\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"9102",leadTitle:null,fullTitle:"Asbestos-related Diseases",title:"Asbestos-related Diseases",subtitle:null,reviewType:"peer-reviewed",abstract:"The issue of asbestos exposure and the resulting health problems is now a global problem. The World Health Organization (WHO) has made recommendations on the eradication of asbestos-related diseases. However, malignant mesothelioma, mainly due to asbestos exposure, is a refractory malignant tumor, and technological innovation in diagnosis and treatment is required. In this context, this book describes the immunological effects of asbestos exposure, blood biomarkers, the pathology of malignant mesothelioma, and the status of immune checkpoint drugs in the treatment of malignant mesothelioma, along with the status of MMP mesothelioma. Concerns about health hazards associated with asbestos exposure may persist for many years to come. We hope this book will help researchers in this area.",isbn:"978-1-83880-833-4",printIsbn:"978-1-83880-832-7",pdfIsbn:"978-1-83880-834-1",doi:"10.5772/intechopen.83098",price:100,priceEur:109,priceUsd:129,slug:"asbestos-related-diseases",numberOfPages:80,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"05268073ee2a653571449e4519749085",bookSignature:"Takemi Otsuki",publishedDate:"April 1st 2020",coverURL:"https://cdn.intechopen.com/books/images_new/9102.jpg",numberOfDownloads:3826,numberOfWosCitations:2,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:2,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:6,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 22nd 2019",dateEndSecondStepPublish:"September 24th 2019",dateEndThirdStepPublish:"November 23rd 2019",dateEndFourthStepPublish:"February 11th 2020",dateEndFifthStepPublish:"April 11th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"34101",title:"Prof.",name:"Takemi",middleName:null,surname:"Otsuki",slug:"takemi-otsuki",fullName:"Takemi Otsuki",profilePictureURL:"https://mts.intechopen.com/storage/users/34101/images/system/34101.jpg",biography:"Honor. Prof. Takemi Otsuki graduated from Kawasaki Medical School (KMS), Kurashiki, Japan, in 1981. In 1986, at the Institutes of Medical Science, University of Tokyo, he was involved in clinical and experimental research in bone marrow transplantation. The theme of the post-doctoral school (1985–1989) was myeloma cell biology. After joining the Department of Hematology, University of Minnesota, USA, in 1992, Dr. Otsuki studied genes involved in chromosomal translocations of lymphomas in the Department of Hematopathology, US National Cancer Institute, National Institutes of Health. He returned to the Department of Hygiene, KMS, in 1996 and become a professor there in 2003. After retiring from KMS and obtaining an honorary professorship, Dr. Otsuki began working at the Shinjo Village National Health Insurance Clinic. Shinjo village has a small population of fewer than 900 people, and Dr. Otsuki is the sole medical doctor there.",institutionString:"Kawasaki Medical School",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"9",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Kawasaki Medical School",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1093",title:"Thoracic Oncology",slug:"thoracic-oncology"}],chapters:[{id:"70769",title:"Suppressed Immune System Caused by Exposure to Asbestos and Malignant Mesothelioma",doi:"10.5772/intechopen.90763",slug:"suppressed-immune-system-caused-by-exposure-to-asbestos-and-malignant-mesothelioma",totalDownloads:710,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Mesothelioma is the most serious of the asbestos-related diseases. It is caused by exposure to relatively low doses of asbestos and takes a long period to develop, which suggests the enactment of gradual adverse effects other than cellular toxicity. The immune system, which can play a role in tumor prevention, is a presumable target of asbestos by accumulation in lymph nodes and then slowly affecting functions of immune cells. Here, we describe key findings obtained from our studies concerning the immune-suppressive effects of asbestos and functional alteration in immune cells of patients with mesothelioma as well as plaque-positive subjects. Asbestos exposure of cell cultures resulted in decreased natural and acquired cytotoxicity exerted by NK cells and CTLs and the ability of Th1 cells to activate and support antitumor immunity. In contrast, asbestos exposure augmented Treg cell function and generation of fibrogenic/suppressive macrophages. Mesothelioma patients also showed similar characteristics in certain alterations caused by asbestos exposure. Additionally, our recent study established immunological screening devices for mesothelioma and asbestos exposure on the basis of comprehensive analysis of peripheral blood. Those findings underscore the importance of the immunological effects of asbestos and should assist further understanding of the mechanism and early detection of mesothelioma.",signatures:"Yasumitsu Nishimura, Naoko Kumagai-Takei, Suni Lee, Kei Yoshitome and Takemi Otsuki",downloadPdfUrl:"/chapter/pdf-download/70769",previewPdfUrl:"/chapter/pdf-preview/70769",authors:[{id:"34101",title:"Prof.",name:"Takemi",surname:"Otsuki",slug:"takemi-otsuki",fullName:"Takemi Otsuki"},{id:"48627",title:"Dr.",name:"Naoko",surname:"Kumagai-Takei",slug:"naoko-kumagai-takei",fullName:"Naoko Kumagai-Takei"},{id:"48631",title:"Dr.",name:"Yasumitsu",surname:"Nishimura",slug:"yasumitsu-nishimura",fullName:"Yasumitsu Nishimura"},{id:"104893",title:"Dr.",name:"Suni",surname:"Lee",slug:"suni-lee",fullName:"Suni Lee"},{id:"219725",title:"Dr.",name:"Kei",surname:"Yoshitome",slug:"kei-yoshitome",fullName:"Kei Yoshitome"}],corrections:null},{id:"69365",title:"Asbestos-Related Diseases and Blood Biomarkers",doi:"10.5772/intechopen.89438",slug:"asbestos-related-diseases-and-blood-biomarkers",totalDownloads:835,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Asbestos-related diseases, including asbestosis, benign pleural diseases, lung cancer, other types of cancer, and especially malignant mesothelioma (MM), still represent an enormous problem all over the world and are among the most investigated occupational diseases. Considering that MM is a highly aggressive and severe malignant cancer of pleura, peritoneum and other serosal surfaces, new blood biomarkers for earlier diagnosis, following response to treatment and disease progression, have been intensively investigated. Several studies suggested that soluble mesothelin-related peptides, fibulin-3, survivin, osteopontin, vimentin, calretinin, and many others could be helpful in diagnosis, detecting the progression of MM and evaluating tumour response to treatment; however, these biomarkers have not been validated in clinical practice. Therefore, search for novel better stand-alone or composite biomarkers