\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\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:"649",leadTitle:null,fullTitle:"Chronic Pancreatitis",title:"Chronic Pancreatitis",subtitle:null,reviewType:"peer-reviewed",abstract:"Chronic pancreatitis is a disease of diverse etiologies in which pain can be devastating, severely impairing quality of life, and treatment is a challenge. 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Saleh",coverURL:"https://cdn.intechopen.com/books/images_new/9873.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"7702",leadTitle:null,title:"Electrolysis of Water",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tWater electrolysis has a longer history than 200 years and the technology is expected to be applied in various fields, such as the realization of a hydrogen society, environmental conservation, sterilization and cleaning, and water purification. When water is electrolyzed, dozens of kinds of ions and radicals are formed, but the stable molecules formed by electrolysis are only four: hydrogen, oxygen, ozone, and hydrogen peroxide.
\r\n\r\n\t
\r\n\tHydrogen gas is the key energy source for hydrogen-based society. Ozone dissolved water is expected as the sterilization and cleaning agent that can comply with the new law enacted by the US Food and Drug Administration (FDA). The law “FDA Food Safety Modernization Act” requires sterilization and washing of foods to prevent food poisoning and has a strict provision that vegetables, meat, and fish must be washed with non-chlorine cleaning agents to make E. coli adhering to food down to “zero”. If ozone dissolved water could be successively applied in this field, electrochemistry would make a significant contribution to society.
\r\n\t
\r\n\tOxygen-enriched water is said to promote the growth of farmed fish. Hydrogen dissolved water is said to be able to efficiently remove minute dust on the silicon wafer when used in combination with ultrasonic irradiation.
\r\n\tAt present researches on direct water electrolysis have shown significant progress. For example, boron-doped diamonds and complex metal oxides are widely used as an electrode, and the interposing polymer electrolyte membrane (PEM) between electrodes has become one of the major processes of water electrolysis.
\r\n\t
\r\n\tThe purpose of this book is to show the latest water electrolysis technology and the future of society applying it.
In order to develop a methodology for promoting sustainable housing design, we have applied the science of control. The reason is that accomplishing sustainability is regarded as the ultimate goal-oriented challenge, and control science is suitable for all goal-oriented tasks.
In order to deal with a variety of problems and achieve sustainability, “human beings must
Meanwhile, the application of control science to sustainable design has required us to develop basic schemes in advance for preparations. First, we have demonstrated the basic control system for sustainability as well as the model of sustainability, so as to facilitate the utilization of control science for various sustainability issues. Moreover, we have devised the two-step preparatory work for sustainable design. The following sections illustrate these basic schemes for applying control science to sustainable design.
After starting research on applying control science to sustainability issues, first of all, we showed the basic control system for sustainability. Recently, we have revised it, based on the IPCC’s recognition, namely the necessity of adaptation measures for sustainability [4–6].
Figure 1 demonstrates the revised version of the basic control system for sustainability. “Controlled objects” are human activities which need to be controlled [7–9]. “Disturbances” are adverse effects on controlled objects which are caused by environmental, social, or economic problems [7–9]. Concrete instances of the disturbances include floods or landslides resulting from environmental destruction, harmful influences caused by environmental pollution, and a variety of impacts resulting from climate change [7–9]. Furthermore, “adaptation” has been added as the course from “disturbances” to “sustainability,” on the basis of the recent recognition of the IPCC [7]. “Controlled variables” are the variables that relate to the human activities and need to be controlled for primarily solving or preventing the problems or adapting to disturbances [7].
Basic control system for sustainability [
“Desired values” are derived from the purpose of control, namely sustainability [7–9]. The model of sustainability (Figure 2) shows that sustainability needs both “Internal Stability” and “Fundamental Stability,” in order to achieve the long-term well-being of all humankind, or ultimate goal, within the finite global environment and natural resources, or absolute limitations [7–9]. “Internal Stability” means social and economic stability; the conditions for Internal Stability are health, safety, mutual help, and self-realization, which are important for well-being of humans [7–9]. On the other hand, “Fundamental Stability” means environmental stability and a stable supply of necessary goods; the conditions for Fundamental Stability are environmental preservation and the sustainable use of natural resources [7–9].
Model of sustainability [
The control objective of the basic control system for sustainability is to adjust the controlled variables to their desired values [7]. Moreover, the control system requires designing and implementing “control measures” or measures for attaining the control objective [7].
