Tocolytics.
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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:"5435",leadTitle:null,fullTitle:"Irritable Bowel Syndrome - Novel Concepts for Research and Treatment",title:"Irritable Bowel Syndrome",subtitle:"Novel Concepts for Research and Treatment",reviewType:"peer-reviewed",abstract:"This book provides comprehensive and up-to-date insights into emerging trends in research and treatment of irritable bowel syndrome (IBS). Key features include pathogenesis, existing and new therapies, as well as nonpharmacological approach in management of IBS. The authors are known experts who contributed significantly for a better understanding of the etiology of IBS as one of the most commonly diagnosed functional disorders. This book provides a state-of-the-art review of different aspects of IBS and is recommended to healthcare providers, clinical scientists, general practitioners, students, and patients.",isbn:"978-953-51-2828-1",printIsbn:"978-953-51-2827-4",pdfIsbn:"978-953-51-4140-2",doi:"10.5772/62930",price:100,priceEur:109,priceUsd:129,slug:"irritable-bowel-syndrome-novel-concepts-for-research-and-treatment",numberOfPages:96,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"809b69e057dbb5ffdf5a04ec922d659a",bookSignature:"Victor Chaban",publishedDate:"December 14th 2016",coverURL:"https://cdn.intechopen.com/books/images_new/5435.jpg",numberOfDownloads:9018,numberOfWosCitations:4,numberOfCrossrefCitations:1,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:2,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:7,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2016",dateEndSecondStepPublish:"May 17th 2016",dateEndThirdStepPublish:"August 1st 2016",dateEndFourthStepPublish:"October 30th 2016",dateEndFifthStepPublish:"November 29th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"83427",title:"Prof.",name:"Victor",middleName:null,surname:"Chaban",slug:"victor-chaban",fullName:"Victor Chaban",profilePictureURL:"https://mts.intechopen.com/storage/users/83427/images/system/83427.jpg",biography:'Dr. Victor V. Chaban is a Professor of Medicine with dual faculty appointment at Charles R. Drew University of Medicine and Science (CDU) and the University of California, Los Angeles (UCLA). Dr. Chaban completed his postdoctoral training in Neuroscience at UCLA and graduate studies in Clinical Research at CDU. His area of expertise is signal transduction mechanisms of nociception associated with clinical presentations of visceral pain. Currently, Dr. Chaban is an Associate Editor In Chief for the International Journal of Research in Nursing. Dr. Chaban is an author of 4 books: the most recent is "Calcium Signaling and Nervous System. Overview and Directions for Research" by Nova Medicine and Health, N.Y., 2020',institutionString:"University of California Los Angeles",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of California Los Angeles",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1021",title:"Hepatology",slug:"gastroenterology-hepatology"}],chapters:[{id:"52702",title:"Irritable Bowel Syndrome: Functional Gastrointestinal Disease Regulated by Nervous System",doi:"10.5772/65767",slug:"irritable-bowel-syndrome-functional-gastrointestinal-disease-regulated-by-nervous-system",totalDownloads:1598,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A functional disorder is a medical condition that impairs the normal function, but without major organic cause such as irritation or inflammation and where the organ or part of the body looks completely normal under medical examination. The accumulation of abnormalities that limit body functions is a major risk factor for patients with irritable bowel syndrome (IBS), defined as a gastrointestinal disorder with abdominal pain or discomfort that is associated with a change in bowel habit. Often, this disorder is accompanied by the concomitant decline in cognitive or motor performance. Pain that in some patients is out of proportion to identifiable pathology is the most immediate and dramatic consequence of IBS and is responsible for a highly negative impact on quality of life and substantial workforce loss. For patients with IBS, the most common comorbid diagnoses include painful bladder syndrome (PBS) or chronic pelvic pain (CPP). Cells of the affected tissues may interact in cell-to-cell manner messages through the transfer of hormones, cytokines, and other mediators that influence normal functioning. The complex interplay and balance between these diverse mediators, ageing, genetic background, and environmental factors may ultimately determine the outcome of the progression of the functional disorder. On a cellular level, these responses are highly complex, involving a vast array of enzymes and receptors of virtually every class, directing recruitment of many types of cells to recover the healthy state. Indeed, a balance between the messengers with the inherent redundancy of the different body systems makes therapeutic intervention of functional disorders a considerable challenge.",signatures:"Victor V. Chaban",downloadPdfUrl:"/chapter/pdf-download/52702",previewPdfUrl:"/chapter/pdf-preview/52702",authors:[{id:"83427",title:"Prof.",name:"Victor",surname:"Chaban",slug:"victor-chaban",fullName:"Victor Chaban"}],corrections:null},{id:"53058",title:"Psychiatric Comorbidities in Irritable Bowel Syndrome (IBS)",doi:"10.5772/66301",slug:"psychiatric-comorbidities-in-irritable-bowel-syndrome-ibs-",totalDownloads:1938,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"FA lot of research has