is under way. The aim of this chapter is to present the importance of blood biomarkers in evaluating the risk of developing asbestos-related diseases, early diagnosis, following the response to treatment and progression of these diseases, with special emphasis on MM.",signatures:"Alenka Franko, Vita Dolzan, Katja Goricar and Metoda Dodic Fikfak",downloadPdfUrl:"/chapter/pdf-download/69365",previewPdfUrl:"/chapter/pdf-preview/69365",authors:[{id:"60449",title:"Prof.",name:"Vita",surname:"Dolžan",slug:"vita-dolzan",fullName:"Vita Dolžan"},{id:"172777",title:"Dr.",name:"Katja",surname:"Goričar",slug:"katja-goricar",fullName:"Katja Goričar"},{id:"195632",title:"Prof.",name:"Alenka",surname:"Franko",slug:"alenka-franko",fullName:"Alenka Franko"},{id:"309329",title:"Prof.",name:"Metoda",surname:"Dodic Fikfak",slug:"metoda-dodic-fikfak",fullName:"Metoda Dodic Fikfak"}],corrections:null},{id:"69060",title:"Asbestos Exposure Results in Asbestosis and Usual Interstitial Pneumonia Similar to Other Causes of Pneumoconiosis",doi:"10.5772/intechopen.89247",slug:"asbestos-exposure-results-in-asbestosis-and-usual-interstitial-pneumonia-similar-to-other-causes-of-",totalDownloads:947,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The progression of asbestosis is supposed to begin with the first order of respiratory bronchiole and extend outward. Recently, grade 4 asbestosis was reported to begin with the subpleural peripheral lobular area or the subpleural lobule. Grade 4 asbestosis is defined as diffuse pulmonary fibrosis caused by the inhalation of excessive numbers of asbestos fibers. Pathologically, the presence of more than two asbestos bodies/cm2 on a glass slide is required. There are many cases of diffuse interstitial pneumonia, mainly usual interstitial pneumonia, that does not fulfill the above criteria among asbestos workers or high-grade environmentally exposed persons. I call these cases “usual interstitial pneumonia seen in asbestos workers” and not idiopathic pulmonary fibrosis. In this chapter, I discuss the above subjects, including the dose-response relationship for asbestos exposure, the heterogeneous response to asbestos exposure, and the relationship between asbestosis and idiopathic pulmonary fibrosis.",signatures:"Yoshinori Kawabata",downloadPdfUrl:"/chapter/pdf-download/69060",previewPdfUrl:"/chapter/pdf-preview/69060",authors:[{id:"307325",title:"Dr.",name:"Yoshinori",surname:"Kawabata",slug:"yoshinori-kawabata",fullName:"Yoshinori Kawabata"}],corrections:null},{id:"68917",title:"Immunocheckpoint Blockade in Malignant Pleural Mesothelioma",doi:"10.5772/intechopen.89116",slug:"immunocheckpoint-blockade-in-malignant-pleural-mesothelioma",totalDownloads:715,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Targeting immunocheckpoint with immunomodulatory monoclonal antibodies has proven to be an effective antitumor strategy across a variety of cancers. The immunosuppressive tumor microenvironment in malignant pleural mesothelioma (MPM) has suggested that MPM might benefit from this kind of immunotherapy. In recent years, immunocheckpoint inhibitors (ICIs) have shown encouraging results for patients with MPM. Antibodies against programmed death 1 (PD-1) and PD-ligand 1 (PD-L1) have demonstrated favorable response, progression-free survival, and overall survival. The toxicity profiles were similar to those observed with ICIs in other malignancies, like melanoma and non-small cell lung cancer, and they appeared to be manageable. Nivolumab, an anti-PD-1 antibody, was approved in Japan for advanced or metastatic MPM patients resistant or intolerant to other chemotherapies. Important future issues include developing a combination therapy, where ICIs are combined with other agents (including other ICIs), and developing biomarkers for determining which patients might respond well and which might experience unacceptable toxicities.",signatures:"Nobukazu Fujimoto",downloadPdfUrl:"/chapter/pdf-download/68917",previewPdfUrl:"/chapter/pdf-preview/68917",authors:[{id:"307730",title:"Dr.",name:"Nobukazu",surname:"Fujimoto",slug:"nobukazu-fujimoto",fullName:"Nobukazu Fujimoto"}],corrections:null},{id:"68636",title:"Potential Roles of Matrix Metalloproteinases in Malignant Mesothelioma",doi:"10.5772/intechopen.88783",slug:"potential-roles-of-matrix-metalloproteinases-in-malignant-mesothelioma",totalDownloads:620,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Malignant mesothelioma (MM) is a rare, aggressive, and highly lethal cancer that is primary induced by exposure to asbestos fibers. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases that are involved in metastasis, and their overexpression correlates with tumor cell invasion and metastasis because they degrade the extracellular matrix (ECM) and process adhesion and cytoskeletal proteins, growth factors, chemokines, and cytokines. Recent evidence has shown that MMPs participate in MM progression, indicating that they are potential novel biomarkers and attractive targets for cancer therapy. In this chapter, we will describe MMPs in carcinogenic mechanisms based on in vivo and in vitro experimental evidence, outline the clinical findings, and speculate the possible roles of MMPs in MM.",signatures:"Shibo Ying, Yanbin Wang and Lyuyang Lyu",downloadPdfUrl:"/chapter/pdf-download/68636",previewPdfUrl:"/chapter/pdf-preview/68636",authors:[{id:"306153",title:"Ph.D.",name:"Shibo",surname:"Ying",slug:"shibo-ying",fullName:"Shibo Ying"},{id:"306352",title:"Ms.",name:"Yanbin",surname:"Wang",slug:"yanbin-wang",fullName:"Yanbin Wang"},{id:"309729",title:"Mr.",name:"Lyuyang",surname:"Lyu",slug:"lyuyang-lyu",fullName:"Lyuyang Lyu"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"10349",title:"Environmental Health",subtitle:null,isOpenForSubmission:!1,hash:"daa4fa476e1d64c56fabfdbf670e7a9b",slug:"environmental-health",bookSignature:"Takemi 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Colnot",reviewType:"peer-reviewed",authors:[{id:"105741",title:"Dr.",name:"David",middleName:null,surname:"Colnot",fullName:"David Colnot",slug:"david-colnot"},{id:"112402",title:"Dr.",name:"Judith",middleName:null,surname:"Lens",fullName:"Judith Lens",slug:"judith-lens"},{id:"112403",title:"Dr.",name:"Jeroen",middleName:null,surname:"Hermanides",fullName:"Jeroen Hermanides",slug:"jeroen-hermanides"},{id:"112404",title:"Dr.",name:"Peter",middleName:null,surname:"Houweling",fullName:"Peter Houweling",slug:"peter-houweling"},{id:"112405",title:"PhD.",name:"Jasper",middleName:null,surname:"Quak",fullName:"Jasper Quak",slug:"jasper-quak"}]},{id:"30095",type:"chapter",title:"Spiral Waves, Obstacles and Cardiac Arrhythmias",slug:"spiral-waves-obstacles-and-cardiac-arrhythmias-",totalDownloads:1717,totalCrossrefCites:0,signatures:"Daniel Olmos-Liceaga",reviewType:"peer-reviewed",authors:[{id:"88371",title:"Dr.",name:"Daniel",middleName:null,surname:"Olmos",fullName:"Daniel