In order to identify a control objective, system designers must identify controlled variables and their desired values. Therefore, preparatory work for designing control measures is primarily intended to identify controlled variables and their desired values. This preparatory work consists of two steps: (1) determining the relationships between the standard human activities and sustainability and (2) sustainability checkup on human activities as an object [10].
The first step aims to comprehensively determine the relationships between the standard human activities and sustainability [10]. The standard human activities mean typical human activities among human activities which belong to one category. Figure 3 demonstrates the concept of this step [10].
Concept diagram of determining the relationships between the standard human activities and sustainability [
The first step starts with selecting important elements from the standard human activities [10]. Human activities in one category include almost the same elements. Therefore, at first, system designers select such common elements from the standard human activities [10]. In this connection, if one or more factors which influence the selection can be found, the selection process will become more efficient [10]. In addition, the elements which are considered to be closely related to sustainability should always be selected as important elements, no matter whether they are common in the present situation [10]. For instance, when “home” is chosen as a category of human activities, “equipment for rainwater use” need to be selected as an important element, even though it is not common in current ordinary homes [10].
After system designers select important elements, they determine the relationships between the selected elements and sustainability [10]. This work is composed of three processes: (1) considering the relationships between each element and the stability conditions for both Internal Stability and Fundamental Stability, including health, safety, and environmental preservation; (2) identifying variables which can indicate the degree of stability; (3) setting the variables’ desired values that can meet relevant stability conditions [10]. As demonstrated in Figure 3, the number of variables that connect to one element is not necessarily one but can be many [10]. In addition, system designers need to identify variables and set their desired values, based on the most recent technology, scientific knowledge, and social conditions [10].
The second step is “sustainability checkup on human activities as an object” [10]. The second step starts with the measurement or estimation of the above-mentioned variables of human activities as an object [10]. Subsequently, comparing the measured or estimated values with the desired values, system designers assess the degree of stability [10].
After the comparison and assessment, the variables that fall below the desired values are necessary to be identified as “controlled variables” [10]. In addition, human activities as an object that includes controlled variables are naturally identified as a “controlled object” [10].
Obesity worldwide has increased over time and is now considered an epidemic with significant health implications. Worldwide obesity has nearly tripled since 1975. In 2015–2016, the prevalence of obesity was 39.8% in adults and 18.5% in youth [1]. Body mass index (BMI) is a widely used method for estimating body fat mass. The World Health Organization defines class I obesity as BMI 30 to <35, class II obesity as BMI 35 to <40, and class III obesity as >40. The prevalence of clinically severe obesity (BMI > 40) is increasing at a much faster rate among adults in the United States than is the prevalence of moderate obesity [2]. In addition to the overall rising rates of severe obesity, the mean waist circumference (WC) has increased continuously among adults over the last 15 years. Abdominal fat deposition is a key component of obesity and some studies have shown that WC may be a better predictor for the risk of myocardial infarction, metabolic syndrome, and all-cause mortality than BMI [3].
From a surgical perspective, facilities need to consider the availability of specialized equipment for morbidly obese patients. Many facilities may lack the appropriate equipment for patient transfer, operating room tables that can accommodate the patient’s weight, and specialized laparoscopic surgical equipment for minimally invasive surgery. Particular challenges of minimally invasive surgery for morbidly obese patients can be seen with central adiposity, which creates a thicker abdominal wall, larger visceral volume, and enlarged mesentaries, which can impact intraperitoneal visualization more difficult [4]. Central adiposity can also create technical challenges for entry into the abdominal cavity, difficulty with maneuvering laparoscopic instruments through a thick abdominal wall, and physiological stress of Trendelenburg position and pneumoperitoneum [5].
With respect to gynecologic minimally invasive surgery, obesity was previously considered a relative contra-indication. The first feasibility study of gynecologic laparoscopic surgery for obese patients was performed in 1976 [6]. With advances in minimally invasive technologies and increased operator experience, there has been growing evidence supporting minimally invasive surgery for obese patients. There is a large amount of data from gynecologic oncology indicating laparoscopic or robotic surgery resulted in shorter hospital stay, less postoperative pain, earlier return to normal activity, decreased postoperative complications, and fewer wound infections [7]. However, there are some studies indicating a higher conversion rate to laparotomy, which was dependent on BMI, noting that women who were morbidly obese had a 57% conversion rate to open laparotomy [8].
