Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\n
Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"5975",leadTitle:null,fullTitle:"Physiology and Pathology of Immunology",title:"Physiology and Pathology of Immunology",subtitle:null,reviewType:"peer-reviewed",abstract:"Having authored and published many successful and important textbooks in primary immunodeficiencies and cancer immunology, the editor of Physiology and Pathology of Immunology has ensured the high standard of writing and authenticity of the contents in this publication. The current book covers a spectrum of high-impact knowledge on the complex interplay between the environment, genes, and immunity that culminates in a generation of notorious processes of immune-related disorders. From evolution of regulatory T-cell function, gigantic cytokine networks within the human body to host-pathogen interactions of Chagas disease and Parkinson's disease, the Physiology and Pathology of Immunology goes further to decipher new codes from the immunity enigma, making it essential for experienced and new learners who wish to join the galaxy of modern immunology.",isbn:"978-953-51-3692-7",printIsbn:"978-953-51-3691-0",pdfIsbn:"978-953-51-4010-8",doi:"10.5772/66541",price:119,priceEur:129,priceUsd:155,slug:"physiology-and-pathology-of-immunology",numberOfPages:264,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"b31eea21dfa90b753604f34bf1c0b8a5",bookSignature:"Nima Rezaei",publishedDate:"December 20th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5975.jpg",numberOfDownloads:26509,numberOfWosCitations:24,numberOfCrossrefCitations:36,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:49,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:109,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 26th 2017",dateEndSecondStepPublish:"February 16th 2017",dateEndThirdStepPublish:"July 20th 2017",dateEndFourthStepPublish:"August 20th 2017",dateEndFifthStepPublish:"October 20th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",biography:"Professor Nima Rezaei obtained an MD from Tehran University of Medical Sciences, Iran. He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"7",institution:{name:"Tehran University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"900",title:"Clinical Immunology",slug:"pure-immunology-clinical-immunology"}],chapters:[{id:"56649",title:"Introductory Chapter: Introduction on Physiology and Pathology of Immunology",doi:"10.5772/intechopen.70429",slug:"introductory-chapter-introduction-on-physiology-and-pathology-of-immunology",totalDownloads:2214,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Farzaneh Rahmani, Mohammad Reza Rahmani and Nima Rezaei",downloadPdfUrl:"/chapter/pdf-download/56649",previewPdfUrl:"/chapter/pdf-preview/56649",authors:[{id:"116250",title:"Dr.",name:"Nima",surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei"}],corrections:null},{id:"57671",title:"Physiology and Pathology of Immune Dysregulation: Regulatory T Cells and Anergy",doi:"10.5772/intechopen.71770",slug:"physiology-and-pathology-of-immune-dysregulation-regulatory-t-cells-and-anergy",totalDownloads:1648,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"The immune system is responsible for the defense of the organism. It controls what is introduced into it and identifies it as self from non-self. The defensive mechanisms activated by the immune system are directed against pathological microbes and toxic or allergenic proteins, and it must avoid responses that produce excessive damage of self-tissues, inducing tolerance to avoid autoimmunity and other immunopathologies. Regulatory T cells play an essential role in these active processes, using several distinct suppressive mechanisms. The immune dysregulatory diseases result from defects affecting regulatory T cell development and/or function, including the impact of essential genes mutations for T regulatory cell functions and the associated autoimmune syndromes.",signatures:"Maria Isabel Torres, Miguel Angel López-Casado, Candelaria Ponce\nde León, Pedro Lorite and Teresa Palomeque",downloadPdfUrl:"/chapter/pdf-download/57671",previewPdfUrl:"/chapter/pdf-preview/57671",authors:[{id:"34102",title:"Dr.",name:"Isabel",surname:"Torres",slug:"isabel-torres",fullName:"Isabel Torres"},{id:"213607",title:"Dr.",name:"Pedro",surname:"Lorite",slug:"pedro-lorite",fullName:"Pedro Lorite"},{id:"213608",title:"Dr.",name:"Miguel Ángel",surname:"López Casado",slug:"miguel-angel-lopez-casado",fullName:"Miguel Ángel López Casado"},{id:"213609",title:"Ms.",name:"Ponce De León",surname:"C",slug:"ponce-de-leon-c",fullName:"Ponce De León C"},{id:"213610",title:"Prof.",name:"Palomeque",surname:"T",slug:"palomeque-t",fullName:"Palomeque T"}],corrections:null},{id:"57932",title:"Physiology and Pathology of Cytokine: Commercial Production and Medical Use",doi:"10.5772/intechopen.72200",slug:"physiology-and-pathology-of-cytokine-commercial-production-and-medical-use",totalDownloads:1843,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Cytokines are small, short-lived proteins secreted by many different cell types. As signaling molecules, cytokines provide communication between cells and play a crucial role in modulating innate and adaptive immune response. The family of cytokines includes interferons, interleukins, chemokines, mesenchymal growth factors, tumor necrosis factor family and adipokines. Interferons (IFNs) are a multigene family of inducible cytokines with antiviral, antiproliferative, and immunomodulatory function. Recombinant DNA technology can be useful in the production of human IFNs. This process includes fermentation, purification, and formation of the final product. Interleukins are classified in families based on sequence homology, receptor-binding properties, biological function, and cellular sources. TNF and IL-1 are considered to be key mediators of inflammatory response, while IL-6 plays a key role in the transition from acute to chronic inflammation. The inhibition of TNF includes administration of anti-TNF antibody and TNF receptor (TNFR). The reduction of IL-1 level can be achieved by the administration of anti-IL-1 antibody or IL-1 receptor antagonist (IL-1Ra), and the reduction of IL-6 level in the treatment of chronic inflammatory diseases can be achieved by the administration of anti-IL-6 antibody and anti-IL-6 receptor antibody. Recombinant cytokines and cytokine antagonists (antibodies and receptors) can be used in treating many different diseases.",signatures:"Nemanja Zdravkovic, Mirko Rosic, Mitar Lutovac and Vladimir\nZdravkovic",downloadPdfUrl:"/chapter/pdf-download/57932",previewPdfUrl:"/chapter/pdf-preview/57932",authors:[{id:"210432",title:"Prof.",name:"Nemanja",surname:"Zdravkovic",slug:"nemanja-zdravkovic",fullName:"Nemanja Zdravkovic"},{id:"212028",title:"Prof.",name:"Vladimir",surname:"Zdravkovic",slug:"vladimir-zdravkovic",fullName:"Vladimir Zdravkovic"},{id:"221287",title:"Prof.",name:"Mirko",surname:"Rosic",slug:"mirko-rosic",fullName:"Mirko Rosic"},{id:"221288",title:"Prof.",name:"Mitar",surname:"Lutovac",slug:"mitar-lutovac",fullName:"Mitar Lutovac"}],corrections:null},{id:"57997",title:"Physiology and Pathology of Drug Hypersensitivity: Role of Human Leukocyte Antigens",doi:"10.5772/intechopen.72133",slug:"physiology-and-pathology-of-drug-hypersensitivity-role-of-human-leukocyte-antigens",totalDownloads:2192,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Drug Hypersensitivity reactions can be distinguished in adverse drug events and adverse drug reactions. They represent a major problem in the medical scheme, since they are often underestimated. Pharmacogenetic analysis demonstrated significant associations between emerging hypersensitivity reactions and distinct genes of the HLA complex. HLA-mediated hypersensitivity reactions particularly affect skin and liver, however, impairment of the bone marrow and kidney function could also be observed. These life threatening medical conditions can be attributed to the activation of autologous drug-specific T-cells. Severe drug hypersensitivity reactions that resemble acute GvHD are linked to certain specific HLA alleles. The most common hypersensitivity reactions occur after the treatment of HLA-B*57:01+ HIV patients with abacavir and HLA-A*31:01+ or B*15:02+ epileptic patients with carbamazepine (CBZ).",signatures:"Gwendolin Simper, Alexander A. Celik, Heike Kunze-Schumacher,\nRainer Blasczyk and Christina Bade-Döding",downloadPdfUrl:"/chapter/pdf-download/57997",previewPdfUrl:"/chapter/pdf-preview/57997",authors:[{id:"72037",title:"Prof.",name:"Rainer",surname:"Blasczyk",slug:"rainer-blasczyk",fullName:"Rainer Blasczyk"},{id:"169291",title:"Dr.",name:"Christina",surname:"Bade-Doeding",slug:"christina-bade-doeding",fullName:"Christina Bade-Doeding"},{id:"203315",title:"Dr.",name:"Gwendolin",surname:"Simper",slug:"gwendolin-simper",fullName:"Gwendolin Simper"},{id:"203316",title:"MSc.",name:"Alexander A.",surname:"Celik",slug:"alexander-a.-celik",fullName:"Alexander A. Celik"},{id:"203317",title:"MSc.",name:"Heike",surname:"Kunze-Schumacher",slug:"heike-kunze-schumacher",fullName:"Heike Kunze-Schumacher"}],corrections:null},{id:"56753",title:"Physiology and Pathology of Autoinflammation: NOD like Receptors in Autoinflammation and Autoimmunity",doi:"10.5772/intechopen.70484",slug:"physiology-and-pathology-of-autoinflammation-nod-like-receptors-in-autoinflammation-and-autoimmunity",totalDownloads:1782,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Immune regulation is an essential feature of immune responses. The failure of such regulation results in allergic reactions and debilitating autoimmune diseases that can be fatal. Furthermore, the recent increase in the prevalence of the latter as well as the medical severity makes this a subject of great medical interest. Autoimmunity results from a breakdown in or the failure of the self-tolerance mechanisms. Many genes have been identified in which mutations cause the predisposition to autoinflammation and autoimmunity in human and in animal models. The relatively small number of genes explored to date unquestionably shows the challenges of identifying the associated genes in outbred populations of humans. One chief contributing gene family to both autoinflammatory and autoimmune diseases is the nucleotide-binding and oligomerization domain (NOD)-like receptor (NLR) family. Ever since their discovery, NLRs have drawn considerable attention for their ability to form multiprotein complexes called inflammasomes and also for their roles as NLRs, independent of inflammasome complexes. We herein first revisit general characteristics of NLRs and inflammasomes. We then couple this knowledge with the most recent findings related to autoinflammatory and autoimmune diseases, while highlighting some unanswered questions and future perspectives in elucidating NLR roles in health and disease.",signatures:"Ceren Ciraci",downloadPdfUrl:"/chapter/pdf-download/56753",previewPdfUrl:"/chapter/pdf-preview/56753",authors:[{id:"212696",title:"Associate Prof.",name:"Ceren",surname:"Ciraci",slug:"ceren-ciraci",fullName:"Ceren Ciraci"}],corrections:null},{id:"56849",title:"Physiology and Pathology of Innate Immune Response Against Pathogens",doi:"10.5772/intechopen.70556",slug:"physiology-and-pathology-of-innate-immune-response-against-pathogens",totalDownloads:6226,totalCrossrefCites:21,totalDimensionsCites:28,hasAltmetrics:1,abstract:"Pathogen infections are recognized by the immune system, which consists of two types of responses: an innate immune response and an antigen-specific adaptive immune response. The innate response is characterized by being the first line of defense that occurs rapidly in which leukocytes such as neutrophils, monocytes, macrophages, eosinophils, mast cells, dendritic cells, etc., are involved. These cells recognize the pathogen-associated molecular patterns (PAMPs), which have been evolutionarily conserved by the diversity of microorganisms that infect humans. Recognition of these pathogen-associated molecular patterns occurs through pattern recognition receptors such as Toll-like receptors and some other intracellular receptors such as nucleotide oligomerization domain (NOD), with the aim of amplifying the inflammation and activating the adaptive cellular immune response, through the antigenic presentation. In the present chapter, we will review the importance of the main components involved in the innate immune response, such as different cell types, inflammatory response, soluble immune mediators and effector mechanisms exerted by the immune response against bacteria, viruses, fungi, and parasites; all with the purpose of eliminating them and eradicating the infection of the host.",signatures:"José Luis Muñoz Carrillo, Flor Pamela Castro García, Oscar\nGutiérrez Coronado, María Alejandra Moreno García and Juan\nFrancisco Contreras Cordero",downloadPdfUrl:"/chapter/pdf-download/56849",previewPdfUrl:"/chapter/pdf-preview/56849",authors:[{id:"214236",title:"Dr.",name:"Jose Luis",surname:"Muñoz-Carrillo",slug:"jose-luis-munoz-carrillo",fullName:"Jose Luis Muñoz-Carrillo"},{id:"216080",title:"Dr.",name:"Alejandra",surname:"Moreno-García",slug:"alejandra-moreno-garcia",fullName:"Alejandra Moreno-García"},{id:"216081",title:"Dr.",name:"Oscar",surname:"Gutiérrez-Coronado",slug:"oscar-gutierrez-coronado",fullName:"Oscar Gutiérrez-Coronado"},{id:"216082",title:"Dr.",name:"Pamela",surname:"Castro-García",slug:"pamela-castro-garcia",fullName:"Pamela Castro-García"},{id:"220717",title:"Dr.",name:"Juan Francisco",surname:"Contreras Cordero",slug:"juan-francisco-contreras-cordero",fullName:"Juan Francisco Contreras Cordero"}],corrections:null},{id:"56631",title:"Physiology and Pathology of Infectious Diseases: The Autoimmune Hypothesis of Chagas Disease",doi:"10.5772/intechopen.70342",slug:"physiology-and-pathology-of-infectious-diseases-the-autoimmune-hypothesis-of-chagas-disease",totalDownloads:1597,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Infectious pathologies are a group of diseases that contribute with great impact on public health worldwide. Among the various diseases, some have a higher epidemiological importance, since their morbidity and mortality are very significant. In addition to the usual immune response, mounted against noxious agents, there is still the concept of infection-induced autoimmunity. Autoimmune diseases are defined as illnesses in which the evolution from benign to pathogenic autoimmunity takes place. However, proving a disease to be of autoimmune etiology is not a simple task. It is well known that both genetic influences and environmental factors trigger autoimmune disorders. However, some theories are still under great discussion. One of the most intriguing self-induced disorders is the hypothesis of autoimmunity during Chagas disease. Since the mid-1970s, the Chagas autoimmunity hypothesis has been considered an important contributor to the complex immune response developed by the host and triggered by Trypanosoma cruzi. New ideas and findings have strengthened this hypothesis, which has been reported in a series of publications from different groups around the world. The aim of this chapter is to discuss the mechanisms involving autoimmunity development during Chagas disease.",signatures:"Armanda Moreira Mattoso-Barbosa, Renato Sathler-Avelar, Jordana\nGrazziela Alves Coelho-dos-Reis, Olindo Assis Martins-Filho, Andrea\nTeixeira-Carvalho and Danielle Marchetti Vitelli-Avelar",downloadPdfUrl:"/chapter/pdf-download/56631",previewPdfUrl:"/chapter/pdf-preview/56631",authors:[{id:"199152",title:"Ph.D.",name:"Renato",surname:"Sathler-Avelar",slug:"renato-sathler-avelar",fullName:"Renato Sathler-Avelar"},{id:"199153",title:"Ms.",name:"Armanda Moreira",surname:"Mattoso-Barbosa",slug:"armanda-moreira-mattoso-barbosa",fullName:"Armanda Moreira Mattoso-Barbosa"},{id:"199154",title:"Dr.",name:"Olindo Assis",surname:"Martins-Filho",slug:"olindo-assis-martins-filho",fullName:"Olindo Assis Martins-Filho"},{id:"200952",title:"Dr.",name:"Andrea",surname:"Teixeira-Carvalho",slug:"andrea-teixeira-carvalho",fullName:"Andrea Teixeira-Carvalho"},{id:"200953",title:"Dr.",name:"Danielle",surname:"Vitelli-Avelar",slug:"danielle-vitelli-avelar",fullName:"Danielle Vitelli-Avelar"},{id:"212248",title:"Dr.",name:"Jordana Graziella",surname:"Coelho-Dos Reis",slug:"jordana-graziella-coelho-dos-reis",fullName:"Jordana Graziella Coelho-Dos Reis"}],corrections:null},{id:"56532",title:"Physiology and Pathology of Autoimmune Diseases: Role of CD4+ T cells in Rheumatoid Arthritis",doi:"10.5772/intechopen.70239",slug:"physiology-and-pathology-of-autoimmune-diseases-role-of-cd4-t-cells-in-rheumatoid-arthritis",totalDownloads:2770,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by synovial inflammation leading to bone erosion and to systemic manifestations in patients with long RA duration. Although the aetiology is unknown, several observations make currently clear that CD4 T cells play a key role in the pathogenesis: (1) RA associates with certain polymorphisms of HLA class II molecules, and (2) the repertoire and aging of CD4 T cells as well as the intracellular signalling mediating CD4 T cell activation are altered in RA patients. We describe herein the alterations found in CD4 T cells and the role of these cells in the development and progression of RA.",signatures:"Patricia Castro-Sánchez and Pedro Roda-Navarro",downloadPdfUrl:"/chapter/pdf-download/56532",previewPdfUrl:"/chapter/pdf-preview/56532",authors:[{id:"205546",title:"Ph.D.",name:"Pedro",surname:"Roda-Navarro",slug:"pedro-roda-navarro",fullName:"Pedro Roda-Navarro"},{id:"205613",title:"MSc.",name:"Patricia",surname:"Castro-Sánchez",slug:"patricia-castro-sanchez",fullName:"Patricia Castro-Sánchez"}],corrections:null},{id:"56745",title:"Physiology and Pathology of Neuroimmunology: Role of Inflammation in Parkinson’s Disease",doi:"10.5772/intechopen.70377",slug:"physiology-and-pathology-of-neuroimmunology-role-of-inflammation-in-parkinson-s-disease",totalDownloads:2251,totalCrossrefCites:5,totalDimensionsCites:7,hasAltmetrics:0,abstract:"Parkinson’s disease (PD) is a neurodegenerative disease that affects 1% of the population aged 65 and over and is the second most common neurodegenerative disease next to Alzheimer’s disease. Interneuronal proteinaceous inclusions called Lewy bodies (LB) and a selective degeneration of dopaminergic neurons of the substantia nigra pars compacta (SNPC) are the main features of PD pathology. The most common clinical manifestations are rigidity, tremor, bradykinesia, postural instability, sleep disorders, alterations in gait, smell, memory, and dementia. Genetic and environmental factors are involved in PD, and, recently, oxidative stress, proteasome-mediated protein degradation, and inflammation have acquired relevance as major mechanisms of neuronal dysfunction. Increased levels of reactive oxygen and nitrogen species in the brain contribute to greater vulnerability of proteins to nitro-oxidative modification and to greater degrees of aggregation. These protein aggregates contain a variety of proteins of which α-synuclein appears to be the main structural component. Interestingly, α-synuclein can be secreted by neuronal cells and may lead the initiation and the maintenance of inflammatory events through the activation of microglia, which contributes to dopaminergic neuron depletion. New evidence also suggests that PD may be the result of an autoimmune response in which the immune cells recognize the neurons as foreign elements and would act against them, causing their death.",signatures:"Genaro Gabriel Ortiz, Héctor González-Usigli, Fermín P. Pacheco-\nMoisés, Mario A. Mireles-Ramírez, Angélica Lizeth Sánchez-López,\nErandis Dheni Torres-Sánchez, Erika Daniela González-Renovato,\nLuis Javier Flores-Alvarado, Miguel Ángel Macías-Islas, Paloma\nRivero-Moragrega and Víctor Sánchez González",downloadPdfUrl:"/chapter/pdf-download/56745",previewPdfUrl:"/chapter/pdf-preview/56745",authors:[{id:"26109",title:"Dr.",name:"Genaro",surname:"Ortiz",slug:"genaro-ortiz",fullName:"Genaro Ortiz"},{id:"166323",title:"Dr.",name:"Fermín",surname:"Pacheco-Moisés",slug:"fermin-pacheco-moises",fullName:"Fermín Pacheco-Moisés"},{id:"166325",title:"Dr.",name:"Miguel A",surname:"Macías-Islas",slug:"miguel-a-macias-islas",fullName:"Miguel A Macías-Islas"},{id:"166328",title:"Dr.",name:"Erandis D",surname:"Tórres-Sánchez",slug:"erandis-d-torres-sanchez",fullName:"Erandis D Tórres-Sánchez"},{id:"173290",title:"MSc.",name:"Erica Daniela",surname:"González-Renovato",slug:"erica-daniela-gonzalez-renovato",fullName:"Erica Daniela González-Renovato"},{id:"173292",title:"Ph.D.",name:"Angélica L.",surname:"Sánchez López.",slug:"angelica-l.-sanchez-lopez.",fullName:"Angélica L. Sánchez López."},{id:"173295",title:"Dr.",name:"Mario",surname:"Mireles-Ramírez",slug:"mario-mireles-ramirez",fullName:"Mario Mireles-Ramírez"},{id:"173377",title:"Dr.",name:"J Luis",surname:"Flores-Alvarado",slug:"j-luis-flores-alvarado",fullName:"J Luis Flores-Alvarado"},{id:"178191",title:"Dr.",name:"Héctor",surname:"González-Usigli",slug:"hector-gonzalez-usigli",fullName:"Héctor González-Usigli"},{id:"210965",title:"Dr.",name:"Paloma",surname:"Rivero-Moragrega",slug:"paloma-rivero-moragrega",fullName:"Paloma Rivero-Moragrega"},{id:"210966",title:"Dr.",name:"Víctor J",surname:"Sánchez-González",slug:"victor-j-sanchez-gonzalez",fullName:"Víctor J Sánchez-González"}],corrections:null},{id:"56792",title:"Physiology and Pathology of Multidrug-Resistant Bacteria: Antibodies- and Vaccines-Based Pathogen-Specific Targeting",doi:"10.5772/intechopen.70488",slug:"physiology-and-pathology-of-multidrug-resistant-bacteria-antibodies-and-vaccines-based-pathogen-spec",totalDownloads:1865,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Multidrug-resistant bacteria (MDR) are increasing rapidly and posing a global threat to mankind. Alternative strategies other than antibiotics have to be explored urgently. In this chapter, we review the current status of nonantibiotics strategies including antibody-based therapy and vaccine development for targeting Gram-positive strains (methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium) and MDR Gram-negative strains (Acinetobacter baumannii and Pseudomonas aeruginosa). Biologics-based clinical progress against these bacterial infections is updated.",signatures:"Yang Zhang, Jie Su and Donghui Wu",downloadPdfUrl:"/chapter/pdf-download/56792",previewPdfUrl:"/chapter/pdf-preview/56792",authors:[{id:"205515",title:"Dr.",name:"Donghui",surname:"Wu",slug:"donghui-wu",fullName:"Donghui Wu"}],corrections:null},{id:"56789",title:"Physiology and Pathology of Multidrug-Resistant Bacteria: Phage-Related Therapy",doi:"10.5772/intechopen.70487",slug:"physiology-and-pathology-of-multidrug-resistant-bacteria-phage-related-therapy",totalDownloads:2121,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Multidrug-resistant bacteria (MDR) are spreading rapidly across the world that outpace development of new antibiotics. Options other than antibiotics treatment are urgently needed. In this chapter, we review the current status of nonantibiotics-based strategies including phage therapy and phage-derived protein therapy for targeting Gram-positive strains (methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium) and MDR Gram-negative strains (Acinetobacter baumannii and Pseudomonas aeruginosa).",signatures:"Lianlian Jiang, Abhishek Saxena and Donghui Wu",downloadPdfUrl:"/chapter/pdf-download/56789",previewPdfUrl:"/chapter/pdf-preview/56789",authors:[{id:"205515",title:"Dr.",name:"Donghui",surname:"Wu",slug:"donghui-wu",fullName:"Donghui Wu"},{id:"213838",title:"Dr.",name:"Lianlian",surname:"Jiang",slug:"lianlian-jiang",fullName:"Lianlian Jiang"},{id:"213839",title:"Dr.",name:"Abhishek",surname:"Saxena",slug:"abhishek-saxena",fullName:"Abhishek Saxena"},{id:"213840",title:"Dr.",name:"Yang",surname:"Zhang",slug:"yang-zhang",fullName:"Yang Zhang"},{id:"213841",title:"Ms.",name:"Jie",surname:"Su",slug:"jie-su",fullName:"Jie 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\r\n\tMagnetic materials acquired a very important position in several high-tech areas and technological developments. Such materials are being classified not only based on their origin but also on the nature of their processing, properties, functions, and applications. Magnetic materials present the basics of magnetism, magnetic materials, magnetic structures, and their applications in device technologies. Recently, new magnetic materials and hybrid structures have been developed using different synthesis and fabrication techniques. Different phenomena and interesting properties are studied theoretically and experimentally using advanced characterization techniques. Magnetic materials are now the building block of all technological innovation.
