Overview of different airway management techniques—advantages and disadvantages in prehospital use.
\r\n\tGlobalization does not represent a pure and generous process for humanity or other species, but rather it implies social exclusion and also provokes situations of vulnerability in groups of people, forced exclusion, and apartheid: poor job opportunities, lack of access to education, worse socio-sanitary conditions. Specifically, it can be said that social segregation entails the apartheid of social groups of different ages, genders, and ethnicities; these groups live a reality manifested through the deepening of poverty, in terms of increased vulnerability of the poor and groups with little economic, social, cultural, labor and health stability.
\r\n\r\n\tThis book aims to talk about some topics that are neglected in the discourses of academic communities and political elites. The inequality process is deeply rooted among humans and is part of many people's lives in the form of modern apartheid, gender segregation, lack of health access, and cultural gap. All those structural inequality processes are the product of the biopower perpetuated and produced in the macrosystem, exosystem, mesosystem, and microsystem. For many people from the academy, the information-consuming public, and the society in general, it is a problem to talk about these processes, since they have either lost interest or have normalized the structural and social inequity. For this reason, we see it as transcendental to explain how this situation occurs from the most internal fibers to the most evident processes, intending to make it more visible and thus expose the situation for possible solutions.
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This practice is also reflected by the current guidelines: the American College of Surgeons Committee on Trauma Advanced Trauma Life Support (ATLS) recommends intubation for patients with a GCS of 8 or lower for airway protection [1]. Also, the practice management guidelines of the Eastern Association for the Surgery of Trauma give a level 1 recommendation for endotracheal intubation of patients with severe cognitive impairment (GCS ≤ 8) [2].
However, the potential benefit of an intubation in TBI, is also associated with risks: Difficult or failed endotracheal intubation may cause hypoxemia, aspiration, and hypotension and requires admission to the intensive care unit (ICU). In fact, there is no direct evidence supporting routine intubation of all patients with a GCS ≤ 8. Consequently, recent evidence challenged the practice of a strict GCS threshold for intubation and even suggested that routine endotracheal intubation for GCS ≤ 8 in TBI may be harmful [3].
The primary goal in the prehospital care of the trauma patient is to secure adequate ventilation until transfer to hospital care. To achieve this goal, various techniques for airway establishment and subsequent ventilation can be performed: endotracheal intubation has been considered as the gold standard. However, ventilation may also be achieved by less invasive and time consuming procedures such bag-valve mask (BVM) ventilation with the optional use of oropharyngeal (OPA) or nasopharyngeal (NPA) adjuncts. More advanced techniques include supraglottic airway (SGA) devices. There is a wide range of medications available to facilitate intubation prehospital or in the ER.
To date, there are no evidence-based guidelines for TBI patients regarding standardized airway management in the prehospital setting or in the ER. This explains also why indications and techniques for airway establishment vary in different systems and countries around the world. In the United States of America (USA) prehospital care is usually provided by emergency medical technicians or trained paramedics, whereas prehospital care in most European countries is provided by physicians [4]. Following these differences of American and European Emergency Medical Service (EMS) systems, the US prehospital care strategy follows more “scoop and run approach” with prioritizing rapid patient transport to trauma centers. In Europe the priority lies more on field triage, on scene assessment and initiation of procedures such as intubation “stay and play approach” [5].
This chapter will address the question what airway management strategy best meet the patients need and is associated with most favorable outcomes in TBI. Indications and optimal method of securing the airway prehospital and in the ER will be discussed. In addition, technical aspects including medication for pretreatment, induction, paralysis and sedation for endotracheal Intubation in the presence of TBI will be outlined.
Advanced prehospital care has been practiced for several decades in Western countries. In TBI particularly, prehospital airway management is one of the most critical aspects that determine patient outcomes. The importance of the airway management is reflected by the Advanced Trauma Life Support (ATLS) algorithm [1], in which the airway takes priority over any other therapeutic interventions.
General prehospital TBI guidelines [6] are emphasizing avoidance and treatment of hypoxia, prevention and correction of hyperventilation, and avoidance and treatment of hypotension. The implementation of these prehospital guidelines showed that adjusted survival doubled among patients with severe TBI and tripled in the severe, intubated cohort. Furthermore, guideline implementation was significantly associated with survival to hospital admission [7]. These findings support the widespread implementation of the prehospital TBI treatment guidelines. However, specific evidence-based guidelines are needed to establish the optimal airway management in the prehospital setting.