There is conflicting data regarding comparisons between robotic vs. conventional laparoscopic surgical outcomes. When looking at bariatric surgery studies, there is some evidence that robotic surgery results in shorter operative times with increased BMI [9]. However, other studies indicate that there are longer operative times [10]. One reason that surgeons may favor the use of robotic surgery is reduced surgeon fatigue, the utility of articulated wristed robotic instruments which allow for more fluid movements and less torque on the abdominal wall [11]. Further prospective studies are required to define the best and most cost-effective minimally invasive surgical method in obese women. Ultimately, every effort should be made to offer the least invasive procedure regardless of BMI, to maximize clinical benefits and quality of life [12].
According to the National Institutes of Health, a BMI >40 increases the risk for diabetes mellitus, cardiovascular disease, and reduced life expectancy [13]. Understanding the differences in anatomy and physiology of morbidly obese patients is critical for surgical planning.
Myocardial infarction, cardiac failure, and sudden cardiac death risk increase in obese individuals. This may be due to increased body mass leading to hemodynamic and cardiovascular changes resulting in increased cardiac output, larger stroke volume, decreased vascular resistance, and increased cardiac workload [14]. In autopsy studies comparing obese and non-obese patients it has been found that obese patients can have 20–55% larger cardiac diameters, hypertrophied ventricles, and increased cardiac weight. These changes in cardiac physiology can result in hypertension and ultimately lead to cardiac failure [15]. Studies have found that ventricular hypertrophy and cardiac failure caused by obesity results in a higher risk of mortality [16]. The eccentric and concentric ventricular hypertrophy associated with obesity can lead to prolonged Q-T intervals or tachyarrhythmia. Additionally, unexplained cardiac arrhythmias are more common in obese patients [11]. The creation of pneumoperitoneum required to perform minimally invasive procedures can cause further cardiac depression. Abdominal insufflation causes an increase in afterload while the subsequent impeding of a venous return causes a decrease in preload. This contributes to an overall reduction in cardiac output [17]. Cardiac depression during laparoscopic procedures is often transient as the patient’s body compensates for the change in physiology. In one study of morbidly obese patients undergoing laparoscopic gastric bypass, cardiac output levels returned to baseline at 2.5 hours after abdominal insufflation [17].
Due to fat deposits in the mediastinum and abdominal cavities, the mechanical properties of the lungs and chest wall are altered in obese patients resulting in reduced compliance of the lungs, chest wall, and entire respiratory system. These changes likely contribute to increased symptoms of wheezing, dyspnea, and orthopnea [18]. Obesity causes reduced chest wall and pulmonary compliance and therefore reduction in gas exchange and increased bronchial resistance and ventilation-perfusion. Increased abdominal pressure and pleural pressures in obesity alter the breathing pattern resulting in a reduction of both expiratory reserve volume (ERV) and the functional residual capacity (FRC). Severely obese patients have a decreased FRC up to 33% [11, 18].
The expiratory reserve volume is also compromised by 35–60%, secondary to cephalad displacement of the diaphragm by the obese abdomen [19]. Sleep-disordered breathing, including obstructive sleep apnea (OSA) and obesity-related respiratory failure (ORRF) is common in obese patients. Studies demonstrated that half of all patients with a BMI >40 kg/m2 demonstrate OSA [20]. Untreated OSA can result in hypoxemia during sleep as well as pulmonary hypertension, both of which increase risk of cardiac arrythmias. In addition, OSA has been associated with postoperative respiratory complications pneumonia, postoperative hypoxemia, and unplanned reintubation [11].
There are additional intrinsic qualities of an obese body habitus that can impair respiratory function. More soft tissue of the upper airway combined with increased tongue size can cause significant upper airway resistance [16]. An increase in breast mass and additional adiposity can cause difficulty with direct laryngoscopy [16]. Finally, a waist-to-hip ratio has been found to poorly impact gas exchange with larger waist-to-hip ratios correlating to worsening arterial blood gas values [11, 16, 21].