\r\n
\r\n\tThis book aims to present an overview of different magnetic materials including theoretical study, synthesis, characterization, and application of magnetic materials. The chapter and different topics of the book hope to provide a key understudying on different magnetic materials. It will be very much helpful to students, researchers, academicians, and professionals. This book hopes to give the readers new ideas and insights into scientific advances and technology related to magnetic materials. Novelties on magnetic materials development will display attractive properties for a wide range of applications in advanced technologies.
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1. Introduction
Unfortunately, coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide despite costly aggressive drug and surgical interventions as a first line strategy [1]. However, these therapies fail to address the origin of the problem, that is, the most proximal risk factors for progression of atherosclerotic CAD, including poor-quality diet patterns, physical inactivity, obesity, and cigarette smoking [1, 2]. Consistent evidence from landmark epidemiological studies supports the concept that these risk factors contribute nearly 80% of population-attributable risk of cardiovascular diseases (CVD) [3-4]. Accordingly, a healthy lifestyle modification may afford close to 80% protection from CAD [5]. Therefore, lifestyle managements to reduce cardiovascular risk are of superior importance as stated in population-based strategies for cardiovascular prevention such as 2012 European guidelines [6] and the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines [7].
Research on the origin of CAD has been ongoing for approximately a century [8]. From the beginning, diet played a paramount role in research on the cause of CAD. At the same time, one of the great interests was explaining differences in the incidence of CAD among populations. In the early 1900s, evidence from cross-cultural studies indicated some associations between diet and cholesterol. However, systemic associations between diet, cholesterol, and CAD were made almost after half a century. In the 1950s, cross-cultural studies indicated that endemic diets had important impact on the variation of CAD across populations [9]. Thus, it was thought that there was a direct relation between cholesterol in diet, cholesterol in blood, and cholesterol in the plaque, and its clinical complications such as myocardial infarction (MI). The findings of cross-cultural studies stimulated further inquiry to determine whether altering the diet could decrease serum cholesterol levels and, thereby, decrease the incidence of CAD. Nearly all clinical trials in the 1960s, 1970s, and 1980s compared usual diets with those characterized by low total fat, low saturated fat, low dietary cholesterol, and increased polyunsaturated fats. Actually, these diets did reduce cholesterol levels. However, they did not reduce the incidence of MI and CAD mortality. Secondary prevention trials in the 1990s, together with primary prevention approaches in the 2000s, indicate that dietary patterns consistent with the traditional Mediterranean-style diets (MedD) with a strong focus on veggies, fruits, fish, whole grain, and olive oil are effective in preventing CAD to a degree greater than low-fat diets and equal to or greater than the benefit observed in statin trials. With accumulating evidence, we have now moved away from a focus on total fat and cholesterol to the importance of considering the content of fat and total calories in the diet. In other words, the type of fat, rather than the total or the ratio or balance between the saturated and certain unsaturated fats may be the determinant. Recent meta-analyses of intervention studies confirm the beneficial effects of replacing saturated with polyunsaturated fatty acid on CAD risk. Nutritional interventions have proven that a complicated set of many nutrients interact to influence CAD risk. Therefore, recent guidelines consider diet as a whole and combine nutrient and energy recommendations into a healthy pattern that is nutrient dense and energy balanced.
This chapter begins with early studies and interventions for prevention of CAD through diet, and it continues with recent clinical trials. In the next section, we will focus on the newer "whole diet" approach, consistent with the traditional MedD, which has proven to be successful in preventing CAD. Finally, we will summarize the current state of knowledge on dietary fats and prevention of CAD by foods.
2. Diets to prevent CAD: From early studies to recent trials
2.1. Early clues that diet may prevent CAD
In 1908, A.I. Ignatowski was first to observe that cholesterol-rich food promoted atherosclerosis in rabbits [10]. Then, as reported by Finking and Hanke, Nikolai N. Anichkov showed in 1913 that cholesterol-enriched diet led to atheromatous changes such as fatty streaks and advanced atheromatous plaques in the vascular wall of rabbits that are similar to the lesions in humans with coronary atherosclerosis [11]. During the ensuing decades, atherosclerosis moved from a laboratory curiosity to a major public health concern.
Starting in the 1950s, research on atherosclerosis gained more credibility and support, as a multidisciplinary community of clinical investigators accomplished new research programs dedicated to unraveling the puzzle about pathophysiological origins and treatment of CAD. In 1952, Kinsell reported that intake of vegetable oil instead of animal fats resulted in a striking decrease in serum cholesterol and phospholipid levels [12]. Groen et al. found out that intake of vegetarian diets decreased serum cholesterol levels [13].
The first study on the variation in the occurrence of CAD across populations was published in 1916 by the Dutch physician De Langen, who observed that cholesterol levels of Dutch immigrants in the former Dutch Indies were approximately twice as high as those of native Javanese [14]. He hypothesized for the first time that differences in diet patterns could be associated difference in average population cholesterol levels. However, the first systemic association between diet, cholesterol, and CAD waited until the 1950s.
2.2. The first systemic association between diet, cholesterol, and CAD: The diet-heart hypothesis
In 1957, Angel Keys cited extensive epidemiological evidence that indicate a sequence of etiologic relations existed between the saturated fat content of the diet, serum cholesterol concentrations, and the development of CAD [9]. These observations, based on the differences in average population serum cholesterol levels and population rates of CAD mortality, played a pivotal role for the development of diet-heart hypothesis: Dietary saturated fat, and in some versions, dietary cholesterol, raise blood cholesterol, which in turn leads to coronary atherosclerosis [9]. In 1957, Keys et al. began the Seven Countries Study by surveying 12,763 men aged 40 to 59 years formed 16 cohorts in seven countries (Italy, Greece, the former Yugoslavia, the Netherlands, Finland, Japan, and the United States). Study communities were chosen for the relative uniformity of their rural laboring populations and their contrasting dietary patterns. Information on biological risk factors (e.g., serum cholesterol, blood pressure, and antrophotometric measurements) were collected and ECG was taken in addition to a physical examination. Information on diet was collected by use of 7-day food records in small samples of each cohort. The risk factor surveys were repeated after five and ten years. Through central chemical analysis of the foods consumed by randomly selected families as well as diet-recall measures, Keys and his colleagues were able to determine that both the blood cholesterol levels and the heart-attack death rates were highest in societies where fat was a major component of every meal (i.e., the US and Finland). Conversely, blood cholesterol was low and heart attacks were rare in cultures where diets were based on fresh fruit and vegetables, bread, pasta, and plenty of olive oil (i.e., the Mediterranean region). The findings of the seven countries study published in 1970 had a significant impact on CAD prevention, as it described one of the first studies to clearly show that dietary saturated fat leads to CAD, and that the relationship is mediated by serum cholesterol [15].
Even though the three major preventable risk factors for CAD (elevated serum cholesterol levels, high blood pressure, and smoking) had been identified as early as 1956, the link between cholesterol and CAD required the results of large epidemiology studies before gaining widespread acceptance [16-18].
AHA was one of the first organizations to recommend dietary changes to decrease atherosclerosis [19]. Together with the Society for the Study of Atherosclerosis, the AHA Nutrition committee published their recommendations in 1957 [20]. In brief, it was concluded that diet might play a crucial role in the pathogenesis of atherosclerosis, and the most essential factors in the diet were the fat content and the total calories. It was also thought that the type of the fat, rather than the total or the ratio or balance between the saturated and certain unsaturated fats, might be the determinant. The same year, the AHA Nutrition Committee suggested for the first time that CAD might be prevented by treating obesity with low-fat diet [20]. The recommendations of the committee requested obese individuals to confine caloric consumption by reducing dietary fat consumption. The following year, in 1958, Brown and Page published a paper entitled "Lowering blood lipid levels by changing food patterns" and they offered two dietary ways to treat serum cholesterol, namely, a diet containing minimum animal fat together with an increase in vegetable oil and a strict low fat diet [21]. Afterwards, by 1961, AHA’s Ad Hoc Committee on Dietary Fat and Atherosclerosis recommended the reduction or control of fat consumption under medical supervision. Additionally, substitution of polyunsaturated for saturated fats to prevent atherosclerosis and decrease the risks of heart attacks and strokes were also recommended [22]. Thereafter, the importance of substitution of polyunsaturated vegetable oil for saturated fat, instead of a low-fat diet, gained widespread acceptance.
2.3.2. Dietary cholesterol reduction
In 1972, the American Medical Association (AMA) Council on Foods and Nutrition in cooperation with the Food and Nutrition Board of National Academy of Sciences-National Research Council published a joint statement that the blood cholesterol level was linked to the risk of CAD [23]. Similar with AHA guidelines, these two representative councils stressed that reasonable means should be followed to modify the nutritional conditions that contribute to elevated plasma cholesterol and triglyceride levels. The primary goals suggested were reduction in foods rich in cholesterol and partial replacement of saturated with polyunsaturated fats.
2.3.3. Clinical trials for secondary prevention of CHD
The US National Diet-Heart Study was a large, double-blind, two-year study on the effects of diet on blood cholesterol levels in both free-living and closed populations [24]. The results of the study indicated that the average change in blood cholesterol with low saturated fat, low dietary cholesterol diets was 25 and 28 mg/dl or -11 and -12% in a free-living population, while it was 36 mg/dl or -17% in the closed-institutional centers.
2.3.4. Lifestyle intervention studies for reversal of CAD
To date, a number of lifestyle intervention studies have been performed. Obtaining substantial differences in lifestyle and diet between the experimental and control groups is complicated. Moreover, it is almost impossible to avoid an aftereffect of a healthy lifestyle and diet advice from the experimental group to the control group. Therefore, comprehensive controlled trials investigating the combined effects of diet and a healthy lifestyle on disease end points in individuals are difficult to perform and expensive.
In 1948, the Framingham Heart Study—under the direction of the National Heart Institute (now known as the National Heart, Lung, and Blood Institute or NHLBI)—embarked on an ambitious project in health research [25]. The objective of the Framingham Heart Study was to identify the common factors or characteristics that contribute to CAD by following its development over a long period of time in men and women free of these conditions at the outset. The first person was examined in September 1948 and four years later 5,209 persons had received their first examination. The group has now been followed in the study for 24 subsequent biennial examinations. As changes in early detection and treatment of CVD advance, prospective epidemiology is needed to document the value and impact of these changes in an organized fashion. The availability of prospective data on two generations adds to the uniqueness of the Framingham Study among ongoing studies of CAD epidemiology [26].
As a result of corroborative evidence from prospective population studies such as the Framingham study, the scientific community focused on systemic intervention studies to test whether reducing risk factors would reduce disease incidence. Nearly all clinical trials in the 1960s, 1970s, and 1980s compared usual diets with those characterized by low total fat, low saturated fat, low dietary cholesterol, and increased polyunsaturated fats. Unsurprisingly, the reduction in cardiovascular mortality and total mortality was greater in the secondary prevention trials and appeared to be dependent on the baseline cholesterol levels; that is, the higher the baseline risk the greater the obtained benefit.
In 1970, the Oslo Study dealed with 412 men, aged 30 to 64 years, randomized one to two years after a first MI [27]. A diet low in saturated fats and cholesterol,and high in polyunsaturated fats was recommended for the experimental group. After 11 years, a significantly reduced MI mortality in the original diet group was found (32 versus 57, P = 0.004). The total number of coronary deaths (fatal MI and sudden death) was 79 in the diet group and 94 in the control group (P = 0.097). The CAD mortality was correlated with age, serum cholesterol level, blood pressure, body weight, smoking habits, and a combination of these risk factors.
An early example of a primary prevention trial that used an intervention with regard to more than 1 factor is the first Oslo trial [28]. In this trial, intervention was focused on both diet and smoking. A total of 16,202 men, aged 40 to 49 years, were screened for coronary risk factors. Of these, 1,232 healthy, normotensive men at high risk of CAD were selected for a five-year randomized trial to show whether the lowering of serum lipids and cessation of smoking could reduce the incidence of CAD. These men had high serum cholesterol levels (7.5 to 9.8 mmol/L), were mostly smokers (80%), had systolic blood pressures below 150 mm Hg, and were at very high risk for CAD. They were randomized into two groups; the patients in the intervention group were recommended to lower their blood lipids by change of diet and to stop smoking, and the control group did not receive any advice. The advised diet was low in saturated fat and high in fiber. Saturated fat intake decreased from 18% to 8% of the total energy intake, and saturated fat was partly replaced by n-6 polyunsaturated fatty acids. During the trial, mean serum cholesterol concentrations were approximately 13% lower in the intervention group than in the control group. This difference was in agreement with the difference in fatty acid composition of the diet between the two groups. Besides the difference in diet, 25% of smokers in the experimental group stopped smoking compared with 17% in the control group. At the end of the observation period, the incidence of MI (fatal and non-fatal) and sudden death was 47% lower in the intervention group than in the controls. When the incidence of strokes was added, the difference between the groups was still significant. The reduction in incidence in the intervention group was correlated with the reduction in total cholesterol, and to a lesser extent, with smoking reduction. It was concluded that, in healthy middle-aged men at high risk of CAD, advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of MI and sudden death.
A large prospective cohort study is the Chicago Heart Association Detection Project in Industry (CHA), which screened blood pressure, cholesterol level, and smoking [28]. Risk factor data were available for 6,766 middle-aged men and women, aged 36 to 64 years. The age-adjusted relative risks of coronary heart disease mortality for low-risk persons compared with those who smoked and had elevated cholesterol and blood pressure levels varied between 0.08 in CHA men aged 18 to 39 years and 0.23 in CHA men aged 40 to 59 years. The life expectancy of persons at low risk was 9.5 years longer in CHA men aged 18 to 39 years and 5.8 years longer in CHA women aged 40 to 59 years compared with persons at elevated risk. These results illustrate the great impact of low risk factor levels on coronary heart disease risk and health in general.
However, the Multiple Risk Factor Intervention Trial (MRFIT), a US multicenter clinical trial, was an unsuccessful large prospective cohort study [29]. The risk factor data were available for more than 360,000 men aged 35 to 57 years. The participants were screened for blood pressure, cholesterol levels, and smoking for 16 years. In the special intervention group, hypertension was treated with standard medications, and smoking cessation was promoted. The dietary goals, reducing saturated fat to less than 8% caloric intake and cholesterol to less than 250 mg/d, with increased polyunsaturated fat (>10%), were nearly accomplished. However, despite the significant reduction in dietary fat, the changes in total cholesterol and low-density lipoprotein cholesterol after seven years of intervention were modest. Total cholesterol decreased by 2.9% in those receiving community care and 5% in those receiving special care. The end points of reduction in total mortality and coronary death were not achieved. This lack of efficacy was striking given that hypertension was better controlled and cigarette cessation was more successful in the special intervention group.
In 1990, Ornish et al. reported a prospective, randomized, controlled trial of 48 patients with angiographically documented CAD [30]. Twenty-eight patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise). Follow-up quantitative coronary angiography was performed after intervention and compared with angiograms in 20 usual-care control patients with documented CAD. Overall, 82% of experimental-group patients had an average change towards regression. Additionally, there was angiographic evidence of progression in 53% in the control group. Coronary arteriography was repeated five years later. Additional regression was noted in 20 patients who maintained their lifestyle changes, with further progression in the 15 control patients. These patients followed a very low-fat (10%) vegetarian diet. It was noted that comprehensive lifestyle changes might be able to bring about regression of even severe coronary atherosclerosis after only one year, without use of lipid-lowering drugs.
2.4. Dietary trials for secondary prevention of CAD
2.4.1. Early trials
In 1989, Burr et al. reported the results of the Diet Reinfarction Trial, a randomized controlled trial that investigated the effect of diet on the secondary prevention of MI, involving 2,033 men [31]. The trial had a factorial design, subjects being randomized independently to receive advice or no advice regarding three dietary factors: (1) total fat intake and the ratio of polyunsaturated to saturated fat; (2) fatty fish consumption; and (3) cereal fiber intake. The results suggested that compliance with the advice was reasonably good. There was a slight (3.6%) reduction in cholesterol in those advised to decrease fat. There was no decrease in cholesterol in patients advised to increase fatty fish or cereal fiber intake. None of these three factors influenced the two-year incidence of reinfarction or cardiac death. However, patients counseled to eat fatty fish had a 29% reduction in the two-year all-cause mortality. It was suggested that the difference attributable to advice on fat was somewhat less than anticipated, partly because of failure to comply with the advice and partly because of spontaneous changes in the diets of control subjects.
