Average ages or times for some reproductive parameters selected by species [28].
\r\n\t
",isbn:"978-1-80356-921-5",printIsbn:"978-1-80356-920-8",pdfIsbn:"978-1-80356-922-2",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"bdff63f3c5e98fc95d76217516cb1420",bookSignature:"Dr. Longbiao Li",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11817.jpg",keywords:"Next-Generation Polymer-Matrix Composites, Next-Generation Ceramic-Matrix Composites, Next-Generation Metal-Matrix Composites, Mechanical Properties, Tensile, Compression, Shear, Fracture, Durability, Creep, Damage Mechanisms, Oxidation",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2022",dateEndSecondStepPublish:"June 17th 2022",dateEndThirdStepPublish:"August 16th 2022",dateEndFourthStepPublish:"November 4th 2022",dateEndFifthStepPublish:"January 3rd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Lecturer at the Nanjing University of Aeronautics and Astronautics and author of 184 SCI journal publications, 8 monographs, 3 edited books, 3 textbooks, 3 book chapters, 30 Chinese Patents, 2 US Patents, 2 Chinese Software Copyrights, and more than 20 refereed conference proceedings.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"302409",title:"Dr.",name:"Longbiao",middleName:null,surname:"Li",slug:"longbiao-li",fullName:"Longbiao Li",profilePictureURL:"https://mts.intechopen.com/storage/users/302409/images/system/302409.jpg",biography:"Dr. Longbiao Li is a lecturer in the College of Civil Aviation at the Nanjing University of Aeronautics and Astronautics. Dr. Li’s research focuses on the vibration, fatigue, damage, fracture, reliability, safety and durability of aircraft and aero engine. In this research area, he is the first author of 184 SCI journal publications (49 JCR Q1), 8 monographs, 3 edited books, 3 textbooks, 3 book chapters, 30 Chinese Patents, 2 US Patents, 2 Chinese Software Copyright, and more than 20 refereed conference proceedings. 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Kawsar Alam",coverURL:"https://cdn.intechopen.com/books/images_new/6805.jpg",editedByType:"Edited by",editors:[{id:"199691",title:"Dr.",name:"Md. Kawsar",surname:"Alam",slug:"md.-kawsar-alam",fullName:"Md. Kawsar Alam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"63607",title:"The Adipokines in Domestic Animal Reproduction: Expression and Role in the Regulation of Ovarian Function",doi:"10.5772/intechopen.81035",slug:"the-adipokines-in-domestic-animal-reproduction-expression-and-role-in-the-regulation-of-ovarian-func",body:'\nThe reproductive system in female domestic animals is regulated precisely by an intricate interplay of hormones produced by the hypothalamus, anterior pituitary and the ovaries. The interplay of hormones results in ovarian cyclicity in females, which in consequence leads to fertilization, delivery by the maintenance of pregnancy of offspring. Moreover, it is now clear that fertility depends on the energy metabolism status. For example, in cattle, genetic selection for high milk production is associated to high negative energy balance in the post-partum period and reduced fertility [1]. In pigs, a negative energy balance and a decrease in body fat results in a reduction in litter size and viability of piglets [2]. In sheep, it is well known that an increase in availability of energy substrates is associated with an increase in prolificacy [3]. Furthermore, obesity and some metabolic disorders influence the reproductive hormones in women [4].
\nThe adipose tissue is well known to be implicated in the secretion of several hormones such as adiponectin, apelin, chemerin, resistin, vaspin and visfatin: the so-called adipokines, which regulate energy balance, food intake, immunology and diabetes. A recent study indicated that several adipokines are expressed in the ovarian cells and that they can modulate ovarian physiology in some domestic animals, like pigs, cows, goats, ewes, chickens and turkeys [5].
\nAdiponectin, apelin, chemerin, resistin, vaspin and visfatin were described as “adipose tissue-derived hormones”. However, their expression and receptors are present in different tissues like the brain, stomach, kidneys, pancreas, liver or blood vessels. They play important roles in several metabolic processes, such as in the regulation of insulin sensitivity, food intake, adipogenesis and inflammation (Figure 1).
\nAdipokines and their receptors are present in different tissues like the brain, stomach, kidneys, pancreas, liver or blood vessels, and play important roles in several metabolic processes.
