we would likely be purchasing from some other major supplier“. Flexibility was measured with items wich assessed the retailers\' perceptions of the degree to which they behaved flexibly in the relationships, such as „in our relationship with our major supplier, we are willing to make adjustments for any reasonable change as needed“. The results point out high level of dependence and low level of flexibility in the case of the Croatian retailers. Namely, they are not ready to easily replace their product line with a similar line from another company (64.3 per cent of the sample) and to purchase from some other major supplier (64.3 per cent of the sample). Additionaly, they are not willing to put aside contractual terms to work through problems raised by their major supplier (71.4 per cent of the sample) and to make adjustments for any reasonable change as needed (92.9 per cent of the sample).
As trust, and relationship commitment were recognized as the major supporting elements of collaboration in general (Barratt, 2004), respondents were asked about their perception of the importance and the quality level of the relationships with their suppliers. The mean scores for relationship commitment and trust (from 3.86 to 4.75) are very high suggesting that Croatian retailers intend to maintain the relationship which they have with their major supplier and that the relationship which they have with their major supplier is something they are very commited to. Finally, there is a high level of trust between investigated retailers and their major supplier.
In order to find out whether relationships between the retailer and its key suppliers may significantly affect performance, six-item performance scale was developed. The items are based on previous studies of Johnson (1999) and Morgan and Hunt (1994) and they are focused on the economic performance of the firm and the supplier’s direct part in it. Correlation analysis (Table 5 in Appendix A) shows only moderate (±0,6 ≤ r ≤ ±0,4) associations (Dancey & Reidy, 2007).
As we can see, there is a moderate positive association between the vertical collaboration (between retailer and its supplier) while developing strategy and improved inventory visibility in the supply chain. In other words, the more retailers consider their key suppliers in strategic decision making, the better is the visibility of inventories in the chain. Positive association between the importance for retailer to maintain the relationship with major supplier and inventory visibility is evident. Chi-square test suggests that all respondents confirmed those findings (χ2 = 10,691, df=6, p=0,014). There is also, moderate positive association between the direct procurement and capacity planning and inventory visibility. It is interesting to mention positive association between the collaboration planning items (reflected through the exchange of information between retailer and supplier and forecasting based on those information) and the improvement in the level of services in the supply chain and the inventory visibility as well. 32.1 per cent of the respondents completely agreed that flow of information between them and their major suppliers contributed to inventory visibility in the chain. Additionally, the collaboration has a positive impact on output measures, information and inventory visibility. More than a half of the sample (53.6 per cent and 53.5 per cent respectively) point out that the „supply“ partnership led them to improved inventory visibility and to increased flexibility in doing business. Moreover, it allows them to increase the service level and to reduce cycle time. Table 5 also shows moderate positive association between the level of trust between retailer and its major supplier and inventory visibility and cycle time reduction. Chi-square test suggests that 78.5 per cent of respondents highly evaluated the impact of collaboration on their economic performance (χ2 = 14,940, df=6, p=0,002). There is also moderate positive association between retailer’s monitoring of every aspect of transactions with its major supplier (to ensure that nothing inappropriate happen) and the improved inventory visibility. 57.1 per cent of the sample answered that as more they monitor transactions with major supplier, the more visible inventories are.
But, it is surprisingly that in the market situation when all business subjects are aware that their customers are their most important value, study among Croatian retailers did not confirm statistically significant relationship between all “basic” dimensions that portray the sampled companies’ profile and improved end-customer satisfaction which resulted from vertical collaboration in the supply chain. This finding does not correspond to previously mention theoretical assumption of more satisfied customer as the greatest value derived from better relationships between retailer and supplier. Namely, when chain members begin to collaborate to solve possible problems and pitfalls in the chain, and to improve service, the customer is the final winner.
As expected, correlation analysis showed strong positive association between some supply collaboration performance outcomes and improved end-customer satisfaction. Namely, improved information visibility and service levels (as the result of vertical collaboration) are strongly correlated to end-customer satisfaction (r=0,702**, p=0,000 for information visibility; and r=0,616**, p=0,000 for service levels). Logically, strong positive association (r=0,690**, p=0,000) between increased flexibility in doing business which resulted from supply chain collaboration and end-customer satisfaction is present. In other words, the collaboration between retailers and their suppliers leads to efficient information flows and to higher level of services. Accordingly, increased flexibility in doing business is present. Finally, this win-win supplier-retailer relationship has got large positive effect on end-customers. In such a way, successful vertical collaboration can result in win-win-win situation for all chain members.
7. Conclusion
This paper is an attempt to reveal the importance of the collaboration between retailer and their suppliers in the supply chain. The fact is that today’s competitive pressure to improve efficiency and to deliver added value for customers, forced all members of the supply chain to change the way of their business relationships. As major players in the supply chain, both retailers and their suppliers have recognized benefits of their closer relationships and the need to transfer from the traditional relationship which has experienced a high level of conflict between chain members. Some of well-known initiatives of suppliers and retailers have included Efficient Consumer Response (ECR), and Collaborative Planning, Forecasting, and Replenishment (CPFR) (Booz and Company (2009)), but in the praxis, a broad-based strategic collaboration remains a rarity, and most retailers still do not consider building collaborative value a core activity.
It is widely accepted that collaboration improves performance, but collaboration between retailers and suppliers is still relatively limited (Deloitte, 2008). Today’s situation characterizes many retailers with their own labels. Therefore, they are increasingly coming into direct competition with suppliers: they are competing both for physical access to consumers and for consumers’ brand loyalty (which is limited) (Deloitte, 2008). In such a situation, there are objective conflicts of interest between vertical participants in supply chains. Everyone in the chain is seeking to appropriate value for themselves from participation and, assuming economically rational behaviour, must wish to appropriate more of the value for themselves if they are able to do so (Cox, 1999). The literature review suggests partnering between firms as an increasingly common way for firms to find and maintain competitive advantage (Mentzer et al., 2000) and to reduce inventory and other logistics costs for both retailer and its supplier. The study conducted in the case of the European country in transition, confirmed that Croatian retailers recognized the importance and benefits of the collaboration with their suppliers. They pointed out positive impact of vertical collaboration on their output measures and improved information and inventory visibility.
Given this, it seems clear that managers on both sides, on the retailer\'s and supplier\'s side as well, require a proper understanding how to select supplier partners and to share the benefits and costs of their joint initiative. Achieving effectively collaboration is not a one-size-fits-all process and requires improved level of negotiation and more holistic relationships between chain members.