Performing a minimally invasive hysterectomy requires the patient to undergo general anesthesia, the creation of pneumoperitoneum, and supine positioning, all of which further impact respiratory physiology in obese patients. The administration of general anesthesia can reduce a patient’s FRC by an additional 20%, while pneumoperitoneum increases inspiratory resistance requiring higher minute ventilation [11, 15]. In one study evaluating respiratory mechanics in laparoscopy, it was found that obese, anesthetized patients in the supine position required 15% higher minute ventilation to maintain normocarbia prior to abdominal insufflation. The authors also reported that these patients had 30% lower static compliance and 68% higher inspiratory resistance after insufflation of the abdomen with CO2 to a pressure of 20 mmHg [15, 22]. While the increase in inspiratory restitance caused by obesity requires higher minute ventilation, oxygenation does not seem to be affected by abdominal insufflation or Trendelenburg positioning. Therefore, patients who are able to tolerate general anesthesia in the supine position are likely also able to tolerate abdominal insufflation and changes in position including Trendelenburg [15, 22].
Gastric and esophageal function may also be impaired in obese patients, which can lead to intra-operative challenges. Gastroesophageal reflux disease (GERD) and hiatal hernias are found more commonly in obese patients and can often be asymptomatic [11]. This is caused by increased intra-abdominal pressure which can be two to three times higher in morbidly obese patients compared with non-obese patients [11]. Studies have found that obese patients tend to have higher gastric volumes, lower gastric pH, and delayed emptying which can increase their risk of intra-operative and post-operative gastric acid aspiration [11, 15]. For this reason, a prophylactic H2 blocker (ranitidine) and a pro-kinetic (metoclopramide) are often recommended prior to a surgical procedure [16].
Obesity is an independent risk factor for venous thromboembolism (VTE). Current data regarding the risk of VTE in gynecologic surgery shows the incidence of VTE in gyn surgery ranges from 0 to 2%. Evidence for these studies is from retrospective studies in non-obese patients who underwent simple laparoscopic procedures [11]. Gynecologic laparoscopic procedures with a duration of >30 min are considered moderate to high risk for VTE. Increasing laparscopic surgical complexity increases rates of VTE after completion of surgery according to the American College of Chest Physicians (ACCP) [23]. For these procedures, the standard treatment for VTE prophylaxis is mechanical prophylaxis with sequential compression devices. For obese patients it is critical these devices are appropriately fitted. Alternatively, pharmacologic prophylaxis with either subcutaneous low molecular weight heparin or unfractionated heparin can be administered. For bariatric surgery patients who have a BMI >55, immobility, history of active or recent VTE, hypercoagulable disorders, or severe OSA there are recommendations for placement of an inferior vena cava (IVC) filter for patients prior to bariatric surgery [24]. There are no current clear guidelines for patients undergoing gynecologic laparoscopic surgery and decisions should be made on an individual basis. The ACCP recommends dual prophylaxis with sequential compression devices and pharmacologic prophylaxis during admission and prolonged pharmacologic prophylaxis for 2–4 weeks after discharge for patients with gynecologic cancer with additional risk factors such as age >60 or history of VTE [23]. Recommendations for patients who are morbidly obese undergoing gynecologic laparoscopy may include combination mechanical and pharmacological prophylaxis during surgery and hospitalization. Taking into consideration patient comorbidities and mobility status, extended prophylaxis after discharge may also be considered [11].
It is imperative that morbidly obese patients who are seen for surgical consultation should have a comprehensive history and physical exam in addition to laboratory and diagnostic testing as their obesity can increase their medical complexity. During a physical exam, there should be documentation of the patient’s body habitus, assessment of the uterine size, uterine mobility, and vaginal caliber. Proper evaluation of the patient’s panniculus and body type is crucial for determining intravenous access, trocar placement, and positioning during laparoscopy [4]. Special attention must be paid to the distribution of the patient’s weight (i.e. increased waist circumference vs. increased hip circumference). Patients with large adipose tissue centered on their waist are likely to be more technically challenging than patients whose adipose is centered on the hips [15]. In patients with large panniculus, trocar placement may be hindered not only by increased thickness but also by a lack of mobility. If the panniculus is soft and mobile, it can be repositioned easily using traction with weights or tape.
In general, preoperative testing should be tailored to the patient’s risk factors. Basic laboratory assessment can include a complete blood count, blood glucose concentration, basic metabolic panel, and blood type and screening. Given the high predisposition for cardiovascular, pulmonary, and endocrine abnormalities in morbidly obese patients, evaluation by subspecialists for additional diagnostic testing should be performed. Informed consent should take into account both the increased medical and surgical complexity of the case and inform the patient of increased risk of infection, increased risk of VTE, and potential increased risk for conversion to laparotomy [11]. As pulmonary and cardiovascular changes are prominent in morbidly obese patients, there are numerous risks associated with general anesthesia including airway complications and oxygenation issues with induction of anesthesia, intubation, and extubation [4]. Increased communication with anesthesia and pre-operative evaluation with anesthesia may be beneficial for these patients. When considering antibiotic prophylaxis, the current standard for routine prophylaxis prior to hysterectomy is 2 g of cefazolin for patients under 120 kg and 3 g for patients over 120 kg [25]. With regards to mechanical bowel prep (MBP), the theoretical advantage is to reduce intestinal volume and mass to improve intraoperative manipulation and visualization. A meta-analysis of elective colorectal surgery has revealed no statistical advantage of MBP [4].