Olmos",slug:"daniel-olmos"}]},{id:"30096",type:"chapter",title:"Electrical Storm",slug:"electrical-storm",totalDownloads:2863,totalCrossrefCites:0,signatures:"Federico Guerra, Matilda Shkoza, Marco Flori and Alessandro Capucci",reviewType:"peer-reviewed",authors:[{id:"15780",title:"Prof.",name:"Alessandro",middleName:null,surname:"Capucci",fullName:"Alessandro Capucci",slug:"alessandro-capucci"},{id:"93467",title:"Dr.",name:"Federico",middleName:null,surname:"Guerra",fullName:"Federico Guerra",slug:"federico-guerra"},{id:"93468",title:"Dr.",name:"Matilda",middleName:null,surname:"Shkoza",fullName:"Matilda Shkoza",slug:"matilda-shkoza"},{id:"93470",title:"Dr",name:"Marco",middleName:null,surname:"Flori",fullName:"Marco Flori",slug:"marco-flori"}]},{id:"30097",type:"chapter",title:"Bradycardia Secondary to Cervical Spinal Cord Injury",slug:"bradycardia-secondary-to-cervical-spinal-cord-injury",totalDownloads:19329,totalCrossrefCites:2,signatures:"Farid Sadaka and Christopher Veremakis",reviewType:"peer-reviewed",authors:[{id:"101031",title:"Dr.",name:"Farid",middleName:null,surname:"Sadaka",fullName:"Farid Sadaka",slug:"farid-sadaka"},{id:"102527",title:"Dr.",name:"Christopher",middleName:null,surname:"Veremakis",fullName:"Christopher Veremakis",slug:"christopher-veremakis"}]},{id:"30098",type:"chapter",title:"Electromagnetic Mapping During Complex RF Ablations",slug:"electroanatomic-mapping-the-approch-to-complex-arrhythmias",totalDownloads:1843,totalCrossrefCites:0,signatures:"Shimon Rosenheck, Jeffrey Banker, Alexey Weiss and Zehava Sharon",reviewType:"peer-reviewed",authors:[{id:"82390",title:"Dr.",name:"Shimon",middleName:null,surname:"Rosenheck",fullName:"Shimon Rosenheck",slug:"shimon-rosenheck"},{id:"125603",title:"Dr.",name:"Alexey",middleName:null,surname:"Weiss",fullName:"Alexey Weiss",slug:"alexey-weiss"},{id:"125604",title:"Dr.",name:"Jeffrey",middleName:null,surname:"Banker",fullName:"Jeffrey Banker",slug:"jeffrey-banker"},{id:"125605",title:"Mrs.",name:"Zehava",middleName:null,surname:"Sharon",fullName:"Zehava Sharon",slug:"zehava-sharon"}]},{id:"30099",type:"chapter",title:"Novel Technologies for Mapping and Ablation of Complex Arrhythmias",slug:"novel-techniques-for-mapping-and-ablation-of-complex-cardiac-arrhhthmias",totalDownloads:2449,totalCrossrefCites:0,signatures:"Louisa Malcolme-Lawes, Shahnaz Jamil-Copley and Prapa Kanagaratnam",reviewType:"peer-reviewed",authors:[{id:"87952",title:"Dr.",name:"Shahnaz",middleName:null,surname:"Jamil-Copley",fullName:"Shahnaz Jamil-Copley",slug:"shahnaz-jamil-copley"},{id:"92901",title:"Dr.",name:"Louisa",middleName:null,surname:"Malcolme-Lawes",fullName:"Louisa Malcolme-Lawes",slug:"louisa-malcolme-lawes"}]},{id:"30100",type:"chapter",title:"The Future of Cardiac Mapping",slug:"the-future-of-cardiac-mapping",totalDownloads:7359,totalCrossrefCites:4,signatures:"Pascal Fallavollita",reviewType:"peer-reviewed",authors:[{id:"85455",title:"Prof.",name:"Pascal",middleName:null,surname:"Fallavollita",fullName:"Pascal Fallavollita",slug:"pascal-fallavollita"}]},{id:"30101",type:"chapter",title:"Mild Induced Therapeutic Hypothermia for Survivors of Cardiac Arrest",slug:"chapter-proposal-for-intech-book-project-entitled-cardiac-arrhythmias-chapter-title-therapeutic-hypo",totalDownloads:2255,totalCrossrefCites:0,signatures:"Kevin Baker, John Prior, Karthik Sheka and Raymond A. Smego, Jr.",reviewType:"peer-reviewed",authors:[{id:"94976",title:"Dr",name:null,middleName:null,surname:"Smego Jr.",fullName:"Smego Jr.",slug:"smego-jr."}]},{id:"30102",type:"chapter",title:"Arrhythmias in Pregnancy",slug:"arrhythmias-in-pregnancy",totalDownloads:7195,totalCrossrefCites:0,signatures:"Marius Craina, Gheorghe Furău, Răzvan Niţu, Lavinia Stelea, Dan Ancuşa, Corina Şerban, Rodica Mihăescu and Ioana Mozoş",reviewType:"peer-reviewed",authors:[{id:"71624",title:"Dr.",name:"Marius",middleName:null,surname:"Craina",fullName:"Marius Craina",slug:"marius-craina"}]},{id:"30103",type:"chapter",title:"Development of Computer Aided Prediction Technology for Paroxysmal Atrial Fibrillation in Mobile Healthcare",slug:"development-of-computer-aided-prediction-technology-for-paroxysmal-atrial-fibrillation-in-mobile-hea",totalDownloads:1852,totalCrossrefCites:0,signatures:"Desok Kim, Jae-Hyeong Park and Jun Hyung Kim",reviewType:"peer-reviewed",authors:[{id:"64487",title:"Dr.",name:"Desok",middleName:null,surname:"Kim",fullName:"Desok Kim",slug:"desok-kim"},{id:"132297",title:"Dr.",name:"Jae-Hyeong",middleName:null,surname:"Park",fullName:"Jae-Hyeong Park",slug:"jae-hyeong-park"},{id:"132299",title:"Dr.",name:"Jun Hyung",middleName:null,surname:"Kim",fullName:"Jun Hyung Kim",slug:"jun-hyung-kim"}]}]},relatedBooks:[{type:"book",id:"4584",title:"Abnormal Heart Rhythms",subtitle:null,isOpenForSubmission:!1,hash:"81532d7ef92dec2fed90a8c7ea7a051c",slug:"abnormal-heart-rhythms",bookSignature:"Francisco R. 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Breijo-Marquez",coverURL:"https://cdn.intechopen.com/books/images_new/947.jpg",editedByType:"Edited by",editors:[{id:"63299",title:"Prof.",name:"Francisco R.",surname:"Breijo-Marquez",slug:"francisco-r.-breijo-marquez",fullName:"Francisco R. Breijo-Marquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"78969",title:"The Problem of the Colorectal Anastomosis",doi:"10.5772/intechopen.100302",slug:"the-problem-of-the-colorectal-anastomosis",body:'An anastomosis is a surgical connection between two structures. It usually means a connection that is created between tubular structures, such as blood vessels or loops of the intestine. Surgeons can choose to join together the two parts of the intestine by using either sewing (sutures) or staples. Sewing by hand has been used successfully for over 100 years. However, stapling takes less time to perform. As with any intervention, anastomosis carries some risks. These include blood clots, bleeding, scarring, blockage, stricture, or abnormal narrowing, damage to the surrounding structures, and infections, all of which can lead to anastomotic leakage, sepsis, septic shock, or even death (Figures 1 and 2).
Intraoperative aspect of an anastomosis performed manually at the level of the small bowel.
Intraoperative aspect of an anastomosis performed mechanically at the level of the small bowel.
Barbed sutures are available in a variety of both absorbable and nonabsorbable monofilament materials. Specifically, currently available bidirectional and unidirectional barbed suture materials include PDO, polyglyconate, poliglecaprone 25, glycomer 631, nylon, and polypropylene. A study performed by Wiggins [1] searched through a systematic review and meta-analysis for the benefits of barbed suture utilization in gastrointestinal anastomosis. The conclusion was that the use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding, or stricture) compared with standard suture materials.