8. Appendix A
Item
Spearman correlation coefficient
When developing our firm\'s strategy, we consider our major supplier as a large part of the picture
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Introduction",level:"1"},{id:"sec_2",title:"2. Theoretical background",level:"1"},{id:"sec_3",title:"3. Understanding the reasons and preconditions for vertical supply chain collaboration",level:"1"},{id:"sec_4",title:"4. Vertical collaboration methods",level:"1"},{id:"sec_5",title:"5. Limitations to vertical supply chain collaboration ",level:"1"},{id:"sec_6",title:"6. The research on the level of vertical collaboration in the supply chain",level:"1"},{id:"sec_6_2",title:"6.1. An outline of retailing in Croatia",level:"2"},{id:"sec_7_2",title:"6.2. Questionnaire design",level:"2"},{id:"sec_8_2",title:"6.3. Sampling procedure",level:"2"},{id:"sec_9_2",title:"6.4. The findings ",level:"2"},{id:"sec_11",title:"7. Conclusion",level:"1"},{id:"sec_12",title:"8. Appendix A",level:"1"}],chapterReferences:[{id:"B1",body:'AnthonyT.2000 Supply chain collaboration: success in the new internet economy, Achieving Supply Chain Excellence through Technology, Montgomery Research Inc., San Francisco, 4144\n\t\t\t'},{id:"B2",body:'AyersJ. B.2006\n\t\t\t\t\tHandbook of Supply Chain Management, 2nd ed. Taylor & Francis Group, 978-0-84933-160-2Boca Raton, USA..'},{id:"B3",body:'AyersJ. B.OdegaardM. 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Faculty of Economics & Business, University of Zagreb, Croatia
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1. Introduction
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Patients with amputations can be found living fulfilled lives. We have all seen them running marathons, in the Olympics, surfing, climbing Mount Everest and even as an MLB pitcher. However, most just want to lead normal lives and be the best parents, siblings, friends, or co-workers they can be. They want to return to their job and function in their daily lives as they did before. Recovery from an amputation is not immediate and takes significant time. Recovery time from amputation is usually prolonged. Wound healing is done in 4–8 weeks, but the prolonged mental, emotional, and physical recovery afterwards takes much longer and will be different for everyone. One of the limiting factors for recovery from an amputation is pain.
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In looking at data from the Amputee Coalition, there are 185,000 in the United States every year. This means that an average of two million people is living with an amputated extremity in the United States alone [1, 2, 3]. Other data to consider is just as alarming; globally, there are 1 million amputations annually. This is an estimated 1–2 amputation per minute. Lower limb amputations are the most common, with most being due to vascular disease. 85% of lower limb amputations are preceded by a foot ulcer. About half of the people with diabetes who get a lower limb amputation will receive a second amputation [4]. African American populations are four times more likely to get an amputation than Caucasian [5]. Around a third of these patients have persistent depression and anxiety after their amputation [6]. Financially, it is noted that amputees have higher healthcare costs and if the amputation was related to vascular disease higher mortality [7].
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All these factors can lead to an unknown fear for a patient undergoing an amputation. Understanding the cause of an amputation first is paramount. This can help guide a plan for better pain control in the perioperative period. The main causes of amputation are progression of disease processes such as peripheral vascular disease (82%) including ischemia and thrombosis. Diabetes and infections such as osteomyelitis and gangrene that is unresponsive to antibiotic treatment. The second major cause is trauma (16.4%). This has a high predominance in upper extremity amputations. Lower extremity amputations with trauma can also be seen with severe fractures that do not heal and frost bites as other causes. Finally, surgical removal of malignancies (0.9%) can result in amputations in upper or lower extremities depending on the location and type of the tumor and growth. Congenital malformations (0.8%) make up the final list for amputation categories [1, 2].
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It is important as we consider the cause of the amputation and perioperative pain control, we also factor in the amount of time each patient had before surgery for their amputation decision. A diabetic patient that had a long time to make a decision for an amputation may have had considerable time to go through the stages of grief and accept the amputation as opposed to a trauma that did not have this time. Other things to consider are support system that the patient has at home. As discussed, wound healing is brief, but psychological healing will take longer in most and require repeated support and reminders to the patient to keep moving in a positive direction [8]. In addition to medical management, these patients will need pain-coping strategies and too many these may be a new technique for them in a life altering situation.
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2. Pain classification with an emphasis on amputees
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Amputation patients have a variety of different pain to consider when treating them in the perioperative setting. The broad classification of this pain is post-amputation pain. However, further classifying it in four categories helps to better understand each pain and how it originates. They are acute post-operative pain, phantom sensations, residual limb pain and phantom limb pain [2, 3].
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Acute post-operative pain is the pain that most surgical patients experience after any surgery. It is the pain at the surgical incision site related to surgical trauma, swelling and tissue damage. This is usually reported as sharp and stabbing by patients due to nociceptive afferent nerve supply at the surgical site. Patient can also report muscle spasms related to the immobility of the limb or the compression dressing or brace applies to the amputation site after surgery [2, 9, 10].
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Phantom sensations are the non-painful sensations arising from the amputated extremity. This is reported by 75% of patients 4 days after the amputations and higher at 6 months. This can be perceived as movement of the prior extremity or portion of the extremity (i.e. toe or finger). The patient can also note temperature changes or position changes or the missing limb. This has also been noted in mastectomies, dental extractions, and enucleations as well, and can also be seen in spinal cord injuries. Many of the phantom sensations are mild and decline but some patients have some degree persistent sensations indefinitely. There are a few patients in whom these sensations progress to severe pain and become problematic, leading to residual limb pain or phantom limb pain. There are reports of phantom sensations that do fade away and they appear to do this in a progressive fashion called telescoping. This is most common in upper extremity amputations where the phantom sensations continue to decrease such that eventually the patient is left with a sensation of the hand on the stump alone instead of distal [2].
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Residual limb pain (stump pain) is the pain localized to the remained affected body segment and can be present for years. Residual limb pain can be of many different modalities as it can be described as deep tissue pain, superficial incision pain and neuropathic in nature. 75% of patients will experience a component of this chronically after surgery [11]. Neuropathic pain will be described as burning and electric in nature. Some patient may even become hyperalgesia or have allodynia on the stump site. This may lead to difficulty with prosthetic fitting for the patient. This pain is usually noted early in recovery. There are causes of increased stump pain: infection, stump neuroma, heterotopic ossification [9]. These should be assessed with prolonged or increased stump pain as these are easily treatable. Infection is not uncommon in these patients due to high prevalence of diabetes and peripheral vascular disease. This should be assessed and treated with antibiotics accordingly to prevent sepsis and wound dehiscence. Stump neuromas occur when the severed nerve at the amputation site have an inflammatory mediated immune reaction. This can cause pain, but it can also cause unmyelinated A and C fibers to form around the nerve. Neuromas develop over time and usually are characterized by point pain on the stump and sensory changes. Heterotopic ossifications usually occur later after amputation as well. These are calcium deposits that occur in the soft tissue of the stump. These ossifications occur much higher in traumatic amputations. There is some association with traumatic brain injury and the risk of this occurrence as well [2, 3, 12].
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Phantom limb pain was first described in 1462 by French Surgeon, Ambrose Pare’ [13]. However, it was not until 1871 that Silas Weir Mitchell, a Civil War surgeon, called this phenomenon “phantom limb” [2, 13]. Phantom limb pain is an unpleasant or painful feeling in the amputated extremity. 45–85% of patients from amputations can suffer from phantom limb pain [9]. This can have neuropathic components with burning and electrical shooting pain and nociceptive components of dull, aching, crushing and cramping pain [13]. There are two times of onset for this pain. One is usually early after amputation in the first month and the second can occur a year after amputation. The further out a patient is from amputation the less likely they will experience this. However, if a patient does begin to experience this, it can last for years. Phantom limb pain does not always have to occur alone and usually occurs with residual limb pain. While residual limb pain may be bothersome early on, phantom limb pain persists and become more bothersome later and tends to last longer. Risk factors for development or prolonging phantom limb pain are found in Table 1 [1, 2, 3, 12, 13].
