Selected meniscal transplant studies survivorship rates.
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These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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Sharma and Rakesh Ranjan",reviewType:"peer-reviewed",authors:[{id:"42664",title:"Dr.",name:"R.C.",middleName:null,surname:"Sharma",fullName:"R.C. 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It is essential to understand the anatomy and biomechanics of the knee joint before performing a sub-total or total meniscectomy due to the possible catastrophic consequences at a long-term follow-up. Moreover, the medial and the lateral compartment of the knee have different kinematic properties and the clinician must take into account the different degree of mobility, bony structure, and load distribution between these two compartments. Biomechanical studies have demonstrated the essential role of the menisci on load transfer, in that a total meniscectomy can increase the contact area by 33 to 50 percent in a fully extended knee [1].
Walker et al. demonstrated that the lateral compartment is much more dependent on meniscal function than the medial one. The lateral meniscus carries a higher percentage of load transfer than the medial meniscus. This is due to a higher load being transferred directly by the exposed cartilage surface of the medial compartment [1]. The different bony morphology of the tibiofemoral compartments also play a part in this. In the sagittal plane, the medial convexity of the femoral condyle and the concavity of the tibial plateau provide a degree of congruity, even after a meniscectomy. While, on the lateral side, both the convexity of the femoral condyle and the lateral tibial plateau make this compartment much more prone to an increase in peak contact pressures after meniscectomy [2].
Clinically, the differences between the medial and lateral meniscus have been confirmed by worse results reported after lateral meniscectomy compared to medial meniscectomy at a long-term follow-up [3, 4]. These findings are even more stark if the meniscectomy is performed during adolescence: in a prospective 30 years of follow-up study, about 80% of patients after medial meniscectomy maintained good or excellent clinical results; in comparison to less than 50% for lateral meniscectomy [5].
The causal relationship of knee arthritis with meniscectomy led to the investigation of meniscal allograft transplantation for the post-meniscectomy patient experiencing pain and demonstrating arthritic changes [6]. Basic science studies have shown that although meniscal allografts cannot fully replicate the function of the native meniscus, the grafts are able to significantly improve joint contact area and decrease contact pressures [7, 8]. Also, early clinical series demonstrated isolated meniscal allograft transplantation to be a feasible procedure [9, 10]. However, the initial studies had variable outcomes due to significant differences in indications, surgical techniques, and tissue processing methods.
As experience was gained, the variables became more defined and the results improved. Numerous short and midterm studies have shown that meniscal allografts are able to provide pain relief and increase function with high rates of graft survivorship [11, 12]. More recently, a long-term study has been published demonstrating >50% graft survival at 20 years [13].
However, if a subtotal meniscectomy has previously been performed, a meniscal scaffold may be a more appropriate procedure, despite the relative lack of relevant articles with extended follow-up. There are two different scaffold types available on the market: the collagen meniscus implant (CMI) derived from a bovine collagen and the Actifit, a polyurethane scaffold [14, 15]. 3D printed scaffolds have been recently proposed as an experimental treatment and only a few case reports are available, while CMI and Actifit have been widely studied.
After a meniscal tear, the effectiveness of meniscal repair strictly relies on the tissue quality and defect location with respect to the vascular supply. Tears in the vascularized “red” peripheral zone are more likely to heal, while the more common lesions in the avascular “white” zone have poor healing potential [16, 17]. When the majority of the meniscus is not salvageable, a meniscectomy is usually performed. It has been well documented that meniscectomy increases the risk of degenerative joint disease of the knee. For example, Persson et al. demonstrated that in almost 2,500 patients followed for more than 20 years, the risk of developing arthritis after a partial meniscectomy was almost 6 times higher than the standard population, with a 17% absolute risk [18].
Structurally, it has been demonstrated that meniscal allografts should be frozen, not sterilized using chemicals or radiation. It the first published series of isolated meniscal allografts, Milakowski et al. found that graft processing methods were vital to the success of the procedure [19]. He reported that lyophilized grafts lead to inferior results compared to fresh frozen grafts. While clinical series have not shown benefit of cryopreserved over fresh frozen, basic science studies have shown slightly better mechanic properties with cryopreserved, with a higher elastic modulus and point of rupture [20].