The Indian Experiment of Infarct Survival Study (1989-1992), a randomized, single-blind, controlled trial, aimed to test whether a fat-reduced diet rich in soluble dietary fiber, antioxidant vitamins, and minerals reduces complications and mortality after acute MI [32]. For this aim, 406 patients with suspected acute MI were randomized to one of two low-fat diets. The experimental group was counseled on a “whole diet approach” that included increased intake of fruits, vegetables, nuts, and fish. Main outcome measures were mortality from cardiac disease and other causes, and serum lipid concentrations and compliance with diet. Total fat was reduced to 24% of daily calories in the experimental group and 28% in control group. Saturated fat was significantly reduced in the experimental group. Dietary cholesterol was 147 mg/d in the experimental group compared with 287 mg/d in the control diet. The experimental group lowered total cholesterol by 13% compared with 5% in the control diet. There was a significant reduction in the combination of nonfatal MI, fatal MI, and sudden death from 82 patients assigned to the control diet to 50 patients on the experimental diet. It was concluded that comprehensive dietary changes in conjunction with weight loss immediately after acute MI might modulate blood lipoproteins and significantly reduced complications and mortality after one year.
In the Lyon Diet Heart Study (1988-1997), a randomized, controlled trial with free-living subjects, 605 survivors of a first MI were randomized to an Mediterranean-type diet (consistent with the new AHA Dietary Guidelines) or a “prudent” low-fat diet on composite measures of the coronary recurrence rate [33]. The Mediterranean-type diet is a whole diet approach that is low in animal products and saturated fat, with an emphasis on the use of olive oil. It is rich in legumes, fruit, vegetables, and fish. Butter and cream were replaced with a canola-based margarine. The saturated fatty acid and oleic acid contents in the margarine were comparable to those in olive oil, with the exception that the margarine was higher in linoleic acid and α-linolenic acid. Subjects in the experimental group participated in a one-hour counseling session. In contrast, control subjects received no specific dietary advice apart from that generally provided by attending physicians and hospital dietitians. The end points of the Lyon Diet Heart Study were cardiovascular death or nonfatal MI. At the end of the trial, the percentage of daily calories from fat was 30.4% in the Mediterranean diet group and 33.6% in the low-fat/low cholesterol control group. The calories derived from saturated fat were significantly lower in the Mediterranean diet group (8% vs. 11.7%), as was the daily cholesterol intake (203 vs. 312 mg/day). In addition, omega-3 consumption (from vegetables, fish, and margarine) was considerably higher and omega-6 consumption was lower for those on the Mediterranean diet. At the end of the trial, there was no significant difference between the total serum cholesterol or low-density lipoprotein cholesterol levels in those on the two diets. The trial was stopped after 27 months when an intermediate analysis showed that those on the Mediterranean diet had a 73% reduction in CVD deaths and nonfatal MI. After 46 months, despite a similar coronary risk factor profile (plasma lipids and lipoproteins, systolic and diastolic blood pressure, body mass index, and smoking status), subjects following the Mediterranean-style diet had a 50% to 70% lower risk of recurrent heart disease, as measured by three different combinations of outcome measures including (1) cardiac death and nonfatal heart attacks; (2) the preceding plus unstable angina, stroke, heart failure, and pulmonary or peripheral embolism; and (3) all of these measures plus events that required hospitalization.
2.4.2. Contemporary approach for primary prevention of CAD: Mediterranean diet
The Mediterranean diet is considered as one of the most favorable diet for cardiovascular health. It is an evidence-based diet to prevent not only CVD but also some other chronic diseases such as breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline [34].
The most important feature of the Mediterranean diet seems to be a synergy between the various cardioprotective nutrients and foods [35]. In general, the Mediterranean diet is characterized by a high intake of monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes, nuts; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets [34, 36, 37].
The high concentration of unsaturated fats, such as olive oil, is the most prominent aspect of the Mediterranean diet. Research on the impact of olive oil consumption for CVD prevention has showed that the cardioprotective effects of olive oil are thought to be attributed to the presence of its phenolic compounds, which are potent antioxidants, free radical scavengers, and enzyme modulators [38].
Numerous observational data show a reduction in CVD by increased consumption of fruits and vegetables. The potential benefit of fruits and vegetables could lie in reduced total caloric burden, or in large amount of micronutrients that they provide. The exact evidence establishes the antioxidant properties of fruit and vegetables [39] and the health benefits of increased flavonol intake [40]. The effects of nitric oxide (NO) species, or concomitant weight loss associated with diets high in fruits and vegetables could be alternative mechanisms [34].
An extensive amount of data suggests a beneficial effect of increased whole grains on CVD morbidity and mortality. AHA guidelines indicate that diets high in fiber such as whole grains, oats and barley reduce cardiovascular disease morbidity and mortality through lipid lowering, and recommend a total dietary fiber intake of 25-30 g per day from whole foods [41].
The data about the beneficial effect of moderate nut consumption are positive. Evaluation of observational studies showed that substituting walnuts, peanuts, almonds, or other nuts for a serving of carbohydrates or saturated fats reduced blood lipids, as well as the risk for cardiovascular disease by 30% and 45%, respectively [42].
Estruch et al. designed a randomized trial, the PREvención con DIeta MEDiterránean (PREDIMED) Study, to test the efficacy of two Mediterranean diets (one supplemented with extra-virgin olive oil and another with mixed nuts), as compared with a control diet (advice on a low-fat diet), on primary cardiovascular prevention [37]. A total of 7,447 men and women (age ranged from 55 to 80 years) in Spain who were at high cardiovascular risk at enrollment, but without evidence of cardiovascular disease, were randomized to one of three diets stated above. Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. Total fat intake was not restricted in patients on the Mediterranean diet, but the source of fat was predominantly from fatty fish and plants. The low fat diet group was counseled to reduce all types of fat, including olive oil and nuts. The primary end point was the rate of major cardiovascular events (MI, stroke, or death from cardiovascular causes). The trial was stopped after a median follow-up of 4.8 years on the basis of the results of an interim analysis. Total dietary fat was higher in the Mediterranean diet groups. Both groups were similar with regard to saturated fat and dietary cholesterol intake. The primary end point, namely MI, stroke, or death from cardiovascular causes, was reduced by 30% in the Mediterranean diet supplemented with extra virgin olive oil and 28% lower in the Mediterranean diet group supplemented with mixed nuts compared with controls.
Conclusively, Estruch et al. suggested that dietary patterns consistent with the traditional Mediterranean-style diet were particularly cardioprotective [37]. Mediterranean-style diets are widely accepted to be effective in preventing CHD even though they do not decrease total serum cholesterol or low-density lipoprotein cholesterol [43].
3. Dietary fats and cardiovascular/coronary heart disease
3.1. Total fat
Since the beginning of the concern about diet and CVD risk assessment, dietary fat, especially the total fat, is the main point of interest. Till the beginning of the 1990s, the recommendations for the public health was focused on limiting the total fat intake, especially to reduce CVD. As part of the Dietary Approaches to Stop Hypertension (DASH) diet, low-fat dairy intake has been shown to lower blood pressure [44]. However, lowering total cholesterol by replacing dietary total fat with carbohydrate may contrarily increase serum triglyceride concentration [45]. Moreover, in a meta-analysis of prospective cohort studies, intake of total fat was not found significantly associated with CHD mortality or CHD events [46]. One of the key studies about total fat intake was the Women’s Health Initiative Dietary Modification Trial. In this study, dietary intervention that reduced total fat intake did not significantly reduce the risk of CHD or CVD in postmenopausal women and only modest effects on CVD risk factors were achieved [47]. According to the 2006 AHA Diet and Lifestyle recommendations, for decreasing the CVD risk, the recommendations are much about limitations of intake of each type of fat, instead of reducing the total fat intake. Specifically, the AHA recommends to supply 7% of energy from saturated fat and 1% of energy from trans fat [48]. And also, according to the Dietary Guidelines for Americans 2010, lowering the percentage of calories from dietary saturated fatty acids to 7% of calories and replacing them with monounsaturated and/or polyunsaturated fatty acids can further reduce the risk of CVD [49].
3.2. Saturated Fatty Acids (SFA)
The primary SFA sources are animal fat such as meat, milk, and dairy products, some plant oils such as palm and coconut oils, and the industrially-prepared food (cookies, cakes, and pies). Several meta-analyses showed that SFA intake was not significantly associated with risk of CAD or CVD [50-52]. Recent data from meta-analyses of cohort studies and randomized control trials suggest that SFA consumption on CVD risk depends on the replacement nutrient. The latest epidemiologic studies and clinical trials suggest that differing effects depending on the replacement nutrient scenario such as replacing saturated fat with polyunsaturated fat in the diet is more beneficial for CAD risk than with carbohydrates [53]. In a pooled analysis of 11 prospective cohort studies, Jakobsen et al. revealed that consumption of polyunsaturated fatty acid (PUFA) in place of SFA was associated with reduced CAD risk [54]. In another study, Mozaffarian et al. indicated as the result of 8 randomised clinical trials that changing the energy intake from SFA to PUFA by 5% reduced the CAD risk by 10% [55]. Additionally, in the Cochrane Collaboration meta-analysis of 48 RCTs, Hooper et al. revealed that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% [13]. And this study also suggested that the beneficial effects occurred in the case of fat modification rather than reduction of fat intake and in a two-year period. Also, males and population who have moderate or high risk of CVD are more prone to have benefits from dietary fat modification. However, dietary fat modification was not found to be beneficial on CVD mortality [56]. Based on recent evidence, both the AHA and the European Society of Cardiology advise to limit saturated fat intake to <10% and <7% of total daily calories, respectively [6, 57]. According to the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, for adults to benefit from LDL cholesterol lowering, only 5%-6% of calories should come from saturated fat (through replacement of PUFA > monounsaturated fat (MUFA) > whole grains > refined carbohydrates). [58]
3.3. Monounsaturated Fatty Acids (MUFA)
The main dietary MUFA is oleic acid, which is abundant in nuts, sunflower oil, olive oil, canola oil, high oleic safflower oil, and avocado. Because olive oil is the essential part of the Mediterranean diet, the role of MUFA in the prevention of CAD has a close interest, especially after Mattson and Grundy showed that high SFA diets increase the LDL cholesterol/HDL cholesterol ratio and changing SFA with MUFA reduces LDL cholesterol levels but not HDL cholesterol [59]. Replacing MUFA with carbohydrates in the diet causes several alterations in the lipid profile, such as TG and VLDL cholesterol decrease and HDL cholesterol and apoA1 increase [60, 61]. However, the epidemiologic data about oleic acid and CAD prevention is controversial. While the Nurses\' Health Study (NHS) found remarkable protection, in the Zutphen and Puerto Rico Heart Health Program studies there were no beneficial effects reported between controls and CAD cases [62-64]. In a recent study, Schwingshackl and Hoffmann recapped the most available data about MUFA and CVD risk in which they found no accepted rationale for MUFA recommendation, although there are no significant side effects of diets with rich MUFA up to date [65]. Also, according to the Cochrane meta-analysis by Hooper et al., reduction of SFA intake and replacement with unsaturated fat is advised for the population under risk of CVD [66].
3.4. Trans Fatty Acids (TFA)
Trans fatty acids (TFA) are a type of unsaturated fat that became commonly produced industrially from vegetable fats for use in margarine, snack food, packaged baked goods, and frying fast food. TFA has at least one carbon-carbon double bond in the trans, rather than the typical cis configuration. Early in the 20th century, TFA was invented for increasing the shelf life of oils and consumption of these fats, as margarine increased all over the world. Recently, it has been recognized that it causes elevated cholesterol levels and has a major role in the risk of CAD [67]. Beyond their energy value, TFA does not have any known health benefits and there is an apparent association between TFA consumption and the risk of heart disease. In a meta-analysis of 28 cohort studies, there has been found a highly significant positive association between TFA intake and CAD morbidity and mortality [68]. Energy replacement of TFA with SFA, MUFA, or PUFA 1% resulted in the decrease of the TC: HDL ratio in controlled trials and each 2% replacement would lower CAD risk in prospective cohort studies [69]. Because of this CVD risk increase, the Food and Drug Administration (FDA) and the other Health Regulatory Agencies required food manufacturers to list TFA on the Nutrition Facts and some Supplement Facts sections on the package of food, although TFA levels of less than 0.5 g per serving can be listed as 0 g [70].
3.5. N-3 fatty acids
Because of the low rates of ischemic heart disease in Greenland Eskimos, there was close attention to their diet. This protection was thought to be caused by long-chained PUFA’s anti-thrombotic effects, which is an important part of their diet [71]. Prospective cohorts revealed the protective effects of intake of n-3 fatty acids on CAD, and since then evidence suggests that n-3 fatty acid intake may be effective for secondary prevention. The possible effects were thought to be prevention of arrhythmias, as well as lowering of heart rate and blood pressure, decreasing platelet aggregation, and lowering triglyceride concentration [72]. The n-3 fatty acids also decrease hepatic TG secretion and increase clearance from plasma. In diabetic patients, n-3 PUFA are found to reduce TG levels by 25% and VLDL levels by 36%; however, LDL concentrations increased slightly by 5.7% [73]. Since then, several meta-analysis and RCTs have been published about the role of seafood n-3 fatty acids on CVD and CVD mortality. Some of them suggested that n-3 fatty acid intake lowers the CVD risk, but some of them found no significant effect on CVD risk and/or mortality. In the last US guidelines on patients with CAD, fish and/or fish oil supplement is indicated only in the control of a patient’s lipid profile (class IIB, level of evidence B) [74]. But in the latest European Society of Cardiology (ESC) guidelines, the protective effects of fish on CVD is associated with n-3 PUFA. Moreover, it is suggested that eating fish at least once a week reduces the CAD risk by 15% [6]. There are controversies between epidemiologic studies and clinical trials, probably due to the different study groups. Epidemiologic observational studies usually evaluate the disease-free population, but clinical trials are often conducted in a population at risk of CVD.
3.6. Plant-based fatty acids
α-linolenic acid (ALA) is a short chain n-3 PUFA found in plant sources such as soybeans, walnuts, rapeseed oil, and flaxseed. It could be an alternative to fish n-3 PUFA because it can be converted to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are n-3 PUFAs that are found in fish. But this conversion is limited and the evidence for ALA in CVD protection is limited. In a systematic review of 14 human studies, at least four weeks of supplementation of ALA has no significant effect on the lipid profile [75]. However, since no current specific recommendations for ALA for CAD risk reduction is present, epidemiologic studies suggest a protective role, the diet including ALA (2 to 3 g per day) has been recommended for both primary and secondary prevention of CAD [76]. Further studies need to strengthen the evidence for the effects of ALA on CVD.
3.7. B Vitamins
The main role of B vitamins is principally for energy production, cell metabolism, and nerve function. Beside these, vitamins B12, B6, and folic acid are known to have homocysteine lowering effect. Several studies suggested that high homocysteine levels are associated with increased risk of MI and/or stroke. Because folic acid, B12, and B6 decreased the blood homocysteine level in 20%-40%, from baseline, it has been assumed that these supplements can subsequently reduce CVD risk [77]. The studies about the effects of folic acid and B vitamin supplementation failed to prove that reducing homocysteine level by folic acid and vitamin B supplements decreases CVD incidence. Most of the epidemiologic studies suggested protective effects of B vitamins on CAD but the randomized clinical trials did not show the same beneficial effects. A meta-analysis of 12 randomized trials that has 16,958 participants with pre-existing vascular disease revealed that folic acid supplementation had no effect on CAD risk [78]. After 1996, the US FDA made a regulation for the fortification of grain products (flour, breads, rice, pasta, cornmeal, etc.) with folic acid. Since then, the prevalence of low plasma folate concentrations has decreased [79]. The role of B vitamins and folate are plausible in the prevention of CVD and more studies are needed.
4. Foods and cardiovascular/coronary heart disease
4.1. Fruit and vegetables
Epidemiological studies have suggested that fruits and vegetables reduce CAD risk. A meta-analysis of nine cohort studies (including 129,701 women, 91,379 men, and 5,007 CAD events) showed that each additional fruit serving a day lowered the CHD risk by 7% (RR 0.93, 95% CI: 0.89-0.96; P < 0.001) [80]. Increasing fruit and vegetable consumption to 600 g/day, could reduce the incidence of ischaemic heart disease and ischemic stroke by 31% and 19%, respectively [81]. In the CARDIO2000 study, daily consumption of more fruit was associated with 72% lower risk of CAD (95% CI: 0.11-0.54, P < 0.001) and of more vegetables was associated with 70% lower risk for CAD (95% CI: 0.22-0.40, P < 0.001) [82]. However, the results of the WHI Dietary Modification Trial suggest that an additional portion of vegetables and fruit daily does not influence the risk of CAD [4]. Fruit and vegetable intake are part of the nutritional recommendations in the interventional studies where fruit and vegetable consumption was associated with lower blood pressure only [83] but the association with other CAD risk factors is not apparent. As the intervention studies did not exist, AHA recommends intake of at least eight vegetables and fruits a day [47]. With all these data, vegetables and fruits that are deeply colored (e.g., carrots, peaches, spinach, and berries) are recommended for consumption and preparation techniques that preserve nutrient and fiber content is important. The mechanism of action of their healthy effects is not known, but it can be attributed to their high dietary fiber and antioxidants content.
4.2. Fish
A meta-analysis of 11 cohort studies of 222,364 individuals showed that individuals who consumed fish 2-4 times/week had 23% lower risk of CAD mortality. Moreover, the individuals with higher frequency of fish consumption, i.e., ≥5 times/week, had greater reduction of risk. It is estimated that a daily fish intake of 20 g was associated with 7% lower risk of CAD mortality [84]. The benefit of fish intake for reducing the risk for CAD is due to n-3 PUFA according to the studies showing that fatty fish is associated with protection but lean fish is not. Fatty fish is the primary source of n-3 fatty acids. A prospective cohort study (including 1,373 men) suggested that fatty fish consumption reduces the risk of sudden coronary death risk compared to lean fish consumption [85]. Besides the type and amount of fish consumed, the cooking method of fish is also important. According to the Cardiovascular Health Study, only modest consumption of tuna or other broiled or baked fish was associated with a lower risk of heart failure, but fried fish was not [86]. The most recent Diet and Lifestyle recommendations of AHA for CVD risk reduction include consuming fatty fish at least twice a week [48]. The AHA also recommends eating fish within the recommendations established by the FDA and Environmental Protection Agency to prevent the possible adverse effects due to environmental pollutants such as mercury [87].
4.3. Whole grains
There are many definitions for whole grain present but according to The American Association of Cereal Chemists, a whole-grain ingredient is "...the intact, ground, cracked, or flaked caryopsis, whose principal anatomical components, the starchy endosperm, germ, and bran, are present in substantially the same relative proportions as they exist in the intact caryopsis" [88]. The alternative definition is used by studies that explicitly describe or define whole grain, but do not meet the classical definition of whole grains, by including bran and germ, and studies that do not explicitly use the term “whole grains” but were in fact conducted with individual whole grains such as oats or barley [89]. Whole-grain foods contain fiber, vitamins, minerals, phenolic compounds, phytoestrogens, and other unmeasured constituents. Whole-grain foods may have favorable effects on health by lowering blood pressure and serum lipids, and by also improving glucose and insulin metabolism and endothelial function [90]. They have also beneficial effects by reducing oxidative stress and inflammation.
Recently, many epidemiologic studies have searched the relation between whole grain intake and CVD risk. A meta-analysis of seven large-prospective cohort studies showed that whole grain intake was related with 21% lower risk of CVD for both genders [91]. In the NHS study, among women with type 2 diabetes with 26 years of follow-up, whole grain intake was found to be associated with lower risk of CVD-specific mortality and also bran intake was significantly associated with 35% lower risk of mortality [92]. As recent evidence about the protective role of whole grains in prevention of CVD was strong, FDA declared in Health Claim Notification for Whole Grain Foods that "Diets high in plant foods—i.e., fruits, vegetables, legumes, and whole-grain cereals—are associated with a lower occurrence of coronary heart disease and cancers of the lung, colon, esophagus, and stomach" [93].
Recently, a meta-analysis of 14 studies indicated that the highest whole grain intake amount compared with the lowest amount was significantly associated with reduced risk for CAD. The association was significant in cohort studies but not in case-control studies [94].
4.4. Alcohol
The data on the association between alcohol and CVD come either from short-term interventional studies or from the effects of alcohol on risk factors, as well as long-term observational mortality studies. Many studies suggested that moderate alcohol consumption, compared to no or heavy alcohol consumption, decreased CVD risk in many populations. The evidence suggests a J- or U-shaped relationship between alcohol consumption and risk of CAD [95]. Moderate intake of alcoholic beverages (1 to 2 drinks per day) is associated with a reduced risk of CAD in healthy populations in both men and women [96] and there is no difference between the types of beverages [97]. Different mechanisms have been suggested about the benefit of light-to-moderate alcohol intake on CVD such as an increase in HDL-C, reduction in plasma increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction in inflammation, and promotion of antioxidant effects [98, 99]. However, these are still not enough to prove causality. Despite the evidence from cohort studies about moderate alcohol drinking and CVD, current guidelines do not recommend to begin consuming alcohol for preventing CVD. The recommendations of AHA on alcoholic drinks are that they should limited to no more than two drinks per day for men and one drink per day for women, ideally with meals [48].