pointed out that irritable bowel syndrome (IBS) is a multifactorial illness involving visceral hypersensitivity, alteration of communication between the enteric nervous system (ENS) and central nervous system (CNS), increased intestinal permeability, minimal intestinal inflammation, and altered intestinal microflora. Psychological, social, and genetic factors appear to be important in the development of IBS symptomatology through several mechanisms. This chapter addresses the relationships between irritable bowel syndrome (IBS) and psychiatric comorbidities. The aim of this chapter is to provide an overview of explanatory hypothesis and to describe a variety of approaches which integrate the vast research data about IBS and psychiatric comorbidities, including genetic, brain imaging, and neuropsychological findings. The section of this chapter which overlooks the psychotropic treatment reviews the comparative efficacy of various drugs.",signatures:"Mihaela Fadgyas Stanculete",downloadPdfUrl:"/chapter/pdf-download/53058",previewPdfUrl:"/chapter/pdf-preview/53058",authors:[{id:"188927",title:"Dr.",name:"Mihaela",surname:"Fadgyas Stanculete",slug:"mihaela-fadgyas-stanculete",fullName:"Mihaela Fadgyas Stanculete"}],corrections:null},{id:"52921",title:"Inflammation as a Potential Therapeutic Target in IBS",doi:"10.5772/66193",slug:"inflammation-as-a-potential-therapeutic-target-in-ibs",totalDownloads:1933,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The pathogenesis of irritable bowel syndrome (IBS) has been intensively researched, and despite a long journey for unraveling all the structures and the pathways involved, it still remains partially obscure. Inflammation was the first to be hypothesized as a potential pathway for the pathogenesis of IBS. It remains a keystone in the complex machinery of the pathogenesis that is currently considered multifactorial. Elucidating the pathogenesis of IBS is crucial for a targeted therapy of the disease. In this chapter, we review information regarding gut inflammation in IBS, underlining some of the newest data or the cornerstones. Additionally, our aim was also to review treatment currently available and future perspectives regarding anti‐inflammatory treatments for IBS. Newer techniques allow detection and research of mediators involved in inflammation, as well as their potential role to be targeted by pharmacological agents. Recent data supports not only further research of the newer agents that are currently being developed but also some of the available ones that do not have sufficient evidence. Emerging therapies that target inflammation are under evaluation, in trials. A multidrug or a multidisciplinary approach needs to be considered in some cases that fail to respond to current treatment.",signatures:"Alexandra Chira, Romeo Ioan Chira and Dan Lucian Dumitrascu",downloadPdfUrl:"/chapter/pdf-download/52921",previewPdfUrl:"/chapter/pdf-preview/52921",authors:[{id:"72369",title:"Prof.",name:"Dan Lucian",surname:"Dumitrascu",slug:"dan-lucian-dumitrascu",fullName:"Dan Lucian Dumitrascu"},{id:"189838",title:"Dr.",name:"Alexandra",surname:"Chira",slug:"alexandra-chira",fullName:"Alexandra Chira"},{id:"190070",title:"Dr.",name:"Romeo",surname:"Chira",slug:"romeo-chira",fullName:"Romeo Chira"}],corrections:null},{id:"53002",title:"Dietary Management in IBS Patients",doi:"10.5772/66192",slug:"dietary-management-in-ibs-patients",totalDownloads:1886,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Irritable bowel syndrome (IBS) is a chronic, relapsing functional disorder of the gastrointestinal tract characterized by abdominal pain, bloating, and changes in bowel habits lacking a known structural or anatomic explanation. According to the Rome IV criteria, IBS consists of a set of altered bowel habits over a period of time and includes abdominal pain and discomfort. The pathogenesis of IBS is not completely understood, although it has been noted that various mechanisms are involved determining the onset of symptoms. The risk factors include antibiotics, enteric infection, food intolerance, altered pain perception, altered brain-gut interaction, dysbiosis, increased intestinal permeability, visceral hypersensitivity, and increased activation of the gut mucosal immune system. There has been interest regarding the possible role of food in IBS. Diet is crucial for managing IBS; it plays an important role both in the genesis and in the improvement of symptoms. The aim of the study was to summarize the evidence from the literature, which explains those causes tending to promoting IBS symptoms, such as food content short-chain carbohydrates and the presence of food allergy or food intolerance.",signatures:"Francesca Pasqui, Carolina Poli, Caterina Magrino and Davide Festi",downloadPdfUrl:"/chapter/pdf-download/53002",previewPdfUrl:"/chapter/pdf-preview/53002",authors:[{id:"189292",title:"Dr.",name:"Francesca",surname:"Pasqui",slug:"francesca-pasqui",fullName:"Francesca Pasqui"},{id:"194931",title:"Dr.",name:"Carolina",surname:"Poli",slug:"carolina-poli",fullName:"Carolina Poli"},{id:"194942",title:"Dr.",name:"Caterina",surname:"Magrino",slug:"caterina-magrino",fullName:"Caterina Magrino"},{id:"194943",title:"Prof.",name:"Davide",surname:"Festi",slug:"davide-festi",fullName:"Davide Festi"}],corrections:null},{id:"53108",title:"Non-Pharmacological Approach to Irritable Bowel Syndrome",doi:"10.5772/66373",slug:"non-pharmacological-approach-to-irritable-bowel-syndrome",totalDownloads:1664,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Irritable bowel syndrome (IBS) is a commonly diagnosed gastrointestinal condition. It represents a significant healthcare burden and still remains a real challenge. Over the years, IBS has been described as a strict illness of the gastrointestinal tract (medical model) or as a more complex multi-symptomatic disorder of the brain-gut axis (biopsychosocial or psychosomatic model). The reason why IBS has been such a challenge and is so difficult to handle might be related to different approaches. These differences in the view of the syndrome have affected the assessment, treatment and handling of the IBS patient. Patients with IBS, where the symptoms from the gastrointestinal tract are one part of a multi-symptom palette sometimes hidden in the body or mind, need a more holistic outlook. The key to an effective treatment approach is a gastroenterological examination to exclude other diseases along with an assessment of the whole body and its awareness by a body-mind therapist. 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Muntean",reviewType:"peer-reviewed",authors:[{id:"90498",title:"Prof.",name:"Mihaela",middleName:null,surname:"Muntean",fullName:"Mihaela Muntean",slug:"mihaela-muntean"}]},{id:"33424",type:"chapter",title:"The Liberation of Intellectual Capital Through the Natural Evolution of Knowledge Management Systems",slug:"the-liberation-of-intellectual-capital-through-the-natural-evoluion-of-knowledge-management-systems",totalDownloads:2629,totalCrossrefCites:0,signatures:"Harold M. Campbell",reviewType:"peer-reviewed",authors:[{id:"112032",title:"Prof.",name:"Harold",middleName:"Moody",surname:"Campbell",fullName:"Harold Campbell",slug:"harold-campbell"}]}]},relatedBooks:[{type:"book",id:"2125",title:"New Research on Knowledge Management Applications and Lesson Learned",subtitle:null,isOpenForSubmission:!1,hash:"636422cd81f69b84802be623ad68482d",slug:"new-research-on-knowledge-management-applications-and-lesson-learned",bookSignature:"Huei-Tse Hou",coverURL:"https://cdn.intechopen.com/books/images_new/2125.jpg",editedByType:"Edited by",editors:[{id:"96493",title:"Prof.",name:"Huei Tse",surname:"Hou",slug:"huei-tse-hou",fullName:"Huei Tse Hou"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"30458",title:"How Industrial Clusters and Regional Innovation Systems Impact the Knowledge Innovation Within the Taiwanese Science-Based Parks Firms?",slug:"how-industrial-clusters-and-regional-innovation-systems-impact-the-knowledge-innovation-within-the-t",signatures:"Han Chao Chang, Chung Lin Tsai and Steven Henderson",authors:[{id:"90476",title:"Prof.",name:"Han Chao",middleName:null,surname:"Chang",fullName:"Han Chao Chang",slug:"han-chao-chang"},{id:"101170",title:"Dr.",name:"Chung-Lin",middleName:null,surname:"Tsai",fullName:"Chung-Lin Tsai",slug:"chung-lin-tsai"},{id:"101171",title:"Prof.",name:"Steven",middleName:null,surname:"Henderson",fullName:"Steven Henderson",slug:"steven-henderson"}]},{id:"30459",title:"Applying Multiple Behavioral Pattern Analyses to Online Knowledge Management Environments for Teachers’ Professional Development",slug:"applying-multiple-behavioral-pattern-analyses-to-online-knowledge-management-environments-for-teache",signatures:"Huei-Tse Hou",authors:[{id:"96493",title:"Prof.",name:"Huei Tse",middleName:null,surname:"Hou",fullName:"Huei Tse Hou",slug:"huei-tse-hou"}]},{id:"30460",title:"Knowledge Management Practice Assessment and the Relationship Between Knowledge Management Practices and Organizational Strategy Development: Empirical Evidence From Turkey",slug:"knowledge-management-practice-assessment-and-the-relationship-between-knowledge-management-practices",signatures:"Rifat Kamasak",authors:[{id:"91678",title:"Prof.",name:"Rifat",middleName:null,surname:"Kamasak",fullName:"Rifat Kamasak",slug:"rifat-kamasak"}]},{id:"30461",title:"Facts, Processes and Common Understandings: The Management of Knowledge in Project Based Organisations",slug:"facts-processes-or-common-understandings-the-management-of-knowledge-in-project-based-organisations",signatures:"Karina Skovvang Christensen and Per Nikolaj Bukh",authors:[{id:"90786",title:"Prof.",name:"Karina Skovvang",middleName:null,surname:"Christensen",fullName:"Karina Skovvang Christensen",slug:"karina-skovvang-christensen"},{id:"98859",title:"Prof.",name:"Per Nikolaj",middleName:null,surname:"Bukh",fullName:"Per Nikolaj Bukh",slug:"per-nikolaj-bukh"}]},{id:"30462",title:"From Intention to Sharing: A Qualitative Study of Barriers to Knowledge Sharing Practices",slug:"from-intention-to-sharing-a-qualitative-study-of-barriers-to-knowledge-sharing-practices",signatures:"Mei-Lien Young and Feng-Yang Kuo",authors:[{id:"96045",title:"Prof.",name:"Mei-Lien",middleName:null,surname:"Young",fullName:"Mei-Lien Young",slug:"mei-lien-young"},{id:"96057",title:"Prof.",name:"Feng-Yang",middleName:null,surname:"Kuo",fullName:"Feng-Yang Kuo",slug:"feng-yang-kuo"}]},{id:"30463",title:"An Empirical and Modeling Approach to Knowledge Management Practices in South American Organizations",slug:"an-empirical-and-modelling-approach-to-knowledge-management-practices-in-south-american-organization",signatures:"Daniel Matzkin-Jakubowicz and Mildred Berrelleza-Rendón",authors:[{id:"95876",title:"Dr.",name:"Daniel",middleName:null,surname:"Matzkin",fullName:"Daniel Matzkin",slug:"daniel-matzkin"},{id:"126866",title:"MSc.",name:"Mildred",middleName:null,surname:"Berrelleza",fullName:"Mildred Berrelleza",slug:"mildred-berrelleza"}]},{id:"30464",title:"Learning from Corporate Memory and Best Practices",slug:"learning-from-experience",signatures:"Nada Matta and Oswaldo Castillo Navetty",authors:[{id:"93445",title:"Prof.",name:"Nada",middleName:null,surname:"Matta",fullName:"Nada Matta",slug:"nada-matta"},{id:"98090",title:"Dr.",name:"Oswaldo",middleName:null,surname:"Castillo",fullName:"Oswaldo Castillo",slug:"oswaldo-castillo"}]},{id:"30465",title:"Documents in Knowledge Management Support: A Case Study in a Healthcare Organization",slug:"documents-in-knowledge-management-support-a-case-study-in-a-healthcare-organization",signatures:"Mauricio B. 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It represents a major cause of neonatal morbidity and mortality in both developed and developing countries with European and North American figures ranges between 5–10% of all deliveries. In the UK it represents 7.3% of live births