While meniscus allograft transplantation appropriately addresses a prior total or subtotal meniscectomy, an allograft is not a solution for the treatment of a partial meniscus defect. The Collagen Meniscus Implant (Ivy Sports Medicine, Germany) is a porous biologic scaffold. It consists of 97% type I collagen purified from bovine Achilles tendon while the remaining portion is composed of glycosaminoglycan (GAG). The specific size of the scaffold’s micropores are controlled to increase the fibrocartilage maturation while avoiding pseudo-capsule formation and foreign body reaction [21].
The second scaffold type consists of a synthetic polyurethane-based material composed of flexible segments made from polycaprolactone 80% and stiff segments made from urethane 20% (Actifit; Orteq Sports Medicine, London, UK). The scaffold slowly biodegrades, with an estimated decomposition time of 4 to 6 years. The implant itself is also highly porous to allow for sufficient ingrowth [22]. Both the Actifit and the CMI implants come in separate configurations for medial or lateral meniscus defects.
The indications for both meniscus allograft and scaffold vary by surgeon, but in general, the patient should have previously undergone a total or partial meniscectomy, respectively, and present with discomfort only in the compartment previously operated upon. Maximal osteoarthritis allowed is grade III and a minimum 2 mm joint space. Also, if the knee is clinically unstable, it should be stabilized at the time of the procedure with respect to the anterior cruciate ligament. If operative knee alignment is more than 3–5 degrees different concerning the involved compartment compared to the contralateral knee, an osteotomy should be performed to unload the affected compartment.
For meniscus allograft transplant, the traditional methodology denotes the use of medial side double bone plugs, and a press-fit bone bridge (keyhole) method on the lateral side (Figure 1). On the medial side bone plugs are used due to graft size and anterior attachment variability, while on the lateral side bone bridges are used due to horn proximity [13]. In the case of a concomitant ACL and lateral meniscus, the femoral and tibial ACL tunnels are drilled initially and then the lateral meniscus trough is made. The femoral side of the ACL is then secured, followed by placement of the lateral meniscal allograft, and finally the tibial side of the ACL is secured. While a number of papers have investigated all-soft tissue constructs, several basic science studies have demonstrated improved biomechanical function with bony meniscal attachments [23, 24].
Lateral keyhole technique with suture fixation and medial bone plug technique with suture fixation.
For meniscus scaffolds, surgical technique is similar for both devices. This begins with arthroscopic resection of the surrounding damaged tissue and subsequent implantation of a custom-sized scaffold. The sized scaffold is then sutured to the meniscal rim and capsule using standard techniques (Figure 2).
Custom meniscal scaffold sizing and fixation.
Initially, a partial meniscectomy is performed, with surgical debridement back to the vascularized zone of the damaged portion of the native meniscus. It is particularly important that the meniscal rim be continuous, especially at the popliteal hiatus of the lateral meniscus. If there is complete loss of the tissue in front of the popliteus tendon, it should be considered a total loss and thus a contraindication for a meniscus scaffold. After debridement, the resulting void is sized along the peripheral edge using the meniscal ruler supplied with the scaffold. The scaffold is then cut to fit, placed into the knee, and finally sutured to the native meniscus. The surgeon can use an all-inside, inside-out, or outside-in suture technique depending on the area to be sutured and their experience and preference [25].
Early results showed meniscus transplant could be a viable procedure; however, the initial results were mixed and raised concerns of long-term durability. It the first series of isolated meniscal allografts, Milakowski et al. demonstrated that graft processing methods were vital to the success of the procedure [9]. He reported the use of lyophilized grafts lead to inferior results compared to fresh frozen grafts. In the first American published series, Garrett et al. reported success in 35 of 43 patients (81%) at 2 to 7-year follow-up [26]. However, 6 of the 11 patients with grade IV chondromalacia failed, leading to the conclusion that while beneficial, grafts should not be placed in knees with advanced arthritis.