The study included consecutive CD patients with ileal/ileocolonic strictures who had SWE shear wave elastography within one week of surgical resection.
The SWE of the stenotic bowel wall was compared to the biofragmentable anastomosis ring used for gastrointestinal anastomoses in a literature review conducted by Bobkiewicz and coauthors [2].
The theoretical idea was that a biofragmentable anastomosis ring (BAR) could be used instead of manual and stapled anastomoses in the upper and lower GI tracts.
The aim of this study was to see how effective BAR was for bowel anastomoses using our own content. Methodologies: Between 2004 and 2014, a retrospective study was conducted on a total of 203 patients who underwent bowel surgery with BAR anastomosis in the upper and lower gastrointestinal tract. The study concluded that using BAR for GI tract anastomoses is an easy and quick procedure with a low rate of perioperative mortality (0.5%) and complication rates (Figures 3 and 4).
Foreign body reaction at the level of the tissues containing suture material.
Colorful surgical nylon monofilament suture with a curved needle.
The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction, which potentially contributes to early anastomotic dehiscence or late anastomotic stricture (Figures 5 and 6).
Linear surgical stapler.
(a and b) circular stapling device and its mode of appliance.
While 2-row stapling has become normal in low anterior resections (LARs), it has no effect on morbidity or the incidence of AL.
Conducted by Nekliudov [3] is the first prospective, randomized clinical trial that compares the success rate of modern 3-row circular staplers to that of traditional 2-row staplers.
According to the hypothesis, the frequency of AL in the 3-row stapler group is not significantly higher than in the 2-row stapler group.
The rate of AL, as determined by imaging studies and measured using the Pearson chi-squared test and Fisher exact test, is the primary endpoint.
Secondary outcomes include AL severity (A, B, or C), anastomotic bleeding, postoperative complication rate (graded using the Clavien-Dindo classification), reintervention rate, stapler dysfunction rate, complications of nonfunctioning stoma, overall and cancer-specific quality of life (measured using short-form (36) questionnaire and quality-of-life (30) questionnaire core, respectively), fecal incontinence, and overall and cancer-specific quality of life.
Following the LAR, both patients will be tracked for a period of 12 months.
This is the first prospective randomized trial to look at the efficacy of 3-row staplers for colorectal anastomosis following rectal cancer surgery.
It could show that 3-row circular staplers are feasible in LAR in terms of short- and long-term patient outcomes (Figures 7 and 8).
2-row staple lines.
3-row staple lines.
A study performed by Jeong and coauthors [4] was assembled to report an institution’s experiences with transanal total mesorectal excision (TME) of rectal cancer using single-port equipment and to discuss the feasibility and safety of the technique. In the institution mentioned, 10 patients (6:4) treated with transanal TME with colorectal anastomosis were examined (Figure 9).
Complete TME specimen (a) and sectioned (b) after abdomino-perineal resection with intact mesorectum.
In six of 10 patients, TME was done without the use of a laparoscope.
The average time spent on the operating table was 303.5 minutes.
The distal margin was 2.1 (0.2–4.2) cm on average.
The average number of lymph nodes harvested is 17.5.
Except for one patient who had an anastomotic leak, the majority of patients began dietary intake on POD 3 and were discharged on POD 7.
The only postoperative complication was an anastomotic leak.
Conclusions: In selected cases of rectal cancer, pure natural orifice transluminal endoscopic surgery (NOTES) TME with coloanal anastomosis was found to be healthy and feasible.
Anastomotic leak (AL) is a common problem in colorectal surgery, and its prevalence has remained steady in recent years.
The use of an intra-abdominal drain or mechanical bowel preparation to prevent AL has been shown to be ineffective and should be avoided.
The function of oral antibiotic preparation regimens should be explained and compared to other routes of administration, such as intravenous or enema, according to a study conducted by Meyer and coauthors [5].
Parallel to this, preoperative antibiotherapy should target pathogens that induce collagenase, as defined by the microbiome study.
Fluorescence angiography may minimize AL even further, resulting in major intraoperative improvements in surgical strategies.
Fluorescence angiography can be used more often.
There have been studies, such as the one by Gained and coauthors [6], that looked at the literature’s connection between colorectal cancer recurrence, microbiome, and anastomotic leakage, and among the findings, one can find the aspect according to which the numerous mechanisms by which environmental factors act on the microbiome to alter its composition and function, with the net effect of adversely affecting oncological outcomes following surgery, are well documented and increasing.
Diet, antibiotic use, the procedures used to prepare the colon for surgery, and the physiological discomfort of the procedure are all examples of environmental causes.
Furthermore, using next-generation sequencing technologies to investigate the intestinal microbiome has the ability to affect cancer outcomes following colon resection. In a systematic review that targeted the endoscopic management of early postoperative complications, a literature search was performed by Clifford and coauthors [7] for published full text articles using the PubMed, Cochrane, and Scopus databases using the search criteria string “colorectal anastomotic (“leak” or “bleed”),” “endoscopy,” and “endoscopic management.” Endoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and is associated with the high rates of technical performance in selected patients, according to a review of 89 papers.
The most suitable method, patient selection, and considering the practical and long-term consequences of this approach remain challenging.
To fully assess the function of these novel strategies, further data from large prospective cohort studies are needed.
Shalaby and coauthors [8] conducted another systematic review on endoluminal vacuum-assisted therapy as a salvage treatment for rectal anastomotic leakage and found the following findings among 476 articles identified, 17 studies reporting on 276 patients:
The weighted mean success rate was 853% (95% confidence interval [CI]: 801–905), with a median time from the start of EVT to full healing of 47 (range 40–105) days.
The weighted mean rate of stoma reversal was 759% (646–872%) across the studies.
After EVT, twenty-five patients (91%) needed additional interventions.
Thirty-eight patients (138%) experienced complications as a result of the procedure.
The weighted mean complication rate was 111% (60–162%) across all tests.
Preoperative radiotherapy, the absence of a diverting stoma, complications, and male sex were all found to be significantly associated with failure.
According to the findings of the study, EVT is linked to a high rate of full healing of anastomotic leakage and stoma reversal.
In appropriately selected patients with anastomotic leakage, it is a viable choice.
Colorectal cancer surgery is thought to involve “high tie” and “low tie” of the inferior mesenteric artery (IMA).
However, the blood supply of the anastomosis is closely linked to the ligation stage, which can increase the leakage rate, and it is unclear which technique confers a lower anastomotic leakage rate (AL) and survival advantage.
The aim of the literature review, as stated by Yang and coauthors [9], was to compare the efficacy and impact of IMA high ligation versus IMA low ligation on anastomotic leakage, lymph node yield rates, and 5-year survival.
Finally, after reviewing studies from 1990 to 2017, researchers came to the conclusion that neither the high-tie nor the low-tie approach has any data in terms of anastomotic leakage, harvested lymph nodes, or 5-year survival rates.
More RCT is needed.
A study conducted by Simianu and coauthors [10] looked at the recency effect, which means that people place disproportionate emphasis on events that occurred recently when making decisions, but the magnitude of this influence on surgeons’ decisions is uncertain.
The use of preventative leak testing before and after colorectal operations with anastomotic leaks is examined in this study to see whether there is a recency effect in surgeons.