Patients require an advanced airway under two sets of circumstances: failure to maintain a patent airway and the inability to oxygenate and ventilate the patient adequately [8]. While endotracheal intubation in the OR is a very safe and straightforward procedure with very low complication rate, emergency intubation of an unstable patient in the field is linked to a high rate of complication with up to 25% mortality in some studies. Emergency intubation remains a hazardous maneuver even under the best conditions. And no matter how skilled the prehospital team is, best conditions are seldom encountered in the field. This is why endotracheal intubation should ideally performed by skilled providers in patients who are likely to benefit from this technique. In a prehospital setting the indication to establish an airway is not always that obvious and depends on multiple factors (Figure 1
Severity of patients’ condition and the presence of hypoxia: Traumatic brain injury (TBI) is frequently associated with depressed level of consciousness, compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. During the past 45 years, the quantitative GCS as a simple and practical numeric method for assessing impairment of the level of conscious has become the universal criterion for mental status assessment [10]. Consequently, the GCS is also a frequently used score to decide whether an intubation should be performed or not. According to the ATLS [1] and the practice management guidelines of the Eastern Association for the Surgery of Trauma [2] intubation is recommended for GCS ≤8. However, there is no scientific evidence supporting this practice. The dogma that patients with a GCS ≤ 8 are at higher risk for aspiration or hypoxic injury has now been challenged. A prospective study from Hong Kong, in 2012, showed that of 33 patients with a GCS ≤ 8 36.4% had intact airway reflexes and potentially capable of maintaining their own airway, whilst many patients with a GCS > 8 have impaired airway reflexes and potentially be at risk for aspiration [11].
The need for immediate establishment of an obstructed or impaired airway or hypoxia is unquestionably associated with better outcomes. However, performing an intubation in a suboptimal environment in the field, especially if performed by paramedics, may be challenging and require multiple attempts and in some cases may result in the loss of airway with catastrophic consequences. A difficult intubation may result in hypoxemia, aspiration, and hypotension, factors that may contribute to worse outcomes. Also, prehospital intubation and hand ventilation is often associated with hyperventilation and hypocapnia, which could worsen brain edema and secondary brain damage. Finally, prolonging the prehospital time and delaying definitive care, may have adverse effects on the patient, especially in the presence imminent herniation due to increased intracranial pressure (ICP) or an ongoing hemorrhage.
In conclusion, it is important to identify those patients who might benefit from prehospital endotracheal intubation and those who can potentially be harmed by the procedure. At this moment there is no class I evidence supporting any specific approach. It might be appropriate to attempt prehospital intubation in a small number of selected patients with imminent airway obstruction or hypoxia not responding to oxygen administration.
Training and skills of the EMS personnel and the available equipment: In the United States of America (USA) prehospital care is usually provided by emergency medical technicians for basic life support (BLS) or trained paramedics for advanced life support (ALS), whereas prehospital care in most European countries is provide by physicians. Basic providers are restricted to splinting, bandaging, alignment of displaced limbs, the administration of oxygen including BVM ventilation, chest compression and the use of an automated external defibrillator (AED) in case of cardiac arrest. However, especially in the USA many of BLS providers have obtained an intermediate level (EMT-I); these individuals can obtain a more definitive airway such as using a SGA device or even perform endotracheal intubation. Paramedics are trained and performed endotracheal intubation. However, very often many paramedics, especially in areas with no large trauma volumes may not use this skill very often and may become less competent with the procedure. On the other hand, especially an experienced physician proficient with endotracheal intubation, is more likely to perform an intubation more liberally, often unnecessarily. In the United States, prehospital care strategy follows the principle of “scoop and run” with prioritizing rapid patient transport to trauma centers and minimal interventions on scene. In Europe there is a strong element on field triage and initiation of more advanced therapeutic interventions, such as intubation. This prehospital strategy is also known as “stay and play”. A matched cohort study compared patients with isolated severe TBI in Switzerland and the United States [12]. In line with the described differences in prehospital strategies, patients in Switzerland had significantly longer scene times (23 vs. 9 minutes, p < 0.001) and prehospital endotracheal intubation was more frequently performed (31% vs. 18.7%, p = 0.034). However, no significant differences in outcomes were observed between the two cohorts. The results what prehospital strategy should be prioritized and if an endotracheal intubation should be performed remain controversial, although there is evidence that a “scoop and run” approach is preferable for penetrating trauma. In these scenarios the number of meaningful interventions that can be made by prehospital providers is limited and rapid transportation to the hospital is the most important aspect, because in-hospital surgery is typically needed for hemorrhage control.
Safety and environment on scene: The safety aspect on scene, as well as the transportation mode and the expected time to reach the next hospital are important for considering airway interventions on scene. Especially for longer transports, the time-saving aspect of the scoop and run approach without airway interventions becomes less important and early establishment of an airway may improve patient outcomes.
