The rate of median values of element in Slovak vs. Norway mosses in year 2000
\r\n\tThis book intends to provide the reader with a comprehensive overview of the current state-of-the-art novel imaging techniques by focusing on the most important evidence-based developments in this area.
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He has authored or co-authored peer-reviewed articles and book chapters in the field of cardiac pacing, defibrillation, electrophysiological study, and catheter ablation.",coeditorOneBiosketch:"Raluca Tomoaia is an MD, Ph.D. in novel techniques in Echocardiography at the University of Medicine and Pharmacy in Cluj-Napoca, Romania., assistant professor, and a researcher in echocardiography and cardiovascular imaging.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"191888",title:"Dr.",name:"Gabriel",middleName:null,surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru",profilePictureURL:"https://mts.intechopen.com/storage/users/191888/images/system/191888.png",biography:"Dr. Cismaru Gabriel is an assistant professor at the Cluj-Napoca University of Medicine and Pharmacy, Romania, where he has been qualified in cardiology since 2011. He obtained his Ph.D. in medicine with a research thesis on electrophysiology and pro-arrhythmic drugs in 2016. Dr. Cismaru began his electrophysiology fellowship at the Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, France, after finishing his cardiology certification with stages in Clermont-Ferrand and Dinan, France. He began working at the Rehabilitation Hospital\\'s Electrophysiology Laboratory in Cluj-Napoca in 2011. He is an experienced operator who can implant pacemakers, CRTs, and ICDs, as well as perform catheter ablation of supraventricular and ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation. He has been qualified in pediatric cardiology since 2022, and he regularly performs device implantation and catheter ablation in children. 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The large-scale biomonitoring programs using selected bioindicators were introduced in Slovakia in the end of 1980s. The bioindicators are commonly available elsewhere in the landscape, and the bioindicated air quality parameters can be related to the particular sampling sites within the ecosystems. mosses and foliage of forest tree species [2,3] as biomonitors of atmospheric deposition of heavy metals began in Slovakia more than 30 years ago, in connection with the problems of dying forests.
Moss species such as
Two complementary analytical techniques, instrumental neutron activation analysis (INAA) and atomic absorption spectrometry (AAS) were used for determination of the elemental concentrations in the samples of moss for year 2000. For INAA, moss samples of about 0.3 g were packed in aluminum cups for long-term irradiation or heat-sealed in polyethylene foil bags for short-term irradiation in the IBR-2 reactor, Dubna, described elsewhere [7]. The samples of mosses were not washed before analysis. Sulfur and nitrogen concentrations were determined using LECO corporation equipment (S: LECO SC 132 and N: LECO SC 228). Atomic absorption spectrometry (VARIAN SPECTRA A-300 and mercury analyzer AMA-254) was carried out in Forest Research Institute Zvolen (1990, 1995, 2000, 2005, 2010). The accuracy of data published in paper was verified by 109 individual laboratories and tested by the IUFRO program [8].
The monitoring studies have been undertaken in the framework of the international project Atmospheric Deposition of Heavy Metals in Slovakia Studied by the Moss Biomonitoring Technique Employing Nuclear and Related Analytical Techniques and GIS Technology.
The principal investigator of the project, Dr. Maňkovská (at that time working in the Forest Research Institute in Zvolen, Slovakia) was invited by Scandinavian specialists (Finland, UNIDO, 1986) to join the existing European biomonitoring program focused on monitoring of actual deposition of selected set of elements using analyses of mosses in 1990. The first collection of moss samples of
In the second European moss survey conducted in 1995, moss samples were collected at 78 permanent monitoring sites. In 1996, moss samples were collected at 69 and in 1997 at 74 permanent monitoring sites. The contents of As, Cd, Cr, Cu, Fe, Hg, Ni, Pb, V, and Zn were determined by AAS and Hg was determined by AMA-254.
The third moss survey at the European scale on actual levels of atmospheric deposition of elements was conducted within the ICP Vegetation in 2000. Collection of moss samples (
In the fourth European moss survey in 2005, moss samples (
Concentration of Cd, Cu, Hg, Fe, Pb, and Zn (average in mg/kg) in mosses for Slovakia in 1990, 1995, 2000, 2005, 2010.
So far, in the last, that is, the fifth European moss survey in 2010 in Slovakia, collection of moss samples was made at 68 permanent monitoring sites (
The concentration of Cd, Cr, Cu, Fe, Hg, Ni, Pb, V, and Zn in mosses between 1990 and 2010 are shown in Fig. 1.
The moss biomonitoring technique is based on the fact that the concentration of heavy metals in mosses correlates with the atmospheric concentration. It was proven that it is possible between the concentration of the given element in mosses and the concentration of the same element in the atmosphere. The concentration of individual elements in precipitation was calculated to the time of exposure of mosses (3 years). In case of each element, there was a good linear relationship between the concentrations of a given element in mosses and in precipitation. There is a valid equation [concentration in moss] mg.kg-1 = [4x atmospheric deposition] mg.m-2.year-1 [13]. The concentration of elements in mosses in comparison with Norway (Table 1 and Table 2) is expressed by means of the coefficient of loading by elements KF and classified into 4 classes; class < 1 – elements are within norm and do not exceed the value 1; class 2 – slight loading (elements range from 1 to 10); class 3 – moderate loading (elements range from 10 to 50); class 4 – heavy loading (elements are higher than 50 times higher value).
\n\t\t\t\t | \n\t\t||||
˃1 | \n\t\t\t1-2 | \n\t\t\t2-5 | \n\t\t\t5-10 | \n\t\t\t˃10 | \n\t\t
Br, I | \n\t\t\tCl, Mn, Na, Ni, Se, Rb, U, Zn, | \n\t\t\tBa, Ca, Co, Cr, Cu, Fe, Hg, K, Sm, Tb, Th, Ti, V | \n\t\t\tAl, Au, Ce, La, Sb, Se,Sr, Yb, Pb | \n\t\t\tAg, Cd, Mo, Ta, W | \n\t\t
The rate of median values of element in Slovak vs. Norway mosses in year 2000
Note: KF = contamination factor as the rate of median values of element in Slovak mosses vs. Norvay mosses (Steinnes et al., 2007).
The marginal 2 hot spots were shown in Central Spiš (metallurgical plants), Žiar basin (nonferrous ores processing and aluminium plant). The protected area of Morské oko (chemical industry) is also of great interest. In comparison with the mean Austrian and Czech values of heavy metal contents in moss, the Slovak atmospheric deposition loads of these elements were found to be 2–3 times higher on average. The transboundary contamination by Hg through dry and wet deposition from Czech Republic and Poland is evident in the bordering territory in the north-western part of Slovakia (Black Triangle II), known for metallurgical works, coal processing, and chemical industries. Spatial trends of heavy metal concentrations in mosses were metal-specific. Since 1990, the metal concentration in mosses has declined for cadmium, chromium, cooper, iron, lead, mercury, nickel, and zinc.
Sites | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t|||
< 1 | \n\t\t\t1 -10 | \n\t\t\t10-50 | \n\t\t\t>50 | \n\t\t||
\n\t\t\t\t | \n\t\t|||||
Žiar basin | \n\t\t\tAu, Br,Cl, I, In, Mn, | \n\t\t\tAg, Al, As, Ba, Ca, Cd, Ce, Co, Cr, Cs, Cu, Fe, Hg, K, La, Mg, Mo, Na, Ni, Rb, Sc, Se, Sm, Sr, Tb, Th, Ti, U, V, W, Zn | \n\t\t\tHf, Pb, Sb, Ta, Yb | \n\t\t\tF | \n\t\t\t\n\t\t\t\t | \n\t\t
Central Spiš | \n\t\t\tAu | \n\t\t\tBr, Ca, Cl, In, K, Mg, Mn, Rb, Se, | \n\t\t\tAl, As, Ba, Cd, Co, Cr, Cs, Cu, Fe, Hg, I, La, Mo, Na, Ni Sc, Sr, Th, U, V, W, Zn | \n\t\t\tAg, Hf, Pb, Sb Ta Tb, Yb | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t|||||
Nízke Tatry | \n\t\t\tAu, Br, I, Mg, S, Se, Sm,Ti | \n\t\t\tAg, Al, As, Ba, Ca, Cd, Ce, Cl, Co, Cr, Cs, Cu, Fe, Hg, In, K, La, Mn, Mo, N, Na, Ni, Pb Rb, Sb, Sc, Sr, Ta, Tb, Th, U, V, W, Yb, Zn, Zr | \n\t\t\tHf | \n\t\t\t\n\t\t\t | \n\t\t\t\t | \n\t\t
Vysoké Tatry | \n\t\t\tAu, Br, Ca, I, Se | \n\t\t\tAg, As, Ba, Cd, Ce, Cl, Co, Cs, Cu, Fe, Hg, In, K, La, Mg, Mn, Mo, N, Na, Ni, Pb, Rb, S, Sc, Se, Sm, Sr, Tb, Th, Ti, U, V, W, Zn | \n\t\t\tAl, Cr, Sb, Ta, Yb, Zr | \n\t\t\tHf | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t|||||
Veľká Fatra | \n\t\t\tAu, Br,In Sm | \n\t\t\tAg, Al, As, Au, Ba, Ca, Cd,Ce, Cl, Co, Cs, Cu, Fe, Hg, I, K, La, Mg, Mn, Mo, N,Na, Ni, Pb Rb, S, Sc, Se, Sr, Ti, U, V, W, Zn | \n\t\t\tCr, Sb, Ta, Tb, Th, Yb, Zr | \n\t\t\tHf | \n\t\t\t\n\t\t\t\t | \n\t\t
Báb | \n\t\t\tAu, Br, In, Mg, N, S, Se | \n\t\t\tAg, As, Ba,Ca, Cl, Co, Cr, Cs,Cu, Fe,Hg, I, K, Mn, Na, Ni, Rb, Sm, Sr, Ti, U, V, W, Zn | \n\t\t\tAl, Cd, Ce, La, Mo, Pb, Sb, Sc, Ta, Tb, Th,Yb, Zr | \n\t\t\tHf | \n\t\t\t\n\t\t\t\t | \n\t\t
Slovenský raj | \n\t\t\tAu, Br, In Sm, Se | \n\t\t\tAl, As, Ba, Ca, Cd, Ce, Cl, Co, Cr, Cs, Cu, Fe, I, K, La, Mg, Mn, N, Na, Ni, Rb, S, Sc, Sr, Th, Ti, U, V, W, Zn | \n\t\t\tAg, Hg, Mo, Pb, Ta, Tb, Yb, Zr | \n\t\t\tHf, Sb | \n\t\t\t\n\t\t\t\t | \n\t\t
Poľana | \n\t\t\tAu | \n\t\t\tBr, Ca, Cl, Cu, In, K, Mg, Mn, Na, Rb, Se, Zn | \n\t\t\tAg, Al, As, Ba, Cd, Co, Cr, Cs, Fe, Hg, I, La, Mo, Ni, Pb, Rb, Sc, Sr, Ta, Tb, Th, U, V, W, Yb | \n\t\t\tSb, Hf | \n\t\t\t\n\t\t\t\t | \n\t\t
Morské oko | \n\t\t\tAu | \n\t\t\tBr,Ca, Cl, In, K, Mg, Mn, Rb, Se, Zn | \n\t\t\tAg, As, Ba, Cd, Co, Cr, Cs, Cu, Fe, Hg, I, La, Mo, Na, Ni, Pb, Sr, U, V, W | \n\t\t\tAl, Hf, Sb, Sc, Ta, Tb, Th, Yb | \n\t\t\t\n\t\t\t\t | \n\t\t
Coefficient of loading by elements KF in the year 2000
The temporal trends in the concentration of Cd, Cr, Cu, Fe, Hg, Ni, Pb, V, and Zn between 1990 and 2010 were observed. In general, the concentration of Cd, Cr, Cu, Fe, Hg, Ni, Pb, V, and Zn in mosses decreased between 1990 and 2010; the decline was higher for Pb than for Cd. The observed temporal trends for the concentrations in mosses were similar to the trends reported for the modeled total deposition of cadmium, lead, and mercury in Europe. The level of elements determined in bryophytes reflects the relative atmospheric deposition loads of the elements at the investigated sites. Factor analysis was applied to determine possible sources of trace element deposition in the Slovakian moss. In the industrial area of Central Spiš, in comparison with the Norwegian limit values (Central Norway is considered a relatively pristine region), exceeded levels for Al, As, Ca, Cd, Cl, Co, Fe, K, Mn, Sb, Sm, Sr, W, and Zn were found.