In the early experience of Noyes et al. they reported a high failure rate [27]. They evaluated 38 patients with 40 grafts, with a follow-up at an average of 40 months (24–62 months). While clinically the patients did significantly better, on MRI 30% of grafts demonstrated “altered characteristics” with another 28% demonstrating gross failure. Patients with no pre-operative arthritis demonstrated 10 abnormal MRIs out of 22, while the arthritic group showed abnormalities in 13 of 18, again demonstrating the folly of allograft implantation in arthritic knees.
Over time, graft processing methods, patient selection parameters, and surgical techniques were refined. With these improvements, meniscus allograft transplant ceased being seen as experimental (Table 1) [28].
Case studies | Year | Follow-up (y) | Survivorship (%) |
---|---|---|---|
Garrett | 1993 | 2+ | 81 |
Noyes | 2004 | 2+ | 72 |
Verdonk | 2006 | 5+ | 79 |
Kim | 2017 | 8+ | 98 |
Carter | 2012 | 10+ | 83 |
Noyes | 2016 | 8+ | 55 |
Van der Waal | 2009 | 11+ | 71 |
Carter | 2020 | 20+ | 56 |
Systematic reviews | |||
Novaretti | 10 | 73.5 | |
15 | 60 | ||
Bin | Medial | 10+ | 53 |
Lateral | 10+ | 57 |
Selected meniscal transplant studies survivorship rates.
Numerous short and mid-term studies reported that the vast majority of the grafts did not require reoperation, and a significant number of patients had decreased pain and improved function [29, 30, 31, 32]. In a large series, Verdonk et al. reported a survivorship of 79% in the first 100 patients at a mean of 7.2 years [33].
Kim et al. published the most optimistic longer-term data on meniscal allograft transplantation, with 2 failures in 49 knees after a minimum follow-up of 8 years. The 10-year survival rate was 98.0% and the 15-year survival rate was 93.3% according to their Kaplan–Meier analysis [34].
Carter et al. demonstrated 10-year results in 40 of his original 46 patients [35]. Thirty-two (80%) stated they had improvement in symptoms from the preoperative level. The 10 year mean IKDC score improved from the pre-op mean 50.6 (range 32.2–68.9) to 70.1 (range 39.1–93.1). Seven patients required partial meniscectomies, for a 10-year graft survivorship of 83%. Of thirty-four patients with plain radiographs available at the time of implantation and at 10 years for comparison, fourteen had no change, 15 had mild osteoarthritis, and 5 moderate to advanced progression.
Noyes et al. in his later series, 58/72 patients had follow-up at a mean of 11.9 years ± 3.2 years [36]. Twenty-six underwent reoperation for a total graft survival rate of 55.2%. While demonstrating lower survivorship, their study group had greater chondral abnormalities and malalignment at baseline. Twenty patients underwent OATS procedures, and fourteen underwent an osteotomy in conjunction with the meniscal allograft at the time of implantation.
Van der Wal et al. reported on 63 meniscal allografts transplanted in 57 patients evaluated at 13.8 ± 2.8 years. Nineteen patients had grade IV chondromalacia at baseline, and their grafts were not secured with bone [37]. Their failure rate was 29% (18 grafts) and twelve patients (21%) were converted to a TKR at a mean follow-up of 10.8 years (range 4.3–13.7). They acknowledged that the degree of chondromalacia, ACL deficiency, and graft fixation contributed to failures, with these results confirming that strict patient selection is vital for long term success.
Systematic reviews have emerged providing data with compiled results at ten-plus years after meniscal transplant implantation. Novaretti et al. combined 11 studies with 688 meniscal allograft transplants and found a 10-year survivorship of 73.5%, and a 15-year survivorship of 60.3% [18]. Bin et al. evaluated the long-term survivorship of medial versus lateral meniscal transplants at greater than ten years in a meta-analysis of 9 studies totaling 694 grafts, and found that 52.6% of medial and 56.6% of lateral grafts were intact [19].