Prehospital airway-management. The indication to establish an airway in a prehospital setting depends on: the severity of patients’ condition and the presence of hypoxia; the training and skills of the EMS personnel including the available equipment; and the safety and environment on scene. Figure provided by Clerc EMS Monthey, Switzerland.
Considering all factors above, complexity of the decision to perform a prehospital intubation becomes obvious, and it is not surprising that the literature on this topic remains contradictory. A retrospective multicenter study including 13,625 patients with moderate to severe TBI showed that prehospital intubation was independently associated with a decrease in survival [13]. Several other studies implicated out-of-hospital intubation as a factor associated with negative outcomes [14, 15]. In a recently published study prehospital airway management in severe TBI patients did not have a significant impact on mortality or long-term neurological outcomes [16]. Other investigations have also demonstrated no difference or even improved outcomes with field intubation [17, 18].
Besides intubation, different other options for airway management are available in a prehospital setting. The simplest approaches such as the jaw thrust or chin lift maneuver are included in the first aid. Oropharyngeal (OPA) or nasopharyngeal (NPA) adjuncts may be inserted orally or nasally to secure an open airway. More advanced airway techniques include the establishment of an airway using an SGA device and finally the performance of endotracheal intubation. In particular cases, a surgical airway must also be considered. A major challenge in prehospital airway management is to determine the appropriate approach for the individual patient in the present environment and setting. Table 1 shows various airway management techniques and summarizes advantages and disadvantages in prehospital use.
Airway management techniques | Skills | Training needed | Time needed | Possible complications | Level of sedation/unconsciousness needed | Equipment needed | Protection against aspiration and airway shutdown | Ventilation possible without face mask |
---|---|---|---|---|---|---|---|---|
Trauma jaw thrust, trauma chin lift | ||||||||
Oropharyngeal airway, Nasopharyngeal airway | ||||||||
Laryngeal mask, laryngeal tube | ||||||||
Endotracheal intubation, surgical airway |
Overview of different airway management techniques—advantages and disadvantages in prehospital use.
A recently published systematic review [19] was assessing comparative benefits and harms across three different airway management approaches (BVM, SGA, and endotracheal intubation) for patients with trauma, cardiac arrest, or medical emergencies requiring prehospital ventilatory support or airway protection. Overall, 99 studies involving 630,397 patients from 1990 to September 2020 were considered for analysis. The evaluated outcomes included mortality, neurological function, return of spontaneous circulation (ROSC), and successful advanced airway insertion. Different meta-analyses were stratified first by study design (RCTs or observational studies), and then by emergency type (cardiac arrest, trauma, medical) and population age (adult, pediatric, mixed-age). All meta-analyses outcomes were reported as favoring one of the two compared approaches, or no difference. Sufficient evidence was not available to address all outcomes and all patient characteristics, provider characteristics, and variations in techniques that were specified a priori. For adult trauma patients 1-month post incidence survival was not different when BVM was compared to endotracheal intubation. Other comparisons for adult trauma patients did not show sufficient evidence to favor an airway management strategy over another. Potential harms of airway management for the entire study population were also compared. When comparing BVM vs. SGA and BVM vs. endotracheal intubation, no difference was found. When comparing SGA to endotracheal intubation, SGA was superior in terms of multiple insertion attempts; endotracheal intubation was superior in terms of inadequate ventilation. No difference was recorded for aspiration, oral/airway trauma and regurgitation. The authors concluded that the currently available evidence does not indicate benefits of more invasive airway approaches based on survival, neurological function, ROSC, or successful airway insertion. However, most included studies were observational. This supports the need for high-quality randomized controlled trials to advance clinical practice and EMS education and policy, and improve patient-centered outcomes.
Similar to the prehospital setting the standard indications for an advanced airway establishment in the ER, include low GCS, failure to maintain a patent airway and the inability to oxygenate and ventilate the patient adequately. In the presence of a TBI a diminished level of consciousness with the concern for the loss of airway control is very common and likely the most frequent indication for ER intubation. Therefore, the GCS is most commonly used to decide whether an intubation should be performed or not.
Patients with TBI and a GCS ≤ 8 have been traditionally managed by ER endotracheal intubation. However, this practice is based mainly on expert opinion and long-standing dogma. There is very little evidence to support this policy! Recent work has challenged this practice! A recently published study including patients with isolated severe head injuries suggested that routine endotracheal intubation in the ER for GCS of 7 and 8 may be even harmful [3]. In this study 2727 patients with GCS 7/8 and isolated blunt head trauma were included. Overall, 1866 (68.4%) patients were intubated within 1 hour of admission (immediate intubation), 223 (8.2%) had an intubation >1 hour of admission (delayed intubation), and 638 (23.4%) patients were not intubated at all. After correcting for age, gender, overall comorbidities, tachycardia, GCS, alcohol, illegal drug use, and head injury severity, immediate intubation was independently associated with higher mortality (OR 1.79, CI 95% 1.31–2.44, p < 0.001) and more overall complications (OR 2.46, CI 95% 1.62–3.73, p < 0.001).