A prospective cohort of adult patients (aged 18 years) undergoing elective colorectal surgery at Washington State hospitals participating in the Surgical Care and Outcomes Assessment Program was used to develop the materials and methods (2006–2013).
The key outcome measure was the difference in leak monitoring between 6 months before and 6 months after an anastomotic leak.
A leak rate of 2.6% (n = 124) was found in 4854 elective colorectal operations performed by 282 surgeons at 44 hospitals.
The anastomosis was not checked in 40 leaks (32%), which were spread through 25 surgeons.
While the small sample size restricted the ability to detect an overall difference in leak testing use, 9 (36%) of the 25 surgeons increased their leak testing by 5% or more after leaks in cases where the anastomosis was not checked.
The above facts led to the conclusion that only one-third of qualified surgeons demonstrated the recency effect.
Understanding the degree to which the recency effect influences clinical decisions may be useful in developing quality management strategies that involve clinician’s behavior change.
Wang and colleagues [11] contrasted many aspects of robot-assisted versus laparoscopic surgery for rectal cancer by reviewing 20 studies with a total of 5496 patients, divided into a robot-assisted surgery group (
Longer operating period (OR: 0.48, 95% CI: 0.14, 0.82), lower conversion to open surgery rate (OR: 0.55, 95% CI: 0.44, 0.69), shorter LOS (Length Of Stay) (OR: −0.15, 95% CI: −0.30, 0.00), faster bowel function recovery (OR: −0.38, 95% CI: −0.74, −0.02), and lower postoperative complications were all correlated with the robot-assisted surgery community (OR: 0.79, 95% CI: 0.65, 0.97).
There were no substantial differences between groups in EBL, anastomosis leak rate, or oncological outcomes such as the number of lymph nodes removed, the DRM, or the PCRM (Figures 10 and 11).
Dehiscence at the level of the anastomosis.
Methylene blue test.
Postoperative ileus generates a high impact on morbidity, hospital stay, and costs. Vergara Fernandez and coauthors [12] conducted a randomized controlled trial of 64 patients who had elective colorectal surgery with primary anastomosis in a tertiary referral center. Patients were divided into two groups: (i) those who chewed their gums (
Illustration of a simple abdominal X-ray exam in a patient with bowel obstruction.
It can sometimes be treated endoscopically, when surgery is contraindicated, by performing, as was found in a case report by Deng and team [13] with minimally invasive endoscopic approach was adopted to repair the obstruction. A needle knife was used to puncture the linear white scar, and contrast agent was injected under endoscopy and fluoroscopic guidance. Fluoroscopically, the proximal bowel was identified and a dual knife-mediated membrane puncture was performed. A guidewire was then passed through the incision into the proximal bowel and progressive pneumatic dilatation was performed successively with a controlled radial expansion balloon dilator until a 1.8-cm-diameter dilation was achieved. After conventional balloon dilatation, the endoscope easily passed through the anastomosis without any patient discomfort. There were no postoperative signs of immediate or delayed complications (Figure 13).
Colonoscopic aspect of a anastomotic stenosis.
Following TME, postoperative defecation dysfunctions known as “anterior resection syndrome” might appear.
Straight colorectal anastomosis (SCA), colon J-pouch (CJP), and side-to-end anastomosis are all common reconstruction techniques (SEA) (Figures 14 and 15).
Types of anastomoses illustrated.
Aspect of the J-pouch.
There are no prospective, randomized, multi-center trials that compare their functional results, including long-term evaluations.
As a result, the primary endpoint of a study designed by Marti and collab [14] that included 336 patients from 15 hospitals who were randomized had a comparison of composite evacuation scores 12 months after TME as a primary endpoint.
Secondary endpoints included a comparison of composite evacuation and incontinence ratings at 6, 18, and 24 months after surgery, as well as morbidity and overall survival.
The study looked at the “per protocol” (PP) population, which complied with all-trial criteria, as well as the “intention-to-treat” (ITT) population.
At any time point, there were no statistically significant variations in the composite evacuation ratings of the PP and ITT populations.
Similarly, at any time point, there was no statistically significant difference in composite incontinence scores for the PP and ITT populations among the three trial weapons.
Conclusions: Within the scope of the investigation, surgeons in charge can continue to conduct intestinal continuity reconstruction following TME at their discretion.
In addition to the studies previously reported, Hou and collab [15] investigated whether the use of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is problematic and conducted a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which has been shown to improve postoperative bowel function.
The meta-analysis included a total of 864 patients from 10 RCTs.
At 12 months after SPR, patients who underwent SEA had a higher defecation frequency and a lower incidence of incomplete defecation than those who underwent CJP anastomosis with low heterogeneity and a lower incidence of incomplete defecation at 3 months after surgery.
The SEA group also had a shorter operating period with no substantial heterogeneity.
The SEA group had a higher anorectal resting strain, but there was a lot of heterogeneity.
There were no significant differences between the groups in terms of efficacy outcomes such as defecation frequency, urgency, incomplete defecation, use of pads, enema, medications, anorectal squeeze pressure, and maximum rectal volume, or safety outcomes such as operating time, blood loss, use of protective stoma, postoperative complications, clinical outcomes, and complication rates.
In comparison with CJP anastomosis, the current evidence indicates that SEA is a successful anastomotic technique for achieving comparable postoperative bowel function without raising the risk of complications.
Shorter operating times, a lower occurrence of incomplete defecation three months after surgery, and improved sphincter function are all advantages of SEA.
However, after SPR, long-term defecation frequency should be closely monitored.
Assessing intraoperative perfusion with indocyanine green (ICG) and near-infrared (NIR) visualization can aid in selecting the degree of intestinal transection and subsequent anastomotic vascular sufficiency, according to the theory.
In a prospective study of nonselected patients undergoing any elective colorectal surgery with anastomosis in three tertiary hospitals over a 3-year span, NIR-ICG was used to look at anastomosis perfusion.
In addition to standard operator visual evaluation alone, a standard procedure was followed to evaluate NIR-ICG perfusion before and after anastomosis construction.
The researchers looked at 540 patients (median age 64 years, 279 men) who had surgery for neoplastic (330) and benign (174) pathology.
A total of 425 operations (853%) were initiated laparoscopically, with a 59% conversion rate.
In total, 220 patients (437%) had high anterior resection or reversal of Hartmann’s procedure, and 90 patients (179%) had low anterior resection.
ICG angiography was effective in every patient, with leak rates of 24% (12 of 504) overall, 26% for colorectal anastomoses, and 3% for low anterior resection.
The anastomotic leak rates were lower when NIR-ICG imaging was used than in the participating centers from over 1000 related operations conducted with the same technique but without NIR-ICG technology. As a result, the study’s findings were as follows:
Patients undergoing elective colorectal surgery should have their NIR-ICG levels checked on a regular basis.
The use of NIR-ICG can alter intraoperative decisions, potentially lowering anastomotic leak rates.
Kryzauskas conducted a systematic review and meta-analysis of publications, which included a total of 23 studies, with a total of 7115 patients, that were conducted to see whether intraoperative testing of the mechanical integrity and perfusion of the colorectal anastomosis could minimize the risk of AL. Intraoperative checks for the integrity (OR: 0.52, 95% CI: 0.34–0.82, P.001) and perfusion (OR: 0.40, 95% CI: 0.22–0.752, P.001) of the lower gastrointestinal tract anastomoses are linked to a substantially lower AL rate, according to a pooled study. The researchers came to the conclusion that intraoperative monitoring for anastomosis integrity or perfusion both reduced the AL dose. Studies combining these two anastomosis testing methods, especially intraoperative endoscopy and indocyanine green fluorescence angiography, could be very promising for further AL reduction. Since diabetes is a well-established independent factor that results in higher anastomotic leakage rates, the effects of biological sealants on colorectal anastomosis and their potential impact in patients with severe diabetes were studied in depth.