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1. Female gender
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2. Elevated pre-amputation pain
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3. Upper extremity
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4. Increasing age
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5. Bilateral amputation
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6. Traumatic amputation
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7. Stump healing
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8. Disease states such as fibromyalgia, migraines, Raynaud’s, IBS, irritable bladder, depression, and anxiety
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9. Poor social support
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10. High expectations
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11. Poor coping strategies
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\n\n
Table 1.
Risk factors for developing or prolonged phantom limb pain.
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\n
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3. Pain signal transmission
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To understand how to treat the pain from amputations, we should first take a moment to review how painful stimulation is transmitted through the body (see Figure 1). The human body receives signals from various inputs. If something painful happens to the body such as surgical insult, the damage is registered by nociceptors in the periphery. The distal nerve fibers coalesce and become peripheral nerves. There are pain receptors that present on the neuron and it is connected by an axon to the spinal cord. Transmission from peripheral nerve to dorsal column is obtained by different nerve fibers. These include: A-alpha fibers, the A-beta fibers, the A-delta fibers, and the C fibers. Pain travels on two different nerve fibers: A-delta and C-fibers. A-delta fibers are large myelinated fibers that carry sharp pain, whereas C-fibers are small and unmyelinated fibers that produce dull, slow spreading pain. This signal arrives to the dorsal horn and then travels up via neurotransmitters to the brain. There are a variety of neurotransmitters from the spinal cord to the thalamus. For pain, the most important to consider are Substance P which is an excitatory neurotransmitter for second order neurons in the dorsal horn. This neurotransmitter has been shown to sensitize nociceptors. In addition to pain, Substance P also related to inflammation, cell growth, vasodilation and even mood regulation. Glutamate is also a primary neurotransmitter for pain. It is the main excitatory neurotransmitter in the body. In the brain, glutamate receptors can be both pro-nociceptive as well as anti-nociceptive. This leads to many pain therapies constructed at glutamate. This is used for central sensitization in chronic pain patients [14]. Once in the dorsal horn, the second order neurons connect with thalamus and other various areas. These can include the somatosensory cortex (physical sensation), limbic system (emotion) and frontal cortex (upper level thinking). This allows a patient to feel and react with pain not just physically but emotionally as well [15].
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Figure 1.
Path pathways.
\n
Let us revisit how the various pain pathways are affected during amputation. Phantom pain sensations likely result from changes in the somatosensory cortex. This causes afferent nociceptive stimulation from body parts near the amputation sites (such as face for upper extremity amputation or bladder for lower extremity amputation). Due to this reorganization in the somatosensory cortex and stimulation input, the phantom sensations occur [2, 9].
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Peripheral nerves likely play a large role in the phantom limb pain and residual limb pain. Damage to distal nerve endings and axons causes inflammation and alteration in neurotransmission along the usual pain pathway. The distal nerve endings will begin to regenerate but there will be non-functional axons, changes in sodium and potassium channels and different input from the spinal cord. Neuromas can form here as discussed previously. This can also result in higher pain due to more catecholamines in circulation due to increased sympathetic discharge [2, 9].
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There are also spinal cord changes in the dorsal horn related to pain after amputation. The peripheral nerves are no longer able to send the usual signals along the axons to the spinal cord. The brainstem reticular areas therefore do not send inhibitory sensory transmission, so the dorsal horn receives input from this body part as high sensory feedback resulting in pain transmission [1, 2, 9].
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These changes in the peripheral and spinal cord need to be considered as we are thinking about treating each patient for amputation pain.
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\n
\n
4. Protocol for perioperative caring for amputation patients
\n
It is well understood that effective control of acute post-amputation pain results in decreased risk of development of residual and phantom limb pain [16]. Perioperative plans need to set up within a multi-disciplinary team, ideally involving surgeon, anesthesia, in-patient acute pain teams, pharmacy, physical therapy, occupational therapy, nutrition, and social work to name a few. The pre-operative optimization is essential to control of acute post-amputation pain and help decrease the risk of development of chronic and phantom pain to help these amputation patients have the best chance for better pain control post-amputation. Thorough pre-operative evaluation is needed to look at co-medical conditions that can be optimized. The patient’s nutrition should be optimized for wound healing as well. Physical therapy and occupational therapy should work with the patient before surgery to improve physical status prior to surgery and make post-operative recovery more successful. Patient should have a pre-operative discussion about post-operative pain management and expectations. This will allow goal setting and help with anxiety the patient may be experiencing.
\n
Patients who struggle with high pain scores prior to amputation may have an elevated risk of developing chronic pain [17]. Thus, aggressive multimodal analgesic therapy instituted pre-operatively and early in the post-operative period could be beneficial in reducing the incidence of chronic pain. One study found that the presence of depressive symptoms was also a predictor of increased intensity of chronic pain in amputees [18]. Thus, it may be worthwhile to address these symptoms prior to elective amputation surgery. Patients with a complex history of chronic pain disorders and/or patients having high baseline daily opioid requirements (> 80 mg oral morphine equivalents) should be further selected to undergo a pre-operative appointment with a pain specialist. This appointment should ideally take place around 4 weeks prior to elective amputation with the goal to optimize the patient’s pain regimen pre-operatively, by maximizing non-opioid modalities and reduction of daily opioid consumption if possible. This is done to improve response to opioid therapy in the immediate post-operative period. Thorough patient education and compassionate counseling also play a key role in developing a team relationship with the patient [19, 20]. See Figure 2 for full protocol.
\n
Figure 2.
Protocol for amputation pain management.
\n
\n
\n
5. Nerve blockade
\n
The current standard of care is pre-operative nerve blockade to prevent peripheral sensitization leading to future onset of phantom limb pain. Successful outcomes necessitate effective communication between the surgeon, anesthesiologist, and the various teams involved in the post-operative rehabilitation of the patient. A consultation with the Acute Pain Service or similar entity that performs peripheral nerve blockade pre-operatively and then follows the patient during their post-operative inpatient course is an important factor in the success in early prevention of acute and chronic pain for these patients.
\n
Most patients that arrive for amputations should be evaluated to receive pre-operative peripheral nerve blocks. If this cannot be done pre-operatively, patients can be evaluated post-operatively for a nerve block. If patients do not require post-operative anti-coagulation that will preclude a continuous peripheral nerve catheter, this would be the preferred nerve block for these patients as this will help with prevention phantom limb pain and chronic post-operative pain [3]. This can be utilized for 3–5 days. Continuous nerve catheter infusions have been found to decrease post-operative morphine requirements [21]. However, in addition, there are other factors that may preclude continuous peripheral nerve catheter placement such as infection, and patient factors. If this is the case, single shot peripheral nerve blocks may be utilized. Interestingly, a systematic review and meta-analysis found no difference in pain scores at 24 hours between patients that received a nerve block and those that did not [22]. However, this study did not look at chronic pain in these patients which is the important component that these nerve blocks are used for [9].