A study [20] evaluating a general trauma population with GCS of 6–8 came to a similar conclusion. An intubation within 1 hour of arrival was associated with an increase in mortality and longer ICU and overall length of stay compared to patients without an intubation. The authors also performed a subgroup analysis of patients with head injury and found similar results to that of the overall trauma population.
These two studies showing worse outcomes associated with immediate intubation and suggest that the existing GCS threshold to mandate intubation in patients with isolated head injuries should be revisited.
Beside the GCS, additional clinical criteria may help to guide the decision to intubate TBI patients in the future. A recently published study showed that head abbreviated injury scale (AIS), tachycardia and younger age were independent clinical factors associated with intubation [3]. These factors could potentially be taken into account to formulate a more selective approach to immediate intubation. In the mentioned study a policy of intubating all isolated blunt head injury patients ≤45 years with head AIS 5 and GCS 7 would have improved intubation management, with 7 immediate instead of delayed intubations and only three potentially unnecessary intubations. If these defined criteria are met (high specificity), an early intubation should be strongly considered. On the other hand, the defined criteria are not suitable to identify patients who definitely do not require an intubation (low sensitivity). Future research should focus on defining more adequate clinical parameters to identify patients requiring immediate intubation and should avoid fixed GCS threshold.
Muakkassa et al. [21] compared trauma patients who were intubated because of combativeness, and not because of medical necessity. In line with the findings above intubating for combativeness was associated with longer hospital LOS, increased rates of pneumonia, and worse discharge status when compared with matched non-intubated patients. It appears that the risks and adverse events of intubation may outweigh the potential benefits of intubation in specific trauma populations.
Therefore, the following potential risks associated with intubation in TBI patients need to be considered by every health care provider. Laryngoscopy and the endotracheal tube can cause a sympathetic or parasympathetic stimulation. Sympathetic stimulation may increase heart rate, blood pressure [22] and ICP [23], whereas parasympathetic stimulation can trigger bronchospasm or hypotension. Especially the increase in ICP from the sympathetic surge can cause an increase in cerebral blood volume, cerebral edema, and development of worsening hemorrhage or hematoma. Finally, both, sympathetic and parasympathetic stimulations may increase mortality and brain injury.
Ventilation after intubation need to be monitored closely, because both hyper- and hypoventilation can contribute to worse outcomes. Severe hyperventilation (arterial pCO2 below 25 mm Hg) should be avoided due to the risk of vasoconstriction and cerebral ischemia. In general, a normo-ventilation with an arterial pCO2 within 35–45 mm Hg should be targeted. However, mild hyperventilation (arterial pCO2 within 30–34 mm Hg) is commonly used to address high intracranial pressure and may potentially be beneficial [24]. More important to address the elevated ICP in TBI patients is the initiation of hyperosmolar therapy with mannitol or hypertonic saline when additional bleeding is suspected [25].
Technical aspects and medications for endotracheal intubation carries also risks for TBI patients. The following section gives an overview including recommendations for pretreatment, induction, paralysis, and sedation of patients with TBI to prevent secondary brain damage.
Endotracheal intubation remains the gold standard for airway management in trauma patients and should be performed via the oral route and a manual in-line stabilization maneuver [26]. Rapid sequence induction (RSI) is widely used for emergency intubation and often considered as the gold standard for trauma patients. This technique uses a fast acting anesthetic in combination with a fast acting relaxant to achieve rapid intubation. Only a few people are aware that this technique was formally described by P. Safar back in 1970 [27]. The primary goal of this technique was to prevent regurgitation during induction of anesthesia in patients with bowel obstruction. Hypoxemia and hypotension were hardly considered at that time, when advanced monitoring and pulse oximetry were still tools of the future. From today’s point of view, this technique is not ideally suited to prevent hypoxemia and hypotension. While in standard OR practice, such short events will hardly result in more than a check on the Q/A sheet, they may have devastating consequences on outcomes in patients with TBI.
In addition, complication rate increases significantly with the number of intubation attempts, with a sharp increase if more than 2 attempts are needed [28]. This suggests that first pass success should be the gold standard in emergency intubation, and return to basic maneuvers or surgical airway should be considered if 2 attempts have failed.
Another important aspect is efficient airway clearance before intubation, which has been shown to significantly increase first pass success [29]. That is why suction of the airway, while having little relevance in the OR can be a game changer in emergency intubation.