5. Conclusions
CHD remains one of the leading causes of morbidity and mortality worldwide, in spite of the advances in pharmacological treatments and better control of risk factors. Diet is a centrally important modifiable risk factor in the prevention and risk reduction of CAD. Progress in understanding the importance of diet on CAD has evolved in the past 100 years. Data on trends in food consumption and ecological studies are the early evidences that showed associations between prevalence and fat intake across and within countries. The last 50 years of clinical trials and nutritional interventions have established a clear link among diet, atherosclerosis, and CAD. Numerous meta-analyses of intervention studies confirm the beneficial effects of replacing saturated with polyunsaturated fatty acid on CAD risk. Moreover, the type of fat, rather than the total or the ratio or balance between the saturated and certain unsaturated fats is determinant. Recent guidelines consider diet as a whole and combine nutrient and energy recommendations into a healthy pattern that is nutrient dense and energy balanced. A “whole diet” approach with equal attention to what is consumed and what is excluded is proven to be more effective in preventing CAD than low-fat, low-cholesterol diets. Dietary patterns consistent with the traditional Mediterranean-style diets with a strong focus on veggies, fruits, fish, wholegrain, olive oil are effective in preventing CAD even though they do not decrease total serum cholesterol.
\n',keywords:"CAD prevention, reducing cholesterol, low-fat diets, Mediterranean diet",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/49188.pdf",chapterXML:"https://mts.intechopen.com/source/xml/49188.xml",downloadPdfUrl:"/chapter/pdf-download/49188",previewPdfUrl:"/chapter/pdf-preview/49188",totalDownloads:1678,totalViews:620,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:1,introChapter:null,impactScore:0,impactScorePercentile:4,impactScoreQuartile:1,hasAltmetrics:1,dateSubmitted:"January 9th 2015",dateReviewed:"August 24th 2015",datePrePublished:null,datePublished:"November 18th 2015",dateFinished:"September 30th 2015",readingETA:"0",abstract:"Our understanding of the potential role of diet in the prevention and risk reduction of coronary artery disease (CAD) has evolved in the past 100 years. Data on trends in food consumption and ecological studies are the early evidences that showed associations between prevalence and fat intake across and within countries. The last 50 years of epidemiology and clinical trials have focused on the efficiency of nutritional interventions in the prevention of CAD.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/49188",risUrl:"/chapter/ris/49188",book:{id:"4642",slug:"coronary-artery-disease-assessment-surgery-prevention"},signatures:"Oguzhan Yildiz, Melik Seyrek and Kemal Gokhan Ulusoy",authors:[{id:"164299",title:"Prof.",name:"Oguzhan",middleName:null,surname:"Yıldız",fullName:"Oguzhan Yıldız",slug:"oguzhan-yildiz",email:"oyildiz@gata.edu.tr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Ankara University",institutionURL:null,country:{name:"Turkey"}}},{id:"164968",title:"Dr.",name:"Melik",middleName:null,surname:"Seyrek",fullName:"Melik Seyrek",slug:"melik-seyrek",email:"mseyrek@gata.edu.tr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Ankara University",institutionURL:null,country:{name:"Turkey"}}},{id:"176080",title:"Dr.",name:"Kemal Gökhan",middleName:null,surname:"Ulusoy",fullName:"Kemal Gökhan Ulusoy",slug:"kemal-gokhan-ulusoy",email:"kgulusoy@gata.edu.tr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Ankara University",institutionURL:null,country:{name:"Turkey"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Diets to prevent CAD: From early studies to recent trials",level:"1"},{id:"sec_2_2",title:"2.1. Early clues that diet may prevent CAD",level:"2"},{id:"sec_3_2",title:"2.2. The first systemic association between diet, cholesterol, and CAD: The diet-heart hypothesis",level:"2"},{id:"sec_4_2",title:"2.3. Dietary recommendations and clinical trials",level:"2"},{id:"sec_4_3",title:"2.3.1. Low fat/low saturated fat/increased polyunsaturated diets",level:"3"},{id:"sec_5_3",title:"2.3.2. Dietary cholesterol reduction",level:"3"},{id:"sec_6_3",title:"2.3.3. Clinical trials for secondary prevention of CHD",level:"3"},{id:"sec_7_3",title:"2.3.4. Lifestyle intervention studies for reversal of CAD",level:"3"},{id:"sec_9_2",title:"2.4. Dietary trials for secondary prevention of CAD",level:"2"},{id:"sec_9_3",title:"2.4.1. Early trials",level:"3"},{id:"sec_10_3",title:"2.4.2. Contemporary approach for primary prevention of CAD: Mediterranean diet",level:"3"},{id:"sec_13",title:"3. Dietary fats and cardiovascular/coronary heart disease",level:"1"},{id:"sec_13_2",title:"3.1. Total fat",level:"2"},{id:"sec_14_2",title:"3.2. Saturated Fatty Acids (SFA)",level:"2"},{id:"sec_15_2",title:"3.3. Monounsaturated Fatty Acids (MUFA)",level:"2"},{id:"sec_16_2",title:"3.4. Trans Fatty Acids (TFA)",level:"2"},{id:"sec_17_2",title:"3.5. N-3 fatty acids",level:"2"},{id:"sec_18_2",title:"3.6. Plant-based fatty acids",level:"2"},{id:"sec_19_2",title:"3.7. B Vitamins",level:"2"},{id:"sec_21",title:"4. Foods and cardiovascular/coronary heart disease",level:"1"},{id:"sec_21_2",title:"4.1. Fruit and vegetables",level:"2"},{id:"sec_22_2",title:"4.2. Fish",level:"2"},{id:"sec_23_2",title:"4.3. Whole grains",level:"2"},{id:"sec_24_2",title:"4.4. Alcohol",level:"2"},{id:"sec_26",title:"5. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation. 2012;125:188-97. DOI: 10.1161/cir.0b013E3182456d46.'},{id:"B2",body:'Sunar H, Halici U, Canbaz S, Yavuz E, Gur O, Duran E. Effect of obesity on coronary artery bypass surgery. Gulhane Med J. 2003;45:338-342.'},{id:"B3",body:'Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16-22. DOI: 10.1056/nejm200007063430103.'},{id:"B4",body:'Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet. 2004;364:937-52. DOI: 10.1016/s0140-6736(04)17018-9.'},{id:"B5",body:'Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: A population-based prospective cohort study. J Am Coll Cardiol. 2014;64:1299-306. DOI: 10.1016/j.jacc.2014.06.1190.'},{id:"B6",body:'Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F. European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33:1635-701. DOI: 10.1093/eurheartj/ehs092.'},{id:"B7",body:'Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline onlifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960-84. DOI: 10.1016/j.jacc.2013.11.003.'},{id:"B8",body:'Connor WE. Diet-heart research in the first part of the 20th century. Acta Cardiol. 1999;54:135-139.'},{id:"B9",body:'Keys A. Diet and the epidemiology of coronary heart disease. JAMA. 1957;164:1912-1919. DOI: 10.1001/jama.1957.62980170024007e.'},{id:"B10",body:'Ignatowski AI. Influence of animal food on the organism of rabbits. S Peterb Izv Imp Voyenno-Med Akad. 1908;16:154-176.'},{id:"B11",body:'Finking G, Hanke H. Nikolajewitsch Anitschkow (1885-1964) Established the cholesterol-fed rabbit as a model for atherosclerosis research. Atherosclerosis. 1997;135:1-7. DOI: 10.1016/s0021-9150(97)00161-5.'},{id:"B12",body:'Kinsell LW. Dietary modification of serum cholesterol and phospholipid levels. J Clin Endocrinol. 1952;12:909-913. DOI: 10.1210/jcem-12-7-909.'},{id:"B13",body:'Groen JJ, Tjiong BK, Kamminga CE, Willebrands AF. Influence of nutrition, individuality, and some other factors, including various forms of stress, on serum cholesterol. Voeding. 1952;13:556-587.'},{id:"B14",body:'de Langen C. Cholesterine-stofwisseling en rassenpathologie. Geneeskundig Tijdschrift voor Nederlansch-Indie (in Dutch). 1916;56:1-34.'},{id:"B15",body:'Keys A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease.1st ed. Harvard University Press Cambridge, MA London England. 1980.'},{id:"B16",body:'Rose GA, Thomson WB, Williams RT. Corn oil in treatment of ischemic heart disease. Br Med J. 1965;1:1531-1533. DOI: 10.1136/bmj.1.5449.1531.'},{id:"B17",body:'Leren P. The Oslo diet-heart study. Eleven-year report. Circulation. 1970;42:935-942. DOI: 10.1161/01.cir.42.5.935.'},{id:"B18",body:'Woodhill JM, Palmer AJ, Leelarthaepin B, McGilchrist C, Blacket RB. Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Adv Exp Med Biol. 1978;109:317-330. DOI: 10.1007/978-1-4684-0967-3_18.'},{id:"B19",body:'Dalen JE, Devries S. Diets to prevent coronary heart disease 1957-2013: What have we learned? Am J Med. 2014;127:364-9. DOI: 10.1016/j.amjmed.2013.12.014.'},{id:"B20",body:'Page IH, Stare FH, Corcoran AC, Pollack H, Wilkinson CF. Atherosclerosis and the fat content of the diet. JAMA. 1957;164:2048-2051. DOI: 10.1001/jama.1957. 62980180004013.'},{id:"B21",body:'Brown HB, Page IH. Lowering blood lipid levels by changing food patterns. JAMA. 1958;168:1989-1995. DOI: 10.1001/jama.1958.03000150031008.'},{id:"B22",body:'Page IH, Allen EV, Chamberlain FL, Keys A, Stamler J, Stare FJ. Dietary fat and its relation to heart attacks and strokes. Circulation. 1961;23:133-136. DOI: 10.1161/01.cir.23.1.133.'},{id:"B23",body:'Johnson PE. Diet and coronary heart disease. Prev Med. 1972;1:559-561. DOI: 10.1016/0091-7435(72)90039-4.'},{id:"B24",body:'Page IH, Brown HB. Some observations on the National Diet-Heart Study. Circulation. 1968;37:313-315. DOI: 10.1161/01.cir.37.3.313.'},{id:"B25",body:'Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383:999-1008. DOI: 10.1016/s0140-6736(13)61752-3.'},{id:"B26",body:'Millen BE, Quatromoni PA. Nutritional research within the Framingham Heart Study. J Nutr Health Aging. 2001;5:139-43.'},{id:"B27",body:'Leren P. The Oslo diet-heart study. Eleven-year report. Circulation. 1970;42:935-4. DOI: 10.1161/01.cir.42.5.935.'},{id:"B28",body:'Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981;2:1303-10. DOI: 10.1016/s0140-6736(81)91338-6.'},{id:"B29",body:'Stamler J, Caggiula A, Grandits GA, Kjelsberg M, Cutler JA. Relationship to blood pressure of combinations of dietary macronutrients. Findings of the Multiple Risk Factor Intervention Trial (MRFIT). Circulation. 1996;94:2417-23. DOI: 10.1161/01.cir.94.10.2417.'},{id:"B30",body:'Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-33. DOI: 10.1016/0140-6736(90)91656-u.'},{id:"B31",body:'Burr ML, Gilbert JF, Holliday RM, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial infarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2:757-761. DOI: 10.1016/s0140-6736(89)90828-3.'},{id:"B32",body:'Singh RB, Rastogi SS, Verma R, et al. Randomized controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: Results of one year follow-up. BMJ. 1992;304:1015-1019. DOI: 10.1136/bmj.304.6833.1015.'},{id:"B33",body:'de Lorgeri M, Renaud S, Mamelle N, et al. Mediterranean alphalinolenic-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454-1459. DOI: 10.1016/s0140-6736(94)92580-1.'},{id:"B34",body:'Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015;128:229-38. DOI: 10.1016/j.amjmed.2014.10.014.'},{id:"B35",body:'Jacobs DJ, Gross MD, Tapsell LC. Food synergy: An operational concept for understanding nutrition. Am J Clin Nutr. 2009;89:1543S-1548S. DOI: 10.3945/ajcn.2009.26736b.'},{id:"B36",body:'Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E,Trichopoulos D. Mediterranean diet pyramid: A cultural model for healthy eating. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1402S-1406S.'},{id:"B37",body:'Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279-90. DOI: 10.1056/nejmoa1200303.'},{id:"B38",body:'Fuhrman B, Aviram M. Flavonoids protect LDL from oxidation and attenuate atherosclerosis. Curr Opin Lipidol. 2001;12:41-48. DOI: 10.1097/00041433-200102000-00008.'},{id:"B39",body:'Knekt P, Ritz J, Pereira MA, O\'Reilly EJ, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Rimm EB, Ascherio A. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80:1508-20.'},{id:"B40",body:'Huxley R, Neil HA. The relation between dietary flavonol intake and coronary heart disease mortality: A meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2003;57:904-908. DOI: 10.1038/sj.ejcn.1601624.'},{id:"B41",body:'Van Horn L. Fiber, lipids, and coronary heart disease. A statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation. 1997;95:2701-2704. DOI: 10.1161/01.cir.95.12.2701.'},{id:"B42",body:'Hu FB, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep. 1999;1:204-9. DOI: 10.1007/s11883-999-0033-7.'},{id:"B43",body:'Collins R, Peto R, Godwin J, MacMahon S. Blood pressure and coronary heart disease. Lancet. 1990;336:370-1. DOI: 10.1016/0140-6736(90)91908-s.'},{id:"B44",body:'Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336 (16):1117-1124. DOI: 10.1056/nejm199704173361601.'},{id:"B45",body:'Ma Y, Li Y, Chiriboga DE, Olendzki BC, Hebert JR, Li W, Leung K, Hafner AR, Ockene IS. Association between carbohydrate intake and serum lipids. J Am Coll Nutr. 2006;25:155-63. DOI: 10.1080/07315724.2006.10719527.'},{id:"B46",body:'Skeaff CM, Miller J. Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55:173-201. DOI: 10.1159/000229002.'},{id:"B47",body:'Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, Kuller LH, LaCroix AZ, Langer RD, Lasser NL, Lewis CE, Limacher MC, Margolis KL, Mysiw WJ, Ockene JK, Parker LM, Perri MG, Phillips L, Prentice RL, Robbins J, Rossouw JE, Sarto GE, Schatz IJ, Snetselaar LG, Stevens VJ, Tinker LF, Trevisan M, Vitolins MZ, Anderson GL, Assaf AR, Bassford T, Beresford SA, Black HR, Brunner RL, Brzyski RG, Caan B, Chlebowski RT, Gass M, Granek I, Greenland P, Hays J, Heber D, Heiss G, Hendrix SL, Hubbell FA, Johnson KC, Kotchen JM. Low-fat dietary pattern and risk of cardiovascular disease: The Women\'s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295:655-66. DOI:10.1001/jama.295.6.655.'},{id:"B48",body:'Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82-96. DOI: 10.1161/circulationaha.106.176158.'},{id:"B49",body:'U.S. Department of Agriculture and U.S. Department of Health and Human Services Dieatray Guidelines for Americans 2010. Available from : http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf [Accessed:2015-07-20].'},{id:"B50",body:'Skeaff CM, Miller J. Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55:173-201. DOI: 10.1159/000229002.'},{id:"B51",body:'Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169:659-69. DOI: 10.1001/archinternmed.2009.38.'},{id:"B52",body:'Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91:535-46. DOI: 10.3945/ajcn.2009.27725.'},{id:"B53",body:'Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010;91:502-9. DOI: 10.3945/ajcn.2008.26285.'},{id:"B54",body:'Jakobsen MU, O\'Reilly EJ, Heitmann BL, Pereira MA, Bälter K, Fraser GE, Goldbourt U, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Major types of dietary fat and risk of coronary heart disease: A pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89:1425-32. DOI: 10.3945/ajcn.2008.27124.'},{id:"B55",body:'Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: A systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252. DOI: 10.1371/journal.pmed.1000252.'},{id:"B56",body:'Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore HJ, Davey Smith G. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2012;5:CD002137. DOI: 10.1002/14651858.CD002137.pub3.'},{id:"B57",body:'Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82-96. DOI: 10.1161/circulationaha.106.176158.'},{id:"B58",body:'Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 1;63 (25 Pt B):2960-84. DOI: 10.1016/j.jacc.2013.11.003.'},{id:"B59",body:'Mattson FH, Grundy SM. Comparison of effects of dietary saturated, monounsaturated,and polyunsaturated fatty acids on plasma lipids and lipoproteins in man. J Lipid Res. 1985;26:194-202.'},{id:"B60",body:'Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: A meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003;77:1146-55.'},{id:"B61",body:'Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM. OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: Results of the OmniHeart randomized trial. J Am Med Assoc. 2005;294:2455-64. DOI: 10.1001/jama.294.19.2455.'},{id:"B62",body:'Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, Hennekens CH, Willett WC. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;337:1491-9. DOI: 10.1056/nejm199711203372102.'},{id:"B63",body:'Garcia-Palmieri MR, Sorlie P, Tillotson J, Costas Jr R, Cordero E, Rodriguez M. Relationship of dietary intake to subsequent coronary heart disease incidence: The Puerto Rico Heart Health Program. Am J Clin Nutr. 1980;33:1818-27.'},{id:"B64",body:'Kromhout D, de Lezenne Coulander C. Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study. Am J Epidemiol. 1984;119:733-41.'},{id:"B65",body:'Schwingshackl L, Hoffmann G. Monounsaturated fatty acids and risk of cardiovascular disease: Synopsis of the evidence available from systematic reviews and meta-analyses. Nutrients. 2012;4:1989-2007. DOI: 10.3390/nu4121989.'},{id:"B66",body:'Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore HJ, Davey Smith G. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2012;5:CD002137. DOI: 10.1002/14651858.CD002137.pub3.'},{id:"B67",body:'Willett WC. Trans fatty acids and cardiovascular disease-epidemiological data. Atheroscler Suppl. 2006;7:5-8. DOI: 10.1016/j.atherosclerosissup.2006.04.002.'},{id:"B68",body:'Skeaff CM, Miller J. Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55:173-201. DOI: 10.1159/000229002.'},{id:"B69",body:'Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr. 2009;63 (Suppl 2):S22-33. DOI: 10.1038/sj.ejcn.1602976.'},{id:"B70",body:'FDA, Labeling & Nutrition 2006. Avaliable from: http://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/ucm274592.htm [Accessed: 2015-07-20].'},{id:"B71",body:'Bang HO, Dyerberg J, Hjoorne N. The composition of food consumed by Greenland Eskimos. Acta Med Scand. 1976;200:69-73. DOI: 10.1111/j.0954-6820.1976.tb08198.x.'},{id:"B72",body:'Harris WS, Miller M, Tighe AP, Davidson MH, Schaefer EJ. Omega-3 fatty acids and coronary heart disease risk: Clinical and mechanistic perspectives. Atherosclerosis. 2008;197:12-24. DOI: 10.1016/j.atherosclerosis.2007.11.008.'},{id:"B73",body:'Hartweg J, Farmer AJ, Perera R, Holman RR, Neil HA. Meta-analysis of the effects of n-3 polyunsaturated fatty acids on lipoproteins and other emerging lipid cardiovascular risk markers in patients with type 2 diabetes. Diabetologia. 2007;50:1593-602. DOI: 10.1007/s00125-007-0695-z.'},{id:"B74",body:'Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV, Anderson JL. American College of Cardiology Foundation/American Heart Association Task Force. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354-471. DOI: 10.1161/cir.0b013e318277d6a0.'},{id:"B75",body:'Wendland E, Farmer A, Glasziou P, Neil A. Effect of alpha linolenic acid on cardiovascular risk markers: A systematic review. Heart. 2006;92:166-9. DOI: 10.1136/hrt.2004.053538.'},{id:"B76",body:'Mozaffarian D. Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med. 2005;11:24-30 quiz 31, 79.'},{id:"B77",body:'Eilat-Adar S, Goldbourt U. Nutritional recommendations for preventing coronary heart disease in women: Evidence concerning whole foods and supplements. Nutr. Metab. Cardiovasc. Dis. 2010 Jul;20(6):459-66. DOI: 10.1016/j.numecd.2010.01.011.'},{id:"B78",body:'Bazzano LA, Reynolds K, Holder KN, He J. Effect of folic acid supplementation on risk of cardiovascular diseases: A meta-analysis of randomized controlled trials. JAMA. 2006;296:2720-6. DOI: 10.1001/jama.296.22.2720.'},{id:"B79",body:'Jacques PF, Selhub J, Bostom AG, Wilson PW, Rosenberg IH. The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med. 1999;340:1449-54. DOI: 10.1056/nejm199905133401901.'},{id:"B80",body:'Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: A meta-analysis of cohort studies. J. Nutr. 2006;136:2588-2593.'},{id:"B81",body:'Lock K, Pomerleau J, Causer L, Altmann DR, McKee M. The global burden of disease attributable to low consumption of fruit and vegetables: Implications for the global strategy on diet. Bull World Health Organ. 2005;83:100-8.'},{id:"B82",body:'Panagiotakos DB, Pitsavos C, Kokkinos P, Chrysohoou C, Vavuranakis M, Stefanadis C, Toutouzas P. Consumption of fruits and vegetables in relation to the risk of developing acute coronary syndromes; the CARDIO2000 case-control study. Nutr J. 2003;2:2. DOI: 10.1186/1475-2891-2-2.'},{id:"B83",body:'Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR. Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: Main results of the premier clinical trial. JAMA. 2003;289:2083-2093. DOI: 0.1001/jama.289.16.2083.'