Moss surveys can provide quick and cheap information about spatiotemporal changes of the current deposition rates of about 40 chemical elements across the country. Figures from the moss surveys may be the only data about elemental deposition rates that have not been determined at measurement stations of air quality (e.g., Be, Li, Se, Tl, Th, and REEs).
Moss biomonitoring is an effective tool for detecting effects of new technologies on deposition zones in the vicinity of emission sources. All results of the Slovak moss surveys were accepted and stored in the UN ECE ICP-Vegetation database for checking of deposition loads in Europe and their environmental effects.
On the basis of biomonitoring using 3-year-old segments of
The concentration of elements (in parentheses) is more than 50 times higher at sites Báb (Hf), Poľana (Hf, Sb); Vysoké Tatry (Hf); Slovenský raj (Hf, Sb); Veľká Fatra (Hf); Central Spiš (Ag, Hf, Pb, Sb Ta Tb, Yb); Žiar basin (F), and site Morské oko (Al, Hf, Sc, Sb, Ta, Tb, Th, Yb) compared to the Norwegian values.
Air pollutants KF varies in the range of 4–45 (4.2 – Nízke Tatry; 6.2 – Žiar basin; 6.7 – Vysoké Tatry; 7.6 – Veľká Fatra; Báb – 8.8; 11.8 – Slovenský raj; 19 – Poľana; 44 – Morské oko; and 45 – Central Spiš). Results of biomonitoring campaigns serve as a reliable basis for planning and long-term exploitation of the landscape of the country and for further environmental investigations.
This article was made possible with the financial support of grant APVV-0663-10, VEGA and by the grant of the Plenipotentiary of the Slovak Republic at the Joint Institute for Nuclear Research, Dubna, Russian Federation.
Total knee arthroplasty is an effective treatment option which has been applied with increasing rates in recent years with its highly satisfactory results. Recently increased total knee arthroplasty (TKA) procedures increase the number of complications too. In addition to proper patient selection, an accurate surgical technique, early diagnosis, and proper management of complications are required. Complications of TKA have a wide range. Complications vary from small skin problems to mortality. The development of complications may be due to many factors. Some of these are listed below:
Error in surgical technique.
Medical error.
Nurse error.
Patient non-compliance.
Trauma.
Associated comorbid diseases.
Reviewing all the risk factors before surgery and being prepared for the complications that may occur may be lifesaving in TKA, which is currently applied frequently. It is important to recognize, identify, and classify the complications in a timely manner in the correct and effective management of complications. The ambiguity about the complications of TKA in the literature helped identify and classify the complications in a study conducted in 2013 by the knee community [1]. According to this study, 22 complications were described. These are [1]:
Bleeding
Wound problems
Thromboembolism
Neural deficit
Vascular issues
Medial collateral ligament injury
Instability
Malalignment
Stiffness-toughness-contracture
Deep wound infection
Fracture
Extensor mechanism injury
Patellofemoral dislocation
Tibiofemoral dislocation
Bearing surface wear
Osteolysis
Implant loosening
Implant breakage
Reoperation
Revision
Re-hospitalization and mortality [1]
When the complications are examined, it is seen that some of them are simple and easy to overcome with a short-term solution, while some of them can be serious and can go to revision arthroplasty. The number of complications such as implant fracture and polyethylene surface wear has been reduced due to the techniques and innovations in implant materials and designs. In a study, it was shown that the most common cause of revisions in the first 5 years postop was infection, and the reasons for revision in the next 5 years were polyethylene loosening [2]. Complications will be classified as intraoperative, early postoperative, and late postoperative complications (\nTable 1\n\n
Intraoperative | \nEarly postoperative | \nLate postoperative | \n
---|---|---|
Vascular injuries | \nBleeding | \nInstability | \n
Neurological complications | \nSuperficial skin problems | \nJoint stiffness | \n
Extensor mechanism injury Patellar tendon injury Quadriceps tendon injury Patella fractures | \nDeep skin problems | \nPeriprosthetic joint infection | \n
Deep vein thrombosis | \nPeriprosthetic fractures | \n|
Pulmonary embolism | \nAseptic loosening | \n|
\n | Osteolysis | \n|
Medial collateral ligament injury | \n\n | Patellofemoral joint problems | \n
Intraoperative, early postoperative, and late postoperative complications.
Although arterial injury during knee replacement is rare, it may have serious results from limb loss to mortality. Arterial injuries can be seen as thromboembolism, direct vascular laceration, pseudoaneurysm, and arteriovenous fistula [3]. The incidence is reported to be 0.03–0.2% in the literature [4].
\nVascular injuries may develop due to the thermal effect of cement polymerization, joint manipulations, dislocations, and excessive manipulation [5]. Considering the issue as specific to the total knee arthroplasty, care should be taken against vascular injury during posterior cruciate ligament and posterior capsular release during femoral condylar cutting. Atypical localization of vascular structures due to changes in adhesions and normal anatomy in revision cases increases the risk of vascular injury twice as compared to primary cases [6]. Nowadays, increasing procedures of TKA bring about the possibility of vascular injuries although they are rare. Therefore, it is necessary to take precautions against vascular injuries that may develop, to identify risky patients and to make an early diagnosis. For this, a good anamnesis and physical examination are essential. It is important to examine the presence of hypertension, diabetes, smoking, and vascular claudication. Coldness of the extremities to be operated during physical examination, skin atrophy and thinning, prominent vascular structures, ulcerative wound, and distal arterial pulse weakness are the findings that need attention. In addition to these findings, the presence of vascular calcifications in radiological scanning, a history of bypass, and an ankle-brachial index below 0.9 are other findings that should be considered. No tourniquet should be used in patients with the abovementioned conditions [7]. Embolism and arterial insufficiency may develop due to tourniquet effect in patients with vascular disease and atheroma plaque in the superficial artery [8]. It has been shown that during the manipulation of the superficial femoral artery fixed during tourniquet effect, intimal damage may occur [9]. Improper placement of retractors can also cause damage by direct mechanical trauma [10]. Particularly during insertion of the posterior retractor, a 1 cm area in the lateral portion of the midline was identified as a risky area [11]. In a cadaver study, neurovascular structures on the tibial side were mapped on a clock diagram. Accordingly, the popliteal vein at 12 o’clock, the popliteal artery at 1 o’clock, and the anterior tibial artery at 2 o’clock for the left knee were shown as in place [12]. Cautious use of the saw between 11 and 3 o’clock defined in the tibial cutting is important in protecting vascular structures [12].
\nIf vascular injury is suspected the tourniquet should be deflated, and bleeding control should be performed before the incision is closed. The possibility of arterial injury should be taken into consideration in the presence of excessive and pulsatile bleeding and in the absence of peripheral pulses. Although recent studies suggest bleeding control after routine tourniquet deflation prior to incision, its benefit is controversial [13]. The surgeon should perform a postoperative peripheral pulse examination routinely, suspect acute ischemia in the presence of cold and delayed distal capillary filling, and request cardiovascular consultation [14]. Acute ischemia cases with delayed diagnosis of 4–6 hours cause irreversible damage. Prophylactic fasciotomy is performed after revascularization [14].
\nPseudoaneurysm may present with pulsatile swelling in the popliteal fossa due to direct damage to the popliteal artery during surgery. Doppler ultrasonography is useful in the diagnosis. In the treatment, excision of the lesion and repair with vascular graft is applied after embolization [15]. Arteriovenous fistula is less common. It usually occurs due to injury to the medial and lateral geniculate arteries and its branches. It may present with pulsatile swelling in the popliteal region that gives “trill.” Hemarthrosis or pseudoaneurysm may develop. Ultrasound and angiography are used for diagnosis [16]. The detected lesions should be evaluated together with cardiovascular surgery, and treatment should be planned. Embolization, lesion excision, and graft repair are treatment options [15].
\nNerve injuries are rare during TKA. Peroneal nerve injury is the most common of these [17]. Sacral plexopathy and sciatica neuropathy are also seen, although rarely [18]. Risk factors for neurological injury are [19]:
Flexion deformity
Advanced valgus deformity
Presence of an intra-articular hematoma
It has been shown that the risk of nerve injury is increased in patients with rheumatoid arthritis [20]. However, none of these risk factors is directly related to nerve injury [18]. Nerve injury is associated not only with the surgical procedure but also with the anesthesiologist-induced regional anesthesia [21]. Hypertension, diabetes, nerve compression history, presence of tethered cord, and rheumatoid arthritis in the patients increase the risk of neural complications secondary to regional anesthesia [22]. The duration of tourniquet use was associated with nerve injuries. According to this, in the tourniquet applications exceeding 2 hours, the risk of peroneal and tibial nerve injuries including 89% peroneal nerve was determined as 7%. All of these have been shown to get recovery. In procedures exceeding 2 hours, the 10–30-minute break and deflation of the tourniquet reduces the complication rate [19]. Although there is a minimal effect on the functional results of the patients effect on the functional results of the patients during the follow-up, paresthesia and numbness are seen in the distal and lateral site of incision due to the injury of the infrapatellar branch of the saphenous nerve. It is seen in the literature at a rate of 25–76%, and most of these recover spontaneously [23]. Nerve injuries are difficult to detect intraoperatively. In the presence of postoperative nerve injury, physical therapy should be planned immediately. EMG examination is recommended after 3 months [20]. If no improvement is observed, nerve exploration may be planned in the future.
\nThe extensor mechanism in the knee joint consists of quadriceps muscle group, quadriceps tendon, patella, patellar retinaculum, patellar tendon, and tuberositas tibia. Extensor mechanism integrity may be impaired during surgery [20]. Although extensor mechanism injuries occur more frequently postoperatively, they may also occur intraoperative. The incidence is reported to be between 1 and 12% [24]. The treatment of extensor mechanism injuries is quite difficult and the results are not satisfactory.