Fibrin sealants have been used to avoid anastomotic dehiscence in both laboratory and clinical trials.
We looked for existing evidence in the field by searching Medline (1966–2016) and Scopus (2004–2016). There is no evidence to support the use of fibrin sealants as a supplement in diabetic patients undergoing colorectal surgery at this time.
Experimental animal models with severe diabetes may be very useful in this area, and more research is required before fibrin sealants are used in a clinical environment.
In a systematic study and meta-analysis, Wu and team [16] analyzed the air leak test conducted intraoperatively.
The intraoperative air leak test (ALT) is a standard intraoperative test used to detect anastomosis that is mechanically inadequate.
The aim of this meta-analysis is to see whether ALT can help reduce postoperative colorectal anastomotic leakage (CAL).
The report included 22 experiments, with the following being the most notable.
According to the data, conducting an ALT using the recorded technique does not substantially reduce the clinical CAL rate, but it is still important due to the increased risk of CAL in ALT(+) cases.
Additional repairs, unfortunately, may not be successful in reducing this risk using current methods.
The findings of this study call for the standardization of ALT methodology and the creation of successful methods for repairing ALT(+) anastomoses.
A meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery was conducted by Guerra and coauthors [17], and after looking at 760 patients from four RCTs that were eligible (RCT comparing drained with undrained anastomoses following rectal surgery), the use of drains showed little benefit in terms of anastomotic leak, pelvic complications, or reintervention.
On the other hand, the drained party had a slightly higher rate of postoperative bowel obstruction.
The researchers concluded that using pelvic drains routinely does not provide a major benefit in preventing postoperative complications following rectal surgery with extraperitoneal anastomosis.
Furthermore, a higher risk of bowel obstruction following surgery should be considered.
Non-surgery-based intraoperative risk factors for anastomotic healing also influence surgical outcome.
After analyzing 117 papers, a review by van Rooijen and team [18] provided an overview of potential modifiable risk factors that could play a role during the operation, and the results (the main outcome measure was the risk of anastomotic leakage and other postoperative complications during colorectal surgery) revealed that diabetes mellitus, hyperglycemia and a high HbA1c, anemia, and data on blood pressure, inotropes/vasopressors, oxygen supplementation, form of analgesia, and goal-directed fluid therapy are all unequivocal.
There was no research that looked into the effect of body core temperature or mean arterial pressure on CAL.
Subjective considerations including the surgeon’s own evaluation of local perfusion and the visibility of the operating field have not been studied for incidence in CAL patients.
The findings revealed that in order to enhance colorectal treatment, both surgery-related and non-surgery-related risk factors that can be changed must be established.
In their ongoing attempt to minimize the number of CAL, surgeons and anesthesiologists can collaborate on these issues.
In the Netherlands, a multicenter cohort study is currently being conducted to determine individual intraoperative risk factors for CAL.
In perforated diverticulitis, for example, there has been no consensus in the management, which is why the Shaban and coauthors [19] felt compelled to perform a systematic review and meta-analysis, particularly because many surgeons choose the Hartmann’s procedure to avoid the risk of an anastomotic leak.
As a result, we proposed that in certain patients, resection with primary anastomosis is a healthy option.
The study found 1933 abstracts, of which 14 trials (2 RCTs, 4 prospective non-randomized, and 8 retrospective non-randomized) with 765 patients met the inclusion criteria, with 482 in the Hartmann’s group and 283 in the primary anastomosis group.
Primary anastomosis had a slightly lower mortality rate (10.6%) than Hartmann’s (20.7%) (
The rate of morbidity was also lower (41.8 vs. 51.2%) (
Primary anastomosis had a risk ratio of 0.92 in favor of mortality (
The average rate of anastomotic leak was 5.9%.
Resection and primary anastomosis should be considered as a feasible and secure operative technique in selected patients with perforated diverticulitis, according to the findings of the study.
However, there is a scarcity of high-level data, and further research is needed.
Resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL), and damage control surgery were among the aspects reviewed in another and more complicated approach to damage control strategy in perforated diverticulitis with generalized peritonitis performed by Sohn and team [20] (DCS).
DCS is divided into two levels.
Limited resection of the diseased colon, oral and aboral closure, lavage, and vacuum-assisted abdominal closure are all options for emergency surgery.
After proper resuscitation, a second look operation is performed: definitive reconstruction with colorectal anastomosis (±DI) or HP.
The inclusion criteria were fulfilled by eight observational studies involving 256 patients.
There was no randomized study available.
Purulent peritonitis affected 67% of the patients, while feculent peritonitis affected 30%. Hinchey stage II diverticulitis was observed in 3% of the patients. The Mannheim peritonitis index (MPI) was greater than 26 in 49% of the cases. In 73% of cases, a colorectal anastomosis was developed during the second surgery. DI was used in 15% of the above group. HP was given to the remaining 27%. The postoperative mortality rate was 9%, and the morbidity rate was 31%. The rate of anastomotic leak was 13%. Without a stoma, 55% of patients were discharged.
Conclusions: DCS is a safe treatment for acute perforated diverticulitis with generalized peritonitis, with a high incidence of colorectal anastomosis and stoma-free hospital discharge in more than half of patients.
Pickhardt [21] compared the accuracy of CT colonography versus optical colonoscopy for neoplastic involvement at the surgical anastomosis 1 year after curative-intent colorectal cancer resection for neoplastic involvement at the surgical anastomosis.
As part of a prospective, multicenter study, 201 patients (mean age 58.6 years; 117 men, 84 women) underwent same-day contrast-enhanced CT colonography and colonoscopy approximately 1 year (mean, 12.1 months; median, 11.9 months) after colorectal cancer resection.
Many of the patients enrolled had no clinical signs of illness and were found to have a low risk of recurrence (stage I–III).
Relevant intraluminal anastomotic pathology tends to be very rare 1 year after colorectal cancer resection in lower-risk cohorts, according to the findings.
Diagnostic contrast-enhanced CT colonography, unlike colonoscopy, successfully measures both the intraluminal and extraluminal dimensions of the anastomosis.
Yang and collab [22] investigated the use of stents as a bridge to surgery in the treatment of acute left-sided obstructive colorectal cancer.
In a meta-analysis of randomized controlled trials, the factor according to which the trials were conducted was taken into account.
The use of self-expanding metallic stents (SEMS) as a bridge to surgery in the treatment of acute left-sided obstructive colorectal cancer has remained contentious.
The following were the outcomes:
We chose 8 RCTs papers with a total of 497 instances.
The stent group had significantly lower directly stoma rates, significantly higher active primary anastomosis rates, and significantly lower post-procedural complication rates.
The stent party, on the other hand, had substantially higher tumor recurrence rates, leading to the following conclusions:
This meta-analysis confirms that SEMS placement can lower the rate of direct stomas and increase the rate of active primary anastomosis; however, it is linked to a higher rate of tumor recurrence.