Good oxygenation throughout the procedure is paramount in brain injured patients, so meticulous attention should be paid to optimizing precondition. A recent study [30] has shown that when intubation is attempted in a patient with a SpO2 < 93%, there is almost 100% incidence of severe hypoxemia while incidence goes down to 17% if SpO2 is 95% or more. While optimizing oxygenation status may take some time, it certainly pays off in terms of patient outcome.
Last but not least a close monitoring during intubation is mandatory. Studies have shown that episodes of hypoxemia during intubation attempts often go unrecognized, both in the field and in the ER. Furthermore, after intubation attention should be taken to avoid hyperventilation as it can cause hypocapnia and thus cerebral vasoconstriction; it also can impair venous return leading to hypotension. As trivial as it might seem, having a team member watching the vital signs is an important factor in the intubation process.
In the following section medication for pretreatment, induction, paralysis and sedation for endotracheal intubation in the presence of TBI are discussed.
There is currently no evidence to support the use of intravenous lidocaine as an intubation pretreatment for RSI in patients with TBI [23]. High-dose fentanyl (at 2–3 mcg/kg) can help to blunt the sympathetic stimulation of intubation and is currently recommended for neuroprotection in patients with increased ICP.
In TBI the induction with etomidate is popular all over the world because of its mild hemodynamic profile. Particularly, in TBI a drop in mean arterial pressure (MAP) and the subsequent decrease in cerebral perfusion pressure (CPP) may have devasting consequences. It’s important to be aware that etomidate has no analgesic properties, and neuroexcitation may need to be addressed separately.
Ketamine for induction is a good option, with the additional benefit of analgesic properties. The concern of sympathetic stimulation, leading to an increase in ICP is no longer valid. On the contrary, ketamine may, in fact, be neuroprotective due to an increase in MAP and CPP [31], without an increase in cerebral oxygen consumption or reducing regional glucose metabolism [32]. Ketamine may best be used for induction in the presence of hypotension because of for the described effect of increasing MAP and CPP [33].
For paralysis succinylcholine or rocuronium can be utilized [34]. Succinylcholine, as a depolarizing neuromuscular blocking agent has the advantage of rapid onset and offset properties, which is beneficial in TBI patients regarding early neurological examinations. Rocuronium on the other hand can lead to delays in proper neurological examinations due to prolonged paralysis. A retrospective study of 2016 compared 233 TBI patients requiring intubation in the ER. RSI was either performed with succinylcholine or rocuronium. Overall mortality rate was similar between the two groups. However, for patients with a high head AIS score (4–6), succinylcholine was associated with increased mortality compared with rocuronium (44% vs. 23%, odds ratio (OR) 4.10, 95% confidence interval (CI) 1.18–14.12; p = 0.026). Prospective studies are need to clarify these findings.
Propofol in TBI patients for post-intubation sedation is widely used and has the advantage of rapid onset of action and short duration of action. However, since it has no analgesic effect, it needs to be combined with medication for pain control. Furthermore, care should be taken in hypotensive patients because it may lower the MAP and subsequently the CPP. For post-intubation continuous sedation, a combination of propofol and fentanyl in the normotensive or hypertensive patient is therefore recommended. Fentanyl is a potent analgesia without appropriate sedation properties. While the hemodynamic properties of fentanyl are relatively stable, a decrease in MAP and HR frequently occur due to the cessation of the sympathetic stimulus triggered by pain. In addition, an increase in ICP has been described in several studies. A minimal appropriate dose for TBI patients is therefore recommended.
In hypotensive patients a combination of midazolam and fentanyl or ketamine alone is a good option. Midazolam as a sedative has the additional benefit of anxiolytic and anticonvulsant properties. Compared to propofol the effect on ICP and CPP are comparable. However, it’s important to have in mind that the onset and offset action of midazolam is initially relatively fast but tissue accumulation over time may be associated with delayed awakening. This is particularly disadvantageous in patients with TBI, as rapid clinical assessment after cessation of the drug is wanted.
A relatively new approach for emergency intubation is the delayed sequence induction (DSI) technique described by Weingart and colleagues [35]. In contrast to RSI, the technique of delayed sequence intubation temporally separates administration of the induction agent from the administration of the muscle relaxant to allow adequate pre-intubation preparation. This technique uses ketamine sedation to optimize preoxygenation with CPAP or assisted ventilation before muscle relaxant is given and intubation performed. Recent studies have shown an improved safety profile in emergency intubation using this technique. A ketamine-only breathing intubation, in which ketamine is used without a paralytic is another promising alternative. In this case the patient continues to breathe spontaneously, while ketamine provide hemodynamic benefits compared to standard RSI and is also a valuable agent for post-intubation analgesia and sedation. When RSI is not an optimal airway management strategy, ketamine’s unique pharmacology can be harnessed to facilitate alternative approaches that may increase patient safety [36].