\nRupture usually occurs at the site of insertion to the tuberositas tibia. The risk of development is less than 1% [25]. Less frequently, intratendinous and infrapatellar tendon rupture may also occur [25]. The risk of injury increases when patellar tendon mobility decreases. These are [26]:
Patella baja
Previous surgery
Severe limitation of movement in the knee
The risk of tendon injury especially on stiffness knees due to forced manipulations and during the tibial bone cutting increases during surgery. The most common injury mechanism after surgery is falling onto the knee while knee is flexed [27]. Patellar tendon injury without trauma is seen by weakening the tendon after repeated contact of the polyethylene insert [27].
\nIn patients with patellar tendon rupture, pain, swelling, loss of extension, and a palpable defect at the infrapatellar side are detected.
\nAge, functional status, tendon rupture localization, and soft tissue status are the determinants of the treatment. Splitting and bracing are considered in patients who do not have functional expectations and are unsuitable for surgery [28]. Treatment of acute patellar tendon rupture intraoperative is primary repair [26]. Several techniques have been described using staple and suture anchors for this purpose [28]. Reconstruction techniques are used in patients with poor soft tissue quality. For this purpose, biological materials (hamstring tendon autograft, achilles, peroneal tendon autograft, and extensor mechanism allograft) and synthetic materials can be used [28, 29, 30].
\nIt is very rare. It is especially seen as a rupture from the intersion side to the patella. Excessive patella cutting, previous quadriceps snip, or V-Y tipping are risk factors [28]. The clinical finding is similar to patellar tendon rupture.
\nGood results have been reported with plaster cast in partial tears [31]. Extensor loss greater than 20° is considered a complete tear and should be treated surgically. It has unsatisfactory results due to high complication rates and tendency to re-rupture depending on tendon quality and soft tissue condition.
\nPatellar fractures are the most common injury among the extensor mechanism injuries [24, 32]. In general, the risk increases with excessive bone cutting while preparing for patellar component. Patellar fracture may occur by direct trauma to the anterior knee or as an avulsion due to the pull of the quadriceps muscle [32].
\nFor diagnosis, pain, swelling, and extensor insufficiency are detected in front of the knee. Lateral knee radiography and tomography in case of clinical suspicion are helpful imaging methods for the diagnosis.
\nA classification has been developed to assess implant stability and extensor mechanism continuity for periprosthetic patella fractures [33]. Type 1, a stable implant and continuous extensor mechanism; Type 2, a stable implant but a discontinuous extensor mechanism; and Type 3, which indicates instable implant and discontinuous extensor mechanism. Patellar bone stock is classified as 3A if good and 3B if poor. Treatment is also determined according to this classification. Conservative treatment methods are preferred for type 1 cases, while surgical treatments are preferred for types 2 and 3 [33]. In recent studies, it is reported that 40–50% of complications occur and more than half strength loss of extensor mechanism is observed [34].
\nDuring total knee replacement, medial collateral ligament (MCL) is important for soft tissue stabilization and coronal plan stability. The incidence of iatrogenic MCL injury is 2.2–2.7% [35]. In the case of surgical injuries, direct repair, constrained prosthesis use, and even revision at the same session are among the options [36]. Unrecognized MCL injuries during surgery cause early instability. This leads to early implant wear and consequently the need for early revision. Therefore, it is important to diagnose and repair the injury during surgery [37]. Sudden instability in the valgus stress test during knee stabilization indicates MCL injury. Injury may occur from femoral insertion, within the tendon or tibial insertion [38]. Primary repair technique varies according to injury level. Fixation with screw is recommended if MCL injury occurs from its femoral insertion site. Otherwise, if it is through tendon, repairing with insoluble suture technique is recommended. Finally, if MCL injury occurs from its tibial insertion site, both insoluble suture anchor technique and fixation with staple technic are recommended [39, 40]. Factors that increase the risk of medial collateral ligament injury during surgery are as follows [39]:
Using a larger saw blade than femoral condyle
Delayed excision of medial side osteophytes
Performing challenging manipulations of varus-valgus
Patients with flexion contractures [39]
Patient-related risk factors include obesity and severe deformities [41, 42].
\nA certain algorithm has not yet been established for the treatment of iatrogenic MCL injuries that occur intraoperative. Many treatment methods with disadvantages and advantages have been used [39, 43, 44]. The traditional method is using constrained prosthesis. However, in this method, it was shown that the stress load on the implant increased and direct repair and treatment with non-constrained prosthesis were recommended instead. In addition, augmentation or increase in polyethylene thickness has been proposed [45]. In one study, it was shown that the risk of instability was 57% in the use of non-constrained prostheses independent of the repair technique after MCL injury [37]. In a 2016 study, four treatment modalities were compared after MCL injury. These are the use of non-constrained prosthesis only, the use of non-constrained prosthesis with primary repair, the use of non-constrained prosthesis only, and the use of constrained prosthesis with primary repair. In 23 patients, the most appropriate treatment method according to the knee community scoring was found to be the use of constrained prosthesis only [46]. However, due to the small number of patients, larger series of studies are needed to determine which treatment is most appropriate.
\nBleeding is seen in varying rates between 0 and 39% after TKA [47]. This naturally increases the need for blood transfusion. Intraoperatively, care should be taken about bleeding and good bleeding control is established. Thus, the amount of bleeding is reduced to a minimum. As a result, the risks of immunological reaction due to transfusion are reduced.
\nBleeding tolerance is low in patients with comorbid disease and in patients with insufficient cardiac capacity, and the risk of complications increases even in small amounts of bleeding. Preoperative blood preparation before surgery and limitation of the use of anticoagulants are among the measures that can be taken. Precautions during and after TKA surgery can reduce the amount of bleeding. These methods are as follows:
Use of femoral intramedullary plugs [48]
Hypotensive anesthesia [49]
Cryotherapy and Jones bandage [50]
Application of tranexamic acid [55]
Fibrinolysis is activated by surgical trauma and tourniquet use [56]. Increased fibrinolytic activity causes increased bleeding during TKA. Tranexamic acid shows an anti-fibrinolytic effect by inhibiting the conversion of plasmin to plasminogen [57]. Tranexamic acid can be administered in four different ways: intravenous, oral, intramuscular, and intra-articular [55]. Transition to maximum plasma levels is 30 minutes for intramuscular use, 5–15 minutes for intravenous use, and 2 hours after oral use [58]. Patients with total knee arthroplasty may be treated with a fast-acting intravenous route. Many studies have shown that administration of tranexamic acid after tourniquet deflation and postoperative dose repeat reduces the amount of bleeding and the need for transfusion [59, 60, 61]. However, many different protocols for the use of tranexamic acid have been implemented. Preoperative single dose and repeated dose every 8 hours for 3 days have been described in the literature and shown to be effective [62]. In a study conducted in 2011, tranexamic acid was administered at a dose of 10 mg/kg 10 minutes before the tourniquet was opened, and the same dose was repeated 3 hours postoperatively. Five hundred mg tranexamic acid was administered orally 3 times a day for 5 days. At the end of this study, it was shown that the amount of hemorrhage and the rate of transfusion decreased effectively [55].
\nThe incidence of wound problems after TKA is 1–25% [63]. The skin problems may be delayed wound healing, skin necrosis, traumatic or atraumatic separation of the lips of the wound, prolonged serous discharge at the wound site, formation of superficial or deep hematoma, allergic reaction to patch, suture material or dressing materials, bullae formation, fat necrosis, bleeding, keloid formation, and superficial or deep infection [64].
\nEtiologic reasons that may develop the problem before TKA should be determined in advance, and appropriate measures should be taken [65]. Presence of systemic diseases such as diabetes, hypertension, rheumatoid arthritis, and vascular insufficiency, which may adversely affect wound healing before TKA, should be questioned. Since the soft tissues around the knee are thinner than the other parts of the body, even the smallest problem that may occur at the wound site can cause serious complications. Incision planning should be made carefully in the case of a history of operation from the same place and scarring beforehand, and if necessary, plastic surgery assistance should be taken.
\nFactors adversely affecting wound healing are obesity, hypertension, diabetes, smoking, chronic drug use, steroid use, previous radiotherapy, scarring, inflammatory disease, malnutrition, albumin levels below 3.5 g/dl, and hemoglobin levels below 10 g/dl. Transferrin and lymphocyte levels may also contribute to wound healing problems [66]. Therefore, a detailed anamnesis and physical examination and laboratory examination before surgery give an idea about possible skin problems. Accordingly, measures are taken, replacement therapies are given, and surgery may be postponed until the current pathology is corrected, if necessary. Adjustment of fasting blood sugar levels below 200 g/dl and keeping HbA1C below 6.5 in patients with diabetes will reduce the risk of possible wound problems [67].
\nPatients with a body mass index above 30 kg/m2 are 6 times more likely to have infection and wound problems [66]. In obese patients, dietician support should be given before surgery; unnecessary exclusion should be avoided during surgery, and soft tissue surgery should be applied carefully.
\nA study of smoking patients showed that there were 2 times more wound problems [65]. Because of the vasoconstrictor effect of nicotine in the cigarette, it is recommended to quit smoking 60 days before surgery due to decreased blood supply at the wound site.
\nIncision planning should be performed in the presence of scar after previous surgery. In the presence of a single longitudinal incision without problems, the same incision should be used. If the old incision cannot be used, a distance of at least 7–8 cm should be left. If there is more than one old incision scar in the anterior part of the knee, the most lateral scar is used considering that the anterior knee feeding is from the medial perforating artery. In addition, the lateral soft tissue flap should not be dissected too much [65]. Unnecessary retractors and additional soft tissue damage should be avoided during surgery. The wound lips should be exactly opposite to each other. Overstretched closing should be avoided. This should be checked with capillary filling time.
\nEspecially in patients with risk factors, it should be performed without tourniquet or at low pressures [65]. Difficult rehabilitation in the early postoperative period should be postponed if possible until it is ensured that there are no wound problems.
\nHematoma formation increases the risk of infection [65]. Therefore, measures should be taken to prevent the formation of hematoma. These include no dead space during wound closure, good bleeding control, use of a Jones bandage, and avoidance of overdose of the prophylactic anticoagulants used [65, 68]. Once the hematoma has developed, a needle aspiration can be performed. However, if the hematoma is organized and the drainage cannot be achieved, discharge and debridement can be achieved by arthrotomy under operating room conditions.
\nThe presence of necrosis in the wound leads to catastrophic consequences. Respect to soft tissue is the most important step to prevent necrosis development. The depth of necrosis is important. Superficial necrosis can be treated by local intervention. If larger, debridement and full-thickness skin grafts or fasciocutaneous flaps are required [69]. If necrosis includes full-thickness soft tissue, closure with fascial skin or muscular skin graft should be performed after urgent aggressive debridement [70].
\nDespite all current precautions, surgical site infections remain the most serious and feared complications of TKA. After TKA, patients should be followed up with daily dressings, and wound discharge should be evaluated carefully. Prolonged wound discharge is defined as a discharge that lasts more than 48 hours regardless of the amount of drainage [64]. Wet wounds greater than 2×2 cm are considered abnormal after 72 hours and are associated with fat necrosis, hematoma, necrosis, or poor closure of the fascia. They are reported as 1–10% after primary knee replacement [65]. In the early stage of treatment, usually dressing and immobilization for 3–5 days is recommended [71]. Continuous discharge for 72 hours is dangerous. If it exceeds 5 days, debridement should be applied in operating room conditions as it will increase the risk of superficial or deep infection [64].