},{id:"B84",body:'He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR, Greenland P. Accumulated evidence on fish consumption and coronary heart disease mortality: A meta-analysis of cohort studies. Circulation. 2004;109:2705-11. DOI: 10.1161/01.cir.0000132503.19410.6b.'},{id:"B85",body:'Streppel MT, Ocke MC, Boshuizen HC, Kok FJ, Kromhout D. Long-term fish consumption and n-3 fatty acid intake in relation to (sudden) coronary heart disease death: the Zutphen study. Eur Heart J. 2008;29:2024-30. DOI: 0.1093/eurheartj/ehn294.'},{id:"B86",body:'Mozaffarian D, Bryson CL, Lemaitre RN, Burke GL, Siscovick DS. Fish intake and risk of incident heart failure. J Am Coll Cardiol. 2005;45:2015-21. DOI: 10.1016/j.jacc.2005.03.038.'},{id:"B87",body:'Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747-57. DOI: 10.1161/01.cir.0000038493.65177.94.'},{id:"B88",body:'Slavin J. Whole grains and human health. Nutr Res Rev. 2004 Jun;17(1):99-110. DOI: 10.1079/nrr200374.'},{id:"B89",body:'de Moura F (editor). Whole grain intake and cardiovascular disease and whole grain intake and diabetes. A review. Life Sciences Research Office; 2008.'},{id:"B90",body:'Anderson JW, Hanna TJ. Whole grains and protection against coronary heart disease: What are the active components and mechanisms? Am J Clin Nutr. 1999;70:307-308.'},{id:"B91",body:'Mellen PB, Walsh TF, Herrington DM. Whole grain intake and cardiovascular disease: A meta-analysis. Nutr Metab Cardiovasc Dis. 2008;18:283-90. DOI: /10.1016/j.numecd.2006.12.008.'},{id:"B92",body:'He M, van Dam RM, Rimm E, Hu FB, Qi L. Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus. Circulation. 2010;121:2162-8. DOI: 10.1161/circulationaha.109.907360.'},{id:"B93",body:'US Food and Drug Administration, Health Claim Notification for Whole Grain Foods. US Department of Health and Human Services, 1999. Available from: http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm073639.htm [Accessed: 2015-07-20].'},{id:"B94",body:'Tang G, Wang D, Long J, Yang F, Si L. Meta-analysis of the association between whole grain intake and coronary heart disease risk. Am J Cardiol. 2015 Mar 1;115(5):625-9. DOI: 10.1016/j.amjcard.2014.12.015.'},{id:"B95",body:'Marmoy M, Brunner E. Alcohol and cardiovascular disease: The status of the U-shaped curve. BMJ. 1991;303:565-568. DOI: 10.1136/bmj.303.6802.565.'},{id:"B96",body:'Goldberg IJ, Mosca L, Piano MR, Fisher EA. Nutrition Committee; Council on Epidemiology and Prevention; Council on Cardiovascular Nursing of the American Heart Association. AHA Science Advisory: Wine and your heart: A science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Circulation. 2001;103:472-475. DOI: 10.1161/01.cir.103.3.472.'},{id:"B97",body:'Marmot MG. Alcohol and coronary heart disease. Int. J. Epidemiol. 2001;30:724-729. DOI: 10.1093/ije/30.4.724.'},{id:"B98",body:'Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies. BMJ. 2011;342:d636. DOI: 10.1136/bmj.d636.'},{id:"B99",body:'Kloner RA, Rezkalla SH. To drink or not to drink? That is the question. Circulation. 2007;116:1306-1317. DOI: 10.1161/circulationaha.106.678375.'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Oguzhan Yildiz",address:"oyildiz@gata.edu.tr",affiliation:'
Department of Medical Pharmacology, Gulhane Faculty of Medicine, Etlik, Ankara, Turkey
Department of Medical Pharmacology, Gulhane Faculty of Medicine, Etlik, Ankara, Turkey
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Carlos Manuel Palmeira and Flávio\nReis",authors:[{id:"107926",title:"Prof.",name:"Flávio",middleName:null,surname:"Reis",fullName:"Flávio Reis",slug:"flavio-reis"},{id:"194774",title:"Dr.",name:"Sara",middleName:null,surname:"Nunes",fullName:"Sara Nunes",slug:"sara-nunes"},{id:"194775",title:"Prof.",name:"Anabela",middleName:null,surname:"Rolo",fullName:"Anabela Rolo",slug:"anabela-rolo"},{id:"194776",title:"Prof.",name:"Carlos",middleName:null,surname:"Palmeira",fullName:"Carlos Palmeira",slug:"carlos-palmeira"}]},{id:"52437",title:"Cirrhotic Cardiomyopathy",slug:"cirrhotic-cardiomyopathy",signatures:"Coskun Celtik, Nelgin Gerenli, Halil Haldun Emiroglu and Nimet\nCındık",authors:[{id:"76156",title:"Prof.",name:"Coskun",middleName:null,surname:"Celtik",fullName:"Coskun Celtik",slug:"coskun-celtik"},{id:"76816",title:"Prof.",name:"Halil Haldun",middleName:null,surname:"Emiroglu",fullName:"Halil Haldun Emiroglu",slug:"halil-haldun-emiroglu"},{id:"189537",title:"Dr.",name:"Nelgin",middleName:null,surname:"Gerenli",fullName:"Nelgin Gerenli",slug:"nelgin-gerenli"},{id:"195415",title:"Dr.",name:"Nimet",middleName:null,surname:"Cindik",fullName:"Nimet Cindik",slug:"nimet-cindik"}]},{id:"52169",title:"Takotsubo Cardiomyopathy as a Neurocardiogenic Injury after Subarachnoid Hemorrhage: Hemodynamics and Fluid Management",slug:"takotsubo-cardiomyopathy-as-a-neurocardiogenic-injury-after-subarachnoid-hemorrhage-hemodynamics-and",signatures:"Tatsushi Mutoh, Tomoko Mutoh, Yasuyuki Taki and Tatsuya\nIshikawa",authors:[{id:"188078",title:"Prof.",name:"Tatsushi",middleName:null,surname:"Mutoh",fullName:"Tatsushi Mutoh",slug:"tatsushi-mutoh"}]},{id:"52489",title:"Advanced Treatments and Emerging Therapies for Dystrophin- Deficient Cardiomyopathies",slug:"advanced-treatments-and-emerging-therapies-for-dystrophin-deficient-cardiomyopathies",signatures:"Jordi Camps, Enrico Pozzo, Tristan Pulinckx, Robin Duelen and\nMaurilio Sampaolesi",authors:[{id:"87287",title:"Prof.",name:"Maurilio",middleName:null,surname:"Sampaolesi",fullName:"Maurilio Sampaolesi",slug:"maurilio-sampaolesi"}]},{id:"53890",title:"Cardiomyopathies in Sub-Saharan Africa: Hypertensive Heart Disease (Cardiomyopathy), Peripartum Cardiomyopathy and HIV-Associated Cardiomyopathy",slug:"cardiomyopathies-in-sub-saharan-africa-hypertensive-heart-disease-cardiomyopathy-peripartum-cardiomy",signatures:"Okechukwu S. Ogah and Ayodele O. Falase",authors:[{id:"188089",title:"Dr.",name:"Okechukwu",middleName:null,surname:"Ogah",fullName:"Okechukwu Ogah",slug:"okechukwu-ogah"}]},{id:"52188",title:"Cardiomyopathies in Animals",slug:"cardiomyopathies-in-animals",signatures:"Kazumasu Sasaki, Tatsushi Mutoh, Kinji Shirota and Ryuta\nKawashima",authors:[{id:"189248",title:"Dr.",name:"Kazumasu",middleName:null,surname:"Sasaki",fullName:"Kazumasu Sasaki",slug:"kazumasu-sasaki"},{id:"194684",title:"Prof.",name:"Tatsushi",middleName:null,surname:"Mutoh",fullName:"Tatsushi Mutoh",slug:"tatsushi-mutoh"},{id:"194685",title:"Prof.",name:"Kinji",middleName:null,surname:"Shirota",fullName:"Kinji Shirota",slug:"kinji-shirota"},{id:"194686",title:"Prof.",name:"Ryuta",middleName:null,surname:"Kawashima",fullName:"Ryuta Kawashima",slug:"ryuta-kawashima"}]},{id:"53749",title:"Cardiac Magnetic Resonance T1 Mapping in Cardiomyopathies",slug:"cardiac-magnetic-resonance-t1-mapping-in-cardiomyopathies",signatures:"Christian R. Hamilton-Craig, Mark W. Strudwick and Graham J.\nGalloway",authors:[{id:"188708",title:"Associate Prof.",name:"Christian",middleName:null,surname:"Hamilton-Craig",fullName:"Christian Hamilton-Craig",slug:"christian-hamilton-craig"}]},{id:"52491",title:"Hypertrophic Cardiomyopathy: Treatment, Risk Stratification, and Implantable Defibrillators",slug:"hypertrophic-cardiomyopathy-treatment-risk-stratification-and-implantable-defibrillators",signatures:"Peter Magnusson",authors:[{id:"188088",title:"Dr.",name:"Peter",middleName:null,surname:"Magnusson",fullName:"Peter Magnusson",slug:"peter-magnusson"}]},{id:"52483",title:"Electrical Devices (Resynchronization and Defibrillators) in the Treatment of Cardiomyopathies: Indications, Present and Future of these Therapies",slug:"electrical-devices-resynchronization-and-defibrillators-in-the-treatment-of-cardiomyopathies-indicat",signatures:"Miguel Ángel García García, María de los Ángeles Rosero Arenas,\nAlfonso Martínez Cornejo, Marta Bertolo Domínguez and Vicente\nMiranda Gozalvo",authors:[{id:"188506",title:"Dr.",name:"Miguel Angel",middleName:null,surname:"Garcia Garcia",fullName:"Miguel Angel Garcia Garcia",slug:"miguel-angel-garcia-garcia"},{id:"194190",title:"Dr.",name:"María Ángeles",middleName:null,surname:"Rosero Arenas",fullName:"María Ángeles Rosero Arenas",slug:"maria-angeles-rosero-arenas"},{id:"194191",title:"Dr.",name:"Alfonso",middleName:null,surname:"Martínez Cornejo",fullName:"Alfonso Martínez Cornejo",slug:"alfonso-martinez-cornejo"},{id:"194192",title:"Dr.",name:"Marta",middleName:null,surname:"Bertolo Domínguez",fullName:"Marta Bertolo Domínguez",slug:"marta-bertolo-dominguez"},{id:"194193",title:"Dr.",name:"Vicente",middleName:null,surname:"Miranda Gozalvo",fullName:"Vicente Miranda Gozalvo",slug:"vicente-miranda-gozalvo"}]},{id:"54319",title:"Invasive Treatment in Advanced (Stage-D) Heart Failure",slug:"invasive-treatment-in-advanced-stage-d-heart-failure",signatures:"Kaan Kırali, Özge Altaş Yerlikhan and Hakan Hançer",authors:[{id:"155565",title:"Prof.",name:"Kaan",middleName:null,surname:"Kırali",fullName:"Kaan Kırali",slug:"kaan-kirali"}]}]}],publishedBooks:[{type:"book",id:"3301",title:"Diagnosis and Treatment of Myocarditis",subtitle:null,isOpenForSubmission:!1,hash:"26205b1915136aa4fe13aa5764c81dcb",slug:"diagnosis-and-treatment-of-myocarditis",bookSignature:"José Milei and Giuseppe Ambrosio",coverURL:"https://cdn.intechopen.com/books/images_new/3301.jpg",editedByType:"Edited by",editors:[{id:"43176",title:"Prof.",name:"Jose",surname:"Milei",slug:"jose-milei",fullName:"Jose Milei"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3384",title:"Calcific Aortic Valve Disease",subtitle:null,isOpenForSubmission:!1,hash:"7d164bdd0560d68ddbb0f5aa8c8c63cd",slug:"calcific-aortic-valve-disease",bookSignature:"Elena Aikawa",coverURL:"https://cdn.intechopen.com/books/images_new/3384.jpg",editedByType:"Edited by",editors:[{id:"37703",title:"Dr.",name:"Elena",surname:"Aikawa",slug:"elena-aikawa",fullName:"Elena Aikawa"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3539",title:"Arteriovenous Fistulas",subtitle:"Diagnosis and Management",isOpenForSubmission:!1,hash:"76a0b35ed058a347a41b56970cfdbf53",slug:"arteriovenous-fistulas-diagnosis-and-management",bookSignature:"Stavropoula I. 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\n
1. Introduction
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Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of fertile age. Pregnancy causes concern for the majority of patients with SLE. The risk of the disease flare during pregnancy, the possibility of fetal loss, and the safety of drugs during pregnancy are of concern. A better understanding of the pathogenesis of SLE and good use of immunosuppressive drugs allows us to better control the disease, and we should not deprive patients with SLE of the opportunity to have children. Prepregnancy information and collaboration between specialists, such as obstetricians and perinatologists, are essential to optimize maternal and fetal outcomes in SLE pregnancies. In this chapter, important issues related to fertility, optimal time of conception, risk of disease flare during pregnancy, course of pregnancy, fetal outcome, safety of various medications used to control SLE during pregnancy and lactation, and a contraceptive education are discussed [1].
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2. Systemic lupus erythematosus fertility
\n
Fertility in patients with SLE is not greatly affected by the diagnosis of the disease. The decrease in fertility in SLE can be a consequence of the drugs used in the treatment of these patients, the flare of the disease, the organic damage caused by the disease, or advanced age. The use of cyclophosphamide (CYC) induces the majority of nonage-related infertility in patients with SLE, although the increasing use of mycophenolate mofetil (MMF) for the treatment of renal and extrarenal manifestations reduces the incidence due to its null ovarian toxicity. The risk of infertility due to CYC is associated with both the cumulative dose and an older age (>37 years old) of the woman at the time of treatment. The probability of maintaining fertility after treatment is greater for patients under 30 years of age, six or less monthly intravenous pulses, a cumulative dose of less than 7 g, and lack of amenorrhea before or during drug administration. It is less likely that other treatments in SLE have a significant impact on fertility, although nonsteroidal anti-inflammatory drugs (NSAIDs) have been suggested as possible contributors to infertility and it is suggested that high doses of corticosteroids have some effect on the cycle menstrual through its effect on the hypothalamic pituitary axis (HPA).
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Patients with SLE may have menstrual disturbances or even amenorrhea secondary to very active disease. In addition, serum levels of anti-mulleriana hormone (AMH) are lower in patients with SLE not treated with CYC than in controls matched by age. It is important to emphasize that renal failure induced by lupus glomerulonephritis can cause hypofertility or infertility due to an alteration of the HPA, which can be reversed with kidney transplantation.
\n
The profile of autoantibodies does not seem to affect fertility in women with SLE. However, the study of aPL in women with lupus is essential for predicting gestational risk, although recent controlled studies do not support an association between aPL and infertility or in vitro deficient fertilization (IVF). Evaluation or treatment of aPL in infertile women is not recommended.
\n
Older age is an important factor of infertility in SLE, as it is in the general population. Female fertility decreases with age due to the progressive loss of the ovarian reserve; many patients with SLE are older when they try to conceive and may encounter difficulties related to age. The onset of SLE is more frequent in the first years of reproduction, and it is advised to avoid pregnancy when the disease is active. Premature ovarian failure (persistent amenorrhea with elevated levels of follicle-stimulating hormone before age 40) may be of autoimmune etiology in the general population but is rarely associated with systemic autoimmune diseases such as SLE [1, 2]. The study of anti-ovarian antibodies has contributed little to this pathology. However, treatment with corticosteroids and/or immunosuppressants has reversed the process in some cases.
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2.1 SLE fertility preservation
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Preserving fertility in women with SLE involves limiting cytotoxic drugs when possible and protecting the ovaries during treatment; however, prompt and effective therapy for a severe disease often takes precedence. The cryopreservation of oocytes or embryos is an effective option but requires ovarian stimulation, which may be impractical given the usual need to institute therapy quickly to avoid damage, as well as the risk of hyperstimulation in a patient with active SLE. The age of the patient to whom CYC is administered is not modifiable, but an effort must be made to minimize the total dose of CYC. The use of MMF may be the best option. Treatment with agonists of the gonadotrophic hormone receptor (GnRH) during CYC therapy to minimize ovarian toxicity has become a common practice. Ovarian toxicity amenorrhea due to CYC has been the classic clinical sign. Now, the measurement of the AMH provides us with a better evaluation of the ovarian reserve. In a study of patients with SLE who received leuprolide with a GnRH agonist between 10 and 14 days before the CYC pulse therapy, a 68% increase in the ovarian reserve was estimated compared to patients with SLE who had not received this treatment. The GnRH agonist should not be administered immediately before the CYC. When administered during the follicular phase of the cycle, it can stimulate the ovaries and worsen ovarian damage. Patients without therapy with GnRH agonists before their first infusion can start treatment after the first cycle and receive treatment at monthly intervals thereafter [2].
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3. Contraception control
\n
SLE patients may be strongly advised to avoid pregnancy, particularly when they have severe disease-related damage or active disease or are taking teratogenic medications. Consequently, contraceptive options should be discussed with all female patients of reproductive age. Counseling patients to defer pregnancy relies on the assumption that they will utilize safe and effective contraception. In practice, SLE patients currently underutilize effective contraception, even those taking teratogenic medications [2]. Contraceptives vary in safety and efficacy. Long-acting reversible contraceptives such as intrauterine devices (IUDs) or subdermal implants have the greatest efficacy. IUDs generally contain either progesterone (levonorgesterol) or copper. Although IUDs have a low risk of infection, patients treated with immunosuppressive medications have not been specifically studied. However, HIV-infected women who have been studied do not have a greater risk of infection. Combined hormonal contraceptives include the pill, transdermal patch, and vaginal ring. Serious side effects include a three- to fivefold increased risk of venous thromboembolism and a twofold increased stroke risk. Medications commonly used for patients with SLE, such as warfarin and MMF, may interact with these agents and alter their efficacy. Concern regarding estrogen-induced flare previously has limited the use of oral contraceptives in patients with SLE. Two recent prospective studies in women with stable SLE showed no increased risk of flare with combined oral contraceptives. But oral contraceptives containing the progestin drospirenone can increase serum potassium and be dangerous in patients with nephritis or who also take angiotensin-converting enzyme (ACE) inhibitors. The vaginal ring and the patch may further increase thrombosis risk compared to oral combined contraceptives, and their safety in SLE has not been studied. No forms of estrogen-containing contraceptives are advised for use in aPL-positive patients due to the increased risk for thrombosis [3]. Progesterone-only contraceptives include oral and intramuscular forms, IUDs, and a subdermal etonogestrel implant. Depot medroxyprogesterone acetate (DMPA) injections may decrease bone density when used chronically, a concern in corticosteroid-treated patients. Progesterone-only contraceptives represent a safe and effective option for aPL-positive patients; with the possible exception of DMPA, the risk for thromboembolism is very low, and they may decrease menstrual blood loss. Emergency contraception can be considered for all SLE patients, including aPL-positive patients. Long-acting reversible contraceptives are preferable for most SLE patients, but every decision regarding contraception must balance the risk and efficacy of the method with the risk of unplanned pregnancy.
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4. Fertility and assisted reproductive techniques
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Fertility is generally unimpaired in patients with systemic lupus erythematosus (SLE), unless they have been treated with cyclophosphamide (CYC). Although CYC is less commonly used for nephritis than in the past because of the availability of MMF, prevention of CYC-induced infertility remains an important concern. Concurrent gonadotropin-releasing hormone (GnRH) analogue therapy, usually leuprolide, appears to decrease risk of premature ovarian failure by CYC. Embryo and oocyte cryopreservation is options to preserve fertility in patients who are stable enough to safely undergo ovarian hyperstimulation. Patients with lupus may undergo assisted reproduction techniques, including in vitro fertilization (IVF). Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF resulting in a capillary leak syndrome; severe OHSS increases risk for thrombosis and renal compromise. Even in a well-controlled cycle, elevated estrogen levels may increase risk of flare and thrombosis in SLE patients. However, thrombosis in aPL-positive patients undergoing IVF is rare, but most reported patients have been treated prophylactically with anticoagulants. Prophylactic anticoagulation may be considered in patients with high-risk aPL profiles and is mandatory for those with confirmed APS. However, aPL antibodies as a cause of failed IVF or infertility is not accepted, and anticoagulation is not indicated to improve IVF cycle outcome [2, 3].