Airway control is particularly important for patients with TBI because hypoxemia and hypercarbia may cause secondary brain damage.
In a prehospital setting the indication to establish an airway depends on multiple factors such as (a) severity of patients’ condition including the presence of hypoxia, (b) the training and skills of the EMS personnel including the available equipment, (c) the safety and environment on scene.
In the presence of a TBI a diminished level of consciousness with the concern for the loss of airway control is very common and likely the most frequent indication for intubation. Traditionally patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been managed by prehospital or ER endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. There is evidence that intubation according to a strict GCS threshold is associated with risks and adverse events that may outweigh the potential benefits of intubation in TBI patients. Future research should focus on defining more adequate clinical parameters to identify patients requiring immediate intubation and should avoid fixed GCS threshold. Furthermore, less invasive airway management strategies such as BVM ventilation or the use of SGA devices may be equally effective and potentially associated with less complications. The cornerstone of prehospital airway management should focus on aggressive prevention and treatment of hypoxemia, hypotension, and, if the patient receiving positive pressure ventilation, prevention of hyperventilation. If an intubation is performed in a TBI patient induction with etomidate or ketamine in the presence of hypotension is recommended. For paralysis succinylcholine or rocuronium can be used. Recommendations for post-intubation continuous sedation medications include a combination of propofol and fentanyl in the normotensive or hypertensive patient. A combination of midazolam and fentanyl or ketamine alone should be considered in the hypotensive patient. Delayed sequence induction (DSI) or a ketamine-only intubation, in which ketamine is used without a paralytic are very promising options for emergency intubation and may become the standard of care in the future. The benefit of these strategies compared to RSI need to be confirmed in large randomized clinical trials.
We thank Clerc EMS Monthey, Switzerland for providing Figure 1.
The authors declare no conflict of interest.
IntechOpen - where academia and industry create content with global impact
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As the science gets more advanced and the information about these two points becomes clearer, the view of this information might modify our understanding to these processes. Then, some topics might be dropped, and others might be raised or become more obvious. However, the feeding of halophyte forages as per se has several drawbacks and therefore, they have to be fed in mixed rations, fortifying these rations with energy supplements.",book:{id:"5978",slug:"new-perspectives-in-forage-crops",title:"New Perspectives in Forage Crops",fullTitle:"New Perspectives in Forage Crops"},signatures:"Salah A. 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CW has been successfully applied as an adsorbent for removing pollutants from wastewater and gas, a precursor for obtaining activated carbon, and a feedstock for producing energy and valuable products using mono-process extraction and biorefinery.",book:{id:"8952",slug:"coffee-production-and-research",title:"Coffee",fullTitle:"Coffee - Production and Research"},signatures:"Felipe J. Cerino-Córdova, Nancy E. Dávila-Guzmán, Azucena M. García León, Jacob J. Salazar-Rabago and Eduardo Soto-Regalado",authors:null},{id:"56029",doi:"10.5772/intechopen.69614",title:"Production of Spineless Cactus in Brazilian Semiarid",slug:"production-of-spineless-cactus-in-brazilian-semiarid",totalDownloads:1905,totalCrossrefCites:4,totalDimensionsCites:8,abstract:"The term “spineless cactus” is used in Brazil to designate cultivars of Opuntia ficus indica Mill and Nopalea cochenillifera Salm Dyck. The spineless cactus was consolidated in Brazilian semiarid as a strategic fundamental food resource in several production livestock systems, constituting a plant with enormous productive potential. Thus, the spineless cactus has been widely cultivated and used for several decades, by enabling the animal feeding in critical periods of year because of its characteristics, morpho‐anatomical and physiological (CAM), which makes it tolerant to long droughts, being a crop that presents high productivity in droughts conditions, when compared to other forages. Nevertheless, the spineless cactus is a crop relatively picky about soil and climate characteristics of region, presenting greater growth in fertile soils, as well as in regions where nighttime temperatures are cool and the air humidity is relatively high. Although the crop be adapted to long droughts periods, many times it’s necessary to perform irrigation in its production system, mainly in regions of low rainfall, for to supply its water needs, thus ensuring productivity and survival of crop. Therefore, the knowledge of characteristics of plant, as well as of appropriate management techniques to crop, is essential for the good performance of spineless cactus.",book:{id:"5978",slug:"new-perspectives-in-forage-crops",title:"New Perspectives in Forage Crops",fullTitle:"New Perspectives in Forage Crops"},signatures:"Wilma Cristina