In order to complete laparoscopic surgery safely and efficiently for morbidly obese patients, proper preparation in the operating room is essential. Proper setup of the operating room will allow for mobility of the surgical team, quick access to instruments, increase patient safety, and the ability for the surgeon to successfully complete the procedure.
The first consideration needs to be placed on basic operating room equipment such as the operating room table and mechanisms for patient transfer. Patients are usually brought to the operating room in a stretcher. Lateral transfer devices that utilize hover technology (Hovermatt) can enable the team to move the patient to the operating room table and back to the transport stretcher in a secure and comfortable manner [26]. Operating room tables must have the capacity to support morbidly obese patients. Many standard tables have weight limits of 227 kg (500 lb). A bariatric bed is wider than traditional beds and can accommodate a weight of up to 1000 lb. If there is no availability of a bariatric bed, two standard operating room tables can be used together. Extra padding, blankets, sheets, or lifting devices may be needed to appropriately position an obese patient. Blood pressure cuffs and sequential compression devices will need to be of appropriate size to provide accurate readings.
An additional consideration should be placed on specialized laparoscopic instruments. Laparoscopes come in various sizes with a standard length of 32 cm and diameters ranging from 2 to 10 mm. There are various angled scopes available. In bariatric surgery, some surgeons endorse using a 45-degree angled scope or an extra-long laparoscope (45 cm) to aid with viewing flexibility in extremely obese patients [27]. Laparoscopic assist trays may include extra-long laparoscopic instruments (41–45 cm), which may aid with the ability to complete the procedure successfully. Instruments such as long trocars, trocars with a non-latex balloon at the distal end for retention of the trocar tip in the abdominal cavity, or a long Veress needle (150 mm) may be used. Uterine manipulators should be considered for safe completion of hysterectomy. Although redundant perineal tissue or a large uterus may limit the full mobility of the uterus, the integrated cervical cup will allow for cephalad traction and proper identification of surgical landmarks for colpotomy creation and increase the distance of the uterine arteries from the ureters [4].
Obese patients are at greater risk for pressure sores and nerve injuries when compared to non-obese patients. Duration of compression and compressive force applied influence the risk of nerve injuries. Prolonged compression for 6–8 hours can cause permanent nerve injuries [11, 28, 29]. For laparoscopic surgical procedures in gynecology, patients are placed in a dorsal lithotomy position with their arms tucked at their sides in a “military” position. It is recommended to initially position the buttocks slightly lower than the edge of the bed as the body will shift cephalad with the weight of the panniculus once in Trendelenburg position.
Several considerations should be taken when tucking the arms. It is important to ensure that all intravenous access and cardiopulmonary monitors are functioning appropriately. Adequate padding should be placed at the hands and elbows to minimze ulnar or branchial plexus injuries [29]. If the arms are hanging too far off the side of the bed, bed extenders or arm sleds can be used. If the patient slides cephalad with shoulder blocks in place or if the arms are extended. Two potential scenarios that can increase the risk of brachial plexus injury are if the patient slides cephalad with shoulder blocks in place or if the surgeon leans on the patient’s extended arms [30]. The legs should be positioned in stirrups in a low lithotomy position with generous padding applied around the hips and knees. The most common stirrups available in the United States are the YellowFin, the YelloFin Elite, and the Ultrafin. The Ultrafin is capable of accommodating calves that are 13 inches wide and have a weight capacity of 800 lb. Appropriate selection of stirrups can potentially aid in decreasing nerve injury. Obese patients have an increased risk for brachial plexus injury given downward shifting in Trendelenburg [11]. There are multiple options to help reduce this cephalad shifting including gel padding, egg-crate foam, surgical bag, and a padded straps. Once the patient has been positioned a “tilt-test” can be performed where the patient is placed into Trendelenburg position for approximately 2–5 minutes in order to assess the stability of the patient’s positioning and assess the impact on the respiratory and cardiac status. Some adjustments that can be made to help insufflation pressures would be to decrease the degree of Trendelenburg or reduce the insuflation pressure.