\n
It is important to understand the anatomy of the amputation site to have successful nerve block placement. For example, a below the knee amputation will rely heavily on a sciatic nerve blockade whereas an above the knee amputation will need blockade of both femoral and sciatic nerves for successful pain control and help with peripheral sensitization for the patient [9]. For upper extremity amputations, a forearm amputation will be lower in the brachial plexus than an above the elbow amputation or shoulder disarticulation. Tourniquet site is also paramount when planning peripheral nerve block placement. If the catheter is in the surgical site or tourniquet site, there is a risk for dislodgement. It is important to remember this with placement and keep the securement of catheter out of the surgical field. This will take good communication between anesthesia provider and surgeon to achieve this effectively.
\n
It should be noted that epidural blockade may also be used for lower extremity amputation, especially if it will be a bilateral lower extremity amputation. There are studies that show pre-operative epidural placement in amputation patients prevent phantom limb pain due to stopping nociceptive input to the spinal cord [3]. There is no comparison of epidural to peripheral nerve catheters for lower extremity amputations, but on a practically note, peripheral nerve blockade will allow better mobilization and participation in physical therapy [3]. In addition, peripheral nerve block does not have the hemodynamic affects that epidural blockade can have [23].
\n
\n
\n
6. Pharmacology
\n
\n
6.1 Opioids
\n
Opioids remain a favored therapy for pain after surgery. They bind to Mu receptors in peripheral and central nerves as an agonist fashion to produce analgesia. They also can affect phantom limb pain by reducing cortical reorganization [10]. There is a wide variety to choose from post-operatively as they come in intravenous and oral formulation. Usually initially a parenteral opioid therapy with a patient-controlled analgesia (PCA) is started on post-operative day (POD) zero. Once the patient is tolerating a diet, the PCA is weaned down incrementally and oral opioid therapy is instituted. For opioid tolerant patients, we attempt to calculate their total daily morphine equivalent requirement and base our starting oral dose based on that. The goal is to wean off the PCA completely by 48 hours, coinciding with the discontinuation of other intravenous infusion [10].
Ketamine has been studied for post-operative pain. It has been shown that the use of this medication lowers the opioid requirements and reverses opioid tolerance needed for acute post-operative pain [24]. Ketamine is a noncompetitive NMDA receptor antagonist that targets primarily in the brain and spinal cord. The NMDA receptor is important for synaptic plasticity, central sensitization, amplification of pain signals and opioid tolerance. For amputations, it lowers the dorsal horn sensitization and stops the events that may lead to phantom limb pain and residual limb pain. Important to note, it will not prevent phantom limb pain but will reduce risks of phantom limb pain and residual limb pain [9]. Ketamine has also been shown to have anti-inflammatory properties which may be effective in the early pre-operative phase. Ketamine infusions can be started in the operating room and continued for 2–3 days post-operatively. Studies show low does ketamine infusions do reduce opioids immediately post-op but there was not a significant reduction in immediate post op pain ratings [2, 3, 10].
\n
\n
\n
6.3 Gabapentinoids
\n
Gabapentin and pregabalin are both anti-convulsant that inhibit alpha 2-delta subunit of voltage-gated calcium channels. They are structural like GABA neurotransmitter, but they are unable to bind to any GABA receptors. In addition to the use with seizures, it has been used for chronic pain, especially neuropathic in nature. Dosages must be titrated slowly, and results are not seen immediately. These doses also must be adjusted for patients with impaired renal function with the help of a pharmacist [25, 26]. However, some studies claim that its efficacy to treat phantom limb pain is inconclusive and limited by dose dependent side effects like somnolence and dizziness [2]. There are other studies more recently that show promise of administration of gabapentinoids for reducing chronic post-surgical pain and this can be exploited to amputees as well [3, 9, 10].
\n
\n
\n
6.4 Acetaminophen
\n
Acetaminophen’s exact mechanism of action is not well understood, but it is thought to reduce the production of prostaglandins in the brain. Prostaglandins are chemicals that cause inflammation and swelling. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. Acetaminophen administration to amputation patients will help with inflammation and an adjunct to help with post-surgical nociceptive pain, which has been shown to decrease opioid requirements. Acetaminophen dosages will be lowered in patients with pre-existing liver disease [27]. This will be the most beneficial in the early pre-operative phase. It may be especially beneficially to start prior to the amputation as part of a pre-emptive analgesia. This is thought to protect the central nervous system from noxious insults which result in the patient getting hyperalgesia and allodynia [10, 28].
\n
\n
\n
6.5 NSAIDs
\n
NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 or COX-2). By blocking the Cox enzymes, many prostaglandins are not made. This means that there is less swelling and less pain. Most NSAIDs block both Cox-1 and Cox-2 enzymes. For pain, this specifically looks at enzymes that work with prostaglandins for inflammation. Like acetaminophen, these medications work well in the acute perioperative phase for nociceptive pain and reducing opioid requirements. Their use can be limited due to post-operative bleeding concerns. Usually these medications do not help with chronic post amputation pain or phantom limb pain. A short course may be suitable for some patients that have normal renal function; however, we do not advocate for chronic NSAID therapy due to the risks of gastrointestinal bleeding and renal toxicity [10, 23, 29].
\n
\n
\n
6.6 Muscle relaxants
\n
As discussed earlier, acute post-operative pain can have spasmodic pain proximal to the stump site, likely due to tissue inflammation. This can also be present with residual limb pain in some patients. There are a variety of muscle relaxants that can be tried for a short period of time [30]. If the patient is on opioids, would be cautious of adding a benzodiazepine for muscle relaxant. There is a lack of adequate literature supporting the use of muscle relaxants for post amputation pain.
\n
\n
\n
6.7 Tri-cyclic antidepressants and selective norepinephrine reuptake inhibitors
\n
Anti-depressants are commonly prescribed for chronic neuropathic pain and coexisting depression that accompanies it. These medications work by inhibiting serotonin-epinephrine uptake blockade, NMDA receptor antagonism and sodium channel blockade. These medications have not been shown to work effectively in phantom limb pain in studies. These are not usually done in the perioperative setting as they require careful titration over weeks to months which is better done as outpatient therapy. Side effects of opioids and other modalities may warrant a small dose trial in the perioperative setting to help with uncontrolled acute or phantom limb pain [9, 10, 31].
\n
\n
\n
6.8 Calcitonin
\n
Calcitonin is a hormone secreted by thyroid gland in parafollicular cells. Unlike the parathyroid hormone, its job is to reduce calcium in the blood. There are synthetic forms of this used for chronic pain syndromes. The exact pain mechanism of action is unknown. There are mixed results of phantom limb pain [10]. The greatest benefit has been shown when it is administered early in the perioperative period; usually within the first 7 days [32]. There are reports of complete resolution of phantom limb pain with its use [9].
\n
\n
\n
\n
7. Therapeutic modalities
\n
There are many additional modalities that may be of benefit to amputee patients after the initial perioperative period to help with phantom limb pain and residual limb pain. Many of these involve experienced providers and therapists [2, 10, 12, 33, 34, 35, 36]. These are summarized in Table 2.
\n
\n
\n\n
\n
1. Desensitization techniques
\n
\n
\n
2. Mirror therapy
\n
\n
\n
3. Massage
\n
\n
\n
4. TENs
\n
\n
\n
5. Exercise
\n
\n
\n
6. Hot/cold therapy
\n
\n
\n
7. Biofeedback
\n
\n
\n
8. Peripheral nerve stimulation
\n
\n
\n
9. Prolonged peripheral nerve blockade
\n
\n
\n
10. Sympathetic nerve blocks
\n
\n
\n
11. Deep brain stimulators
\n
\n
\n
12. Spinal cord stimulators
\n
\n
\n
13. Neurolysis
\n
\n\n
Table 2.