Cavalcante dos Santos Sá, Edson Mauro Santos,\nJuliana Silva de Oliveira and Alexandre Fernandes Perazzo",authors:[{id:"139631",title:"Dr.",name:"Edson Mauro",middleName:null,surname:"Santos",slug:"edson-mauro-santos",fullName:"Edson Mauro Santos"},{id:"180036",title:"Dr.",name:"Juliana",middleName:null,surname:"Oliveira",slug:"juliana-oliveira",fullName:"Juliana Oliveira"},{id:"203022",title:"MSc.",name:"Wilma",middleName:null,surname:"Sá",slug:"wilma-sa",fullName:"Wilma Sá"},{id:"207265",title:"Dr.",name:"Alexandre",middleName:null,surname:"Perazzo",slug:"alexandre-perazzo",fullName:"Alexandre Perazzo"}]},{id:"70151",doi:"10.5772/intechopen.89224",title:"The Harvest and Post-Harvest Management Practices’ Impact on Coffee Quality",slug:"the-harvest-and-post-harvest-management-practices-impact-on-coffee-quality",totalDownloads:1868,totalCrossrefCites:3,totalDimensionsCites:7,abstract:"Coffee is one of the most important agricultural commodities in the world. The coffee quality is associated with pre-harvest and post-harvest management activities. Each step starting from selecting the best coffee variety for plantation until the final coffee drink preparation determines the cupping quality. The overall coffee quality influenced by the factors which involve in changes the physicochemical properties and sensorial attributes, including the post-harvest operations. The post-harvest processing activities contribute about 60% of the quality of green coffee beans. The post-harvest operations include pulping, processing, drying, hulling, cleaning, sorting, grading, storage, roasting, grinding, and cupping. This chapter comprises the harvest and post-harvest operations of coffee and their impacts on coffee quality.",book:{id:"8952",slug:"coffee-production-and-research",title:"Coffee",fullTitle:"Coffee - Production and Research"},signatures:"Mesfin Haile and Won Hee Kang",authors:null},{id:"69900",doi:"10.5772/intechopen.89508",title:"Coffee By-Products: Nowadays and Perspectives",slug:"coffee-by-products-nowadays-and-perspectives",totalDownloads:1169,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Coffee is one of the most consumed products around the world; 2.25 billions of coffee cup are consumed everyday in the world. For coffee crop production, different by-products are produced, such as coffee peel, coffee husk, parchment, and spent coffee grounds. These by-products have several problems associated at the final disposition. In this book chapter, we study the main coffee varieties produced in the world, the by-products produced, and its composition and finally assess the potential of supramolecular solvents (SUPRAS) and water as green solvents for high-added-value compound extractions. Bioactive compounds were extracted from fresh and dried coffee peel in an acceptable rate for industrial applications. SUPRAS offer advantages in terms of rapidity (5 min) and simplicity (stirring and centrifugation at room temperature), thus avoiding costly processes based on high pressure and temperature. Extractions carried out using water as solvent is another technique of extraction mixing temperature (above 60°C) and time (4.5 min) obtained a beverage or solution with presence a bioactive compounds how caffeine, chlorogenic acid and polyphenols.",book:{id:"8952",slug:"coffee-production-and-research",title:"Coffee",fullTitle:"Coffee - Production and Research"},signatures:"Laura Sofía Torres-Valenzuela, Johanna Andrea Serna-Jiménez and Katherine Martínez",authors:null}],mostDownloadedChaptersLast30Days:[{id:"71528",title:"A Detail Chemistry of Coffee and Its Analysis",slug:"a-detail-chemistry-of-coffee-and-its-analysis",totalDownloads:2433,totalCrossrefCites:5,totalDimensionsCites:6,abstract:"This review article highlights the detailed chemistry of coffee including its components; chemical constituents like carbohydrates, proteins, lipids, and caffeine; aromatic principles; oil and waxes; and minerals and acids. The high extent of caffeine can be found in the coffee plants; hence, in the second part of the study, various analytical methods are designed for the proper identification, separation, optimization, purification, and determination of caffeine present in coffee, tea, and marketed coffee. These analytical methods are appropriated for the separation and quantification of caffeine. The various analytical methods include spectroscopy methods like UV, IR, and NMR spectroscopy; chromatographic methods like paper, TLC, column, HPLC, and gas chromatography; and hyphenated techniques like LC–MS, GC–MS, and GC–MS/MS. This article compares and contrasts the amount of caffeine by various analytical methods.",book:{id:"8952",slug:"coffee-production-and-research",title:"Coffee",fullTitle:"Coffee - Production and Research"},signatures:"Hemraj Sharma",authors:null},{id:"70151",title:"The Harvest and Post-Harvest Management Practices’ Impact on Coffee Quality",slug:"the-harvest-and-post-harvest-management-practices-impact-on-coffee-quality",totalDownloads:1885,totalCrossrefCites:3,totalDimensionsCites:7,abstract:"Coffee is one of the most important agricultural commodities in the world. The coffee quality is associated with pre-harvest and post-harvest management activities. Each step starting from selecting the best coffee variety for plantation until the final coffee drink preparation determines the cupping quality. The overall coffee quality influenced by the factors which involve in changes the physicochemical