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5. Preconception orientation
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Good information to the patients and pregnancy planning is essential for a woman with SLE who wants a child. Pregnancy planning is a key point for women with SLE. Postponing conception until the disease is inactive for at least the previous 6 months significantly improves the results. Women with irreversible lesions in vital organs are more likely to suffer maternal-fetal morbidity and mortality during and after pregnancy. The pregnancy should be delayed, such as a severe disease flare in the previous 6 months, a recent stroke, and active lupus nephritis. In some situations, pregnancy may be contraindicated (\nTable 1\n). A profile of autoantibodies, such as aPL (anticardiolipin, anti-β2 glycoprotein I, and lupus anticoagulant), serum levels of complement, anti-SSA, and anti-SSB antibodies [4], is essential as risk factors for complications during pregnancy. Keeping the SLE inactive and the function of organs with safe medications during pregnancy should be a goal. There is an increased risk of complications among women with severe impairment of organ function, with or without serious pre-existing damage. The care of pregnant women with SLE must focus on three mainstays: a coordinated medical-obstetrical care, a well-defined management protocol, and a well-structured prenatal follow-up.
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Preconception visit checklist
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Contraindications to pregnancy
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Age
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Severe lupus flares within the previous 6 months
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Any previous pregnancy?
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Severe restrictive lung disease (FVC < 1 L)
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Previous pregnancy complications?
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Heart failure
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Presence of severe irreversible damage?
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Chronic renal failure (Cr < 30 mg/dL)
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Recent or current lupus activity?
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Stroke within the previous 6 months
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Presence of antiphospholipid antibodies/syndrome?
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Previous severe preeclampsia of HELLP syndrome despite therapy with aspirin and heparin
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Other chronic medical conditions?
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Severe lung hypertension
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(Hypertension, diabetes, etc.)
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(Estimated systolic PAP > 50 mm Hg or symptomatic)
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Previous nephritis or active nephritis
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Current treatment: any forbidden drugs (including cyclophosphamide, methotrexate, mycophenolate, thalidomide, or thalidomide lyks, angiotensin-converting, enzyme inhibitors, angiotensin II receptor blockers, diuretics, and statins)
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Positive anti-Ro and anti-La
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Anti-DNA, complement levels C3 and C4
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Table 1.
Preconception visit checklist and contraindications to pregnancy in women with SLE.
In pregnancy, it is necessary to perform routine pregnancy testing plus other tests that include a complete blood count, kidney and liver function, and proteins in a 24-hour urine collection (\nTable 2\n). Complementary studies should include additional tests such as complement study (C3 and C4), aCL, LA, aβ2GPI, anti-DNA, anti-SSA, and anti-SSB antibodies [4]. Evaluate the activity of the disease during the prenatal phase. The hormonal changes during pregnancy cause an alteration of the domain of Th1 to Th2 lymphocytes, and, consequently, it is expected that autoimmune disorders involving the Th2 response, such as SLE, are activated. In general, it is accepted that pregnancy can lead to higher rates of outbreaks of the disease, ranging from 25 to 65%. Skin rashes and musculoskeletal symptoms are less common, while renal and hematological flares are more frequent. The risk of flare seems to be related to the onset of disease activity 6–12 months before conception. There is an increased risk of flares during pregnancy when there is lupus nephritis at conception and even in women with pre-existing nephritis in remission. One study showed an exacerbation rate of 30% of SLE activity during pregnancy or postpartum in women with pre-existing lupus nephritis. It is sometimes difficult to distinguish signs and symptoms related to pregnancy from those due to SLE. Some ambiguous manifestations such as fatigue, headaches, arthralgias, edema, hair loss, palmar and malar erythema, anemia, and thrombocytopenia can be confused with clinical manifestations of SLE. An evaluation by physicians experienced in pregnant women with SLE is important. Blood tests with basal blood counts and urinalysis with measurement of proteinuria are useful to control the state of the disease and identify the flare. The production of C3 and C4 increases in the liver during pregnancy, and, therefore, their levels may be within the range of normality in cases of active SLE. Relative variations of complement are more important than absolute levels, and a 25% drop in serum complement levels may suggest a flare of lupus. The determination of the products of complement degradation would be the best way to identify a greater activation. Currently, we have indices to measure the activity of SLE during pregnancy, such as the pregnancy activity index of systemic lupus erythematosus (SLEPDAI) and the index of lupus activity in pregnancy (LAI-P). In practice, the clinical judgment of an experienced clinician is still considered the gold standard, and these indices are essential for publications on SLE and pregnancy. The SLEPDAI scale is an instrument similar to the SLE disease activity index (SLEDAI) to evaluate the activity of lupus, assigning different scores for the various clinical and laboratory manifestations of lupus activity, however, taking into account the changes, physiological factors of pregnancy, and main pathologies of the pregnancy-puerperal cycle that can simulate an active SLE. The risk of hypertensive disorders during pregnancy increases in the context of active lupus nephritis. The frequency of preeclampsia varies from 7.5 to 22.5% for all women with SLE. Renal involvement of lupus is often associated with hypertension, and the diagnosis of preeclampsia is difficult because it may coincide with chronic hypertension exacerbated during pregnancy. Likewise, in the case of women with SLE with residual glomerular lesions, an increase in proteinuria can be observed, due to the increase in the glomerular filtration rate during pregnancy, and this fact is not related to preeclampsia. The diagnosis of preeclampsia may be more difficult due to the increase in blood pressure and previous proteinuria. The differential diagnosis of preeclampsia in patients with lupus may be facilitated by changes in the C3, C4, and CH50 measurements, since a reduction in these levels is expected during lupus activity. Other laboratory tests are useful to perform a differential diagnosis, such as an abnormal urinary sediment, erythrocytic dysmorphia or cell casts, and increased titers of anti-DNA antibodies (common in lupus nephritis). SLE of onset during pregnancy should be considered as an active lupus and may be associated with a worse outcome of pregnancy. Differentiating preeclampsia into an early SLE during pregnancy is a challenge and often delays the diagnosis of SLE. Among patients with stable SLE at the time of conception, it is expected that the activity of the disease does not worsen, and even if so, the flare is usually mild and involves some type of treatment modification.
Systemic lupus erythematosus pregnancy evaluation and monitoring.
Adjust interval of monitoring based on clinical situation.
In patients with proteinuria, consider repeating 24-hour urine test each trimester.
If positive for first time, repeat in 12 weeks.
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7. Evaluation of fetal growth and vitality
\n
Fetal complications are frequent in patients with SLE. Miscarriages and intrauterine fetal death can occur in 20% of pregnancies in patients with SLE. Patients with a history of nephritis have a higher risk of such adverse outcomes. The rate of restriction of fetal growth (FGR) is close to 30%, even in mild disease, with an increased risk if there is renal involvement. Several studies concluded that the result of the mortality rate for women with SLE tends to be higher, a condition strongly associated with the presence of flares of the disease during pregnancy. Serial obstetric ultrasound is the most important method to guide the monitoring of fetal growth. The measurement of the length of the cranial crown in the first trimester is presented as the most accurate measurement. At 16–22 weeks of gestation, an anatomical survey should be followed that considers the diagnosis of fetal anomalies, which also allows the first growth monitoring. In each 4-week period, new scans must be performed, measuring the volume of amniotic fluid. If preeclampsia is diagnosed, the interval should be reduced. The monitoring of fetal vitality is an important part of the prenatal care of patients with SLE. This should include the nonstress test (NST), the biophysical profile (BPP), and the Doppler velocimetry of the fetal umbilical artery, beginning at 26–28 weeks and continuing weekly until birth. In patients with SLE, alterations of the umbilical artery Doppler velocimetry should be handled in a similar way to those without the condition. The normal evaluation of these tests has a high negative predictive value for fetal death. A relationship exists between abnormal uterine artery Doppler and posterior fetal loss, preeclampsia, FGR, and preterm birth. For women with anti-SSA/anti-SSB antibodies, fetal echocardiography should be performed between 18 and 26 weeks to exclude congenital heart blockage of the fetus. An urgent referral to a tertiary care center should be requested in case of abnormal fetal heart rate, mainly a low heart rate.
\n
\n
\n
8. Recommended SLE treatment during pregnancy
\n
An active SLE is harmful to the mother and the fetus, and an appropriate reflection is necessary between the risks and benefits of the indicated treatment. In practice, it is common for women with SLE to interrupt their medication before conception, for fear of fetotoxicity, which happens through medical advice and proper planning [5]. Stopping the medication can lead to an active SLE and unfavorable pregnancy outcomes. Immunosuppressive treatment in pregnant women with quiescent lupus should not be changed unless it induces fetal malformations. The glucocorticoids and antimalarials are the drugs most used in the treatment of lupus and should be maintained at the same doses during pregnancy. Prednisone at a dose of 5–10 mg/day is considered safe and sustainable during pregnancy. The mild flare of the disease can be treated with low doses of prednisone (less than 20 mg/day), and higher doses of corticosteroids, such as intravenous pulses, will be indicated to treat moderate to severe lupus activity. The antimalarial is not teratogenic and is recommended to prevent the activity of the disease and reduce the risk of cardiac neonatal lupus in patients with anti-Ro antibodies. The use of immunosuppressants is possible during pregnancy, and azathioprine is the safest. Changing other immunosuppressants to azathioprine in a patient with SLE who wants pregnancy is recommended. Some recent report describes leukopenia, thrombocytopenia, and slow development of children exposed to azathioprine during pregnancy. Cyclosporine and tacrolimus, classified as category C by the Federal Drug Association (FDA), are safe during pregnancy initially demonstrated in pregnant women with kidney transplantation. CYC should not be prescribed during the first trimester for causing fetal chromosome, if it can be used during the second or third trimester for severe flares not controlled with pulses of methylprednisolone or other immunosuppressants. The use of CYC during the second and third trimesters does not seem to increase the risk of congenital anomalies, although spontaneous abortions and premature labor may be more frequent. Treatment with mycophenolate mofetil may be another option during the second and third trimesters, although more experience is lacking. Leflunomide is associated with teratogenic and fetotoxic effects in animals, and its metabolite is detectable in plasma up to 2 years after the interruption. In pregnant women, it is formally contraindicated, and pregnancy should be excluded before starting a treatment with leflunomide. Methotrexate, classified as drug X by the FDA, is teratogenic and produces abortion at high doses; therefore, it is contraindicated in pregnancy. If used in the first trimester, it is associated with FGR and some important malformations, such as absence or hypoplasia of the frontal bones, craniosynostosis, large fontanelle, and ocular hypertelorism. Thalidomide or thalidomide-like is used for the treatment of cutaneous lupus, producing malformations in the fetus, such as phocomelia by thalidomide. Rituximab has a very low transplacental transfer during the first trimester of pregnancy, and some studies of safe pregnancies and deliveries have already been reported in cases of exposure; in the second or third trimester, it can cross the placenta and induce severe neonatal lymphopenia. Therefore, in these cases, live vaccines should be avoided in these children during the first 6 months of life. High blood pressure is a common condition among patients with lupus nephritis; an adequate treatment of blood pressure during pregnancy can reduce the progression of the disease and avoid several adverse pregnancy outcomes. The labetalol, nifedipine, hydralazine, and methyldopa are safe medications to treat hypertension in pregnant women. Angiotensin-converting enzyme (ACE) inhibitors should be avoided due to their association with multiple congenital anomalies. A low dose of aspirin is recommended, since it reduces the risk of preeclampsia and perinatal death; In addition, it is associated with an increase in birth weight in those cases with risk factors, including kidney disease. Complete anticoagulation with low molecular weight heparin (LMWH) is recommended if there has been a previous thrombotic event. Calcium supplements are required, mainly for those women who use corticosteroids and heparin. Also, vitamin D supplements can be given, but it does not reduce unfavorable obstetric risks.
\n
\n
\n
9. Lupus flare management during pregnancy
\n
Many physiological changes in pregnancy can overlap with the characteristics of active disease, which makes differentiation difficult (\nTable 3\n). Some common laboratory tests also become less reliable: mild anemia and thrombocytopenia are common, the erythrocyte sedimentation rate (ESR) increases, and up to 300 mg/day proteinuria can occur during normal pregnancy. Complement levels increase by 10–50% during normal pregnancy and may appear to remain in the “normal” range, despite the activity of the disease. Anti-DNA antibodies may be useful in the evaluation of disease activity. The scales of activity of the specific disease of pregnancy, the activity index of pregnancy SLE (SLEPDAI), the LAI-P, and the BILAG2004-Pregnancy index have been developed with modifications in the descriptors. A combination of laboratory parameters along with clinical judgment may be the best tool to evaluate the activity of the disease. Based on the numerous risks associated with pregnancy, it is recommended that women with SLE have a preconception assessment and multidisciplinary management with maternal-fetal drugs and rheumatology during pregnancy. Active SLE at the time of conception is a predictor of adverse outcomes. It is suggested that the disease remain inactive for 6 months before attempting pregnancy. Laboratory tests should include, at a minimum, antiphospholipid antibodies (LA, IgG and IgM aCL, IgG, and IgM anti-aβ2GPI I antibodies), anti-Ro/SSA and anti-La/SSB antibodies, and an evaluation of renal function (creatinine, protein/creatinine ratio in urine). Women who have anti-Ro/SSA and anti-La/SSB antibodies should have intensive fetal monitoring for cardiac arrest with fetal echocardiography by weekly pulsed Doppler (to measure the mechanical PR interval) beginning at 16–18 weeks and continuing up to 26–28 weeks of pregnancy. Ideally, all women with SLE should receive HCQ and low doses of aspirin during pregnancy, unless contraindicated. Women who continue HCQ during pregnancy have fewer outbreaks of disease and better outcomes as well as mothers with positive anti-Ro/SSA and anti-LA/SSB antibodies. Low-dose aspirin initiated at 12–16 weeks of gestation reduces the risk of preeclampsia and fetal growth restriction [6]. The interruption of medications used to control the activity of the disease increases the risk of flares and complications associated with pregnancy. Serial ultrasound exams should be performed to assess fetal growth and fetal monitoring before delivery should begin in the third trimester. Renal involvement is common in patients with SLE and may be suspected in the presence of proteinuria or elevated serum creatinine. Hypertension and nephrotic syndrome consist of intense proteinuria, hypoalbuminemia, and peripheral edema, and patients have characteristically low levels of complement (C3) and high levels of anti-DNA. The involvement of the renal vasculature in cases of lupus nephritis is a sign of poor prognosis. In thrombotic microangiopathy, damage to the endothelial cells of small arterioles and capillaries results in thrombosis and mortality. Neuropsychiatric symptoms observed should be considered and excluded, including electrolyte abnormalities, infection, renal failure, and the effects of drugs. In the absence of a standard gold diagnostic test, this can represent a significant clinical challenge, especially in pregnancy and the postpartum period, where specific conditions of pregnancy, such as preeclampsia and eclampsia, can produce the same symptoms. The APS is an autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity in the presence of persistent antiphospholipid antibodies. A small subset of patients with APS (<1%) develops multiple organ failure secondary to a disseminated thrombotic disease, a condition called catastrophic APS (CAPS) that has a mortality rate of up to 50%.
\n
\n
\n
\n
\n\n
\n
\n
Pregnancy changes
\n
SLE activity
\n
\n\n\n
\n
Clinical features
\n
Facial flush
\n
Photosensitive rash
\n
\n
\n
\n
Palmar erythema
\n
Oral or nasal ulcers
\n
\n
\n
\n
Arthralgias
\n
Inflammatory arthritis
\n
\n
\n
\n
Fatigue
\n
Fatigue, lethargy
\n
\n
\n
\n
Mild edema
\n
Moderate to severe edema
\n
\n
\n
\n
Mild resting dyspnea
\n
Pleuritis, pericarditis
\n
\n
\n
Laboratory features
\n
Mild anemia
\n
Immune hemolytic anemia
\n
\n
\n
\n
Mild thrombocytopenia
\n
Thrombocytopenia
\n
\n
\n
\n
\n
Leukopenia, lymphopenia
\n
\n
\n
\n
Mild increased ESR
\n
Increased inflammatory marker levels
\n
\n
\n
\n
Physiologic proteinuria
\n
Proteinuria > 300 mg/day
\n
\n
\n
\n
\n
Active urinary sediment
\n
\n\n
Table 3.
Overlapping features of pregnancy and systemic lupus erythematosus (SLE).
The treatment of flares during pregnancy is guided by the severity and involvement of the organ, similar to the state of nonpregnancy. However, the choice of agents is limited to safe medications, as discussed above. The steroids should be used in the lowest possible doses, but short cycles of high doses can be used for flare control. NSAIDs can produce malformations, and in general their indication in the SLE is in disuse. The antimalarial should be continued throughout pregnancy. Azathioprine and anti-calcineurin can occur throughout pregnancy. Azathioprine is a safe immunosuppressant with much experience in pregnancy, although delays in the development of the offspring have recently been reported. IVIg and plasmapheresis are still alternative options, but the increased risk of thrombosis with IVIg and fluid overload should be considered, although it is rarely necessary if we exclude intravenous Ig treatment of severe thrombocytopenia in pregnancy. Physiological changes in pregnancy such as an increase in glomerular filtration rate and renal plasma flow can worsen pre-existing kidney disease. However, in theory, a rapid decrease in the levels of the pregnancy hormone, particularly estrogen, may be advantageous. It is known that the immunosuppressive drugs used to treat SLE, such as CYC, cross the placenta and have teratogenic effects. In addition, this particular medication has been associated with premature and irreversible ovarian failure.
\n
\n
\n
10. Lupus pregnancy, nephritis, and eclampsia
\n
Lupus nephritis is an important risk factor for both maternal and fetal complications. A meta-analysis of 37 studies from 1980 to 2009 included 2751 pregnancies with SLE: the SLE flare rate was 25.6%, and the rates of preterm birth and IUGR were 39.4 and 12.7%, respectively. Positive associations were identified between preterm birth and active nephritis, hypertension and active nephritis, and preeclampsia and history of nephritis [7]. Up to 25% of women with SLE will develop preeclampsia compared to 5% in the general population. Doctors who treat lupus and pregnancy should ask themselves questions like does the presence of increased proteinuria and hypertension represent a flare or does the presence of increased proteinuria and hypertension represent the onset of preeclampsia? At the beginning of pregnancy, the presence of new or worsening proteinuria and hypertension will almost always represent a flare of lupus nephritis. However, beyond 20 weeks of gestation, differentiating a flare of preeclampsia poses a diagnostic as well as a therapeutic challenge (\nTable 4\n). Flare of lupus nephritis in pregnancy may be the first presentation of lupus and is relatively rare in those without previous nephritis or inactive nephritis at the beginning of pregnancy. However, if a woman has proteinuria, hypertension, renal function decreased at the beginning of pregnancy, and a history of lupus nephritis, she is likely to have a flare of lupus nephritis. The clinical history plus appropriate biochemical investigations is key to the diagnosis of clinical complications in SLE and pregnancy. The complement should be normal or high in pregnancy because it behaves as an acute phase reactant since this is pregnancy. The decrease in complement, even within the normal range, should alert us to a possible flare of SLE and more when associated with an increase in anti-dsDNA. If proteinuria is significant and unexpected, it can mean a change in immunosuppression and even renal biopsy if the woman is in the first trimester or in part during the second trimester, although it is only necessary if the clinic and laboratory are discordant. Always keep in mind if the woman is at risk of bleeding after the biopsy and for how long anticoagulation can be delayed in a pregnant woman with intense proteinuria and possibly phospholipid antibodies who, therefore, have a high risk of thrombovenous embolism, since the procoagulant factors are added, pregnancy, nephropathy, SLE activity, and/or aPL. If the risk of having thromboembolism outweighs the benefit of a firm diagnosis, a biopsy should not be done. However, if there is a biochemistry compatible with a flare of lupus, patient’s history contains nephritis flares and it is seems that it is going to be repeated; a kidney biopsy could be justified. The distinction of nephritis from lupus of pregnancy preeclampsia (from 26/40 weeks of gestation) can be difficult. In both, there will be an increase in proteinuria, hypertension, generalized symptoms, thrombocytopenia, and kidney damage. In women with isolated preeclampsia, there should be no hematuria, urinary cylinders, a decreasing complement, or increasing anti-dsDNA. However, a flare of lupus nephritis increases the risk of preeclampsia, so, again, distinguishing the two can be a challenge for the clinician. The two treatments are different; preeclampsia requires delivery sooner rather than later, and lupus nephritis requires immunosuppressive treatment. It is not yet a usual practice, but it is likely to be exceptionally useful, measuring angiogenic and antiangiogenic factors, to determine if there is preeclampsia present. Women with APS and SLE who developed preeclampsia had a median of sFlt-1 (tyrosine kinase similar to soluble fms), low placental growth levels (PIGF), and a significantly higher sFlt-1/PlGF ratio, and significantly higher PIGF levels lower compared with women with APS and SLE and without preeclampsia after 12 weeks of gestation. These differences increased with gestational age. The sFlt-1/PlGF ratio became a significant predictor of preeclampsia at 12 weeks, showing the highest levels at 20, 24, and 28 weeks of gestation [8, 9]. Later, the fall of the placental growth factor predicted the appearance of preeclampsia even in women with pre-existing chronic kidney disease. A recent publication highlights the evidence (or more commonly the lack of evidence) for the best use of antirheumatic drugs before and during pregnancy. Women who take azathioprine, hydroxychloroquine, cyclosporine, and tacrolimus can safely breastfeed their babies, so women who take these medications should not be discouraged from breastfeeding.