Extreme preterm birth is defined as preterm birth prior to 28 weeks gestation. It accounts for 5–10% of preterm deliveries. The major concern of extreme preterm birth is the significant risk of neonatal mortality as the survival rates are very low at these gestations (0.4% at 22 weeks, 7% at 24 weeks) while the main concern of preterm births above 28 weeks is the neonatal morbidity as the survival rates are 77% at 28 weeks and 97% at 36 weeks.
The aetiology of preterm labour is multifactorial with a common pathway resluting in increased relasee of prostaglandins and cytokines within the cervix, myometrium and fetal membranes. The release of prostaglandins is triggered by infective or inflammatory process [1], uterine overdistension as in cases with polyhydraminons and mutiple preganacy or choriodecudidual haemorrhage as in cases with abruption.
In modern obstetrics, 30–40% of preterm deliveries are iatrogenic. The most common cause of which is severe pre-eclampsia associated with intrauterine growth restriction (IUGR) and antenatal fetal distress. Other common iatrogenic preterm deliveries include, Grade 3 and 4 placenta praevia or placenta abruption with major bleeding, sever IUGR with absent or reversed end-diastolic flow. It is also notable that the increased number of large loop excision of transformation zone (LLETZ) procedures for abnormal cervical cells leads to cervical scarring and iatrogenic cervical incompetence and hence preterm delivery.
Identifying high risk patients is crucial in managing and preventing preterm labour. Prediction of preterm labour is possble through; risk assessment, uterine activity monitoring, cervical length assessment and fetal fibronectin assessment.
Patients with previous preterm labour are at higher risk of having pretem term birth. The risk is 17% after one previous preterm delivery and increases to 28% after two preterm deliveries. Patients with previous preterm premature rupture of membranes (PROM) [2], previous second trimester loss and thoese who are known to have cervical incomptence and congenital uterine anaomalies are at higher risk for preterm birth. Fruther more uterine overdistention as with Polyhydraminos and mutiple pregnancy is associated with preterm delivery. Patient with placental abruption are also known to be at higher risk of preterm labour.
It notable that uterine activity increases prior to onset of pretrm labour by 24 hours. However, the use of home uterine contraction monitors or self palpations has not proven to be useful as they had poor postive predictive vlaues and their use did not improve the perinatal outcomes.
Clinical assessment of cervical status in terms of dilatation, softening and effacement can predict preterm labour, However it has low sensitivity and repeated vaginal examination in it self may incease the cervical prostaglandins relase and subsquently increase the incidnce of preterm labour.
Utrasound assessment of cervical length is a reliable method and highest predictive value up to 70% is notable with cervical length under 25 mm in womens with risk factors for preterm labour. Serial cervical length assessment is recommended in hight isk group between 16–24 weeks. Cervical length is best measured by transvaginal scan with empty bladder as full bladder may lead to false increase in the cervical length measurments. The risk of preterm labour increases from 1% at cervical length of 25 mm to 4% at 15 mm cervical length. The marked increased risk is notable at 5 mm cervical length with preterm birth risk of 78% [4, 5].
Cervical length assessment is not routine in womens with no risk factors for preterm birth as the positive predictive value is low in this group. Also, preventive interventions as cervical cerclage is not recommended in low risk group as they have shown no improvement in the outcome in this group [4].
The presence of funnelling of the internal os is another helpful finding in predicting the preterm birth, However, it is less accurate compared to cervical length assessment due to inter and intra observer variations [6].
Fetal fibronectin is normally present in high concentration prior to 21 weeks of gestation in cervical and vaginal secretions prior to membranes fusion. Inflammatory process, uterine overdistension and choriodecidual haemorrhage increase fetal fibronectin secretion after 21 weeks gestation.
Fetal fibronectin testing by swabbing the posterior fornix or ectocervix between 22 and 34 weeks gestation in recommended as postive results in high risk group especially in presence of symptoms warrant admistration of steriods and hospital admission. Fetal fibronectin testing is not recommeded in womens with no risk factors as it has not shown to be effective in improving the outcome despite more than half of preterm birth occurs in this group [7].