Management of the patient’s panniculus in a caudad position during laparoscopic surgery can aid in improving the patient’s ventilation and therefore potentially decreasing the conversation to laparotomy. One technique involves the use of a foley catheter that is passed through the patient’s abdominal wall. The foley balloon is insuflated and the catheter is pulled up and clamped to a retractor attached to the foot of the bed [31]. A second technique involves using towel clips on the lower edge of the panniculus with 1-liter saline bags attached and hanging between the legs. Lastly, adhesive dressing can be used to secure the panniculus to the patient’s thighs.
Morbid obesity can increase the difficulty of initial abdominal access in laparoscopic surgery due to the increased thickness of the abdominal wall and lack of reliable landmarks. Traditionally, the umbilicus is a common landmark used for abdominal entry as it may represent the thinnest part of the abdominal wall. However, in obese patients, the umbilicus is often located at or cephalad to the aortic bifurcation. In obese women, the mean umbilical location was found to be on average 2.9 cm caudal to the aortic bifurcation in comparison to nonobese women in which the umbilicus was 0.4 cm caudual to the bifurcation [32]. Given this migration of the umbilicus, if it is used for entry into the abdomen, it may compromise adequate triangulation with the surgical pathology [11]. There are multiple techniques for abdominal entry including the Veress needle, use of an optical trocar, or an open technique. In obese patients, there is a higher likelihood for the Veress technique to result in a higher rate of false entry and preperitoneal insufflation [11]. If there is no substantial panniculus and the umbilical approach is chosen, a 90-degree entry can be used and the use of a long Veress needle (150 mm) may help decrease pre-peritoneal insufflation. If an optical trocar is used, it may be beneficial to use a long trocar to aid in correct placement. Supraumbilical and left upper quadrant are two alternative abdominal entry sites. If the left upper quadrant is used, a nasogastric or orogastric drainage tube should be placed to decompress the stomach. This site is contraindicated in patients who have a history of gastric bypass, splenectomy, and splenomegaly.
Obesity is an important factor to consider when determining an appropriate surgical approach to hysterectomy. A systematic review published in 2015 by Blikkendaal et al., found that laparoscopic hysterectomy and vaginal hysterectomy are associated with significantly fewer postoperative complications and shorter lengths of hospital stay [31]. While vaginal hysterectomy is generally the preferred surgical approach and is associated with improved outcomes, it seems to be less favorable in obese patients due to large uterine size, early-stage endometrial cancer, or lack of vaginal access and exposure secondary to the patient’s body habitus [31]. In patients who are not good candidates for vaginal surgery, conventional laparoscopic hysterectomy and robotic hysterectomy are alternative approaches that are shown to be safe and feasible in this patient population [31, 32].
The benefits of minimally invasive surgery are well studied. Compared to laparotomy, laparoscopic hysterectomy results in fewer postoperative complications, decreased blood loss, less time in the hospital, and faster recovery [31, 33]. One study showed that obese patients who underwent laparoscopic hysterectomy compared with laparotomy had fewer incidences of postoperative ileus (0% vs. 13.3%), less postoperative fevers (5.5% vs. 31.1%), and a decrease in wound infections (9% vs. 22%) [15]. Additionally, obese women undergoing laparoscopic hysterectomies, bilateral salpingo-oophorectomy, and lymph node dissection for stage I endometrial carcinoma were found to have shorter hospital stays (2.5 vs. 5.6 days), less pain (32.2 vs. 124.1 mg of pain medication), and earlier return to normal activity [15].
Despite the clear benefits of minimally invasive techniques, research evaluating surgeons’ surgical preference shows that the rate of abdominal hysterectomy increases as BMI increases [31]. In fact, in the past obesity was considered a relative contraindication to laparoscopic surgery. This is due to associated difficulties with Verees needle placement, accumulation of fat in the omentum obstructing the operative field and manipulation of laparoscopic instruments [15]. However, more recent studies have shown that minimally invasive approaches including robotics and conventional laparoscopic techniques can be successful in obese patients with proper planning and appropriate laparoscopic surgical experience.