\nSuperficial infection: It is defined as infection of the soft tissue above the skin—subcutaneous and deep fascia that has not passed under the deep fascia, not opened into the joint cavity. It occurs most frequently in the first 30 days after surgery. The incidence of superficial infection after TKA has been reported as 10% [72]. It may occur through direct contamination or blood. Improper preparation of direct contamination sterilization environment, inadequate surgical field preparation, presence of sloppy surgical team, non-sterile dressing materials, and application may occur as a result of the presence of infected patients in the same environment [73]. The risk of direct contamination can be minimized by precautions. Hematogen contamination can occur if there is any other focus of infection in the body. Therefore, in the presence of a possible infection focus with detailed anamnesis and examination before the operation, the current focus treatment can be planned through detailed examination.
\nInfection after TKA can be evaluated as patient-related risk factors, surgical intervention-related factors, and postoperative factors [66, 68, 74, 75, 76, 77].
\n
\n
\n
Superficial wound infection is considered with the presence of at least one of the following: discharge from the wound incision, culture of the wound from aseptic conditions, suspicion of infection in clinical evaluation, disproportionate pain, increased temperature, erythema, and localized swelling [79].
\nIn superficial wound infection, unlike deep infection, there is no progressive change in erythrocyte sedimentation rate, C-reactive protein level, and peripheral leukocyte count; the increase is below 25% [82]. In addition, leukocytes in synovial fluid are detected less than 2000/ml, and polymorphonuclear leukocytes are detected under 50%. Alpha defensin and leukocyte esterase tests are negative [71].
\nWhen superficial wound infection is detected, the development of deep infection can be prevented by early intervention. Otherwise, it may develop into periprosthetic infection and cause catastrophic results. In the presence of superficial infection, local wound care due to the underlying cause and debridement should be performed if appropriate anti-therapy is required [80]. In the selection of antibiotics, consultation with infectious diseases should be requested. Antibiotherapy is continued after reproduction. If deep infection is excluded in surgical debridement, the joint should not be opened, and the implant should not be touched [83]. Hyperbaric oxygen therapy has a positive effect on appropriate patient selection [84].
\nDeep vein thrombosis is the general name of thrombosis in the venous circulatory system. It occurs most commonly in the deep veins of the lower extremity [85]. From asymptomatic deep vein thrombosis to pulmonary embolism, which can be fatal, it can be confused with clinical manifestations of varying degrees [85]. It is one of the important complications that increase morbidity and mortality after TKA [86]. Even with mechanical or pharmacological methods, the incidence of asymptomatic DVT is 5.1%, and the incidence of symptomatic DVT is 0.4% [87]. The mortality rate due to pulmonary embolism after TKA is 0.08% [88].
\nIt is important to understand the Virchow triad in the pathogenesis of DVT development. There is a slowdown in blood flow (stasis), endothelial damage, and hypercoagulability [89]. The admixture of fat and bone marrow particles into the venous system after engraving of the femoral canal during TKA explains the hypercoagulability branch of the Virchow triad. Hyperflexion of the leg during surgery and anterior manipulation of the tibia with retractors explain endothelial damage. In addition, this manipulation causes obstruction of the popliteal veins and prolonged immobilization of the leg, leading to venous pooling and stasis [89].
\n\n
VTE risk increases after age of 40 and doubles every 10 years after that age [90]. Age increases the risk of VTE regardless of other risk factors.
Genetic factors are also an important parameter that increases the risk of DVT. Factor V Leiden mutation that causes thrombophilia, as well as protein C, protein S, and antithrombin III deficiency are among the factors that increase the risk of DVT.
Although tourniquet use has been reported to cause venous stasis, it has been shown that it does not significantly increase the risk of DVT because of its fibrinolytic effect [91, 92].
The type of anesthesia also affects the risk of developing DVT. General anesthesia has been shown to increase the risk of DVT compared to neuraxial anesthesia (spinal or epidural). Neuroaxial blockade causes vasodilatation in the lower extremities and reduces venous pooling; therefore it explains the mechanism of action [93].
Other risk factors that increase the risk of DVT are immobilization, smoking, oral contraceptive and hormone use, history of VTE, obesity, malignancy, and difficult knee manipulations.
A painful, swollen, and reddened leg after TKA should suggest the possibility of DVT. Incomplete DVTs usually do not show signs. Incomplete DVTs are seen especially after arthroplasty. Clinical findings are seen in 1% of all DVT cases. Physical examination findings include redness, swelling, and Homan’s sign test and Pratt test positivity. Clinical Wells risk score was established for the diagnosis of deep vein thrombosis [94]. Clinical Wells Scoring criteria are malignancy, paralysis (paresthesia or splinting lower extremity), immobilization for more than 3 days, localized tenderness in the deep venous system, swelling of the lower extremity, 3-cm-diameter differentiation from the other leg, pretibial gode positive edema, history of deep vein thrombosis, and collateral superficial veins. The presence of each risk factor was evaluated as 1 point, and clinical scoring of 3 and above was found to be a high risk for the development of deep vein thrombosis.
\nClinical data are not sufficient for the diagnosis of DVT. Therefore, further examination with clinical risk scoring, D-dimer level, Doppler ultrasonography, contrast-enhanced venography, CT, and MRI should be performed. Venography is the best method for the diagnosis of DVT in the lower extremities. The accuracy rate was 97% in the lower extremity veins and 70% in the iliac veins [95]. Venography is not preferred as first-line imaging because it has a 3% risk of DVT and is an invasive method, and also it requires contrast matter that can be toxic to the kidneys. Doppler USG is the most commonly used first-line imaging method because of its cheapness, reproducibility, and patient comfort in the suspicion of DVT. Proximal DVT sensitivity was 96%, distal DVT sensitivity was 44%, and DVT specificity was 93% [96].
\nPulmonary embolism should be suspected in the case of sudden shortness of breath, tachypnea, tachycardia, and chest pain after TKA. However, since there are many other diseases with these findings, risk factor assessment and effective differential diagnosis should be made. Wells pulmonary embolism clinical probability scoring was established [97]. Pulmonary angiography is the gold standard for the diagnosis of pulmonary embolism [85].
\nPrimary treatment of DVT and related pulmonary embolism is very difficult and cost-effective. Therefore, it is more plausible to establish protocols that prevent the development of DVT and to give ideal prophylaxis. Many pharmacological and mechanical prophylaxis methods are available. The aim is to prevent the development of DVT and not to increase bleeding. Therefore the drug or method of choice should be patient-specific:
\n
\n
\n
\n
\n
Other oral anticoagulants that may be used:
The development of instability after TKA is the third most common cause of revision (17%) after aseptic loosening and infection [102]. Patients present with signs of pain and swelling with movement and weight loss. There may also be pain, emptiness, or abnormal friction and rattling noise in some range of motion. On the knee during walking, varus or valgus orientation and recurvatum can be seen. Anterior knee pain during sitting up is typical in flexion instabilities. The heaviest table is knee dislocation. The treatment of instability is revision surgery. However, the rate of recurrent instability after revision was 18–60% [103]. This high rate is usually due to the lack of correct identification of the cause of instability.
\nA clinical classification of knee instability was established. Components of this classification are flexion-extension gap mismatch, component alignment problem, isolated ligament failure, extensor mechanism failure, component loosening, and global instability [103].
\nThe success of total knee replacement depends on the correct alignment of the lower limb mechanical axis. It is recommended that the postoperative lower limb mechanical axis should be in neutral alignment. The tibial cut surface in the coronal plane should be made perpendicular to the mechanical axis of the tibia. Similarly the femoral cut in the coronal plane should be made perpendicular to the mechanical axis of the femur. It is necessary for a stable knee to obtain a rectangular gap in both flexion and extension after bone incisions and soft tissue release in TKA. Balancing the gaps is important to ensure stability and for full range of motion. Flexion gap controlled by posterior femoral condylar cut and tibial cut. Extansion gap controlled by distal femoral condylar cut and the tibial cut. If there is a symmetric gap problem, tibial bone cut is adjusted first; otherwise if there is asymmetric gap problem, adjust femoral bone cut first. For example, if the knee is tight both in extension and flexion, it is called symmetrical gap problem, and its solution is to cut more proximal tibia. The asymmetric gap is one of the most common causes of instability. In some patients, the underlying cause increases the risk of instability. These reasons can be listed as follows:
Knee with advanced deformity.
Regional muscle weakness.
Neuromuscular disease.
Internal side ligament or posterior cruciate ligament failure.
Obesity and rheumatoid arthritis.
Charcot arthropathy
It is necessary for a stable knee to obtain a rectangular gap in both flexion and extension after bone incisions and soft tissue release in TKA. If the cavity is larger than the prosthesis, the term symmetrical discrepancy is used. The reason for this instability is that the distal femoral incision or the tibial incision is more than necessary [85].
\nIf the tibial incision is excessive, both extension and flexion will be loose. If this condition is noticed intraoperatively, it is thought that the problem is solved with a thicker insert, but in fact, both the patellofemoral joint problems can arise as the joint line will go down more inferiorly and the early relaxation and fixation problems can arise because the tibial component will sit on the narrower surface.
\nIf the distal femoral incision is excessive, there will be looseness in the extension range. The use of a thick insert during surgery will improve the looseness of the extension, but there will be tightness in flexion [104]. In addition, as the joint line will increase, both the effective distance of collateral ligament will decrease, and patellofemoral joint problems will occur. Therefore, if the distal femoral incision is excessive, the use of distal femoral augment should be preferred instead of the use of a thick insert [105].
\nAsymmetric mismatches occur when the joint space is trapezoidal rather than rectangular. It occurs mostly during surgery after excessive loosening of the soft tissue and is most commonly seen in extension. In this case, the transition to the restrictive prosthesis should be considered [106].
\nOne of the reasons that greatly affect patient satisfaction after TKA operations is the amount of joint range of motion. To achieve good results, a flexion range of at least 90° is required. Sixty-five degrees of flexion is required during walking; 106° of flexion is required when sitting on a chair and tying shoes. Postoperative limited and painful joint movements significantly reduce patient comfort. A flexion range of less than 90° for 6 weeks after TKA surgery is defined as a rigid knee [107].
\nHip osteoarthritis, heterotropic ossification, and reflex symptomatic dystrophy can be considered as independent factors. Inadequate posterior femoral incision and inadequate medial collateral ligament releasing of the knee with severe varus deformity may be among the causes for a rigid knee due to surgical technique [108, 109]. In one study, it was observed that joint stiffness occurred more frequently than unilateral knee arthroplasty in patients who underwent bilateral total knee arthroplasty in the same session, and manipulation was required under anesthesia [110].
\nExcessive tight extension and flexion gap, tight PCL, malrotation of components, and inadequate tibial slop angle may lead to joint stiffness [108].
\nOne of the most important indicators of joint stiffness is the extremely limited range of motion in the knee before surgery [109]. The range of motion obtained within the surgery should be considered in the determination of joint stiffness. A sudden loss of motion should suggest a mechanical problem, loosening, and infection.