Laparoscopic anterior resection (LAR) is nowadays routine practice in specialized high-volume centers, with equivalent oncological outcomes to open surgery. Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. Therefore, recognition of the risk factors of postoperative complications is essential in order to be prevented. Moreover, one must underline the importance of some risk factors such as age, nutrition status of the patient, experience of the surgeon, and many other factors that influence outcome of colorectal surgery. Some risk factors can be modified before the intervention to prevent postoperative complications. Contrary to that, long-term postoperative complications may promote tumor recurrence and decrease survival.
The author declares no conflict of interest.
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Knowing that almost 90% of failures occur in the distribution systems, great interest was dedicated to this part of the system, and the first work was oriented to reliability indices defined as objectives to attempt and as performance measures in the electricity market. Some works deal with the managers’ behavior, and the customers reactions are modeled using economic criteria in uncertain future and inspired from game theory. When studying components, degradation models were introduced and combined with the effects of socks to study the reliability changing during system operation. In some works, the correlation between maintenance policies and reliability aspects was highlighted. 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The effectiveness of the application is demonstrated by examples.",book:{id:"6584",slug:"probabilistic-modeling-in-system-engineering",title:"Probabilistic Modeling in System Engineering",fullTitle:"Probabilistic Modeling in System Engineering"},signatures:"Igor Goncharov, Nikita Goncharov, Pavel Parinov, Sergey\nKochedykov and Alexander Dushkin",authors:[{id:"231528",title:"Ph.D.",name:"Igor",middleName:null,surname:"Goncharov",slug:"igor-goncharov",fullName:"Igor Goncharov"},{id:"240727",title:"Mr.",name:"Nikita",middleName:null,surname:"Goncharov",slug:"nikita-goncharov",fullName:"Nikita Goncharov"},{id:"240728",title:"Mr.",name:"Pavel",middleName:null,surname:"Parinov",slug:"pavel-parinov",fullName:"Pavel Parinov"},{id:"240729",title:"Mr.",name:"Sergey",middleName:null,surname:"Kochedykov",slug:"sergey-kochedykov",fullName:"Sergey Kochedykov"},{id:"249097",title:"Dr.",name:"Alexander",middleName:null,surname:"Dushkin",slug:"alexander-dushkin",fullName:"Alexander Dushkin"}]},{id:"56062",doi:"10.5772/intechopen.69721",title:"A Decision Support System for Planning and Operation of Maintenance and Customer Services in Electric Power Distribution Systems",slug:"a-decision-support-system-for-planning-and-operation-of-maintenance-and-customer-services-in-electri",totalDownloads:1702,totalCrossrefCites:4,totalDimensionsCites:7,abstract:"This chapter aims to present the design and development of a decision support system (DSS) for the analysis, simulation, planning, and operation of maintenance and customer services in electric power distribution system (EPDS). The main objective of the DSS is to improve the decision‐making processes through visualization tools and simulation of real cases in the EPDS, in order to allow better planning in the short, medium, and long term. Therefore, the DSS helps managers and decision‐makers to reduce maintenance and operational costs, to improve system reliability, and to analyze new scenarios and conditions for system expansion planning. First, we introduce the key challenges faced by the decision‐makers in the planning and operation of maintenance and customer services in EPDS. Next, we discuss the benefits and the requirements for the DSS design and development, including use cases modeling and the software architecture. Afterwards, we present the capabilities of the DSS and discuss important decisions made during the implementation phases. We conclude the chapter with a discussion about the obtained results, pointing out the possible enhancements of the DSS, future extensions, and new use cases that may be addressed.",book:{id:"6024",slug:"system-reliability",title:"System Reliability",fullTitle:"System Reliability"},signatures:"Carlos Henrique Barriquello, Vinícius Jacques Garcia, Magdiel\nSchmitz, Daniel Pinheiro Bernardon and Júlio Schenato Fonini",authors:[{id:"180154",title:"Dr.",name:"Daniel",middleName:"P",surname:"Bernardon",slug:"daniel-bernardon",fullName:"Daniel Bernardon"},{id:"180657",title:"Dr.",name:"Vinicius Jacques",middleName:"Jacques",surname:"Garcia",slug:"vinicius-jacques-garcia",fullName:"Vinicius Jacques Garcia"},{id:"203699",title:"Dr.",name:"Carlos",middleName:null,surname:"Barriquello",slug:"carlos-barriquello",fullName:"Carlos Barriquello"},{id:"206560",title:"Mr.",name:"Magdiel",middleName:null,surname:"Schmitz",slug:"magdiel-schmitz",fullName:"Magdiel Schmitz"},{id:"206562",title:"BSc.",name:"Júlio",middleName:null,surname:"Schenato Fonini",slug:"julio-schenato-fonini",fullName:"Júlio Schenato Fonini"}]},{id:"57878",doi:"10.5772/intechopen.71501",title:"Time Series and Renewable Energy Forecasting",slug:"time-series-and-renewable-energy-forecasting",totalDownloads:900,totalCrossrefCites:2,totalDimensionsCites:6,abstract:"Reliability is a key important criterion in every single system in the world, and it is not different in engineering. Reliability in power systems or electric grids can be generally defined as the availability time (capable of fully supplying the demand) of the system compared to the amount of time it is unavailable (incapable of supplying the demand). For systems with high uncertainties, such as renewable energy based power systems, achieving a high level of reliability is a formidable challenge due to the increased penetrations of the intermittent renewable sources such as wind and solar. A careful and accurate planning is at the utmost importance to achieve high reliability in renewable energy based systems. This chapter will assess wind-based power system’s reliability issues, and provide a case study that proposes a solution to enhance the reliability of the system.",book:{id:"6086",slug:"dependability-engineering",title:"Dependability Engineering",fullTitle:"Dependability Engineering"},signatures:"Mahmoud Ghofrani and Anthony Suherli",authors:[{id:"183482",title:"Dr.",name:"Mahmoud",middleName:null,surname:"Ghofrani",slug:"mahmoud-ghofrani",fullName:"Mahmoud Ghofrani"},{id:"216997",title:"Mr.",name:"Anthony",middleName:null,surname:"Suherli",slug:"anthony-suherli",fullName:"Anthony Suherli"}]},{id:"66913",doi:"10.5772/intechopen.85571",title:"Reliability Evaluation of Power Systems",slug:"reliability-evaluation-of-power-systems",totalDownloads:2014,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Reliability evaluation of electric power systems is an essential and vital issue in the planning, designing, and operation of power systems. An electric power system consists of a set of components interconnected with each other in some purposeful and meaningful manner. The object of a reliability evaluation is to derive suitable measures, criteria, and indices of reliable and dependable performance based on component outage data and configuration. For evaluating generated reliability, the components of interest are the generating units and system configuration, which refer to the specific unit(s) operated to serve the present or future load. The indices used to measure the generated reliability are probabilistic estimates of the ability of a particular generation configuration to supply the load demand. These indices are better understood as an assessment of system-wide generation adequacy and not as absolute measures of system reliability. The indices are sensitive to basic factors like unit size and unit availability and are most useful when comparing the relative reliability of different generation configurations. The system is deemed to operate successfully if there is enough generation capacity (adequate reserve) to satisfy the peak load (maximum demand). Firstly, generation model and load model are convolved (mutually combined) to yield the risk of supply shortages in the system. Secondly, probabilistic estimates of shortage risk are used as indices of bulk power system