\n
\n
\n
\n
\n\n
\n
Clinical measure
\n
Preeclampsia
\n
Lupus nephritis
\n
\n\n\n
\n
Time
\n
>20 weeks
\n
>20 weeks
\n
\n
\n
Hypertension
\n
Present
\n
Often present
\n
\n
\n
Urine active sediment
\n
Rare
\n
Common
\n
\n
\n
Onset of proteinuria
\n
Abrupt, after 20 weeks
\n
Abrupt or gradual, anytime
\n
\n
\n
Uric acid
\n
>4.9 mg/dl
\n
<4.9 mg/dl
\n
\n
\n
C3 and C4
\n
Usually normal
\n
Usually low or decreasing
\n
\n
\n
Complement products
\n
Normal
\n
Usually higher
\n
\n
\n
Anti-DNA
\n
Negative or stable
\n
Positive or increasing
\n
\n
\n
Lupus activity
\n
No
\n
Yes
\n
\n
\n
Urine calcium
\n
<195 mg/day
\n
>195 mg/day
\n
\n
\n
Thrombocytopenia
\n
Yes (HELLP)
\n
20% of SLE
\n
\n
\n
Liver function test
\n
May be elevated (HELLP)
\n
Usually normal
\n
\n
\n
Kidney biopsy
\n
Glomeruloendotheliosis
\n
SLE nephritis
\n
\n
\n
sFlt-1/PlGF ratio
\n
Higher
\n
Normal
\n
\n\n
Table 4.
Differentiation of preeclampsia from lupus nephritis flare in pregnancy.
There are still no safety data on the MMF, so breastfeeding is discouraged if MMF is required. The woman with SLE and pregnancy should be treated as high-risk. At the controls ask for symptoms of the disease to detect SLE flare, and always check the blood pressure to detect preeclampsia. A blood and urine test should be done every quarter to detect biological changes in the complement and anti-DNA that suggest a flare. The fetus must be carefully monitored to detect growth and blood flow. Good multidisciplinary coordination among obstetrician, nephrologists, rheumatologists, and nursing experts is essential for better results.
\n
\n
\n
11. Pregnancy and antiphospholipid antibodies
\n
Pregnancy in women with SLE and aPL-positive courses with obstetric is 80% of cases. The current standard treatment for patients with obstetric includes LDA (75–100 mg/day) and low molecular weight heparin (subcutaneous enoxaparin, dalteparin, nadroparin, or subcutaneous tinzaparin) or unfractionated heparin. These recommendations are based on the results of randomized controlled trials comparing LDA alone or in combination with heparin with APS [7]. Kutteh et al. reported a significant improvement in the rate of live births with LDA and heparin versus LDA alone (80 versus 44%, P < 0.05). Rai et al. showed a significantly higher rate of live births with LDA and unfractionated heparin (5000 units) versus LDA alone (71 versus 42%, OR, 3.37, 95% CI, 1.40–8.10). However, no differences were found in the results with the combined treatment versus the LDA in two other randomized trials, both with LMWH, with live birth rates close to 80% in both groups. The heterogeneity in the findings seems to be attributed to the relatively poor results in women who received LDA alone in the two previous studies. In addition, data from observational studies have reported pregnancy success rates of 79–100% with LDA alone in this subgroup of women, although many of these cases had low levels of aPL antibodies. The current recommendation for the treatment of obstetric APS is to initiate LDA plus LMWH at therapeutic doses.
\n
All women should be evaluated for risk factors for venous thromboembolism and should receive postpartum thromboprophylaxis. The Royal College of Gynecology in the United Kingdom, for example, recommends, for aPL-positive women without clinical manifestations of APS, 7 days after thromboprophylaxis of labor, and for women with APS, this extends to 6 weeks. All women with APS can deliver natural light, unless there are obstetric reasons to suggest otherwise. In addition, all women should be encouraged to stop smoking and reduce/discontinue alcohol consumption in accordance with the national pregnancy guidelines. Patients with a recent thrombotic event in the last 3 months, particularly high blood pressure and/or uncontrolled, should be encouraged to postpone new pregnancies. Patients with pulmonary hypertension in general are advised not to get pregnant. Women with previous thrombosis should receive long-term anticoagulation once the risk of postpartum hemorrhage has stabilized. Both AVK (antivitamin K) and heparins are compatible with breastfeeding. With respect to fetal monitoring during pregnancy, the bilateral uterine notch between 23 and 25 weeks of gestation has been shown to be an independent risk factor for the development of early-onset preeclampsia and gestational hypertension. Therefore, the bilateral notch of the uterine artery should be considered in the risk assessment for the development of these pregnancy complications. The evaluation of thrombotic risk should also be considered in patients with a history of obstetric primary health center. Among others, Lefevre et al. demonstrated that patients with obstetric APS have a higher thrombotic risk compared to healthy women (3.3 versus 0–0.5/100 patient years), even if treated with LDA. Similarly, in a 10-year observational study of 1592 women with pure obstetric SAP and no history of thrombosis, Gris et al. demonstrated that the LA was a risk factor for superficial and superficial venous thrombosis and unprovoked distal and similar results have been demonstrated in other studies.
\n
The current treatment to prevent obstetric morbidity in primary health center (PHC) has improved the outcome of pregnancy at a rate of live births of more than 70%. Given that 30% of women continue to have complications during pregnancy, international groups are currently evaluating different options to improve pregnancy outcomes in women with APS. The additional use of low doses of steroids has been evaluated in refractory APS. It has been suggested that intravenous immunoglobulin improves pregnancy complications in obstetric PHC. Treatment with pravastatin suggests a beneficial role in those women with preeclampsia related to established aPL. In their case series, 11 patients are treated with pravastatin 20 mg/day in addition to the standard treatment, while the controls continued alone with LDA and LMWH. In all patients exposed to pravastatin, signs of preeclampsia, such as blood pressure and proteinuria, improved and signs of placental perfusion remained stable without further deterioration compared to the control group. HCQ has also been evaluated. The HCQ immunomodulator can have beneficial effects not only in the treatment of thrombotic APS but also in the prevention of pregnancy complications [10]. The European randomized controlled multicenter trial “HYPATIA” will evaluate the role of HCQ versus placebo in pregnant women with aPL and, hopefully, provide stronger evidence on the use of HCQ in this context. Complement activation, and therefore a potential role for eculizumab, has also been introduced as a potential target for therapy with APS. The participation of complement activation was investigated for the first time in murine models of pregnancy morbidities related to aPL, and increasing evidence is emerging from both in vitro and in vivo studies. The complement can be activated by binding of the C3 fragment to the Fc receptor of aPL antibodies or by the formation of autoantibodies against C1q, which are frequently detected in patients with APS. The activation of the complement pathway and, consequently, the production of inflammatory molecules such as C5a by aPL, can directly activate platelets and monocytes, inducing the coagulation cascade, which leads to the clinical manifestations of APS. Although in the current literature several case reports describe the successful use of eculizumab in severe cases of APS, such as catastrophic antiphospholipid syndrome (CAPS) and cases of APS and thrombotic microangiopathy, the potential role of eculizumab should be further investigated.
\n
\n
\n
12. Neonatal lupus
\n
Pregnancies in women with anti-Ro and anti-La have an increased risk of developing neonatal lupus (NLS) with or without lupus. Maternal antibodies cross the placental barrier giving a passively acquired fetal autoimmunity. Cutaneous lesions of subacute lupus and hematologic and/or hepatic alterations of the NLS tend to resolve with the elimination of maternal antibodies from 6 to 8 months of age, but the lesion of the developing fetal cardiac conduction pathway can be irreversible. Cardiac injuries include conduction defects, structural abnormalities, cardiomyopathy, and congestive heart failure, but the most serious complication is the development of irreversible complete heart block (CHB), which is associated with a high fetal mortality of 20%. NLS can affect 2% of pregnancies exposed to anti-Ro, but recurrence rates in new pregnancies are 16–20% after a first NLS event. The majority (up to 70%) of the survivors require the insertion of a permanent pacemaker and periodic changes of the same as the child will grow. The CHB may be preceded by lower degrees of driving delays, although it may be sudden onset. Most of the events occur between 18 and 24 weeks of gestation, but there are later cases, and even postpartum CHB has been described. Early detection and initiation of treatment could stop progression to CHB, but reversal of established CHB has not been reported. Multiple monitoring tools have been proposed for the early detection of cardiac conduction disorder, but fetal Doppler echocardiography remains the most widely used method. The most vulnerable period is between 18 and 24 weeks of pregnancy, so it is recommended in this period of pregnancy to monitor weekly all exposed fetuses, and then every 2 weeks. The detection of an early conduction defect with a prolonged RP interval should indicate the start of a prophylactic treatment to avoid CHB, although we do not have any effective guidelines. The maternal administration of fluorinated corticosteroids and beta-agonists has shown benefits in some specific cases. The treatment of established CHB remains an unresolved problem with minimal benefit with any available approach. The high risk of recurrence in subsequent pregnancies justifies prophylactic therapy for pregnancies at risk. The beneficial effects of IVIg were reported in open studies, but two randomized controlled trials were negative. Both trials have been criticized for their methodology, but the use of IVIg in this context can still be considered as an option. HCQ again deserves special mention. Several studies have shown that HCQ reduces the risk of cardiac NLS in fetuses at risk and possible recurrences. In view of the multiple beneficial effects of HCQ, it is indicated in all pregnant women with lupus and anti-Ro [11].
\n
\n
\n
13. Delivery
\n
Women with SLE have an increased risk of preterm birth. This can occur spontaneously or due to maternal and/or fetal complications, such as a flare of severe lupus, preeclampsia, and FGR. Between 24 and 34 weeks of gestation, the acceleration of fetal lung maturation is essential, with steroids (preferably betamethasone), regardless of any steroid administered previously. Magnesium sulfate when gestational age is <32 weeks, due to its neuroprotective benefits for the fetus, should be administered in cases of severe preeclampsia. The objective in a pregnant patient with SLE should be a spontaneous delivery at term via the vagina. However, available data have revealed that women with SLE undergo a higher cesarean section (>33%, odds ratio (OR) 1.7, confidence interval (CI) 95% 1.6–1.9). Despite this, it is recommended that cesarean sections be reserved only for obstetric indications, due to their additional risk factor for venous thromboembolism (VTE), blood loss and infection, and repercussions for future pregnancies. Intravenous hydrocortisone may be necessary to overcome the physiological stress of labor if long-term oral steroids, which are very common in SLE, have been taken. The standard prophylactic LMWH should be discontinued at the start of spontaneous delivery and the night before induced labor or elective cesarean section. Regional anesthesia (epidural or spinal) can be performed 12 hours after the last dose of LMWH.
\n
\n
\n
14. Postpartum care
\n
In the puerperium, we must control the activity of the SLE for the detection of flare or coexisting preeclampsia. The treatment for postpartum active SLE is similar to that of nonpregnant women. However, the use of some drugs may have effects on the nursing infant. Therefore, the risks and benefits of continuing to breastfeed should be clarified to the nursing mother. All women who received antenatal LMWH should continue using it for 6 weeks after delivery, in a prophylactic dose, since the puerperium is also a period of increased risk of VTE. In patients with SLE, postpartum advice to offer safe contraception is particularly important. Good options are long-acting reversible contraception methods. The use of progestogens is only safe and can become an appropriate option. Contraceptives containing estrogen will not use women with aPL or APS, SLE with moderate to severe flare, lupus nephritis, and some other conditions, such as hypertension, smoking, obesity, or previous VTE, since they increase the risk of VTE. In cases of well-defined SLE with stable and/or mild disease, the use of combined oral contraceptives may be indicated. Contraceptive barrier methods have a high failure rate (15–32%) and, therefore, should not be used as a single method.
\n
\n
Abbreviations
SLE
systemic lupus erythematosus
LA
lupus anticoagulant
aCL
anticardiolipin antibody
aβ2GPI
anti-β2 glycoprotein I
aPL
antiphospholipid antibody
HELLP
hemolysis, elevated liver enzymes, and low platelets
sFlt-1
soluble fms-like tyrosine kinase
PlGF
placental growth factor
CYC
cyclophosphamide
LMWH
low molecular weight heparin
ESR
erythrocyte sedimentation ratio
MMF
mycophenolate mofetil
HPA
hypothalamic pituitary axis
AMH
anti-mulleriana hormone
GnRH
gonadotrophic hormone receptor
IUDs
intrauterine devices
IVF
in vitro fertilization
OHSS
ovarian hyperstimulation syndrome
SLEPDAI
SLE pregnancy disease activity index
LAI-P
lupus activity index pregnancy
FGR
fetal growth restriction
NSAIDs
nonsteroidal anti-inflammatory drugs
ACE
angiotensin-converting enzyme
DMPA
depot medroxyprogesterone acetate
SLEDAI
SLE disease activity index
PHC
primary health center
FDA
Federal Drug Association
\n',keywords:"lupus, pregnancy, fertility, antibody, treatment",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/65566.pdf",chapterXML:"https://mts.intechopen.com/source/xml/65566.xml",downloadPdfUrl:"/chapter/pdf-download/65566",previewPdfUrl:"/chapter/pdf-preview/65566",totalDownloads:862,totalViews:0,totalCrossrefCites:1,dateSubmitted:"June 15th 2018",dateReviewed:"December 19th 2018",datePrePublished:"February 8th 2019",datePublished:"March 25th 2020",dateFinished:"February 8th 2019",readingETA:"0",abstract:"Systemic lupus erythematosus (SLE) mainly affects women in the fertile age of life. A patient with SLE is as fertile as the general population except for treatment with drugs with ovarian toxicity, severe flare of the disease, or autoimmune oophoritis for anti-ovarian antibodies. Pregnancy in a woman with SLE implies greater maternal and fetal mortality and morbidity. Fetal loss, premature birth, intrauterine growth restriction associated with antiphospholipid antibodies (aPL), and neonatal lupus associated with anti-Ro are important fetal problems. Similarly, preeclampsia and lupus nephritis may lead to diagnostic confusion. Treatment options during pregnancy are limited to a few safe medications, which further restricts options. The loss of refractory pregnancy associated with antiphospholipid antibodies and the complete heart block associated with anti-Ro antibodies remain unresolved problems. The planning of pregnancy with sustainable treatments during pregnancy, no flare of SLE in the previous 6 months, and absence of nephritis are important for a good maternal and fetal prognosis. A gestation planning, multidisciplinary approach, and close monitoring are essential to obtain optimal results.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/65566",risUrl:"/chapter/ris/65566",signatures:"Jose Ordi-Ros, Cristina Sole Marce and Josefina Cortes-Hernandez",book:{id:"7073",type:"book",title:"Lupus",subtitle:"New Advances and Challenges",fullTitle:"Lupus - New Advances and Challenges",slug:"lupus-new-advances-and-challenges",publishedDate:"March 25th 2020",bookSignature:"Sophia Lionaki",coverURL:"https://cdn.intechopen.com/books/images_new/7073.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-170-0",printIsbn:"978-1-83880-169-4",pdfIsbn:"978-1-83880-184-7",isAvailableForWebshopOrdering:!0,editors:[{id:"213115",title:"M.D.",name:"Sophia",middleName:null,surname:"Lionaki",slug:"sophia-lionaki",fullName:"Sophia Lionaki"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"263306",title:"Dr.",name:"Josep",middleName:null,surname:"Ordi - Ros",fullName:"Josep Ordi - Ros",slug:"josep-ordi-ros",email:"jordi@vhebron.net",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"269964",title:"Dr.",name:"Cristina",middleName:null,surname:"Sole Marçe",fullName:"Cristina Sole Marçe",slug:"cristina-sole-marce",email:"cristina.sole@vhir.org",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Vall d'Hebron Research Institute",institutionURL:null,country:{name:"Spain"}}},{id:"269965",title:"Dr.",name:"Josefina",middleName:null,surname:"Cortes Hernandez",fullName:"Josefina Cortes Hernandez",slug:"josefina-cortes-hernandez",email:"fina.cortes@vhir.org",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Vall d'Hebron Research Institute",institutionURL:null,country:{name:"Spain"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Systemic lupus erythematosus fertility",level:"1"},{id:"sec_2_2",title:"2.1 SLE fertility preservation",level:"2"},{id:"sec_4",title:"3. Contraception control",level:"1"},{id:"sec_5",title:"4. Fertility and assisted reproductive techniques",level:"1"},{id:"sec_6",title:"5. Preconception orientation",level:"1"},{id:"sec_7",title:"6. Laboratory evaluation during prenatal care",level:"1"},{id:"sec_8",title:"7. Evaluation of fetal growth and vitality",level:"1"},{id:"sec_9",title:"8. Recommended SLE treatment during pregnancy",level:"1"},{id:"sec_10",title:"9. Lupus flare management during pregnancy",level:"1"},{id:"sec_11",title:"10. Lupus pregnancy, nephritis, and eclampsia",level:"1"},{id:"sec_12",title:"11. Pregnancy and antiphospholipid antibodies",level:"1"},{id:"sec_13",title:"12. Neonatal lupus",level:"1"},{id:"sec_14",title:"13. Delivery",level:"1"},{id:"sec_15",title:"14. Postpartum care",level:"1"},{id:"sec_18",title:"Abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'\nPastore DEA, Costa ML, Parpinelli MA, Surita FG. A critical review on obstetric follow-up of women affected by systemic lupus erythematosus. Revista Brasileira de Ginecologia e Obstetrícia. 2018;40:209-224\n'},{id:"B2",body:'\nBălănescu A, Donisan T, Bălănescu D. An ever-challenging relationship: Lupus and pregnancy. Reumatology. 2017;55:29-37\n'},{id:"B3",body:'\nSammaritano LR. Management of systemic lupus erythematosus during pregnancy. Annual Review of Medicine. 2017;68:271-285\n'},{id:"B4",body:'\nBuyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: A cohort study. Annals of Internal Medicine. 2015;4:153-163\n'},{id:"B5",body:'\nLateef A, Petri M. Systemic lupus erythematosus and pregnancy. Rheumatic Diseases Clinics of North America. 2017;43:215-226\n'},{id:"B6",body:'\nEudy AM, Siega-Riz AM, Engel SM, Franceschini N, Howard AG, Clowse MEB, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2018;77:855-860\n'},{id:"B7",body:'\nMoroni G, Ponticelli C. Important considerations in pregnant patients with lupus nephritis. Expert Review of Clinical Immunology. 2018;14:489-498\n'},{id:"B8",body:'\nMayer-Pickel K, Stern C, Eberhard K, Lang U, Obermayer-Pietsch B, Cervar-Zivkovic M. Angiogenic factors in pregnancies of women with antiphospholipid syndrome and systemic lupus erythematosus. Journal of Reproductive Immunology. 2018;127:19-23\n'},{id:"B9",body:'\nKim MY, Guerra MM, Kaplowitz E, Laskin CA, Petri M, Branch DW, et al. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus. Annals of the Rheumatic Diseases. 2018;77:549-555\n'},{id:"B10",body:'\nCortés-Hernández J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology (Oxford, England). 2002;41:643-650\n'},{id:"B11",body:'\nAbdwani R, Al Shaqsi L, Al-Zakwani I. Neonatal and obstetrical outcomes of pregnancies in systemic lupus erythematosus. Oman Medical Journal. 2018;33:15-21\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Jose Ordi-Ros",address:"jordi@vhebron.net",affiliation:'
Internal Medicine, Vall d’Hebron Hospital, Spain
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Lupus Research Unit, Vall d’Hebron Research Institute, Spain