\nArthrofibrosis is the most treatment-resistant cause of joint stiffness. It develops due to excessive increase of fibrous tissue in the joint [108].
\nThe strongest determinant of postoperative flexion movements is the degree of preoperative flexion. Other than that, age, preoperative diagnosis, and severity of deformity are other factors [111].
\nThe efficacy of conservative treatment is limited in joint stiffness after TKA. Aggressive range of motion improvement of 3.1° was observed with aggressive physical therapy for almost 1 year [112]. It has been shown that the use of continuous passive motion device (CPM) in the early postoperative period reduces bleeding and is beneficial in preventing joint stiffness by reducing the formation of fibrosis [113].
\nAlthough there is no consensus in the literature, manipulation under anesthesia should be performed in cases where knee flexion is below 90° between 2 weeks and 3 months. Revision rates are lower in patients with early manipulation [114]. Manipulation is performed under general anesthesia using a muscle relaxant until the knee and hip reach at least 90°. After this procedure, an average gain of 30–47° was reported [115].
\nIf the joint movement limitation continues despite these methods, surgical procedures are performed. These are arthroscopic release, open release and limited revision knee arthroplasty, and total revision knee arthroplasty [116].
\nDeep infection after TKA is the most common cause of revision. Systemic complications such as septicemia and cardiopulmonary insufficiency may also occur in patients with periprosthetic infection [117]. As a result, it increased mortality rates. Nowadays, the incidence of deep infection after TKA varies between 0.4 and 2% [74]. Factors that pave the way for infection in the postoperative period include the presence of rheumatoid arthritis, diabetes, hemophilia, malignancy, HIV, obesity, smoking, intravenous drug addiction, knee septic arthritis and osteomyelitis, prolonged surgical time, malnutrition, steroid use, and prolonged skin problems.
\nAntibiotic prophylaxis is the most effective method to prevent infection [118]. Prophylaxis should be administered 30–60 minutes. Before skin incision [119]. It has been shown that short postoperative antibiotherapy is more beneficial than the longer one [120].
\nFewer people entering the operating room, using drapes to prevent superficial contamination, providing laminar air flow, effective sterilization of surgical instruments, and keeping the surgical time 150 minutes below are also necessary to prevent infection [121].
\nRisk groups of patients should be identified before the operation, and a separate planning should be made for each patient according to comorbid diseases. Antibiotic cement has been shown to reduce the infection rate in patients at risk [122]. However, it has been reported that the use of antibiotic cement in the patient group with no risk may cause premature loosening [123].
\nThe most common organisms produced after infected knee arthroplasties are
Bacteria that cause prosthetic infection form a biofilm layer on the implant. This biofilm layer increases the virulence of the agent. In addition, it forms resistance to treatment because of its limitation on antibiotic permeability. The best antibiotic to cross the biofilm layer is rifampicin [127]. There are studies suggesting the addition of rifampicin to antibiotic treatment specific for the reproductive bacteria [127, 128].
\nDetailed anamnesis and detailed physical examination should be performed in the diagnosis of periprosthetic infection. In addition, the presence of a progressive radiolucent area around the prosthesis with direct radiographs, osteopenia, or osteolysis extending to the subchondral bone and the formation of new bone in the periosteal area can be evaluated in favor of infection [129]. The pain caused by rest is unique. However, increasing severity of pain and prolonged drainage at the wound site can also be evaluated in favor of infection. Arthrocentesis is then performed. In the case of active isolation, the necessary treatment is started. Empirical antibiotic therapy should be avoided. Wait until the agent is isolated. Because empirical antibiotherapy will suppress a possible infection and may cause deep infection due to delayed diagnosis of prosthesis infection that may be saved by debridement and may require removal of the prosthesis [130].
\nCRP and sedimentation values should be evaluated in diagnosis. However, it should be remembered that CRP returns to its previous level after 14–21 days postoperatively [131]. Alpha defensin, lactoferrin, ELA-2, BPI, procalcitonin, and synovial CRP values are other parameters that can be used in diagnosis [132].
\nCurrent consensus has been reached in the diagnosis of periprosthetic infection [133]. Accordingly:
Major criteria
Generation of the same agent in two positive cultures.
Presence of sinus mouth associated with prosthesis. In the presence of one of them, the diagnosis is established [133].
Minor criteria
Calculated weights of high serum CRP (>1 mg/dL), D-dimer (>860 ng/mL), and erythrocyte sedimentation rate (>30 mm/h) are also 2, 2, and 1 points, respectively.
High synovial fluid white cell count (>3000 cells/μL), alpha defensin (signal cutoff ratio > 1), leukocyte esterase (++), polymorphonuclear percentage (>80%), and synovial CRP (>6.9 mg/L) were arranged as 3, 3, 3, 2, and 1 points, respectively.
Patients with a total score equal to or greater than 6 were considered infected.
\nThe goal of infection treatment in total knee arthroplasty is eradication of the infection, pain relief, and maintenance of limb function. Treatment options are antibiotic pressure, debridement, single- or double-stage revision, arthrodesis, resection arthroplasty, and amputation. Revision surgery also has single-stage or double-stage revision options [134, 135, 136].
\nPeriprosthetic fractures around the knee are fractures that occur during or after surgery within 15 cm of the knee joint or within 5 cm of the intramedullary part of the prosthesis, if any [137]. The incidence of these fractures after TKA is 0.3–2.5% for femur and 0.4 01% for tibia [138, 139].
\nThe main risk factor related to the patient is the age of the patient. This risk is due to an increased risk of falling due to the patient’s age and osteoporosis associated with age [140]. Corticosteroid use, diseases that may increase the risk of falling with rheumatoid arthritis (epilepsy, Parkinson’s, cerebellar ataxia, myasthenia gravis) can be counted as other patient-related risk factors [141].
\nIntraoperative diaphyseal femoral fractures may occur due to incorrect placement of the intramedullary guide and osteopenia [142]. Unsuitable bone incisions, aggressive impaction of the ligamentous posterior stabilized femoral component, and eccentric placement of trial components are also risk factors for femoral fracture. It has been shown to increase the frequency of periprosthetic fractures due to increased resistance in flexion and rotation movements in anterior femoral notching [143]. The possibility of periprosthetic fracture is increased in revision TKA cases [144]. Periprosthetic fractures are more common due to the rotational forces of restrictive prosthesis using shear forces in the prosthesis [141].
\nDue to the stronger structure of the tibia, fracture development is rare.
\nFor femoral periprosthetic fractures, there is a classification that questions fracture displacement and component fixation.
Type 1 describes fractures with non-displaced and stable components.
Type 2 refers to component stable fractures with displacement of more than 5 mm or angulation of more than 5°.
Type 3 indicates loose fractures [145].
The femur fractures vertically more than the metaphyseal region. A stable periosteum prevents displacement. It is followed conservatively without any additional intervention. For fractures penetrating the femoral cortex, whether or not a bone graft is used, the penetration level should be treated with a stem prosthesis that is at least twice the diameter of the femoral canal [146].
\nWhen non-displaced fractures and stable prosthesis occur after TKA, conservative treatment may be preferred. Four to six weeks of non-weight procedure, long leg plaster, or hinged orthosis is followed.
\nDisplaced and unreducible supracondylar fractures are almost always treated surgically in the presence of adequate bone stock (\nFigure 1\n) [147].
\nLocked compression plates are preferred for knee periprosthetic fractures [144]. Prosthetic revision should be performed in fractures that cause prosthesis loosening and malposition. In these cases, stented prosthesis of sufficient length should be placed to obtain a stable fixation of the intact bone [138]. Knee replacement revision after periprosthetic fractures is often associated with the loss of range of motion (ROM) [148].
\nSupracondylar periprosthetic femur fracture treated with open reduction and internal fixation.
The majority of tibial periprosthetic fractures during surgery involve the plateau region and are generally non-displaced [146, 149]. If prosthetic loosening is present, revision surgery using a stem component long enough to cross the fracture line is required [150].
\nPostoperative tibial fractures can be examined in four groups. In type 1 fracture, revision is recommended because tibial component will be in varus alignment. The medial defect should be closed with bone graft or metal support [150]. Type 2 fractures are treated with nonsurgical treatment if the component is stable and there is minimal displacement [149]. Displaced type 2 fractures are treated with internal fixation. If the component is unstable, it must be revised using a long tibial stem to cross the fracture line [149]. Internal fixation should be performed for type 3 and 4 fractures [145].
\nThe deterioration of the relationship between prosthesis and bone is defined as loosening. The loosening may be between the prosthetic cement and the cement bone. Loosening is inevitable in long-term prostheses. It is useful to distinguish the concepts of osteolysis and loosening. Without prosthesis osteolysis, loosening of the cement may occur. The mechanisms that cause loosening are micromotion, component collapse, and periprosthetic osteolysis [151].
\nOveruse and osteopenia are the causes of patient-related loosening. Implant design may also be the cause of loosening. According to this, loosening is more likely in cementless prosthesis and constrained prosthesis. One of the most important causes of aseptic loosening is malalignment. It has been shown that a 4 mm medial collapse of the tibial component and varus deformity of more than 2° increases the likelihood of loosening [152]. In the early period, a radiolucent line is seen between the component and bone on radiography, and a collapse occurs as the loosening progresses. Loosening is more common around the tibial component [152]. In the presence of loosening around the whole component, septic loosening should be considered, and differential diagnosis should be performed.
\nIn the case of loosening, the treatment is decided according to symptoms and progress. If pain is associated with instability and there are X-ray findings, early revision surgery is recommended for bone stock preservation.
\nOsteolysis usually occurs due to inflammatory reactions caused by worn polyethylene particles or in the presence of infection. Metal particles can also cause osteolysis. Titanium causes more osteolysis than cobalt and chromium. Giant cells that develop against abrasive particles act by forming a membrane [153]. Particle size is important for this mechanism. The particle sizes range from 1 to 100 micrometers under the electron microscope. Large parts do not cause osteolysis [153]. There is no osteolysis if the parts are not spread to the cancellous bone, so osteolysis is not seen when the cancellous bone is properly covered with cement [154]. On the other hand, the incidence of osteolysis increases when pres-fit prosthesis is applied; screw fixation without cement is used or cement breaks [155]. Osteolysis is closely related to prosthetic design. Osteolysis usually occurs after 2 years of TKA. Occurrence is rare before 2 years [156]. Osteolysis is mostly seen in the tibia [157]. Diagnosis includes pain, joint effusion, and synovitis due to joint instability. Focal bone destruction may be seen on radiolucent line and X-ray. It can be seen that there is no continuity of trabeculae and bone cortex in cancellous bone. Therefore, control X-rays are very important in patient follow-up and must be compared with old radiographs in controls. CT and MRI can be used for osteolysis that cannot be detected on direct radiography [158].
\nIf the lesion is small in treatment and the prosthesis is stable, observation is sufficient. Bisphosphonate and calcium supplementation can be initiated [159]. If the prosthesis is instable, two options can be applied. The first one is debridement, polyethylene replacement, and curettage, followed by impaction of the defect with bone graft. The second is revision [159].