Therapeutic modalities for chronic amputee limb pain.
\n
\n
\n
8. Conclusions
\n
As patient’s present for amputations, it is important to remember the care for these patients needs to be multi-disciplinary to prevent chronic pain. If perioperative pain plans are developed early and worked on as a team, the patient will benefit the most and have the best chance for success at not having long-term phantom limb pain and/or residual limb pain which adversely impact their quality of life. Psychological preparation is paramount but may not always be accomplished if amputation is needed in emergent or traumatic fashion. These patients can still be cared for effectively in a modified format with high success rate if early post-operative intervention is achieved.
\n
\n\n',keywords:"amputation, phantom pain, neuropathic pain",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/73273.pdf",chapterXML:"https://mts.intechopen.com/source/xml/73273.xml",downloadPdfUrl:"/chapter/pdf-download/73273",previewPdfUrl:"/chapter/pdf-preview/73273",totalDownloads:764,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 4th 2020",dateReviewed:"September 1st 2020",datePrePublished:"September 21st 2020",datePublished:"March 24th 2021",dateFinished:"September 21st 2020",readingETA:"0",abstract:"Considerable number of new amputations yearly in the United States and internationally represent considerable population experiencing pain that is not just acutely from surgical insult but chronically that is related to phantom limb pain and residual limb pain. This chronic pain can last from weeks to years in these patients and lead to other debilitation such as depression, anxiety and even opioid addiction. Early interventions help lessen long-term pain for these patients. These interventions include nerve blockade as well as multi-modal therapy. Understanding the pathophysiology of the pain experienced by these patients will better allow any provider to care for these patients effectively and help alleviate chronic pain in the long term.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/73273",risUrl:"/chapter/ris/73273",signatures:"Melinda S. Seering and Sangini Punia",book:{id:"9483",type:"book",title:"Pain Management",subtitle:"Practices, Novel Therapies and Bioactives",fullTitle:"Pain Management - Practices, Novel Therapies and Bioactives",slug:"pain-management-practices-novel-therapies-and-bioactives",publishedDate:"March 24th 2021",bookSignature:"Viduranga Yashasvi Waisundara, Ines Banjari and Jelena Balkić",coverURL:"https://cdn.intechopen.com/books/images_new/9483.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-897-6",printIsbn:"978-1-83880-026-0",pdfIsbn:"978-1-83880-898-3",isAvailableForWebshopOrdering:!0,editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"323090",title:"Dr.",name:"Melinda S.",middleName:null,surname:"Seering",fullName:"Melinda S. Seering",slug:"melinda-s.-seering",email:"melinda-seering@uiowa.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"329349",title:"Dr.",name:"Sangini",middleName:null,surname:"Punia",fullName:"Sangini Punia",slug:"sangini-punia",email:"sangini-punia@uiowa.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Pain classification with an emphasis on amputees",level:"1"},{id:"sec_3",title:"3. Pain signal transmission",level:"1"},{id:"sec_4",title:"4. Protocol for perioperative caring for amputation patients",level:"1"},{id:"sec_5",title:"5. Nerve blockade",level:"1"},{id:"sec_6",title:"6. Pharmacology",level:"1"},{id:"sec_6_2",title:"6.1 Opioids",level:"2"},{id:"sec_7_2",title:"6.2 N-Methyl-D-Aspartate (NMDA) Receptor Antagonists",level:"2"},{id:"sec_8_2",title:"6.3 Gabapentinoids",level:"2"},{id:"sec_9_2",title:"6.4 Acetaminophen",level:"2"},{id:"sec_10_2",title:"6.5 NSAIDs",level:"2"},{id:"sec_11_2",title:"6.6 Muscle relaxants",level:"2"},{id:"sec_12_2",title:"6.7 Tri-cyclic antidepressants and selective norepinephrine reuptake inhibitors",level:"2"},{id:"sec_13_2",title:"6.8 Calcitonin",level:"2"},{id:"sec_15",title:"7. Therapeutic modalities",level:"1"},{id:"sec_16",title:"8. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'\nKuffler DP. Origins of phantom limb pain. Mol Neurobiol 2018;55:60-69.\n'},{id:"B2",body:'\nHsu E, Cohen SP. Postamputation pain: Epidemiology, mechanisms, and treatment. J Pain Res 2013;6:121-136.\n'},{id:"B3",body:'\nSrivastava D. Chronic post-amputation pain: Peri-operative management - review. Br J Pain 2017;11:192-202.\n'},{id:"B4",body:'\nGlaser JD, Bensley RP, Hurks R et al. Fate of the contralateral limb after lower extremity amputation. J Vasc Surg 2013;58:1571-1577.e1.\n'},{id:"B5",body:'\nBuckenmaier CC, 3rd, Kwon KH, Howard RS et al. Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery. Pain Med 2010;11:790-799.\n'},{id:"B6",body:'\nHawamdeh ZM, Othman YS, Ibrahim AI. Assessment of anxiety and depression after lower limb amputation in jordanian patients. Neuropsychiatr Dis Treat 2008;4:627-633.\n'},{id:"B7",body:'\nde Mestral C, Hsu AT, Talarico R et al. End-of-life care following leg amputation in patients with peripheral artery disease or diabetes. Br J Surg 2020;107:64-72.\n'},{id:"B8",body:'\nMcKechnie PS, John A. Anxiety and depression following traumatic limb amputation: A systematic review. Injury 2014;45:1859-1866.\n'},{id:"B9",body:'\nNeil M. Pain after amputation. BJA Education 2016;16:107-112.\n'},{id:"B10",body:'\nKuffler DP. Coping with phantom limb pain. Mol Neurobiol 2018;55:70-84.\n'},{id:"B11",body:'\nJensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983;17:243-256.\n'},{id:"B12",body:'\nUustal H, Meier RH, 3rd. Pain issues and treatment of the person with an amputation. Phys Med Rehabil Clin N Am 2014;25:45-52.\n'},{id:"B13",body:'\nWeeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: Theories and therapies. Neurologist 2010;16:277-286.\n'},{id:"B14",body:'\nSwaran Singh TS, Wikle, J. & Rastogi, R. Multifactorial pathophysiology. In: Abd-Elsayed A. Pain: A review guide. Cham Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B15",body:'\nZaky S, Zaky, C., and Abd-Elsayed, A. Anatomy of the nervous system. In: Abd-Elsayed A. Pain: A review guide. Cham, Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B16",body:'\nKaranikolas M, Aretha D, Tsolakis I et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: A prospective, randomized, clinical trial. Anesthesiology 2011;114:1144-1154.\n'},{id:"B17",body:'\nHanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain 2007;8:102-109.\n'},{id:"B18",body:'\nEphraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey. Arch Phys Med Rehabil 2005;86:1910-1919.\n'},{id:"B19",body:'\nRetreived from:\nHttps://www.Cdha.Nshealth.Ca/amputee-rehabilitation-musculoskeletal-program/patients-families-amputee-rehabilitation/coping-your-.\n'},{id:"B20",body:'\nService UKNH. Retreived from:Https://www.Nhs.Uk/conditions/amputation/. 2020.\n'},{id:"B21",body:'\nAyling OG, Montbriand J, Jiang J et al. Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation. Eur J Vasc Endovasc Surg 2014;48:559-564.\n'},{id:"B22",body:'\nBosanquet DC, Glasbey JC, Stimpson A, Williams IM, Twine CP. Systematic review and meta-analysis of the efficacy of perineural local anaesthetic catheters after major lower limb amputation. Eur J Vasc Endovasc Surg 2015;50:241-249.\n'},{id:"B23",body:'\nDe Jong R, Shysh AJ. Development of a multimodal analgesia protocol for perioperative acute pain management for lower limb amputation. Pain Res Manag 2018;2018:5237040.\n'},{id:"B24",body:'\nBell RF, Kalso EA. Ketamine for pain management. Pain Rep 2018;3:e674.\n'},{id:"B25",body:'\nO’Connor AB, Dworkin RH. Treatment of neuropathic pain: An overview of recent guidelines. Am J Med 2009;122:S22–S32.\n'},{id:"B26",body:'\nDworkin RH, O’Connor AB, Backonja M et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 2007;132:237-251.