Testing for fetal fibronectin is contraindicated before 22 weeks gestation, in presence of preterm premature rupture of membranes, active vaginal bleeding and intercourse in the previous 24 hours.
Other biochemical markers such as Insulin like growth factor binding protein-1, interleukin-6, interleukin-8 and tumour necrosis factor-alpha (TNF-α) were assessed in research setting for use in predicting preterm labour. However, none of those markers is currently used in routine practice [8].
Preterm birth is associated with significant neonatal morbidities such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, intraventricular haemorrhage and periventricular leucomalacia. Longterm impact of prematurity are mainly cognitive and motor impairement which are more prevelant in extreme preterm births. Prolongation of pregnancy with tocolytic agents and adminstration of antenatal steriods signficantly reduces the neonatal morbidities in preterm births [1, 9].
EPICure data [9] may be useful tool in counselling the parents about fetal prognosis. Neonatal mortality is higher with preterm birth at lower gestational ages with survival rate of 7% at 24 weeks compared to 77% at 28 weeks and 97% at 32 weeks. The survival rates improves 2.2% daily between 24 and 28 weeks gestions. Preterm delivery at 36 weeks is associated with 99% survival rate [1, 9, 10].
Mutiple preventive measures were tested for prevention of preterm labour such as treatment of asymptomatic bacteruria and bacterial vaginosis, prophylactic antibiotics in womens with postive fetal fibronectin and reduced cervical length, cervical cerclage, prophlactic tocolysis and hormonal supplements. Some were proved to be effective in reducing preterm deliveries while others shown no significant diffierence in the outcome regarding the incidance of preterm birth and its associated morbidities.
Bacterial vaginosis occurs in 10–22% of pregnant womens with unknown aetiology. Treating the bacterial vagnoisis and hence reducing its associated inflammatory process was proved to reduce the incidance of preterm birth in womens with risk factors for preterm labour especially those with postive fetal fibronectin testing. Asymptomatic bacteruria occurs in 2–9% pregnant womens and its associated inflammtory process can participate in increasing prostagladins levels in cervicovaginal secretions and hence the preterm birth. Treating asymptomatic bacteruria in high risk group reduces the incidence of preterm birth but not in low risk group.
Antibiotic treatment for prophylactic antibiotics in womens with postive fetal fibronectin and in womens reduced cervical length in absence of infective or inflammatory process is not recommeded due to limited evidence and lack of proven efficacy.
Cervical cerclage proved to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation [4, 11]. Cervical cerclage can be done by transvaginal route (McDonald or Shirodkar techniques) or transadominal route when there is insufficient cervical tissue to hold the suture or when the vaginal approach has failed previously [1, 4]. Counselling prior such procedure is essential to involve the pros and cons. Complications of the procedure can include; bleeding, infection (endometritis), increased frequency of contractions, cervical trauma, preterm premature rupture of membranes, suture displacement, sepsis, cervical scarring. Cervical cerclage is contraindicated in presence of fetal anomaly, intrauterine infection, active bleeding and preterm premature rupture of membranes [1, 6].
Prophylactic tocolysis for high risk women has not proved to reduce the preterm birth rate and is not recommended.
Progesterone supplement via vaginal or intramuscular route on weekly basis till 36 weeks can be considered to promote reduction of uterine activity. Its use is limited to clinical trials in European guidlines [12, 13] while the recent NICE guideline in UK and in North America, progesterone supplementation is recommended for clinical use for reuction of preterm births [1, 14].
Use of cervical pessaries, bed rest and restrticting physical activity and intercourse have no proved evidence of preventing preterm labour [15, 16].
The mangement of preterm labour fall into five areas; the use of tocolysis, adminstration of antibiotics, admistration of antenatal steriods, magnisum sulphate for neuroprotection and finally the considerations for the mode of delivery.
It is important to realise that the aim of tocolysis in modern obstertics is limited to gain few days to allow admistration of antenatal steriods which proved to reduce perinatal morbidities in preterm birth and allow in utero transfer (Table 1).