\nPatellofemoral joint problems after TKA generally cause anterior knee pain. Patients’ ability to tolerate this pain rarely causes patellofemoral joint problems to be revised [160]. It should be kept in mind that not only patellar component-related procedures but also procedures involving the tibiofemoral joint may cause this problem. Even in revision surgery due to a problem of patellofemoral origin, it is often caused by a component in the tibia and femur [161]. In a study, patella and malrotation were among the eight most common causes of failed TKA [162].
\nAdvanced valgus alignment, previous high tibial osteotomy, or tuberositas tibia osteotomy increases the rate of patellofemoral joint problems in TKA [160].
\nThere are many points to be considered in the surgical technique to prevent patellofemoral joint problems. These are [163]:
\n
\n
\n
\n
Patellar surface replacement is controversial today. However, in a recent study, it was found that anterior knee pain was less common in patients who underwent patellar surface change than those who did not. In the same study, the causes of PF joint revision were more common in patients without patella surface changes [166].
\nThe results in patients with patellar articular surface alteration due to persistent anterior knee pain after TKA are not as successful as those with surface replacement during primary TKA [167]. In the treatment of anterior knee pain after TKA, mechanical causes should be investigated after the exclusion of an underlying infection.
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Shishkovsky"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9313",title:"Clay Science and Technology",subtitle:null,isOpenForSubmission:!1,hash:"6fa7e70396ff10620e032bb6cfa6fb72",slug:"clay-science-and-technology",bookSignature:"Gustavo Morari Do Nascimento",coverURL:"https://cdn.intechopen.com/books/images_new/9313.jpg",editedByType:"Edited by",editors:[{id:"7153",title:"Prof.",name:"Gustavo",middleName:null,surname:"Morari Do Nascimento",slug:"gustavo-morari-do-nascimento",fullName:"Gustavo Morari Do Nascimento"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10045",title:"Fillers",subtitle:null,isOpenForSubmission:!1,hash:"aac44d6491e740af99bec2f62aa05883",slug:"fillers",bookSignature:"Emmanuel Flores Huicochea",coverURL:"https://cdn.intechopen.com/books/images_new/10045.jpg",editedByType:"Edited by",editors:[{id:"206705",title:"Dr.",name:"Emmanuel",middleName:null,surname:"Flores Huicochea",slug:"emmanuel-flores-huicochea",fullName:"Emmanuel Flores Huicochea"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8188",title:"Ion Beam Techniques and Applications",subtitle:null,isOpenForSubmission:!1,hash:"4f212072e7141ba20788b6fe79d28370",slug:"ion-beam-techniques-and-applications",bookSignature:"Ishaq Ahmad and Tingkai Zhao",coverURL:"https://cdn.intechopen.com/books/images_new/8188.jpg",editedByType:"Edited by",editors:[{id:"25524",title:"Prof.",name:"Ishaq",middleName:null,surname:"Ahmad",slug:"ishaq-ahmad",fullName:"Ishaq Ahmad"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6737",title:"Powder Technology",subtitle:null,isOpenForSubmission:!1,hash:"65211e3ea1db91e795908df350115d1f",slug:"powder-technology",bookSignature:"Alberto Adriano Cavalheiro",coverURL:"https://cdn.intechopen.com/books/images_new/6737.jpg",editedByType:"Edited by",editors:[{id:"201848",title:"Dr.",name:"Alberto Adriano",middleName:null,surname:"Cavalheiro",slug:"alberto-adriano-cavalheiro",fullName:"Alberto Adriano Cavalheiro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6306",title:"Additive Manufacturing of High-performance Metals and Alloys",subtitle:"Modeling and Optimization",isOpenForSubmission:!1,hash:"0e08cc35cef3caf389096ca4b999742f",slug:"additive-manufacturing-of-high-performance-metals-and-alloys-modeling-and-optimization",bookSignature:"Igor V. Shishkovsky",coverURL:"https://cdn.intechopen.com/books/images_new/6306.jpg",editedByType:"Edited by",editors:[{id:"178616",title:"Prof.",name:"Igor",middleName:"V.",surname:"Shishkovsky",slug:"igor-shishkovsky",fullName:"Igor Shishkovsky"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5759",title:"Lamination",subtitle:"Theory and Application",isOpenForSubmission:!1,hash:"9a4f81291f9d75ed83b1f4f5e0b56f36",slug:"lamination-theory-and-application",bookSignature:"Charles A. Osheku",coverURL:"https://cdn.intechopen.com/books/images_new/5759.jpg",editedByType:"Edited by",editors:[{id:"148660",title:"Dr.",name:"Charles",middleName:"Attah",surname:"Osheku",slug:"charles-osheku",fullName:"Charles Osheku"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3683",title:"Engineering the Future",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"engineering-the-future",bookSignature:"Laszlo Dudas",coverURL:"https://cdn.intechopen.com/books/images_new/3683.jpg",editedByType:"Edited by",editors:[{id:"135546",title:"Prof.",name:"Laszlo",middleName:null,surname:"Dudas",slug:"laszlo-dudas",fullName:"Laszlo Dudas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:8,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"12376",doi:"10.5772/10380",title:"Digital Factory – Theory and Practice",slug:"digital-factory-theory-and-practice",totalDownloads:7079,totalCrossrefCites:9,totalDimensionsCites:14,abstract:null,book:{id:"3683",slug:"engineering-the-future",title:"Engineering the Future",fullTitle:"Engineering the Future"},signatures:"Milan Gregor and Stefan Medvecky",authors:null},{id:"60707",doi:"10.5772/intechopen.75832",title:"Processing Parameters for Selective Laser Sintering or Melting of Oxide Ceramics",slug:"processing-parameters-for-selective-laser-sintering-or-melting-of-oxide-ceramics",totalDownloads:2073,totalCrossrefCites:7,totalDimensionsCites:12,abstract:"In this chapter, we present a detailed introduction to the factors which influence laser powder bed fusion (LPBF) on oxide ceramics. These factors can be in general divided in three main categories: laser-related factors (wavelength, power, scanning speed, hatch distance, scan pattern, beam diameter, etc.), powder- and material-related factors (flowability, size distribution, shape, powder deposition, thickness of deposited layers, etc.), and other factors (pre- or post-processing, inert gas atmosphere, etc.). The process parameters directly affect the amount of energy delivered to the surface of the thin layer and the energy density absorbed by the powders; therefore, decide the physical and mechanical properties of the built parts, such as relative density, porosity, surface roughness, dimensional accuracy, strength, etc. The parameter-property relation is hence reviewed for the most studied oxide ceramic materials, including families from alumina, silica, and some ceramic mixtures. Among those parameters, reducing temperature gradient which decreases the thermal stresses is one of the key factors to improve the ceramic quality. Although realizing crack-free ceramics combined with a smooth surface is still a major challenge, through optimizing the parameters, it is possible for LPBF processed ceramic parts to achieve properties close to those of conventionally produced ceramics.",book:{id:"6306",slug:"additive-manufacturing-of-high-performance-metals-and-alloys-modeling-and-optimization",title:"Additive Manufacturing of High-performance Metals and Alloys",fullTitle:"Additive Manufacturing of High-performance Metals and Alloys - Modeling and Optimization"},signatures:"Haidong Zhang and Saniya LeBlanc",authors:[{id:"213235",title:"Prof.",name:"Saniya",middleName:null,surname:"LeBlanc",slug:"saniya-leblanc",fullName:"Saniya LeBlanc"},{id:"213239",title:"Dr.",name:"Haidong",middleName:null,surname:"Zhang",slug:"haidong-zhang",fullName:"Haidong Zhang"}]},{id:"59094",doi:"10.5772/intechopen.72973",title:"Structure and Properties of the Bulk Standard Samples and Cellular Energy Absorbers",slug:"structure-and-properties-of-the-bulk-standard-samples-and-cellular-energy-absorbers",totalDownloads:735,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"The development of additive technology revealed a real prospect of their use for the manufacture of complex shapes. Now, it is possible to produce parts that previously were either very difficult to produce using the subtracting technology and joining technology, or it was not at all feasible. In the manufacture of parts of complex shape, it is necessary to use a supporting structure, which is necessary to place such a way that they can be easily removed. Additionally, they must necessarily be absent in certain places. In this regard, the preparation model can take significant time to satisfy all of these, often conflicting, requirements. In this paper, we show optimization examples of the model preparation with support structures for parts manufactured at the facility EOSINT M270 and used in medicine and engineering. Additional emphasis is on the fact that, during the manufacture of parts, solidification’s modes of massive parts differ from those of the thin-walled portions of parts. The results of the complex studies on the different stainless steels (including martensitic) are described with an emphasis on their structure and mechanical properties. The results of a honeycomb energy absorbers, which are quite seldom produced by the additive technologies, are presented in this chapter.",book:{id:"6306",slug:"additive-manufacturing-of-high-performance-metals-and-alloys-modeling-and-optimization",title:"Additive Manufacturing of High-performance Metals and Alloys",fullTitle:"Additive Manufacturing of High-performance Metals and Alloys - Modeling and Optimization"},signatures:"Pavel Kuznetcov, Anton Zhukov, Artem Deev, Vitaliy Bobyr and\nMikhail Staritcyn",authors:[{id:"223064",title:"Dr.",name:"Pavel",middleName:null,surname:"Kuznetsov",slug:"pavel-kuznetsov",fullName:"Pavel Kuznetsov"},{id:"227212",title:"Mr.",name:"Artem",middleName:null,surname:"Deev",slug:"artem-deev",fullName:"Artem Deev"},{id:"227213",title:"Mr.",name:"Vitaliy",middleName:null,surname:"Bobyr",slug:"vitaliy-bobyr",fullName:"Vitaliy Bobyr"},{id:"227215",title:"Mr.",name:"Anton",middleName:null,surname:"Zhukov",slug:"anton-zhukov",fullName:"Anton Zhukov"},{id:"227216",title:"Mr.",name:"Mikhail",middleName:null,surname:"Staritcyn",slug:"mikhail-staritcyn",fullName:"Mikhail Staritcyn"}]},{id:"59742",doi:"10.5772/intechopen.74331",title:"Advanced Technologies in Manufacturing 3D-Layered Structures for Defense and Aerospace",slug:"advanced-technologies-in-manufacturing-3d-layered-structures-for-defense-and-aerospace",totalDownloads:1820,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"In the past 20 years, a great progress has been made in additive manufacturing techniques, which has led to numerous applications in aeronautical and defense structures. Though not all advanced materials and alloys, can be automatically layered by a rapid prototyping system or machine, several interesting application have seen the light of publicity in many sectors. Efforts are underway to apply the automated layering technologies in as many materials as possible, mostly nowadays plastics, reinforced-polymers, and metals can be processed by such systems in order to produce three-dimensional parts. The work is underway internationally in order to promote more and more applications of additive manufacturing or automated layering and to lower the costs in such systems. This paper aims at presenting a review of the additive manufacturing history presenting the major steps that lead to the explosion of this technology, and with a special focus on advanced 3D structures in aerospace and defense applications. An insight is also given on the four dimensions of manufacturing concept.",book:{id:"5759",slug:"lamination-theory-and-application",title:"Lamination",fullTitle:"Lamination - Theory and Application"},signatures:"Dionysios E. Mouzakis",authors:[{id:"107011",title:"Associate Prof.",name:"Dionysios",middleName:"E.",surname:"Mouzakis",slug:"dionysios-mouzakis",fullName:"Dionysios Mouzakis"}]},{id:"61242",doi:"10.5772/intechopen.76860",title:"Theory and Technology of Direct Laser Deposition",slug:"theory-and-technology-of-direct-laser-deposition",totalDownloads:1278,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"Presently the additive technologies in manufacturing are widely developed in all industrialized countries. Replacing the traditional technology of casting and machining with additive technologies, one can significantly reduce