The one study to discuss 20-year follow-up was Carter et al. where 48/56 (86.7%) of patients were able to be contacted, and of those, had 21 required surgical treatment of the graft. Thirteen patients had an isolated partial meniscectomy. Eight patients had knee arthroplasty with 1 having prior partial graft removal and one also had a high tibial osteotomy (HTO). The average time to arthroplasty was 12.7 years. The graft survivorship was therefore 56.2% [13].
The take-away points from the usage of meniscal transplants involve proper patient selection, use of a properly prepared graft, and implantation in an appropriate knee. When an average-weight patient without varus or valgus knee abnormalities has a fresh meniscal allograft placed in a stable knee without moderate or severe arthritis or chondral loss, the graft survival can potentially be greater than twenty years.
The data supporting meniscal scaffold implantation does not go back nearly as long as meniscal transplant but is also robust. Clinical studies report outcomes for CMI ranging up to 12 years, while the longest study on Actifit reports up to 8 years, both demonstrating improvements in all knee clinical outcome scales (Table 2).
Case studies (CMI) | Year | Follow-up (y) | Survivorship (%) |
---|---|---|---|
Monllau | 2011 | 10+ | 83 |
Bulgheroni | 2015 | 6+ | not listed |
Zaffagnini | 2011 | 10+ | 88 |
Leroy | 2017 | 5+ | 77 |
(Actifit) | |||
Schuttler | 2016 | 2+ | 100 |
Systematic reviews | |||
Filardo | 2015 | CMI/Actifit 2+ | 94 |
Selected meniscal scaffold studies survivorship rates.
For the CMI implant, Monllau et al. demonstrated 83% good and excellent results at 10-year follow-up for 22 patients [38]. In a randomized trial comparing the long-term results of patients with ACL rupture and partial medial meniscus defects treated with ACL reconstruction and partial medial meniscectomy versus medial CMI implant, Bulgheroni et al. demonstrated significant improvement of all clinical scores at an average of 9.6 years [39]. Also, Zaffagnini et al. showed prospective study results between medial CMI implantation and partial medial meniscectomy [40]. The CMI group showed significantly lower VAS for pain, higher objective IKDC, and Tegner scores at 10-year follow-up.
The Actifit results are similarly impressive. Schuttler et al. demonstrated significant improvement in VAS from 5 preoperatively to 1 at 4 years of follow-up in a group of 18 Actifit patients [41]. Leroy et al. also showed, with a minimal follow-up of 5 years, 15 patients improved from 5.3 and 50 preoperative VAS and subjective IKDC scores respectively to 2.9 and 79 [42]. Finally, a meta-analysis of 613 Actifit patients demonstrated both VAS and Tegner scores improving significantly remaining higher up to 72 months [43]. Overall, there has been degeneration of the scaffold over time with some resulting increase in osteoarthritis, with a reported rate of 9.9% at a mean follow-up of 40 months and 6.7% at a mean follow-up of 44 months, for the Actifit and CMI patients, respectively [43].
The vast majority of meniscal scaffold literature has been published on medial implants, with a recent systematic review including 396 CMI with only 10% of them were implanted in the lateral compartment [44]. Zaffagnini et al. investigated 43 patients at 24± 1.9 months after lateral CMI implant. Their Lysholm score improved from 64.3 ± 18.4 preoperatively to 93.2 ± 7.2 at final follow-up, with pain experienced during strenuous activity and at rest was significantly reduced. At 2 years of follow-up, roughly 60% of patients reported activity levels similar to their preinjury values with a satisfaction rate of 95%. The presence of a higher BMI, the need for concomitant procedures, and a chronic injury pattern resulted in reduced outcomes [45].
Finally, Hirschmann et al. demonstrated the results of a series of 67 patients undergoing medial or lateral CMI implantation associated with ACL reconstruction (45%), high tibial osteotomy (7.5%) or microfracture (4.5%). At one year the cohort demonstrated a marked decrease in pain with a subsequent improvement in the Tegner, IKDC and Lysholm scores, with comparable results of the medial and the lateral groups [46].
And so, for the meniscal scaffolds, the useage and survivorship appear to be similar to those of the transplants; however, these implants are placed into patients with contained meniscal defects as opposed to the full meniscal loss which necessitates the use of a meniscus transplant. When an average-weight patient without varus or valgus knee abnormalities has a meniscal scaffold placed in a partially debreided meniscus in an otherwise stable knee without moderate or severe arthritis or chondral loss, the graft survival can potentially be greater than ten years based on current data.