\n'},{id:"B27",body:'\nMartinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L. Non-opioid analgesics in adults after major surgery: Systematic review with network meta-analysis of randomized trials. Br J Anaesth 2017;118:22-31.\n'},{id:"B28",body:'\nSyal K, Goma M, Dogra RK, Ohri A, Gupta AK, Goel A. “Protective premedication”: A comparative study of acetaminophen, gabapentin and combination of acetaminophen with gabapentin for post-operative analgesia. J Anaesthesiol Clin Pharmacol 2010;26:531-536.\n'},{id:"B29",body:'\nMelsom H, Danjoux G. Perioperative care for lower limb amputation in vascular disease. Continuing Education in Anaesthesia Critical Care & Pain 2011;11:162-166.\n'},{id:"B30",body:'\nKetz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil 2008;89:1127-1132.\n'},{id:"B31",body:'\nPilowsky I, Hallett EC, Bassett DL, Thomas PG, Penhall RK. A controlled study of amitriptyline in the treatment of chronic pain. Pain 1982;14:169-179.\n'},{id:"B32",body:'\nHall N, Abd-Elsayed, A, & Eldabe, S. Phantom limb pain. In: Abd-Elsayed A. Pain: A review guide. Cham, Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B33",body:'\nKaur A, Guan Y. Phantom limb pain: A literature review. Chin J Traumatol 2018;21:366-368.\n'},{id:"B34",body:'\nBorghi B, D’Addabbo M, White PF et al. The use of prolonged peripheral neural blockade after lower extremity amputation: The effect on symptoms associated with phantom limb syndrome. Anesth Analg 2010;111:1308-1315.\n'},{id:"B35",body:'\nRauck RL, Cohen SP, Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation 2014;17:188-197.\n'},{id:"B36",body:'\nHerrador Colmenero L, Perez Marmol JM, Martí-García C et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review. Prosthet Orthot Int 2018;42:288-298.\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Melinda S. Seering",address:"melinda-seering@uiowa.edu",affiliation:'
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Ashkenazi, E. Mentovich, D. Cvikel, O. Barkai, A. Aronson and Y. 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In this chapter, we have presented a brief comprehensive survey of cultural heritage using augmented reality systems. This survey describes the main objectives and characteristics of marker-less augmented reality systems through presenting up-to-date research results in this area. 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While the Oldowan as the earliest technocomplex continues to be elusive, the oldest Acheulean is dated to ~1.5 Ma and the early Middle Paleolithic is ~385 ka (from the same site). New Late Pleistocene dates have been reported for the Middle Paleolithic which continues up to 38 Ka in southern India. The Upper Paleolithic remains ambiguous and requires critically multidisciplinary investigations. The microlithic evidence appears to spread rapidly across the subcontinent soon after its emergence at ~48 Ka (though its origin is debated) and continues into the Iron Age. The timeline of the initial arrival of Homo sapiens continues to be debated based on the archaeology (advanced Middle Paleolithic vs. microlithic) and genetic studies on indigenous groups. Other issues that need consideration are: interactions between archaics and arriving moderns, the marginal occurrence of symbolic behavior, the absolute dating of rock art and the potential role of hominins in specific animal extinctions and ecological marginalization. The region does not appear to have been a corridor for dispersals towards Southeast Asia (although gene flow may have occurred). Instead, once various prehistoric technologies appeared in the Subcontinent, they possibly followed complex trajectories within relative isolation.",book:{id:"9251",slug:"pleistocene-archaeology-migration-technology-and-adaptation",title:"Pleistocene Archaeology",fullTitle:"Pleistocene Archaeology - Migration, Technology, and Adaptation"},signatures:"Parth R. Chauhan",authors:[{id:"307040",title:"Dr.",name:"Parth",middleName:null,surname:"Chauhan",slug:"parth-chauhan",fullName:"Parth Chauhan"}]},{id:"73386",title:"Island Migration, Resource Use, and Lithic Technology by Anatomically Modern Humans in Wallacea",slug:"island-migration-resource-use-and-lithic-technology-by-anatomically-modern-humans-in-wallacea",totalDownloads:732,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Island migration and adaptation including both marine and terrestrial resource use and technological development by anatomically modern humans (AMH) are among the most significant issues for Pleistocene archaeology in Southeast Asia and Oceania, and directly related to the behavioral and technological advancements by AMH. This paper discusses such cases in the Wallacean islands, located between the past Sundaland and the Sahul continent during the Pleistocene. The Pleistocene open sea gaps between the Wallacean islands and both landmasses are very likely the major factor for the relative scarcity of animal species originating from Asia and Oceania and the high diversity of endemic species in Wallacea. They were also a barrier for hominin migration into the Wallacean islands and Sahul continent. We summarize three recent excavation results on the Talaud Islands, Sulawesi Island and Mindoro Island in Wallacea region and discuss the evidence and timeline for migrations of early modern humans into the Wallacean islands and their adaptation to island environments during the Pleistocene.",book:{id:"9251",slug:"pleistocene-archaeology-migration-technology-and-adaptation",title:"Pleistocene Archaeology",fullTitle:"Pleistocene Archaeology - Migration, Technology, and Adaptation"},signatures:"Rintaro Ono, Alfred Pawlik and Riczar Fuentes",authors:[{id:"177123",title:"Dr.",name:"Rintaro",middleName:null,surname:"Ono",slug:"rintaro-ono",fullName:"Rintaro Ono"},{id:"300616",title:"Dr.",name:"Alfred",middleName:null,surname:"Pawlik",slug:"alfred-pawlik",fullName:"Alfred Pawlik"},{id:"330591",title:"Dr.",name:"Riczar",middleName:null,surname:"Fuentes",slug:"riczar-fuentes",fullName:"Riczar Fuentes"}]}],onlineFirstChaptersFilter:{topicId:"263",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"10",title:"Animal Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",isOpenForSubmission:!0,editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},{id:"11",title:"Cell Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",isOpenForSubmission:!0,editor:{id:"133493",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/133493/images/3091_n.jpg",biography:"Prof. Dr. Angel Catalá \r\nShort Biography Angel Catalá was born in Rodeo (San Juan, Argentina). He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",isOpenForSubmission:!0,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). 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Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}}},{id:"13",title:"Plant Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/13.jpg",isOpenForSubmission:!0,editor:{id:"332229",title:"Prof.",name:"Jen-Tsung",middleName:null,surname:"Chen",slug:"jen-tsung-chen",fullName:"Jen-Tsung Chen",profilePictureURL:"https://mts.intechopen.com/storage/users/332229/images/system/332229.png",biography:"Dr. Jen-Tsung Chen is currently a professor at the National University of Kaohsiung, Taiwan. He teaches cell biology, genomics, proteomics, medicinal plant biotechnology, and plant tissue culture. Dr. Chen\\'s research interests include bioactive compounds, chromatography techniques, in vitro culture, medicinal plants, phytochemicals, and plant biotechnology. He has published more than ninety scientific papers and serves as an editorial board member for Plant Methods, Biomolecules, and International Journal of Molecular Sciences.",institutionString:"National University of Kaohsiung",institution:{name:"National University of Kaohsiung",institutionURL:null,country:{name:"Taiwan"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:43,paginationItems:[{id:"81796",title:"Apoptosis-Related Diseases and Peroxisomes",doi:"10.5772/intechopen.105052",signatures:"Meimei Wang, Yakun Liu, Ni Chen, Juan Wang and Ye Zhao",slug:"apoptosis-related-diseases-and-peroxisomes",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"The Metabolic Role of Peroxisome in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/10837.