material consumption and labor costs. They also allow obtaining products with desired properties. The most promising for manufacturing large-sized products is the additive technology of high-speed direct laser deposition. Using this technology allows to create complex parts and construction to one technological operation without using addition equipment and tools. This technology allows decreasing of consumption of raw materials and decrease amount of waste. Equipment for realization of DLD technology is universal and based on module design principle. DLD is based on layer-by-layer deposition and melting of powder by laser beam from using a sliced 3D computer-aided design (CAD) file. The materials used are powders based on Fe, Ni, and Ti. This chapter presents the results of machine design and research HS DLD technology from various materials.",book:{id:"6306",slug:"additive-manufacturing-of-high-performance-metals-and-alloys-modeling-and-optimization",title:"Additive Manufacturing of High-performance Metals and Alloys",fullTitle:"Additive Manufacturing of High-performance Metals and Alloys - Modeling and Optimization"},signatures:"Gleb Turichin and Olga Klimova-Korsmik",authors:[{id:"212068",title:"Dr.",name:null,middleName:null,surname:"Klimova-Korsmik",slug:"klimova-korsmik",fullName:"Klimova-Korsmik"}]}],mostDownloadedChaptersLast30Days:[{id:"72209",title:"Multifunctional Clay in Pharmaceuticals",slug:"multifunctional-clay-in-pharmaceuticals",totalDownloads:820,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Clay has its widespread applications in pharmaceuticals from ancient world to modern era. It is one of the excellent excipients present in the commercially available pharmaceuticals. Its use in many of dosage forms viz. in suspension, emulsion, ointments, gels, tablet and as drug delivery carrier as suspending agent, emulsifying agent, stiffening agent, binder, diluent, opacifier, and as release retardant have been explored in many studies. Variety of minerals is used as both excipient and as an active ingredient; among that kaolinite, talc, and gypsum are important. Their inertness, low toxicity, versatile physiochemical properties and cost effectiveness has increased its usage in pharma industries. Many minerals have its own pharmacological action as antacid, anti-bacterial, anti-emetic, anti- diarrheal agent and as skin protectant etc. Their unique structure which helps them to absorb material onto their layered sheets has opened a wide variety of applications in drug delivery. The understanding of surface chemistry and particle size distribution of clay minerals has led the pharmaceutical field in many directions and future perspectives.",book:{id:"9313",slug:"clay-science-and-technology",title:"Clay Science and Technology",fullTitle:"Clay Science and Technology"},signatures:"Nandakumar Selvasudha, Unnikrishnan-Meenakshi Dhanalekshmi, Sekar Krishnaraj, Yogeeswarakannan Harish Sundar, Nagarajan Sri Durga Devi and Irisappan Sarathchandiran",authors:[{id:"317602",title:"Ph.D.",name:"Nandakumar",middleName:null,surname:"Selvasudha",slug:"nandakumar-selvasudha",fullName:"Nandakumar Selvasudha"},{id:"319654",title:"Dr.",name:"Unnikrishnan-Meenakshi",middleName:null,surname:"Dhanalekshmi",slug:"unnikrishnan-meenakshi-dhanalekshmi",fullName:"Unnikrishnan-Meenakshi Dhanalekshmi"},{id:"319655",title:"Dr.",name:"Sekar",middleName:null,surname:"Krishnaraj",slug:"sekar-krishnaraj",fullName:"Sekar Krishnaraj"},{id:"319656",title:"Mr.",name:"Yogeeswarakannan Harish",middleName:null,surname:"Sundar",slug:"yogeeswarakannan-harish-sundar",fullName:"Yogeeswarakannan Harish Sundar"},{id:"319657",title:"Mrs.",name:"Nagarajan Sri",middleName:null,surname:"Sridurga Devi",slug:"nagarajan-sri-sridurga-devi",fullName:"Nagarajan Sri Sridurga Devi"},{id:"319658",title:"Dr.",name:"Irisappan",middleName:null,surname:"Sarathchandiran",slug:"irisappan-sarathchandiran",fullName:"Irisappan Sarathchandiran"}]},{id:"80125",title:"Perspective Chapter: Additive Manufactured Zirconia-Based Bio-Ceramics for Biomedical Applications",slug:"perspective-chapter-additive-manufactured-zirconia-based-bio-ceramics-for-biomedical-applications",totalDownloads:185,totalCrossrefCites:3,totalDimensionsCites:2,abstract:"Zirconia was established as one of the chief vital ceramic materials for its superior mechanical permanency and biocompatibility, which make it a popular material for dental and orthopedic applications. This has inspired biomedical engineers to exploit zirconia-based bioceramics for dental restorations and repair of load-bearing bone defects caused by cancer, arthritis, and trauma. Additive manufacturing (AM) is being promoted as a possible technique for mimicking the complex architecture of human tissues, and advancements reported in the recent past make it a suitable choice for clinical applications. AM is a bottom-up approach that can offer a high resolution to 3D printed zirconia-based bioceramics for implants, prostheses, and scaffold manufacturing. Substantial research has been initiated worldwide on a large scale for reformatting and optimizing zirconia bioceramics for biomedical applications to maximize the clinical potential of AM. This book chapter provides a comprehensive summary of zirconia-based bioceramics using AM techniques for biomedical applications and highlights the challenges related to AM of zirconia.",book:{id:"10974",slug:"advanced-additive-manufacturing",title:"Advanced Additive Manufacturing",fullTitle:"Advanced Additive Manufacturing"},signatures:"Sakthiabirami Kumaresan, Soundharrajan Vaiyapuri, Jin-Ho Kang, Nileshkumar Dubey, Geetha Manivasagam, Kwi-Dug Yun and Sang-Won Park",authors:[{id:"246235",title:"Prof.",name:"Geetha",middleName:null,surname:"Manivasagam",slug:"geetha-manivasagam",fullName:"Geetha Manivasagam"},{id:"426610",title:"Prof.",name:"Park",middleName:null,surname:"Sangwon",slug:"park-sangwon",fullName:"Park Sangwon"},{id:"429162",title:"Dr.",name:"Sakthiabirami",middleName:null,surname:"Kumaresan",slug:"sakthiabirami-kumaresan",fullName:"Sakthiabirami Kumaresan"},{id:"442019",title:"Dr.",name:"Soundharrajan",middleName:null,surname:"Vaiyapuri",slug:"soundharrajan-vaiyapuri",fullName:"Soundharrajan Vaiyapuri"},{id:"442021",title:"Dr.",name:"Jin-Ho",middleName:null,surname:"Kang",slug:"jin-ho-kang",fullName:"Jin-Ho Kang"},{id:"442023",title:"Prof.",name:"Nileshkumar",middleName:null,surname:"Dubey",slug:"nileshkumar-dubey",fullName:"Nileshkumar Dubey"},{id:"442024",title:"Prof.",name:"Kwi-Dug",middleName:null,surname:"Yun",slug:"kwi-dug-yun",fullName:"Kwi-Dug Yun"}]},{id:"72560",title:"Limestone Clays for Ceramic Industry",slug:"limestone-clays-for-ceramic-industry",totalDownloads:674,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Limestone clays are used in the ceramic segment in the manufacture of bricks, ceramic tiles, and in the production of cement, among others. Limestone can be present in soils in pure form or as a contaminant, but always from marine environments. The limestone after burning can present a high loss of mass (35–45%), which can cause serious problems with the sintering of ceramic products such as bricks, tiles. The calcium or magnesium carbonate once dissociated forms calcium oxide (CaO) and releases carbon dioxide (CO2). CaO in contact with water subsequently experiences very high expansions that can cause cracks in the materials. Researchers have studied procedures to inhibit limestone action on clays as well as to set the correct temperature for firing. In this chapter, examples of clays with different percentages of calcium carbonate (CaCO3) that are used in the ceramic segment and their characteristics will be given.",book:{id:"9313",slug:"clay-science-and-technology",title:"Clay Science and Technology",fullTitle:"Clay Science and Technology"},signatures:"Herbet Alves de Oliveira and Cochiran Pereira dos Santos",authors:[{id:"316552",title:"Dr.",name:"Herbet",middleName:null,surname:"Alves de Oliveira",slug:"herbet-alves-de-oliveira",fullName:"Herbet Alves de Oliveira"},{id:"320536",title:"Dr.",name:"Cochiran",middleName:null,surname:"Pereira dos Santos",slug:"cochiran-pereira-dos-santos",fullName:"Cochiran Pereira dos Santos"}]},{id:"60707",title:"Processing Parameters for Selective Laser Sintering or Melting of Oxide Ceramics",slug:"processing-parameters-for-selective-laser-sintering-or-melting-of-oxide-ceramics",totalDownloads:2078,totalCrossrefCites:7,totalDimensionsCites:12,abstract:"In this chapter, we present a detailed introduction to the factors which influence laser powder bed fusion (LPBF) on oxide ceramics. These factors can be in general divided in three main categories: laser-related factors (wavelength, power, scanning speed, hatch distance, scan pattern, beam diameter, etc.), powder- and material-related factors (flowability, size distribution, shape, powder deposition, thickness of deposited layers, etc.), and other factors (pre- or post-processing, inert gas atmosphere, etc.). The process parameters directly affect the amount of energy delivered to the surface of the thin layer and the energy density absorbed by the powders; therefore, decide the physical and mechanical properties of the built parts, such as relative density, porosity, surface roughness, dimensional accuracy, strength, etc. The parameter-property relation is hence reviewed for the most studied oxide ceramic materials, including families from alumina, silica, and some ceramic mixtures. Among those parameters, reducing temperature gradient which decreases the thermal stresses is one of the key factors to improve the ceramic quality. Although realizing crack-free ceramics combined with a smooth surface is still a major challenge, through optimizing the parameters, it is possible for LPBF processed ceramic parts to achieve properties close to those of conventionally produced ceramics.",book:{id:"6306",slug:"additive-manufacturing-of-high-performance-metals-and-alloys-modeling-and-optimization",title:"Additive Manufacturing of High-performance Metals and Alloys",fullTitle:"Additive Manufacturing of High-performance Metals and Alloys - Modeling and Optimization"},signatures:"Haidong Zhang and Saniya LeBlanc",authors:[{id:"213235",title:"Prof.",name:"Saniya",middleName:null,surname:"LeBlanc",slug:"saniya-leblanc",fullName:"Saniya LeBlanc"},{id:"213239",title:"Dr.",name:"Haidong",middleName:null,surname:"Zhang",slug:"haidong-zhang",fullName:"Haidong Zhang"}]},{id:"60683",title:"MPFEM Modeling on the Compaction of Al/SiC Composite Powders with Core/Shell Structure",slug:"mpfem-modeling-on-the-compaction-of-al-sic-composite-powders-with-core-shell-structure",totalDownloads:974,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Uniaxial die compaction of two-dimensional (2D) Al/SiC core/shell (core: SiC; shell: Al) composite powders with different initial packing structures was numerically reproduced using DEM-FEM coupled MPFEM modeling from particulate scale. The effects of external pressure, initial packing structure, and SiC content on the packing densification were systematically presented. Various macro and micro properties such as relative density and distribution, stress and distribution, particle rearrangement (e.g. sliding and rolling), deformation and mass transfer, and interfacial behavior within composite particles were characterized and analyzed. The results show that by properly controlling the initial packing structure, pressure, and SiC content, various anisotropic and isotropic Al/SiC particulate composites with high relative densities and uniform density/stress distributions can be obtained. At early stage of the compaction, the densification mechanism mainly lies in the particle rearrangement driven by the low interparticle forces. In addition to sliding, accompanied particle rolling also plays an important role. With the increase of the compaction pressure, the force network based on SiC cores leads to extrusion on Al shells between two cores, contributing to mass transfer and pore filling. During compaction, the debonding between the core and shell of each composite particle appears and then disappears gradually in the final compact.",book:{id:"6737",slug:"powder-technology",title:"Powder Technology",fullTitle:"Powder Technology"},signatures:"Xizhong An, Yu Liu, Fen Huang and Qian Jia",authors:[{id:"114055",title:"Prof.",name:"Xizhong",middleName:null,surname:"An",slug:"xizhong-an",fullName:"Xizhong