properties and sensorial attributes, including the post-harvest operations. The post-harvest processing activities contribute about 60% of the quality of green coffee beans. The post-harvest operations include pulping, processing, drying, hulling, cleaning, sorting, grading, storage, roasting, grinding, and cupping. This chapter comprises the harvest and post-harvest operations of coffee and their impacts on coffee quality.",book:{id:"8952",slug:"coffee-production-and-research",title:"Coffee",fullTitle:"Coffee - Production and Research"},signatures:"Mesfin Haile and Won Hee Kang",authors:null},{id:"72400",title:"Factors Affecting Efficiency of Vegetable Production in Nigeria: A Review",slug:"factors-affecting-efficiency-of-vegetable-production-in-nigeria-a-review",totalDownloads:823,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Vegetables are important for maintenance of good health; their production and marketing are veritable sources of employment and livelihood. To promote vegetables’ contribution to the above, there is a need for sustainable and efficient production process. The paper reviewed production, socioeconomic factors, and constraint affecting efficiency of production of three important vegetables (tomato, pepper, and onion). The review showed that socioeconomic factors found to increase technical efficiency in vegetable production were educational level, extension contact, and household size. Influence of farmer age on technical efficiency was inconclusive due to varied opinions. Increase in farm size, quantity of seed, amount of fertilizer, and agrochemical were found to have positive influence on output. Majority of the literature reviewed opined that increase in quantity of labour raises productivity; however, it must be utilized efficiently. The mean technical efficiency of the vegetables varied from the southern to the northern part of the country. The cross cutting constraints in vegetables production are pest and diseases, inadequate storage facilities, and high cost of improved inputs. The study recommends increase awareness and sensitization on optimum levels of resource use for increased productivity and appropriate intervention to constraints in the value chain.",book:{id:"10142",slug:"agricultural-economics",title:"Agricultural Economics",fullTitle:"Agricultural Economics"},signatures:"Iyabo Bosede Adeoye",authors:[{id:"317695",title:"Dr.",name:"Iyabo Bosede",middleName:null,surname:"Adeoye",slug:"iyabo-bosede-adeoye",fullName:"Iyabo Bosede Adeoye"}]},{id:"65591",title:"Insect Pest Management in Organic Farming System",slug:"insect-pest-management-in-organic-farming-system",totalDownloads:2666,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Due to the regulations of organic farming, few options remain for organic farmers to manage pests and diseases in their crops compared to conventional farming. However, major pests could still be managed through manipulation of the agroecosystem processes in advantage of the crops and disadvantage of pests. The limited number of active plant protection substances authorized for use in organic farming can provide support to natural and biological control agents in suppression of pests and diseases. This chapter highlights the principles and strategies of crop protection in organic farming, the cultural practices adopted, the active substances allowed for use to suppress pests, and the impacts on faunal and floral biodiversity. A case study of organic date palm cultivation is discussed.",book:{id:"6988",slug:"multifunctionality-and-impacts-of-organic-and-conventional-agriculture",title:"Multifunctionality and Impacts of Organic and Conventional Agriculture",fullTitle:"Multifunctionality and Impacts of Organic and Conventional Agriculture"},signatures:"Hamadttu Abdel Farag El-Shafie",authors:[{id:"192142",title:"Dr.",name:"Hamadttu",middleName:null,surname:"Abdel Farag El-Shafie",slug:"hamadttu-abdel-farag-el-shafie",fullName:"Hamadttu Abdel Farag El-Shafie"}]},{id:"69412",title:"Soil Management and Water-Use Efficiency in Brazilian Coffee Crops",slug:"soil-management-and-water-use-efficiency-in-brazilian-coffee-crops",totalDownloads:821,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Brazil is a world leader in coffee production. However, currently, it coexists with recurrent and severe droughts, accompanied by intense heat, strong insolation and low relative humidity. As the cultivation is carried out primarily in the rainy season, these world climate variations have affected crops yields and fruits quality, requiring innovative actions that promote efficient use of water stored in the soil. Among several soil management practices that promote a more rational use of water, deep tillage combined with liming, gypsum and fertilizer amendments lead to an increase in effective depth of coffee roots, therefore reducing water stress. Moreover, intercropping with Urochloa sp. is highly efficient in enhancing soil structure, water infiltration and plant available water capacity. 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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"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. 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He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. 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He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. 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