For the patient with “post-meniscectomy syndrome” with either a partially or entirely deficient meniscus, surgical treatment options exist which have demonstrated both short, medium, and in the case of meniscus allograft, long term success. Allografts have demonstrated greater than 50% survivorship at 20-year follow-up, while scaffolds have demonstrated the progressive reabsorption with substitution with a meniscus-like tissue with a potential chondroprotective effect in shorter-term studies. For both allografts and scaffolds, patient selection and the treatment of concomitant knee pathology is mandatory in order to achieve both short and long-term clinical improvement.
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Extreme weather conditions and changes in humidity rates significantly affect the concrete compressive strength development. Concrete as one of the substantial material used in residential buildings and infrastructures is subjected to a massive strength change under extreme weather conditions. For understanding, the different concrete’s behavioral aspects, various commercial cement types under different temperatures, and humidity rates are investigated in this chapter. The experiments are aimed to investigate the concrete strength development over time when the material is cast at lower to mild temperatures and different humidity index rates. Results show that reducing the curing temperature more than 15° could result in 20% reduction in total compressive strength, while decreasing humidity rates by 50% leads to less than 10% drop in ultimate strength. To understand the strength developing process, maturity tests are conducted. 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In addition to ordinary Portland cement, the essential components of the base of concrete are aggregates and water. For practical requirements, additives and admixtures can be added to these raw materials to improve some desirable characteristics. The following requirements should be considered in producing high performance concrete (HPC): (i) low water/cement (w/c) ratio; (ii) fine aggregate; (iii) large quantity of mineral additives, silica fume, and fly ash; (iv) high dosage of superplasticizer; and (v) high-pressure steam curing. The microstructure of high performance concrete (HPC) is more homogenous than that of normal concrete (NC) due to the physical and chemical contribution of the additives (silica fume and fly ash) as well as it is less porous due to reduced w/c ratio with the addition of a superplasticizer. Inclusion of additives (individually or in combination) helped in improving the strength and durability of concrete mixes due to the additional reduction in porosity of cement paste and an improved interface between it and the aggregate.",book:{id:"5214",slug:"high-performance-concrete-technology-and-applications",title:"High Performance Concrete Technology and Applications",fullTitle:"High Performance Concrete Technology and Applications"},signatures:"Ameer A. Hilal",authors:[{id:"180518",title:"Dr.",name:"Ameer",middleName:null,surname:"Hilal",slug:"ameer-hilal",fullName:"Ameer Hilal"}]},{id:"51861",doi:"10.5772/64779",title:"Concretes with Photocatalytic Activity",slug:"concretes-with-photocatalytic-activity",totalDownloads:2832,totalCrossrefCites:8,totalDimensionsCites:15,abstract:"This chapter is a short review about the modified concretes with photocatalytic activity. In the beginning, the photocatalysis process is explained; the authors are focused on the mechanism of organic contamination and nitrogen oxide decomposition. Next the three main methods for concretes modification are presented: the first group is when the concrete is covered by thin layer of TiO2 materials, e.g., paints or TiO2 suspensions. The second group is the concretes with thick layer of photoactive concrete on the top. The third group constitutes concretes modified in mass with TiO2. The two main methods for photocatalytic activity of the modified concrete determination were shown: an air purification by a nitrogen oxide decomposition and the self-cleaning properties by dyes decomposition. Also in this chapter the mechanical properties of the modified concrete are presented. In the end, the examples of the buildings made of photocatalytic concretes are shown.",book:{id:"5214",slug:"high-performance-concrete-technology-and-applications",title:"High Performance Concrete Technology and Applications",fullTitle:"High Performance Concrete Technology and Applications"},signatures:"Magdalena Janus and Kamila Zając",authors:[{id:"180824",title:"Associate Prof.",name:"Magdalena",middleName:null,surname:"Janus",slug:"magdalena-janus",fullName:"Magdalena Janus"}]},{id:"64801",doi:"10.5772/intechopen.82489",title:"Bitumen