An"},{id:"237739",title:"Mr.",name:"Yu",middleName:null,surname:"Liu",slug:"yu-liu",fullName:"Yu Liu"},{id:"237740",title:"Ms.",name:"Fen",middleName:null,surname:"Huang",slug:"fen-huang",fullName:"Fen Huang"},{id:"242885",title:"Ms.",name:"Qian",middleName:null,surname:"Jia",slug:"qian-jia",fullName:"Qian Jia"}]}],onlineFirstChaptersFilter:{topicId:"292",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82676",title:"Electrospinning of Fiber Matrices from Polyhydroxybutyrate for the Controlled Release Drug Delivery Systems",slug:"electrospinning-of-fiber-matrices-from-polyhydroxybutyrate-for-the-controlled-release-drug-delivery-",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.105786",abstract:"The submission provides an overview of current state of the problem and authors’ experimental data on manufacturing nonwoven fibrous matrices for the controlled release drug delivery systems (CRDDS). The choice of ultrathin fibers as effective carriers is determined by their characteristics and functional behavior, for example, such as a high specific surface area, anisotropy of some physicochemical characteristics, spatial limitations of segmental mobility that are inherent in nanosized objects, controlled biodegradation, and controlled diffusion transport. The structural-dynamic approach to the study of the morphology and diffusion properties of biopolymer fibers based on polyhydroxybutyrate (PHB) is considered from several angles. In the submission, the electrospinning (ES) application to reach specific characteristics of materials for controlled release drug delivery is discussed.",book:{id:"11127",title:"Electrospinning - Material Technology of the Future",coverURL:"https://cdn.intechopen.com/books/images_new/11127.jpg"},signatures:"Anatoly A. Olkhov, Svetlana G. Karpova, Anna V. Bychkova, Alexandre A. Vetcher and Alexey L. Iordanskii"},{id:"81249",title:"Electrospun Polymeric Substrates for Tissue Engineering: Viewpoints on Fabrication, Application, and Challenges",slug:"electrospun-polymeric-substrates-for-tissue-engineering-viewpoints-on-fabrication-application-and-ch",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.102596",abstract:"Electrospinning is the technique for producing nonwoven fibrous structures, to mimic the fabrication and function of the native extracellular matrix (ECM) in tissue. Prepared fibrous with this method can act as potential polymeric substrates for proliferation and differentiation of stem cells (with the cellular growth pattern similar to damaged tissue cells) and facilitation of artificial tissue remodeling. Moreover, such substrates can improve biological functions, and lead to a decrease in organ transplantation. In this chapter, we focus on the fundamental parameters and principles of the electrospinning technique to generate natural ECM-like substrates, in terms of structural and functional complexity. In the following, the application of these substrates in regenerating various tissues and the role of polymers (synthetic/natural) in the formation of such substrates is evaluated. Finally, challenges of this technique (such as cellular infiltration and inadequate mechanical strength) and solutions to overcome these limitations are studied.",book:{id:"11127",title:"Electrospinning - Material Technology of the Future",coverURL:"https://cdn.intechopen.com/books/images_new/11127.jpg"},signatures:"Azadeh Izadyari Aghmiuni, Arezoo Ghadi, Elmira Azmoun, Niloufar Kalantari, Iman Mohammadi and Hossein Hemati Kordmahaleh"},{id:"82145",title:"Slope Casting Process: A Review",slug:"slope-casting-process-a-review",totalDownloads:9,totalDimensionsCites:0,doi:"10.5772/intechopen.102742",abstract:"Semi solid processing is a near net shape casting process and one of the promising techniques to obtain dendritic free structure of metals. Semi solid casting gives numerous advantages than solid processing and liquid processing. Semi solid casting process gives, Laminar flow filling of die without turbulence, Lower metal temperature, Less shrinkage, Less porosity, Higher mechanical properties. Semi solid casting process is industrially successful, producing a variety of products with good quality. Slope Casting process is a simple technique to produce semi solid feed-stoke with globular microstructure and dendrite free structure castings. Slope casting process depends on different process parameters like slope length, slope angle, pouring temperature etc. The present study mainly focuses on review of various explorations made by researchers with different process parameters of the Slope casting process and explain the mechanisms that lead to microstructural changes which leads to good mechanical properties.",book:{id:"11119",title:"Casting Processes",coverURL:"https://cdn.intechopen.com/books/images_new/11119.jpg"},signatures:"Mukkollu Sambasiva Rao and Amitesh Kumar"},{id:"81611",title:"Biomass Electrospinning: Recycling Materials for Green Economy Applications",slug:"biomass-electrospinning-recycling-materials-for-green-economy-applications",totalDownloads:35,totalDimensionsCites:0,doi:"10.5772/intechopen.103096",abstract:"The development and advancement of electrospinning (ES) presents a unique material technology of the future achieved by fabricating novel nanofibrous materials with multifunctional physical (three-dimensional [3D] structure, nanoscalable sizes) and chemical characteristics (functional groups). Advancing the possibility of preparing various classes of novel organic and inorganic electrospun fiber composites with unique features such as polymer alloys, nanoparticles (NPs), active agents, and devices. This feature gives provision for internal access of the setup parameters such as polymer precursor material, polymer concentration, solvent, and the method of fiber collection that consequentially improves the intrinsic control of the construction mechanism of the final nanofibrous architecture. In synthetic electrospinning, the nanofibrous material processing allows for internal control of the electrospinning mechanism and foster chemical crosslinking to generate covalent connections between polymeric fibers. Comparing technologies according to materials of the future revealed that electrospinning supports the formation of micro-scale and in some cases nano-scale fibers while the formation of thin films is facilitated by the electrospraying system. Recent innovations point to various biomass waste streams that may be used as an alternative source of polymeric materials for application in electrospinning to produce materials for the future.",book:{id:"11127",title:"Electrospinning - Material Technology of the Future",coverURL:"https://cdn.intechopen.com/books/images_new/11127.jpg"},signatures:"Farai Dziike, Phylis Makurunje and Refilwe Matshitse"},{id:"81245",title:"Functional Nanofibers for Sensors",slug:"functional-nanofibers-for-sensors",totalDownloads:30,totalDimensionsCites:0,doi:"10.5772/intechopen.102597",abstract:"Electrospun nanomaterials and their applications have increasingly gained interest over the last decade. Nanofibers are known for their exceptional surface area and wide opportunities for their functionalization. These properties have been attractive for various sensing applications; however, mostly electric sensing principles have been reported. An overview of most frequently studied concepts will be presented. A novel approach based on optical detection will be described. Various functionalized nanofiber materials have been used to demonstrate feasibility of realization of miniature sensors of biomedical and chemical values (enzymes reactions, metal ions content, concentration, etc.). Compactness and sensitivity of the sensors are significantly enhanced through original hybrid fiber-optic/nanofiber design. The potential of the new detection principle for various applications (bio-medical, chemical, forensic, automotive, etc.) will be discussed.",book:{id:"11127",title:"Electrospinning - Material Technology of the Future",coverURL:"https://cdn.intechopen.com/books/images_new/11127.jpg"},signatures:"Stanislav Petrík and Mayza Ibrahim"},{id:"80458",title:"Production of Nanofibers from Plant Extracts by Electrospinning Method",slug:"production-of-nanofibers-from-plant-extracts-by-electrospinning-method",totalDownloads:32,totalDimensionsCites:0,doi:"10.5772/intechopen.102614",abstract:"The fact that different plants grow in each climate type, that each plant has different and many benefits, and that it can obtain bio-structured, sustainable, economic, and ecological products has increased the work of researchers in this field. The long-term toxicity and harmful side effects of herbal extracts are generally less compared to synthetic drugs. Studies on the production of nanofibrous membrane structures from plant extracts are relatively limited and are an emerging field. Herbal extracts have a positive effect in electrospinning applications with their biodiversity, ability to maintain biological functionality, and wound healing effects against pathogenic microorganisms. With the creation of nanofiber structures of plants obtained from natural sources, applications in fields such as wound healing, tissue engineering, drug release are increasing day by day.",book:{id:"11127",title:"Electrospinning - Material Technology of the Future",coverURL:"https://cdn.intechopen.com/books/images_new/11127.jpg"},signatures:"Nilşen Sünter Eroğlu"}],onlineFirstChaptersTotal:11},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. 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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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A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,annualVolume:11416,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"28",title:"Animal Reproductive Biology and Technology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",isOpenForSubmission:!0,annualVolume:11417,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). 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Portugal",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:47,paginationItems:[{id:"82938",title:"Trauma from Occlusion: Practical Management Guidelines",doi:"10.5772/intechopen.105960",signatures:"Prashanth Shetty, Shweta Hegde, Shubham Chelkar, Rahul Chaturvedi, Shruti Pochhi, Aakanksha Shrivastava, Dudala Lakshmi, Shreya Mukherjee, Pankaj Bajaj and Shahzada Asif Raza",slug:"trauma-from-occlusion-practical-management-guidelines",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg",subseries:{id:"2",title:"Prosthodontics and Implant Dentistry"}}},{id:"82654",title:"Atraumatic Restorative Treatment: More than a Minimally Invasive Approach?",doi:"10.5772/intechopen.105623",signatures:"Manal A. 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She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}]},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}]},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. 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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. 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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. 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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. 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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. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. 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Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"20",type:"subseries",title:"Animal Nutrition",keywords:"Sustainable Animal Diets, Carbon Footprint, Meta Analyses",scope:"An essential part of animal production is nutrition. Animals need to receive a properly balanced diet. One of the new challenges we are now faced with is sustainable animal diets (STAND) that involve the 3 P’s (People, Planet, and Profitability). 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He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,series:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517"},editorialBoard:[{id:"175762",title:"Dr.",name:"Alfredo J.",middleName:null,surname:"Escribano",slug:"alfredo-j.-escribano",fullName:"Alfredo J. 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Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/47814",hash:"",query:{},params:{id:"47814"},fullPath:"/chapters/47814",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()