Robotic surgery may help overcome some of the inherent challenges of minimally invasive surgery in obese patients. Robotic surgery offers greater flexibility, articulation, and control of the instruments with reduced hand tremors. Improved ergonomics and the 3D-HD view allow for surgeons to more easily operate within the confined space of an obese abdomen and reduce surgeon fatigue [33]. This is especially relevant in obese patients with endometrial cancer when lymphadenectomy is required [34]. The advantages of robotic surgery may help facilitate the completion of hysterectomy using a minimally invasive approach, however, the cost is significant. Each robotic console has a direct cost of $2.6 million USD and about $2000 per surgical case [34].
While most studies comparing robotic surgery to laparoscopic surgery have not been able to show an improvement in safety or efficacy compared with conventional laparoscopy, there is evidence that robotic surgery may provide clinical benefits in specific populations like the morbidly obese [34, 35, 36]. In fact, there is evidence of cost neutralization with robotic procedures when the rate of conversion to laparotomy is decreased [34]. A recent systematic review and meta-analysis comparing laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity found similar perioperative complication rates but a decrease in conversion to laparotomy in robotic procedures performed on patients with BMI > 40 kg/m2 (7.0% vs. 3.8%) [34]. Additionally, the qualitative reasons for conversion were different in robotic hysterectomy and conventional laparoscopic hysterectomy. Conversion to laparotomy from conventional laparoscopy was more often due to obesity-related anesthetic concerns (30% vs. 6%) while conversion from robotic assisted laparoscopy was attributed more frequently to increased uterine size [34].
After properly positioning the patient and obtaining adequate pneumoperitoneum, the surgeon must determine adequate and safe port site placement. This step can be more challenging in obese patient as traditional landmarks may be altered. The surgeon should choose trocars that are adequate in length. Although extra-long trocars, up to 150 mm, are available and may be useful in patients with very thick anterior abdominal walls, they are often not necessary [29, 37]. In order to safely place accessory trocars, some authors recommend increasing the insufflation pressure to 25 mmHg to increase the distance for trocar placement in order to avoid vascular and visceral complications [37]. Once the initial trocar is placed and pneumoperitoneum is achieved, ancillary trocars can be placed under direct visualization after localization with a spinal needle [37]. In general, most authors recommend more cephalad and lateral placement of ancillary port in obese women. This is due to the difficult visualization of the inferior epigastric vessels and the extent of the panniculus [11, 29, 38]. When placing ancillary trocars, they should be angled toward the operative field to prevent slippage and torquing of the instruments [15]. Surgeons should have a low threshold for adding additional ports that may improve ergonomics, triangulation, or retraction [29, 38].
Surgical exposure can be challenging in obese patients. This is due to increased visceral adiposity, a fatty rectosigmoid colon, or limited Trendelenburg positioning due to difficulty with ventilation [29, 32]. Mobilizing the cecum and sigmoid reflection from their lateral peritoneal attachments can help facilitate moving the large bowel out of the pelvis [29]. Additionally, the rectosigmoid colon can be retracted by using a puppet stitch to pull the epiploic appendices to the anterior abdominal wall [11]. Another option is using a pre-tied endoscopic loop that can be brought through the anterior abdominal wall using a fascial closure device or bringing the suture through a trocar to be tied off [29, 38].
Effective uterine manipulation is especially important to perform laparoscopic and robotic hysterectomies safely in obese patients. This is because the amount of Trendelenburg may be limited and exposure to the pelvis may be challenging [37]. There are many uterine manipulation devices available including the Zinnati Uterine Manipulator injector (ZUMI) (Cooper Surgical, Trumball, CT), the VCare (ConMed Endosurgery, Utica, NY), and the Reusable Uterine Manipulator Injector (RUMI) Arch (Cooper Surgical, Trumball, CT). It is recommended that surgeons choose a device that will be applicable to the majority of their cases so that the entire surgical team can become familiar with its use, allowing for reliable uterine manipulation [37].
As with non-obese patients, closure of the fascia is recommended in incisions greater than 10 mm to prevent port site evisceration. Exposure to the fascia can be more challenging in obese patients. Facial closure devices like the reusable Carter-Thomason CloseSure System XL device (Cooper Surgical, Trumball, CT) allow for the closure to be performed under direct visualization. If the device is not long enough, the disposable Endoclose device (Covidien, Norwalk, CT) can be used [37].