Tocolytics | Mechanism | Dose | Side effects | Contraindications |
---|---|---|---|---|
Ritodrine - b2-agonists Currently not in use | b2-receptor stimulation reduces free intra-cellular Ca+2 via cyclic AMP and hence muscle relaxation | 50–100 μ g/min IV then, increase by 50 μ g/min every 10 min. (up to 350 μ g/min) | Maternal; Hyperglycemia hypokalemia Tremors and nervousness Dyspnea and chest pain Palpitations and arrhythmia Hypotension Pulmonary edema Fetal/neonatal; Tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia hypotension IVH | Dysrhythmias or other significant cardiac disease Diabetes mellitus Uncontrolled thyroid disease |
Calcium channel blockers (CCB) - Nifedipine Currently first line | Inhibit influx of calcium into cell and hence prevent myometrial contraction | 20–30 mg, then 10–20 mg every 4–8 hours (max 90 mg/day) | Maternal; Transient hypotension, headache and dizziness, Nausea Flushing Fetal/neonatal; None | Cardiac disease Hypotension Use with magnesium (collapse) Use with caution in renal disease |
Atosiban - Oxytocin receptor antagonists Currently second line | Competitively inhibit oxytocin receptors | 6.75 mg IV bolus, then 300 μg/min every 3 hours. (max 45 hours) | Maternal; Minimal; Nausea and vomiting Hot flushes Hypotension and dizzness Fetal; None | None |
Cyclo-oxygenase (COX) inhibitors Non-selective; indomethacin Selective (COX-2 inhibitor); sulindac nimesulide | Inhibition of COX leads to reduced PGs synthesis and hence myometrial relaxation | Indomethacin: 50–100 mg loading dose, then 25–50 mg every 6 hours for max 48 hours Sulindac: 200 mg every 12 hours for max 48 hours. | Maternal; Minimal if used for 48 hours; Less with COX2 inhibitors; Peptic ulcerations Thrombocytopenia Postpartum haemorrhage Allergic reaction. Fetal; Main concern; premature closure of ductus arteriosus Risk of neonatal necrotizing enterocolitis, IVH and renal dysfunction | Renal or hepatic disease Active peptic ulcer Uncontrolled hypertension NSAID-sensitive asthma and thrombocytopenia |
Magnesium sulfate (MgSO4) Currently not in use | Intracellular calcium antagonist | Initial: 4–6 g/30 min, then: 2–4 g/h | Maternal; Headache and flushing Lethargy Muscle weakness and diplopia Dry mouth Pulmonary edema Fetal/neonatal; Lethargy Hypotonia Hypocalcemia Respiratory depression | Myasthenia gravis |
Tocolytics.
Ritodrine and other b-agonists as terbutaline, salbutamol were used as tocolytic agent but currently not recommeded as first line due to its maternal and neonatal side effects. They act on b2 receptors in myometrial smooth muscles via a cAMP dependent mechanism leading to reduction in the intracellular calcium causing muscular relaxation. Cochrane review on B2-agonists concluded that they decrease the number of preterm births within 48 hours but not within 7 days [1, 17, 18].
Maternal side effects include; palpitations and arrhythmias, chest pain, hypotension, flushing, nausea, headache, pulmonary oedema, hypokalaemia and hyperglycaemia. Neonatal side effects include; tachycardia, hypotension, hypoglycaemia, hypocalcemia and ileus. It is not proved that B2-agnosists are associated with neonatal periventericular haemorrhage [18].
It is a nonsteroidal anti-inflamatory agent which inhibit cyclo-oxygenase enzyme and subsequently reduces myomeytrial prostaglandins concentration which inturn down regulates myometrial cells gap junctions, down regulates oxytocin receptors and reduces intracellular calcium levels. It has better tocolytic effect and better safety profile than b-agonists but its routine use is limited due to the associated fetal side effects [18].
Maternal side effects include; risks of peptic ulcerations, thrombocytopenia and postpartum haemorrhage and allergic reaction. Fetal side effects include; premature closure of ductus arteriosus. There is risk of neonatal necrotizing enterocolitis, intraventericular haemorrhage and renal dysfunction [18].
It is a nonsteriodal anti-inflammatory agent which act specifically on cycloxgenase-2 enzyme which is upregulated in preterm labour. The mechanism of action is simillar to indomethacin but with better maternal side effect profile. Its routine use is limited due to fetal concerns over premature closure of the ductus and renal idysfunction [18].
Atosiban is an oxytocin analogue competitively blocks oxytocin and vasopressin receptors leading to reduced intracelluar calcium and lesser prostagladins production. It is recommended and licenced in preterm labour [1, 18, 19]. Its side effects include; maternal nausea, vomiting, hot flushes, hypotension and dizzness. It has simillar effectivness to B2-agonists and nifidipine but with a safer profile however, it is more expensive and given intravenously [1, 18].
It is a calcium channel blocker that is proved to be effective in reducing preterm birth with lesser side effects compared to B2-agonists. It is admnistered orally and it is considered first line treatment option [1, 18]. The side effects of its use include; headache, dizzness, ankle odema, and constipation.
Cochrane review did not support its use for tocolysis as studies repeorted did not show that magnesium sulphate delayed or prevented preterm birth [18].
The use of antibiotics is recommeded with preterm premature rupture of membranes (PPROM) based on ORACLE trial and chochrane review which proved that they reduce the time to delivery and the incidence of chorioamnionitis. They also decrease the ioccurance of neonatal sepsis and the need for neonatal surfactant and oxygen therapy. On the other hand; the ORACLE trial did not recommed its use in preterm labour without premature rupture of membranes as there was no difference in the neonatal outcomes [1, 20, 21].
It is also concluded that erythromycin is a better choice compared to coamoxiclav in women with preterm labour associated with premature rupture of membranes due to increased risk of necrotizing enetrocoilitis with the use of co-amoxiclav [20, 21].
The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.
The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].
The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].
It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.
The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
Children born to women given magnesium sulphate for seizure prevention in severe pre-eclampsia were noted to have lower rates of cerebral palsy. This is possibly because magnisum decreases extracellular glutamate with hypoxia and hence reduces excitotoxicity. It also limits calcium influx through voltage-gated channels and in turn reduces the activation of apoptosis. Further more it reduces oxidative stress and reduces the production of pro-inflammatory cytokines.