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He is a full professor in Human Physiology and the Head of the Department of Physiology at the Faculty of Medicine, Medical University Plovdiv. He served two terms as a Dean of the Faculty of Medicine at the Medical University Plovdiv.\r\nAs a medical practitioner, Prof. Boyadjiev serves as a Consultant in Exercise Physiology and Sports Medicine. He gives lectures in human physiology, sports physiology, and sports medicine at universities worldwide.\r\nHis research interests in the field of human physiology include: the metabolic changes during physical activity, extreme environmental conditions, some diseases (metabolic syndrome, septic conditions, renal and liver failure) etc.; studies on the functional adaptations of athletes from different kinds of sports; methods for optimization of the recovery process of athletes; doping and side effects of anabolic androgenic steroids and selective androgen receptor modulators (SARMs). \r\nProf. Boyadjiev is an author of more than 150 scientific studies in the field of exercise physiology and sports medicine and is also an author and editor of 20 textbooks and manuals which have been cited more than 500 times. He is the author of the book Muscle Work and Adaptation to Physical Exercise and a member of the Editorial boards of several International journals.",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v4b3cQAA/Profile_Picture_2022-06-07T08:30:58.jpeg",totalCites:0,totalChapterViews:"0",outsideEditionCount:null,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:{name:"Medical University Plovdiv",institutionURL:null,country:{name:"Bulgaria"}}},booksEdited:[],chaptersAuthored:[{id:"73005",title:"Outdoor Recreation: Physiological Effects and Prevention of Socially Important Diseases",slug:"outdoor-recreation-physiological-effects-and-prevention-of-socially-important-diseases",abstract:"Physical activity improves the condition of the cardiovascular system, respiration, muscles, and metabolism and increases physical working capacity. This review of physiological effects and adaptation mechanisms of the outdoor recreation and its health benefits provides accessible information from a scientific point of view and research practice. Increased frequency of many socially important diseases such as diabetes mellitus type 2, metabolic syndrome and obesity, cardiovascular diseases, and others is associated with dramatically decreased physical activity in the last decades. Outdoor recreation for children, adolescents, adults, and older population is important for the prevention of these conditions. In this chapter, the authors describe in detail the physiological effects of different kinds of outdoor recreation physical activity with different intensities (such as walking, cycling, skiing, rowing, climbing, practicing some outdoor sports, etc.) and assess their benefits in the prevention of socially important diseases.",signatures:"Nikolay Boyadjiev, Katerina Nikolova Georgieva and Penka Angelova Angelova Hristova",authors:[{id:"205070",title:"Prof.",name:"Katerina",surname:"Georgieva",fullName:"Katerina Georgieva",slug:"katerina-georgieva",email:"kng@plov.net"},{id:"319575",title:"Ph.D.",name:"Penka",surname:"Angelova Angelova Hristova",fullName:"Penka Angelova Angelova Hristova",slug:"penka-angelova-angelova-hristova",email:"angelovapepa@abv.bg"},{id:"319576",title:"Prof.",name:"Nikolay",surname:"Boyadjiev",fullName:"Nikolay Boyadjiev",slug:"nikolay-boyadjiev",email:"boyad@plov.net"}],book:{id:"9839",title:"Outdoor Recreation",slug:"outdoor-recreation-physiological-and-psychological-effects-on-health",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"158692",title:"Ph.D.",name:"Hilde Dorthea Grindvik",surname:"Nielsen",slug:"hilde-dorthea-grindvik-nielsen",fullName:"Hilde Dorthea Grindvik Nielsen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158692/images/system/158692.png",biography:"Hilde G. Nielsen has a Ph.D. in Exercise Immunology from the Faculty of Medicine, University of Oslo, Norway, and a master’s degree in Exercise Physiology from the Norwegian University of Science and Technology. She also completed a Leadership Foundation Programme, a course in Project Management at the BI Norwegian Business School and courses in Contract and Tort law at Kristiania University College. Dr. Nielsen has been a member of several evaluation committees for Ph.D. students, a peer reviewer, and an editorial board member for three international journals. Her research interests and publications are within the fields of exercise physiology, exercise immunology, training, and physical activity and health.",institutionString:"The Research Council of Norway",institution:{name:"The Research Council of Norway",institutionURL:null,country:{name:"Norway"}}},{id:"205070",title:"Prof.",name:"Katerina",surname:"Georgieva",slug:"katerina-georgieva",fullName:"Katerina Georgieva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",institutionURL:null,country:{name:"Bulgaria"}}},{id:"308043",title:"Prof.",name:"Tegwen",surname:"Gadais",slug:"tegwen-gadais",fullName:"Tegwen Gadais",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Quebec at Montreal",institutionURL:null,country:{name:"Canada"}}},{id:"316357",title:"Dr.",name:"Brendon",surname:"Hyndman",slug:"brendon-hyndman",fullName:"Brendon Hyndman",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Charles Sturt University",institutionURL:null,country:{name:"Australia"}}},{id:"316413",title:"Dr.",name:"Mariya",surname:"Leont'Eva",slug:"mariya-leont'eva",fullName:"Mariya Leont'Eva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"316416",title:"Dr.",name:"Tatiana",surname:"Levchenkova",slug:"tatiana-levchenkova",fullName:"Tatiana Levchenkova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"316615",title:"Dr.",name:"Shirley",surname:"Wyver",slug:"shirley-wyver",fullName:"Shirley Wyver",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Macquarie University",institutionURL:null,country:{name:"Australia"}}},{id:"319206",title:"Dr.",name:"Marija",surname:"Opačak",slug:"marija-opacak",fullName:"Marija Opačak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319206/images/14447_n.jpg",biography:"Name: Marija Opačak\t\t\nGender: Female\nDate of Birth: May 12, 1987\nNationality: Croatian\nResearch Areas: Environmental Economics, Tourism Economics, environmental and natural resource management policy, sustainable development.\nEducational Experience:\nPhD Environmental Economics, School of Economics and Management, Dalian University of Technology, P.R. China, 2020.\nBA Sinology, Faculty of Arts, University of Ljubljana, Slovenia, 2017.\nMA Finance, Faculty of Economics, University of Zagreb, Croatia, 2012.\nBA Analysis and Business Planning, Faculty of Economics, University of Zagreb, Croatia, 2010.",institutionString:null,institution:null},{id:"319575",title:"Ph.D.",name:"Penka",surname:"Angelova Angelova Hristova",slug:"penka-angelova-angelova-hristova",fullName:"Penka Angelova Angelova Hristova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"329627",title:"Prof.",name:"Andrée Anne",surname:"Parent",slug:"andree-anne-parent",fullName:"Andrée Anne Parent",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Université du Québec à Rimouski",institutionURL:null,country:{name:"Canada"}}}]},generic:{page:{slug:"open-access-funding-funders-list",title:"List of Funders by Country",intro:"
If your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).
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IMPORTANT: You must be a member or grantee of the listed funders in order to apply for their Open Access publication funds. Do not attempt to contact the funders if this is not the case.
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UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
Wellcome Trust (Funding available only to Wellcome-funded researchers/grantees)
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Important species in Chilean aquaculture include salmonids, algae, mollusks, and turbot. Salmonids are the dominant species in Chilean aquaculture for both harvest volume and export value, their production reaching greater than 800-thousand tons in 2015. However, this growth has been accompanied by an increase in disease presence, requiring greater drug use to control. This increase in drug use is an environmental and public health concern for the authorities, the salmon industry itself, and the destination markets. In this chapter, we review the literature on drug use, antibiotic resistance, regulatory framework, and alternatives, with focus on Chile.",book:{id:"6179",slug:"antibiotic-use-in-animals",title:"Antibiotic Use in Animals",fullTitle:"Antibiotic Use in Animals"},signatures:"Ivonne Lozano, Nelson F. Díaz, Susana Muñoz and Carlos Riquelme",authors:[{id:"208847",title:"Dr.",name:"Ivonne",middleName:null,surname:"Lozano",slug:"ivonne-lozano",fullName:"Ivonne Lozano"},{id:"208895",title:"Dr.",name:"Nelson F.",middleName:null,surname:"Díaz",slug:"nelson-f.-diaz",fullName:"Nelson F. Díaz"},{id:"208897",title:"Dr.",name:"Carlos",middleName:null,surname:"Riquelme",slug:"carlos-riquelme",fullName:"Carlos Riquelme"},{id:"208898",title:"MSc.",name:"Susana",middleName:null,surname:"Muñoz",slug:"susana-munoz",fullName:"Susana Muñoz"}]},{id:"58486",doi:"10.5772/intechopen.72865",title:"Quality of Chicken Meat",slug:"quality-of-chicken-meat",totalDownloads:3344,totalCrossrefCites:19,totalDimensionsCites:28,abstract:"Chicken meat is considered as an easily available source of high-quality protein and other nutrients that are necessary for proper body functioning. In order to meet the consumers’ growing demands for high-quality protein, the poultry industry focused on selection of fast-growing broilers, which reach a body mass of about 2.5 kg within 6-week-intensive fattening. Relatively low sales prices of chicken meat, in comparison to other types of meat, speak in favor of the increased chicken meat consumption. In addition, chicken meat is known by its nutritional quality, as it contains significant amount of high-quality and easily digestible protein and a low portion of saturated fat. Therefore, chicken meat is recommended for consumption by all age groups. The technological parameters of chicken meat quality are related to various factors (keeping conditions, feeding treatment, feed composition, transport, stress before slaughter, etc.). Composition of chicken meat can be influenced through modification of chicken feed composition (addition of different types of oils, vitamins, microelements and amino acids), to produce meat enriched with functional ingredients (n-3 PUFA, carnosine, selenium and vitamin E). By this way, chicken meat becomes a foodstuff with added value, which, in addition to high-quality nutritional composition, also contains ingredients that are beneficial to human health.",book:{id:"6384",slug:"animal-husbandry-and-nutrition",title:"Animal Husbandry and Nutrition",fullTitle:"Animal Husbandry and Nutrition"},signatures:"Gordana Kralik, Zlata Kralik, Manuela Grčević and Danica Hanžek",authors:[{id:"207236",title:"Dr.",name:"Gordana",middleName:null,surname:"Kralik",slug:"gordana-kralik",fullName:"Gordana Kralik"},{id:"227281",title:"Prof.",name:"Zlata",middleName:null,surname:"Kralik",slug:"zlata-kralik",fullName:"Zlata Kralik"},{id:"227283",title:"Dr.",name:"Manuela",middleName:null,surname:"Grčević",slug:"manuela-grcevic",fullName:"Manuela Grčević"},{id:"227284",title:"BSc.",name:"Danica",middleName:null,surname:"Hanžek",slug:"danica-hanzek",fullName:"Danica Hanžek"}]},{id:"39624",doi:"10.5772/50320",title:"Dairy Propionibacteria: Less Conventional Probiotics to Improve the Human and Animal Health",slug:"dairy-propionibacteria-less-conventional-probiotics-to-improve-the-human-and-animal-health",totalDownloads:5797,totalCrossrefCites:11,totalDimensionsCites:24,abstract:null,book:{id:"2991",slug:"probiotic-in-animals",title:"Probiotic in Animals",fullTitle:"Probiotic in Animals"},signatures:"Gabriela Zárate",authors:[{id:"150953",title:"Dr.",name:"Gabriela",middleName:null,surname:"Zárate",slug:"gabriela-zarate",fullName:"Gabriela Zárate"}]}],mostDownloadedChaptersLast30Days:[{id:"56612",title:"Reproduction in Goats",slug:"reproduction-in-goats",totalDownloads:2924,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Reproductive activity of the goat begins when the females reach puberty, which happens at 5 months of age. The ovarian or estrous cycle is the period between two consecutive estrus. It is also the time that lasts the development of the follicle in the ovary, until rupture occurs and ovulation takes place, which coincides with the appearance of estrus. This chapter will describe the physiological and endocrinological bases of estrus in the goat. Likewise, factors affecting the presence of estrus and ovulation will be described. At another point, synchronization of estrus and ovulation, factors affecting the presence of estrus and external symptoms of estrus, will be described. To achieve synchronization of estrus or induction of ovulation within or outside the breeding season, it may be necessary to manage light hours, male effect, and/or use of hormones. The importance of artificial insemination is described, as well as the current situation of this technique worldwide. Currently, the techniques of artificial insemination in goats have been limited worldwide, due to the lack of resources of producers and trained technicians. The techniques of artificial insemination with estrous synchronization programs and ovulation with current research results will be described.",book:{id:"5987",slug:"goat-science",title:"Goat Science",fullTitle:"Goat Science"},signatures:"Fernando Sánchez Dávila, Alejandro Sergio del Bosque González\nand Hugo Bernal Barragán",authors:[{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila"},{id:"206127",title:"Dr.",name:"Alejandro Sergio",middleName:null,surname:"Del Bosque-Gonzalez",slug:"alejandro-sergio-del-bosque-gonzalez",fullName:"Alejandro Sergio Del Bosque-Gonzalez"},{id:"206128",title:"Dr.",name:"Hugo",middleName:null,surname:"Bernal-Barragán",slug:"hugo-bernal-barragan",fullName:"Hugo Bernal-Barragán"}]},{id:"58095",title:"The Innovative Techniques in Animal Husbandry",slug:"the-innovative-techniques-in-animal-husbandry",totalDownloads:3819,totalCrossrefCites:4,totalDimensionsCites:8,abstract:"Technology is developing rapidly. In this development, the transfer of computer systems and software to the application has made an important contribution. Technologic instruments made farmers can work more comfortable and increased animal production efficiency and profitability. Therefore, technologic developments are the main research area for animal productivity and sustainability. Many technologic equipment and tools made animal husbandry easier and comfortable. Especially management decisions and applications are effected highly ratio with this rapid development. In animal husbandry management decisions that need to be done daily are configured according to the correctness of the decisions to be made. At this point, smart systems give many opportunities to farmers. Milking, feeding, environmental control, reproductive performance constitute everyday jobs most affected by correct management decisions. Human errors in this works and decisions made big effect on last product quality and profitability are not able to be risked. This chapter deal with valuable information on the latest challenges and key innovations affecting the animal husbandry. Also, innovative approaches and applications for animal husbandry are tried to be summarized with detail latest research results.",book:{id:"6384",slug:"animal-husbandry-and-nutrition",title:"Animal Husbandry and Nutrition",fullTitle:"Animal Husbandry and Nutrition"},signatures:"Serap Göncü and Cahit Güngör",authors:[{id:"215579",title:"Prof.",name:"Serap",middleName:null,surname:"Goncu",slug:"serap-goncu",fullName:"Serap Goncu"},{id:"218971",title:"Dr.",name:"Cahit",middleName:null,surname:"Güngör",slug:"cahit-gungor",fullName:"Cahit Güngör"}]},{id:"58486",title:"Quality of Chicken Meat",slug:"quality-of-chicken-meat",totalDownloads:3351,totalCrossrefCites:19,totalDimensionsCites:29,abstract:"Chicken meat is considered as an easily available source of high-quality protein and other nutrients that are necessary for proper body functioning. In order to meet the consumers’ growing demands for high-quality protein, the poultry industry focused on selection of fast-growing broilers, which reach a body mass of about 2.5 kg within 6-week-intensive fattening. Relatively low sales prices of chicken meat, in comparison to other types of meat, speak in favor of the increased chicken meat consumption. In addition, chicken meat is known by its nutritional quality, as it contains significant amount of high-quality and easily digestible protein and a low portion of saturated fat. Therefore, chicken meat is recommended for consumption by all age groups. The technological parameters of chicken meat quality are related to various factors (keeping conditions, feeding treatment, feed composition, transport, stress before slaughter, etc.). Composition of chicken meat can be influenced through modification of chicken feed composition (addition of different types of oils, vitamins, microelements and amino acids), to produce meat enriched with functional ingredients (n-3 PUFA, carnosine, selenium and vitamin E). By this way, chicken meat becomes a foodstuff with added value, which, in addition to high-quality nutritional composition, also contains ingredients that are beneficial to human health.",book:{id:"6384",slug:"animal-husbandry-and-nutrition",title:"Animal Husbandry and Nutrition",fullTitle:"Animal Husbandry and Nutrition"},signatures:"Gordana Kralik, Zlata Kralik, Manuela Grčević and Danica Hanžek",authors:[{id:"207236",title:"Dr.",name:"Gordana",middleName:null,surname:"Kralik",slug:"gordana-kralik",fullName:"Gordana Kralik"},{id:"227281",title:"Prof.",name:"Zlata",middleName:null,surname:"Kralik",slug:"zlata-kralik",fullName:"Zlata Kralik"},{id:"227283",title:"Dr.",name:"Manuela",middleName:null,surname:"Grčević",slug:"manuela-grcevic",fullName:"Manuela Grčević"},{id:"227284",title:"BSc.",name:"Danica",middleName:null,surname:"Hanžek",slug:"danica-hanzek",fullName:"Danica Hanžek"}]},{id:"56453",title:"Goat System Productions: Advantages and Disadvantages to the Animal, Environment and Farmer",slug:"goat-system-productions-advantages-and-disadvantages-to-the-animal-environment-and-farmer",totalDownloads:4379,totalCrossrefCites:5,totalDimensionsCites:20,abstract:"Goats have always been considered very useful animals. Goats success is related to its excellent adaptability to the difficult mountain conditions, extreme weather and low value feed acceptance, versatile habits and high production considering their size. These are some reasons because goats are among the first animals to be domesticated. In terms of evolution, goats could be separated by their dispersion area in three large groups: the European, the Asian, and the African. Global goat populations, mainly in Africa and in Asia, have increased for centuries but very strongly in the past decades, well above the world population growth. They are also used for forest grazing, an integrated and alternative production system, very useful to control weed growth reducing fire risk. Despite some exceptions, no large‐scale effort to professionalize this industry has been made so far. There are consumers for goat dairy products and there is enough global production, but misses a professional network between both. Regarding goat meat, the world leadership also stays in Africa and Asia, namely in China, and there is a new phenomenon, the spreading of goat meat tradition through Europe due to migrants from Africa and other places with strong goat meat consumption.",book:{id:"5987",slug:"goat-science",title:"Goat Science",fullTitle:"Goat Science"},signatures:"António Monteiro, José Manuel Costa and Maria João Lima",authors:[{id:"190314",title:"Prof.",name:"António",middleName:"Cardoso",surname:"Monteiro",slug:"antonio-monteiro",fullName:"António Monteiro"},{id:"203680",title:"Prof.",name:"Maria João",middleName:null,surname:"Lima",slug:"maria-joao-lima",fullName:"Maria João Lima"},{id:"203683",title:"MSc.",name:"José Manuel",middleName:null,surname:"Costa",slug:"jose-manuel-costa",fullName:"José Manuel Costa"}]},{id:"70760",title:"Induction and Synchronization of Estrus",slug:"induction-and-synchronization-of-estrus",totalDownloads:1751,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Estrus cycle is a rhythmic change that occur in the reproductive system of females starting from one estrus phase to another. The normal duration of estrus cycle is 21 days in cow, sow, and mare, 17 days in ewe, and 20 days in doe. The species which exhibit a single estrus cycle are known as monstrous and species which come into estrus twice or more are termed polyestrous animals. Among them some species have estrus cycles in a particular season and defined as seasonal polyestrous. It includes goats, sheep, and horses. On the other hand, cattle undergo estrus throughout the year. The estrus inducers can grossly be divided into two parts, that is, non-hormonal and hormonal. Non-hormonal treatments include plant-derived heat inducers, mineral supplementation, uterine and ovarian massage, and use of Lugol’s iodine. The hormones that are used in estrus induction are estrogen, progesterone, GnRH, prostaglandin, insulin, and anti-prolactin-based treatment. Synchronization can shorten the breeding period to less than 5 days, instead of females being bred over a 21-day period, depending on the treatment regimen. The combination of GnRH with the prostaglandin F2α (PGF2α)- and progesterone-based synchronization program has shown a novel direction in the estrus synchronization of cattle with the follicular development manipulation.",book:{id:"8545",slug:"animal-reproduction-in-veterinary-medicine",title:"Animal Reproduction in Veterinary Medicine",fullTitle:"Animal Reproduction in Veterinary Medicine"},signatures:"Prasanna Pal and Mohammad Rayees Dar",authors:[{id:"299126",title:"Dr.",name:"Mohammad Rayees",middleName:null,surname:"Dar",slug:"mohammad-rayees-dar",fullName:"Mohammad Rayees Dar"},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal"}]}],onlineFirstChaptersFilter:{topicId:"297",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters: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:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"82526",title:"Deep Multiagent Reinforcement Learning Methods Addressing the Scalability Challenge",doi:"10.5772/intechopen.105627",signatures:"Theocharis Kravaris and George A. 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Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. 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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