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81723",title:"Peroxisomal Modulation as Therapeutic Alternative for Tackling Multiple Cancers",doi:"10.5772/intechopen.104873",signatures:"Shazia Usmani, Shadma Wahab, Abdul Hafeez, Shabana Khatoon and Syed Misbahul Hasan",slug:"peroxisomal-modulation-as-therapeutic-alternative-for-tackling-multiple-cancers",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"The Metabolic Role of Peroxisome in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/10837.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81638",title:"Aging and Neuropsychiatric Disease: A General Overview of Prevalence and Trends",doi:"10.5772/intechopen.103102",signatures:"Jelena Milić",slug:"aging-and-neuropsychiatric-disease-a-general-overview-of-prevalence-and-trends",totalDownloads:14,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg",subseries:{id:"11",title:"Cell Physiology"}}},{id:"81566",title:"New and Emerging Technologies for Integrative Ambulatory Autonomic Assessment and Intervention as a Catalyst in the Synergy of Remote Geocoded Biosensing, Algorithmic Networked Cloud Computing, Deep Learning, and Regenerative/Biomic Medicine: Further Real",doi:"10.5772/intechopen.104092",signatures:"Robert L. 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Military Reserve Officer serving with the 100 Support Command, 100 Troop Command, 40 Infantry Division, CA National Guard.",institutionString:null,institution:{name:"Loma Linda University",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"6925",title:"Endoplasmic Reticulum",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6925.jpg",slug:"endoplasmic-reticulum",publishedDate:"April 17th 2019",editedByType:"Edited by",bookSignature:"Angel Català",hash:"a9e90d2dbdbc46128dfe7dac9f87c6b4",volumeInSeries:2,fullTitle:"Endoplasmic Reticulum",editors:[{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}}]},{type:"book",id:"6924",title:"Adenosine Triphosphate in Health and Disease",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6924.jpg",slug:"adenosine-triphosphate-in-health-and-disease",publishedDate:"April 24th 2019",editedByType:"Edited by",bookSignature:"Gyula Mozsik",hash:"04106c232a3c68fec07ba7cf00d2522d",volumeInSeries:3,fullTitle:"Adenosine Triphosphate in Health and Disease",editors:[{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",institutionURL:null,country:{name:"Hungary"}}}]},{type:"book",id:"8008",title:"Antioxidants",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/8008.jpg",slug:"antioxidants",publishedDate:"November 6th 2019",editedByType:"Edited by",bookSignature:"Emad Shalaby",hash:"76361b4061e830906267933c1c670027",volumeInSeries:5,fullTitle:"Antioxidants",editors:[{id:"63600",title:"Prof.",name:"Emad",middleName:null,surname:"Shalaby",slug:"emad-shalaby",fullName:"Emad Shalaby",profilePictureURL:"https://mts.intechopen.com/storage/users/63600/images/system/63600.png",biography:"Dr. Emad Shalaby is a professor of biochemistry on the Biochemistry Department Faculty of Agriculture, Cairo University. He\nreceived a short-term scholarship to carry out his post-doctoral\nstudies abroad, from Japan International Cooperation Agency\n(JICA), in coordination with the Egyptian government. Dr.\nShalaby speaks fluent English and his native Arabic. He has 77\ninternationally published research papers, has attended 15 international conferences, and has contributed to 18 international books and chapters.\nDr. Shalaby works as a reviewer on over one hundred international journals and is\non the editorial board of more than twenty-five international journals. He is a member of seven international specialized scientific societies, besides his local one, and\nhe has won seven prizes.",institutionString:"Cairo University",institution:{name:"Cairo University",institutionURL:null,country:{name:"Egypt"}}}]}]},openForSubmissionBooks:{},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{paginationCount:617,paginationItems:[{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNVJQA4/Profile_Picture_2022-03-07T13:23:04.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. degree from Integral University. Currently, he’s working as an Assistant Professor of Pharmaceutics in the Faculty of Pharmacy, Integral University. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than 32 original articles published in reputed journals, 3 edited books, 5 book chapters, and a number of scientific articles published in ‘Ingredients South Asia Magazine’ and ‘QualPharma Magazine’. He is a member of the American Association for Cancer Research, International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs that aim to provide practical solutions to current healthcare problems.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}},{id:"226275",title:"Ph.D.",name:"Metin",middleName:null,surname:"Budak",slug:"metin-budak",fullName:"Metin Budak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226275/images/system/226275.jfif",biography:"Metin Budak, MSc, PhD is an Assistant Professor at Trakya University, Faculty of Medicine. He has been Head of the Molecular Research Lab at Prof. Mirko Tos Ear and Hearing Research Center since 2018. His specializations are biophysics, epigenetics, genetics, and methylation mechanisms. He has published around 25 peer-reviewed papers, 2 book chapters, and 28 abstracts. He is a member of the Clinical Research Ethics Committee and Quantification and Consideration Committee of Medicine Faculty. His research area is the role of methylation during gene transcription, chromatin packages DNA within the cell and DNA repair, replication, recombination, and gene transcription. His research focuses on how the cell overcomes chromatin structure and methylation to allow access to the underlying DNA and enable normal cellular function.",institutionString:"Trakya University",institution:{name:"Trakya University",country:{name:"Turkey"}}},{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",biography:"Anca Pantea Stoian is a specialist in diabetes, nutrition, and metabolic diseases as well as health food hygiene. She also has competency in general ultrasonography.\n\nShe is an associate professor in the Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. She has been chief of the Hygiene Department, Faculty of Dentistry, at the same university since 2019. Her interests include micro and macrovascular complications in diabetes and new therapies. Her research activities focus on nutritional intervention in chronic pathology, as well as cardio-renal-metabolic risk assessment, and diabetes in cancer. She is currently engaged in developing new therapies and technological tools for screening, prevention, and patient education in diabetes. \n\nShe is a member of the European Association for the Study of Diabetes, Cardiometabolic Academy, CEDA, Romanian Society of Diabetes, Nutrition and Metabolic Diseases, Romanian Diabetes Federation, and Association for Renal Metabolic and Nutrition studies. She has authored or co-authored 160 papers in national and international peer-reviewed journals.",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",country:{name:"Romania"}}},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279792/images/system/279792.jpg",biography:"Graduate and master in Biology from the University of Coimbra.