and Its Modifier for Use in Pavement Engineering",slug:"bitumen-and-its-modifier-for-use-in-pavement-engineering",totalDownloads:1547,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter focuses on bitumen specifically. This chapter consists of several parts that can be mentioned, including the history of the appearance of bitumen and the types of constituent elements, as well as its mechanical properties and chemical structure and its thermal sensitivity. In all parts, the effects of bitumen on asphalt are discussed. In the following sections, the bitumen modification mechanism, polymer modifiers, and their behavior on the bitumen resistance to asphalt failures are also discussed. This chapter is very suitable for students and researchers interested in improving polymerization asphalt and bitumen and will help them to carry out research and concepts.",book:{id:"8412",slug:"sustainable-construction-and-building-materials",title:"Sustainable Construction and Building Materials",fullTitle:"Sustainable Construction and Building Materials"},signatures:"Mehrdad Honarmand, Javad Tanzadeh and Mohamad Beiranvand",authors:[{id:"268734",title:"M.Sc.",name:"Mehrdad",middleName:null,surname:"Honarmand",slug:"mehrdad-honarmand",fullName:"Mehrdad Honarmand"},{id:"271251",title:"Prof.",name:"Javad",middleName:null,surname:"Tanzadeh",slug:"javad-tanzadeh",fullName:"Javad Tanzadeh"}]},{id:"64787",doi:"10.5772/intechopen.82525",title:"A Decade of Research on Self-Healing Concrete",slug:"a-decade-of-research-on-self-healing-concrete",totalDownloads:1453,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"The main findings of a decade of research on the design and development of the first self-healing concrete are summarized in this chapter. The autonomous healing concept is introduced, and plethora of design campaigns is enlisted. Healing agent encapsulation and agent tubes vascular networks are reported as the most efficient healing configurations for laboratory-scale and real-size applications, respectively. Crack formation, closure after healing and further damage are phenomena tracked by using advanced experimental monitoring methods and their performance is critically revised. The effect of self-healing technology on concrete mechanical response, durability and long-term response to damage are critically discussed. 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. 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His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. 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In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
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Dr. Rahman was also adjunctly attached with Kanazawa University, Japan (Visiting Research Professor, Dec 2014 to Mar 2015; JSPS Postdoctoral Research Fellow, Apr 2012 to Mar 2014), and Tokyo Institute of Technology, Japan (TokyoTech-UNESCO Research Fellow, Oct 2004–Sep 2005). \nHe received his Ph.D. degree in Environmental Analytical Chemistry from Kanazawa University, Japan (2011). He also achieved a Diploma in Environment from the Tokyo Institute of Technology, Japan (2005). Besides, he has an M.Sc. degree in Applied Chemistry and a B.Sc. degree in Chemistry, all from the University of Chittagong, Bangladesh. \nDr. Rahman’s research interest includes the study of the fate and behavior of environmental pollutants in the biosphere; design of low energy and low burden environmental improvement (remediation) technology; implementation of sustainable waste management practices for treatment, handling, reuse, and ultimate residual disposition of solid wastes; nature and type of interactions in organic liquid mixtures for process engineering design applications.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",slug:"zinnat-ara-begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",biography:"Zinnat A. Begum received her Ph.D. in Environmental Analytical Chemistry from Kanazawa University in 2012. She achieved her Master of Science (M.Sc.) degree with a major in Applied Chemistry and a Bachelor of Science (B.Sc.) in Chemistry, all from the University of Chittagong, Bangladesh. Her work affiliations include Fukushima University, Japan (Visiting Research Fellow, Institute of Environmental Radioactivity: Mar 2016 to present), Southern University Bangladesh (Assistant Professor, Department of Civil Engineering: Jan 2015 to present), and Kanazawa University, Japan (Postdoctoral Fellow, Institute of Science and Engineering: Oct 2012 to Mar 2014; Research fellow, Venture Business Laboratory, Advanced Science and Social Co-Creation Promotion Organization: Apr 2018 to Mar 2021). 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