It is use for neuroprotection is recommeded for use in women with established preterm labour or planned to hace elective preterm birth within 24 hours at gestations between 24 and 30 weeks. It is can be considered between 30 and 34 weeks [1, 23].
Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].
The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.
There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].
Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].
Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.
IntechOpen publishes different types of publications
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Metallurgical properties of sinter and pellets (reducibility, strength, softening and melting temperatures) with different contents of red mud in iron ore raw materials are also presented, including the technology of red mud usage in ferrous metallurgy carried out through industrial and laboratorial tests. Additionally, the main technical and economic indicators of blast furnace smelting (productivity, coke consumption, chemical composition of pig iron and slag, etc.) are presented. The possibility and expediency of utilisation of red mud in a blast furnace are shown.",book:{id:"7557",slug:"recovery-and-utilization-of-metallurgical-solid-waste",title:"Recovery and Utilization of Metallurgical Solid Waste",fullTitle:"Recovery and Utilization of Metallurgical Solid Waste"},signatures:"Andrey Dmitriev",authors:null},{id:"37118",doi:"10.5772/33969",title:"Size Reduction by Grinding as an Important Stage in Recycling",slug:"comminution-as-an-important-stage-in-recycling",totalDownloads:5409,totalCrossrefCites:3,totalDimensionsCites:6,abstract:null,book:{id:"2254",slug:"post-consumer-waste-recycling-and-optimal-production",title:"Post-Consumer Waste Recycling and Optimal Production",fullTitle:"Post-Consumer Waste Recycling and Optimal Production"},signatures:"Marek Macko",authors:[{id:"98075",title:"Dr.",name:"Marek",middleName:null,surname:"Macko",slug:"marek-macko",fullName:"Marek Macko"}]}],mostDownloadedChaptersLast30Days:[{id:"77881",title:"Chemical Recycling of Polyolefins (PE, PP): Modern Technologies and Products",slug:"chemical-recycling-of-polyolefins-pe-pp-modern-technologies-and-products",totalDownloads:391,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Chemical recycling is one of the most intensively developed potential solutions for the global plastic waste issue. This broadly defined term covers several different technologies that lead to many diverse products. Polyolefins (polyethylene and polypropylene) can be chemically recycled by pyrolysis (cracking) or gasification. These polymers’ chemical composition and structure make them a great potential source of valuable hydrocarbons or carbon atoms for syngas production. Thermal and catalytic cracking of polyethylene and polypropylene can be optimised to maximise specific types of hydrocarbons that, after optional additional processing, such as hydrotreatment, steam cracking or distillation, can be used as intermediates in petrochemical plants, fuels or fuel components, monomers for polymerisation of new, virgin polymers or as specialty chemicals (final market products). Gasification of plastic waste transforms polymers into a mixture of hydrogen, carbon monoxide and carbon dioxide, which can be further used as a source of these gasses, transformed into chemicals and fuels, or used directly to produce energy. This chapter presents all of these process paths with examples of existing technologies and their level of technology readiness and perspectives for scale-up.",book:{id:"10855",slug:"waste-material-recycling-in-the-circular-economy-challenges-and-developments",title:"Waste Material Recycling in the Circular Economy",fullTitle:"Waste Material Recycling in the Circular Economy - Challenges and Developments"},signatures:"Daria Frączak",authors:[{id:"353408",title:"Dr.Ing.",name:"Daria",middleName:null,surname:"Frączak",slug:"daria-fraczak",fullName:"Daria Frączak"}]},{id:"77840",title:"Recent Advances in Pre-Treatment of Plastic Packaging Waste",slug:"recent-advances-in-pre-treatment-of-plastic-packaging-waste",totalDownloads:321,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"There is an urgent need to close the loop of plastic waste. One of the main challenges towards plastic packaging waste recycling is the presence of a variety of contaminants. These contaminants include organic residues, additives, labels, inks and also other plastic types that can be present in the waste stream due to missorting or in multimaterial structures (e.g. multilayer films in packaging). In this context, pre-treatment processes are a promising route to tackle the difficulties that are encountered in mechanical and chemical recycling due to these contaminants. This chapter gives better insight on the already existing pre-treatment techniques and on the advances that are being developed and/or optimized in order to achieve closed-loop recycling. Some of these advanced pre-treatments include chemical washing to remove inks (deinking), extraction methods to remove undesired plastic additives and dissolution-based pre-treatments, such as delamination and dissolution-precipitation techniques.",book:{id:"10855",slug:"waste-material-recycling-in-the-circular-economy-challenges-and-developments",title:"Waste Material Recycling in the Circular Economy",fullTitle:"Waste Material Recycling in the Circular Economy - Challenges and Developments"},signatures:"Rita Kol, Martijn Roosen, Sibel Ügdüler, Kevin M. Van Geem, Kim Ragaert, Dimitris S. Achilias and Steven De Meester",authors:[{id:"95620",title:"Dr.",name:"Dimitris S.",middleName:null,surname:"Achilias",slug:"dimitris-s.-achilias",fullName:"Dimitris S. 