Many studies have compared vaginal vs. laparoscopic vaginal cuff closure with more recent data showing a reduction in vaginal cuff dehiscence with laparoscopic closure (1% vs. 2.7%) [24]. A study by Uccella et al. further demonstrated a reduction in vaginal bleeding (2.7% vs. 4.9%), vaginal cuff hematoma (0.9% vs. 2.3%), need for vaginal re-suturing (0.9% vs. 2.3%) and postoperative infection (0.9% vs. 2.3%) [39]. In obese patients with limited vaginal access due to weight distribution or a large panniculus, laparoscopic closure may also be more accessible.
Some research suggests that obesity may be a protective factor against vaginal cuff dehiscence and evisceration. One study found that after laparoscopic hysterectomy, obese women were 86% less likely to experience vaginal cuff dehiscence than non-obese women [40, 41]. Although intercourse is a significant risk factor for cuff dehiscence, it is hypothesized that positioning during intercourse may be different for obese women, resulting in the application of less physical force at the apex of the vagina [40, 41]. The authors further also postulate that an increase in adipose tissue leads to less energy being delivered to the vaginal tissue during the creation of colpotomy, which can improve healing by causing less tissue desiccation.
Studies have shown that the incidence of postoperative complications increases as BMI increases. However, when surgeries are performed in a minimally invasive fashion, complication rates for obese patients are similar to non-obese patients [29].
Patients with known or presumed cardiovascular disease, OSA, or high perioperative risk should be monitored closely in the postoperative period. Patients who have OSA should be observed overnight because of the increased risk of pulmonary complications [11, 29]. A multi-modal approach to analgesia is recommended to limit narcotic analgesic which can worsen atelectasis and hypoxia. This may include acetaminophen, nonsteroidal anti-inflammatory agents, cyclooxygenase-2 inhibitors, gabapentin, or pregabalin as well as local or regional anesthesia [29, 42]. Early ambulation and the use of incentive spirometry can help inflate dependent lung regions and decrease impairment of lung function induced by anesthesia. As discussed above in the thromboembolism section of this chapter, morbidly obese patients are at increased risk for VTE and may benefit from from extended VTE prophylaxis for 10–35 days following surgery [11, 23].
Minimally invasive laparoscopic hysterectomy is feasible for morbidly obese patients. Additional considerations regarding cardiopulmonary physiological changes seen in morbid obesity should be stressed as these have implications for preoperative surgical risk assessment and the patient’s ability to tolerate surgical positioning and pneumoperitoneum.
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Overall, optical methods can support traditional periodontal diagnosis and improve treatment planning and clinical periodontal care.",book:{id:"7244",slug:"periodontology-and-dental-implantology",title:"Periodontology and Dental Implantology",fullTitle:"Periodontology and Dental Implantology"},signatures:"Fardad Shakibaie and Laurence Walsh",authors:[{id:"179467",title:"Prof.",name:"Laurence",middleName:null,surname:"Walsh",slug:"laurence-walsh",fullName:"Laurence Walsh"},{id:"235443",title:"Dr.",name:"Fardad",middleName:null,surname:"Shakibaie",slug:"fardad-shakibaie",fullName:"Fardad Shakibaie"}]},{id:"24363",title:"Biomechanics of Tooth-Movement: Current Look at Orthodontic Fundamental",slug:"biomechanics-of-tooth-movement-current-look-at-orthodontic-fundamental",totalDownloads:26821,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"277",slug:"principles-in-contemporary-orthodontics",title:"Principles in Contemporary Orthodontics",fullTitle:"Principles in Contemporary Orthodontics"},signatures:"Joanna Antoszewska and Nazan Küçükkeles",authors:[{id:"50158",title:"Prof.",name:"Joanna",middleName:null,surname:"Antoszewska",slug:"joanna-antoszewska",fullName:"Joanna Antoszewska"}]},{id:"71271",title:"Flap Techniques in Dentoalveolar Surgery",slug:"flap-techniques-in-dentoalveolar-surgery",totalDownloads:2638,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Most dentoalveolar procedures involve the reflection of mucosal flaps. 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Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. 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He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a scientist and Principal Investigator at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering the lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via artificial intelligence-based analyses of exosomal Raman signatures. Dr. Paul also works on spatial multiplex immunofluorescence-based tissue mapping to understand the immune repertoire in lung cancer. Dr. Paul has published in more than sixty-five peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award and the 2022 AAISCR-R Vijayalaxmi Award for Innovative Cancer Research. He is a senior member of the Institute of Electrical and Electronics Engineers (IEEE) and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"15",type:"subseries",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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