\n\nI am a research fellow at the Macroalgae Laboratory Unit, in the MARE-UC – Marine and Environmental Sciences Centre of the University of Coimbra. My principal function is the collection, extraction and purification of macroalgae compounds, chemical and bioactive characterization of the compounds and algae extracts and development of new methodologies in marine biotechnology area. \nI am associated in two projects: one consists on discovery of natural compounds for oncobiology. The other project is the about the natural compounds/products for agricultural area.\n\nPublications:\nCotas, J.; Figueirinha, A.; Pereira, L.; Batista, T. 2018. An analysis of the effects of salinity on Fucus ceranoides (Ochrophyta, Phaeophyceae), in the Mondego River (Portugal). Journal of Oceanology and Limnology. in press. DOI: 10.1007/s00343-019-8111-3",institutionString:"Faculty of Sciences and Technology of University of Coimbra",institution:null},{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279788/images/system/279788.jpg",biography:"Leonel Pereira has an undergraduate degree in Biology, a Ph.D. in Biology (specialty in Cell Biology), and a Habilitation degree in Biosciences (specialization in Biotechnology) from the Faculty of Science and Technology, University of Coimbra, Portugal, where he is currently a professor. In addition to teaching at this university, he is an integrated researcher at the Marine and Environmental Sciences Center (MARE), Portugal. His interests include marine biodiversity (algae), marine biotechnology (algae bioactive compounds), and marine ecology (environmental assessment). Since 2008, he has been the author and editor of the electronic publication MACOI – Portuguese Seaweeds Website (www.seaweeds.uc.pt). He is also a member of the editorial boards of several scientific journals. Dr. Pereira has edited or authored more than 20 books, 100 journal articles, and 45 book chapters. He has given more than 100 lectures and oral communications at various national and international scientific events. He is the coordinator of several national and international research projects. In 1998, he received the Francisco de Holanda Award (Honorable Mention) and, more recently, the Mar Rei D. Carlos award (18th edition). He is also a winner of the 2016 CHOICE Award for an outstanding academic title for his book Edible Seaweeds of the World. In 2020, Dr. Pereira received an Honorable Mention for the Impact of International Publications from the Web of Science",institutionString:"University of Coimbra",institution:{name:"University of Coimbra",country:{name:"Portugal"}}},{id:"61946",title:"Dr.",name:"Carol",middleName:null,surname:"Bernstein",slug:"carol-bernstein",fullName:"Carol Bernstein",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61946/images/system/61946.jpg",biography:"Carol Bernstein received her PhD in Genetics from the University of California (Davis). She was a faculty member at the University of Arizona College of Medicine for 43 years, retiring in 2011. Her research interests focus on DNA damage and its underlying role in sex, aging and in the early steps of initiation and progression to cancer. In her research, she had used organisms including bacteriophage T4, Neurospora crassa, Schizosaccharomyces pombe and mice, as well as human cells and tissues. She authored or co-authored more than 140 scientific publications, including articles in major peer reviewed journals, book chapters, invited reviews and one book.",institutionString:"University of Arizona",institution:{name:"University of Arizona",country:{name:"United States of America"}}},{id:"182258",title:"Dr.",name:"Ademar",middleName:"Pereira",surname:"Serra",slug:"ademar-serra",fullName:"Ademar Serra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/182258/images/system/182258.jpeg",biography:"Dr. Serra studied Agronomy on Universidade Federal de Mato Grosso do Sul (UFMS) (2005). He received master degree in Agronomy, Crop Science (Soil fertility and plant nutrition) (2007) by Universidade Federal da Grande Dourados (UFGD), and PhD in agronomy (Soil fertility and plant nutrition) (2011) from Universidade Federal da Grande Dourados / Escola Superior de Agricultura Luiz de Queiroz (UFGD/ESALQ-USP). Dr. Serra is currently working at Brazilian Agricultural Research Corporation (EMBRAPA). His research focus is on mineral nutrition of plants, crop science and soil science. Dr. Serra\\'s current projects are soil organic matter, soil phosphorus fractions, compositional nutrient diagnosis (CND) and isometric log ratio (ilr) transformation in compositional data analysis.",institutionString:"Brazilian Agricultural Research Corporation",institution:{name:"Brazilian Agricultural Research Corporation",country:{name:"Brazil"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. The series on human physiology deals with the various mechanisms of interaction between the various organs, nerves, and cells in the human body.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11408,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. Neiva",profilePictureURL:"https://mts.intechopen.com/storage/users/213786/images/system/213786.png",institutionString:null,institution:{name:"University of Beira Interior",institutionURL:null,country:{name:"Portugal"}}},{id:"39275",title:"Prof.",name:"Herbert Ryan",middleName:null,surname:"Marini",slug:"herbert-ryan-marini",fullName:"Herbert Ryan Marini",profilePictureURL:"https://mts.intechopen.com/storage/users/39275/images/9459_n.jpg",institutionString:null,institution:{name:"University of Messina",institutionURL:null,country:{name:"Italy"}}},{id:"196218",title:"Dr.",name:"Pasquale",middleName:null,surname:"Cianci",slug:"pasquale-cianci",fullName:"Pasquale Cianci",profilePictureURL:"https://mts.intechopen.com/storage/users/196218/images/system/196218.png",institutionString:null,institution:{name:"University of Foggia",institutionURL:null,country:{name:"Italy"}}}]},onlineFirstChapters:{},publishedBooks:{},testimonialsList:[{id:"18",text:"It was great publishing with IntechOpen, the process was straightforward and I had support all along.",author:{id:"71579",name:"Berend",surname:"Olivier",institutionString:"Utrecht University",profilePictureURL:"https://mts.intechopen.com/storage/users/71579/images/system/71579.png",slug:"berend-olivier",institution:{id:"253",name:"Utrecht University",country:{id:null,name:"Netherlands"}}}},{id:"27",text:"The opportunity to work with a prestigious publisher allows for the possibility to collaborate with more research groups interested in animal nutrition, leading to the development of new feeding strategies and food valuation while being more sustainable with the environment, allowing more readers to learn about the subject.",author:{id:"175967",name:"Manuel",surname:"Gonzalez Ronquillo",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",slug:"manuel-gonzalez-ronquillo",institution:{id:"6221",name:"Universidad Autónoma del Estado de México",country:{id:null,name:"Mexico"}}}},{id:"8",text:"I work with IntechOpen for a number of reasons: their professionalism, their mission in support of Open Access publishing, and the quality of their peer-reviewed publications, but also because they believe in equality.",author:{id:"202192",name:"Catrin",surname:"Rutland",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",slug:"catrin-rutland",institution:{id:"134",name:"University of Nottingham",country:{id:null,name:"United Kingdom"}}}}]},submityourwork:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],subseriesList:[],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:null},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/18507",hash:"",query:{},params:{id:"18507"},fullPath:"/chapters/18507",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()