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The proven metalized pellet-producing process would be highlighted that green pellets made from iron-bearing sludge are dried and preheated in a traveling grate firstly, and then reduced at high temperature in a rotary kiln or a rotary hearth furnace (RHF) to get direct reduced iron (DRI), served as a good iron source for blast furnace.",book:{id:"7557",slug:"recovery-and-utilization-of-metallurgical-solid-waste",title:"Recovery and Utilization of Metallurgical Solid Waste",fullTitle:"Recovery and Utilization of Metallurgical Solid Waste"},signatures:"Hu Long, Dong Liu, Lie-Jun Li, Ming-Hua Bai, Yanzhong Jia and Wensheng Qiu",authors:null},{id:"77937",title:"An Evaluation of Recycled Polymeric Materials Usage in Denim with Lifecycle Assesment Methodology",slug:"an-evaluation-of-recycled-polymeric-materials-usage-in-denim-with-lifecycle-assesment-methodology",totalDownloads:259,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Today, World economy is only 8.6% circular, which creates a huge potential in materials reuse. To close the Emission Gap by 2032, this percentage needs to be doubled. The circular economy ensures that with less virgin material input and fewer emissions. With the help of effective recycling technologies, virgin material use can be decreased and especially petroleum based materials impact can fall within planetary boundaries. This book chapter analyzes different chemical and biological recycling technologies, their advantages and challenges in denim production. Moreover, Life Cycle Assessment (LCA) analysis will be used to evaluate the environmental impact of recycled polymeric materials usage in denim fabrics. 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She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. 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She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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He is also Member of the Laboratory of genetic, animal and feed resource and member of Animal science Department of INAT. He graduated from Higher School of Agriculture of Mateur, University of Carthage, in 2002 and completed his masters in 2006. Dr. M’HAMDI completed his PhD thesis in Genetic welfare indicators of dairy cattle at Higher Institute of Agronomy of Chott-Meriem, University of Sousse, in 2011. 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Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",country:{name:"Argentina"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",biography:"Francisco Javier Martín-Romero (Javier) is a Professor of Biochemistry and Molecular Biology at the University of Extremadura, Spain. He is also a group leader at the Biomarkers Institute of Molecular Pathology. Javier received his Ph.D. in 1998 in Biochemistry and Biophysics. At the National Cancer Institute (National Institute of Health, Bethesda, MD) he worked as a research associate on the molecular biology of selenium and its role in health and disease. After postdoctoral collaborations with Carlos Gutierrez-Merino (University of Extremadura, Spain) and Dario Alessi (University of Dundee, UK), he established his own laboratory in 2008. The interest of Javier's lab is the study of cell signaling with a special focus on Ca2+ signaling, and how Ca2+ transport modulates the cytoskeleton, migration, differentiation, cell death, etc. He is especially interested in the study of Ca2+ channels, and the role of STIM1 in the initiation of pathological events.",institutionString:null,institution:{name:"University of Extremadura",country:{name:"Spain"}}},{id:"217323",title:"Prof.",name:"Guang-Jer",middleName:null,surname:"Wu",slug:"guang-jer-wu",fullName:"Guang-Jer Wu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217323/images/8027_n.jpg",biography:null,institutionString:null,institution:null},{id:"148546",title:"Dr.",name:"Norma Francenia",middleName:null,surname:"Santos-Sánchez",slug:"norma-francenia-santos-sanchez",fullName:"Norma Francenia Santos-Sánchez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/148546/images/4640_n.jpg",biography:null,institutionString:null,institution:null},{id:"272889",title:"Dr.",name:"Narendra",middleName:null,surname:"Maddu",slug:"narendra-maddu",fullName:"Narendra Maddu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272889/images/10758_n.jpg",biography:null,institutionString:null,institution:null},{id:"242491",title:"Prof.",name:"Angelica",middleName:null,surname:"Rueda",slug:"angelica-rueda",fullName:"Angelica Rueda",position:"Investigador Cinvestav 3B",profilePictureURL:"https://mts.intechopen.com/storage/users/242491/images/6765_n.jpg",biography:null,institutionString:null,institution:null},{id:"88631",title:"Dr.",name:"Ivan",middleName:null,surname:"Petyaev",slug:"ivan-petyaev",fullName:"Ivan Petyaev",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Lycotec (United Kingdom)",country:{name:"United Kingdom"}}},{id:"423869",title:"Ms.",name:"Smita",middleName:null,surname:"Rai",slug:"smita-rai",fullName:"Smita Rai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424024",title:"Prof.",name:"Swati",middleName:null,surname:"Sharma",slug:"swati-sharma",fullName:"Swati Sharma",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"439112",title:"MSc.",name:"Touseef",middleName:null,surname:"Fatima",slug:"touseef-fatima",fullName:"Touseef Fatima",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424836",title:"Dr.",name:"Orsolya",middleName:null,surname:"Borsai",slug:"orsolya-borsai",fullName:"Orsolya Borsai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca",country:{name:"Romania"}}},{id:"422262",title:"Ph.D.",name:"Paola Andrea",middleName:null,surname:"Palmeros-Suárez",slug:"paola-andrea-palmeros-suarez",fullName:"Paola Andrea Palmeros-Suárez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Guadalajara",country:{name:"Mexico"}}}]}},subseries:{item:{id:"95",type:"subseries",title:"Urban Planning and Environmental Management",keywords:"Circular economy, Contingency planning and response to disasters, Ecosystem services, Integrated urban water management, Nature-based solutions, Sustainable urban development, Urban green spaces",scope:"