reliability evaluation for the considered configuration.",book:{id:"7687",slug:"reliability-and-maintenance-an-overview-of-cases",title:"Reliability and Maintenance",fullTitle:"Reliability and Maintenance - An Overview of Cases"},signatures:"Abdullah M. Al-Shaalan",authors:[{id:"274935",title:"Prof.",name:"Abdullah",middleName:"Mohammed",surname:"Al-Shaalan",slug:"abdullah-al-shaalan",fullName:"Abdullah Al-Shaalan"}]}],mostDownloadedChaptersLast30Days:[{id:"50094",title:"Reliability of Systems",slug:"reliability-of-systems",totalDownloads:3451,totalCrossrefCites:1,totalDimensionsCites:0,abstract:"Many objects consist of more components. The mutual arrangement of the individual elements influences the resultant reliability. The formulae are shown for the resultant reliability of series arrangement, as well as for parallel and combined arrangement. The possibility of reliability increasing by means of redundancy is explained, and also the principle of optimal allocation of reliabilities to individual elements. Everything is illustrated on examples.",book:{id:"5317",slug:"concise-reliability-for-engineers",title:"Concise Reliability for Engineers",fullTitle:"Concise Reliability for Engineers"},signatures:"Jaroslav Menčík",authors:[{id:"142710",title:"Prof.",name:"Jaroslav",middleName:null,surname:"Menčík",slug:"jaroslav-mencik",fullName:"Jaroslav Menčík"}]},{id:"50095",title:"Time to Failure of Deteriorating Objects",slug:"time-to-failure-of-deteriorating-objects",totalDownloads:1690,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter explains the prediction of the time to failure in the following cases: fatigue of metallic components under cyclic loading or in the presence of cracks, static fatigue, wear and creep, variable loading (damage accumulation). Prediction of the time to failure based on monitoring of the changing response. Probabilistic aspects of the lifetime prediction. The determination of the time to failure is illustrated on examples.",book:{id:"5317",slug:"concise-reliability-for-engineers",title:"Concise Reliability for Engineers",fullTitle:"Concise Reliability for Engineers"},signatures:"Jaroslav Menčík",authors:[{id:"142710",title:"Prof.",name:"Jaroslav",middleName:null,surname:"Menčík",slug:"jaroslav-mencik",fullName:"Jaroslav Menčík"}]},{id:"66913",title:"Reliability Evaluation of Power Systems",slug:"reliability-evaluation-of-power-systems",totalDownloads:2014,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Reliability evaluation of electric power systems is an essential and vital issue in the planning, designing, and operation of power systems. An electric power system consists of a set of components interconnected with each other in some purposeful and meaningful manner. The object of a reliability evaluation is to derive suitable measures, criteria, and indices of reliable and dependable performance based on component outage data and configuration. For evaluating generated reliability, the components of interest are the generating units and system configuration, which refer to the specific unit(s) operated to serve the present or future load. The indices used to measure the generated reliability are probabilistic estimates of the ability of a particular generation configuration to supply the load demand. These indices are better understood as an assessment of system-wide generation adequacy and not as absolute measures of system reliability. The indices are sensitive to basic factors like unit size and unit availability and are most useful when comparing the relative reliability of different generation configurations. The system is deemed to operate successfully if there is enough generation capacity (adequate reserve) to satisfy the peak load (maximum demand). Firstly, generation model and load model are convolved (mutually combined) to yield the risk of supply shortages in the system. Secondly, probabilistic estimates of shortage risk are used as indices of bulk power system reliability evaluation for the considered configuration.",book:{id:"7687",slug:"reliability-and-maintenance-an-overview-of-cases",title:"Reliability and Maintenance",fullTitle:"Reliability and Maintenance - An Overview of Cases"},signatures:"Abdullah M. Al-Shaalan",authors:[{id:"274935",title:"Prof.",name:"Abdullah",middleName:"Mohammed",surname:"Al-Shaalan",slug:"abdullah-al-shaalan",fullName:"Abdullah Al-Shaalan"}]},{id:"58172",title:"X-Ray Techniques",slug:"x-ray-techniques",totalDownloads:2443,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"This chapter reviewed existing X-ray techniques that can be used for the analysis of materials, inclusive of those used as engineering and structural components. These techniques are X-ray fluorescence (XRF) spectrometry, proton-induced X-ray emission (PIXE) spectrometry, and X-ray diffraction (XRD). These analytical techniques provide qualitative and quantitative information on the composition and structure of materials with precision. XRD gives information on the crystalline forms and amorphous content of materials, which could be quite useful in failure analysis if the type of failure brings about morphological changes in the material under investigation. PIXE and XRF provide information on the types of elements present in a sample material and their concentrations. PIXE is however preferable to XRF due to its higher sensitivity to trace elements and lower atomic number elements as well as its faster analysis. XRF and XRD are more commonly used than PIXE which is a powerful, high-tech method that is relatively new in the field of chemical research. In this chapter, the theory and principles of these analytical techniques are explained, and diagrams showing the components of spectrometers and diffractometers are provided with descriptions of how they function.",book:{id:"5720",slug:"failure-analysis-and-prevention",title:"Failure Analysis and Prevention",fullTitle:"Failure Analysis and Prevention"},signatures:"Clementina Dilim Igwebike-Ossi",authors:[{id:"219931",title:"Dr.",name:"Clementina",middleName:null,surname:"Igwebike-Ossi",slug:"clementina-igwebike-ossi",fullName:"Clementina Igwebike-Ossi"}]},{id:"57936",title:"Power System Reliability: Mathematical Models and Applications",slug:"power-system-reliability-mathematical-models-and-applications",totalDownloads:2799,totalCrossrefCites:5,totalDimensionsCites:10,abstract:"This chapter deals with power systems reliability including technical, economical, and decisional aspects. Knowing that almost 90% of failures occur in the distribution systems, great interest was dedicated to this part of the system, and the first work was oriented to reliability indices defined as objectives to attempt and as performance measures in the electricity market. Some works deal with the managers’ behavior, and the customers reactions are modeled using economic criteria in uncertain future and inspired from game theory. When studying components, degradation models were introduced and combined with the effects of socks to study the reliability changing during system operation. In some works, the correlation between maintenance policies and reliability aspects was highlighted. In a recent work, considering the importance of new technologies integration and renewable energy insertion to power systems, it was revealed that reliability aspects and energy sustainability are two fundamental issues of progress in a given society.",book:{id:"6024",slug:"system-reliability",title:"System Reliability",fullTitle:"System Reliability"},signatures:"Rabah Medjoudj, Hassiba Bediaf and Djamil Aissani",authors:[{id:"182165",title:"Dr.",name:"Rabah",middleName:null,surname:"Medjoudj",slug:"rabah-medjoudj",fullName:"Rabah Medjoudj"},{id:"182167",title:"Prof.",name:"Djamil",middleName:null,surname:"Aissani",slug:"djamil-aissani",fullName:"Djamil Aissani"},{id:"208149",title:"Ms.",name:"Hassiba",middleName:null,surname:"Bediaf",slug:"hassiba-bediaf",fullName:"Hassiba Bediaf"}]}],onlineFirstChaptersFilter:{topicId:"123",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. 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:"June 29th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:32,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:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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