Adiponectin is mainly produced by a white adipose tissue (WAT) and secreted into the bloodstream. The adiponectin level in serum is inversely related to body weight. Circulating levels range between 2 and 30 μg/ml in human plasma and are higher in females than in males [6]. In chicken plasma, the adiponectin levels are in the range of 4–10 μg/ml. The protein (26 kDa) was described for the first time by Scherer et al. [7] and is present in cells and plasma in three forms: trimers, hexamers and high-molecular weight (HMW) [8]. A number of post-translational modifications are required to obtain these forms. Three adiponectin receptors have been identified: AdipoR1, AdipoR2 and T-cadherin. The first two are the main adiponectin receptors and consist of seven transmembrane domains. AdipoR1 is abundantly expressed in skeletal muscles and is associated with the activation of AMP-activated kinase pathways. AdipoR2 is mainly expressed in the liver and is associated with the activation of peroxisome proliferator-activated receptor (PPAR)-α pathways. Then, T-cadherin is a receptor for hexameric and HMW adiponectin and is expressed on vascular cells and smooth muscles [9]. Adiponectin is an insulin-sensitizing, vascular protective, anti-apoptotic, anti-lipotoxic and anti-inflammatory protein on different cell types. Thus, it has been considered as a beneficial adipokine. Moreover, these functions mark this protein as a potent drug targeting diabetes and obesity-associated diseases [10].
\nApelin has been isolated from the bovine stomach extracts as an endogenous ligand of the previous orphan receptor APJ [11]. APLN gene encoding human apelin is located on chromosome Xq 25–26 [11]. Preproapelin, a precursor of the mature form, consists of 77 amino acids and is transformed into active forms by enzymatic hydrolysis. They are distinguished within four forms having different biological activities: apelin-36 (preproapelin 42–7), apelin-17 (preproapelin 61–77), apelin-13 (preproapelin 65–77) and pyroglutamate-apelin-13 (Pyr-apelin 13) [11]. The shorter apelin-13 has much higher biological potency than the longer apelin-36. Mature apelin is apparently the only monomeric protein without cysteine residues which occur in the precursor [12]. This adipokine was described in various tissues and organs such as the uterus, ovary, heart, lung, stomach and brain. The expression of apelin increases during adipocyte differentiation. Insulin, growth hormone (GH) or tumor necrosis factor (TNF-α) are among the agents regulating the production of apelin [13]. Apelin exerts some influence on the cardiovascular system, food intake, fluid homeostasis and energy metabolism. According to Castan-Laurell et al. [14], lean women exhibit plasma apelin levels in the range of 272 pg/ml, indicating a positive correlation between the plasma apelin level and body mass index (BMI).
\nChemerin was first termed tazarotene-induced gene 2 protein (TIG2) and retinoic acid receptor responder protein 2 (RARRES2). It has been suggested to play a role in the metabolic syndrome. It is secreted as 143 residue prochemerin, which is largely expressed in the liver, WAT, skin, pancreas and kidneys. It is also the main form in the plasma. The level of active chemerin is negligible in basal conditions [15]. Various isoforms of chemerin have been detected in different tissues and fluids, including plasma, synovial fluid, muscles, liver and ovary. Three isoforms have been identified, chemerinS, chemerinF and chemerinK and three G-protein coupled receptors have been detected, CMKLR1 (chemokine-like receptor1), GPR1 (G protein-coupled receptor 1) and CCRL2 (chemokine receptor like 2). CMKLR1 is coupled with the Gi/o proteins and inhibits the cyclic adenosine 3′,5′-monophosphate (cAMP) signaling pathway, promoting Ca2+ mobilization and extracellular signal–regulated kinases (ERK1/2) activation. The CMKLR1 sequence is closely related to GPR1 and activates the same pathways, while the role of CCRL2 remains unclear. Chemerin binding does not promote any signaling pathway and does not induce CCRL2 internalization [15]. Chemerin was reported to regulate adipogenesis, adipocytes differentiation, insulin secretion, inflammation and blood pressure. Obesity and type 2-diabetes are associated to high levels of chemerin [15].
\nResistin is a cysteine-rich, secretory protein, also known as adipocyte secreted factor (ADSF), belongs to the family of Found in Inflammatory Zone (FIZZ) proteins [16]. Resistin is produced by the adipocytes in mice whereas it is predominantly expressed in macrophages in humans. Human resistin is a 12.5 kDa cysteine-rich peptide with a mature sequence consisting of 108 amino acids, while the rat and mouse resistin has 114 amino acids. The comparison of the amino acid sequences of bovine resistin with that of humans, pigs, rats and mice showed 73, 80, 58 and 57% identity, respectively [17]. The resistin concentration in human plasma and follicular fluid ranges from 5 to 50 ng/ml [18], while in the follicular fluid in pigs it is around 0.323 ng/μg protein, depending on the stage of the estrous cycle [19]. Recent reports have suggested potential receptors for resistin, such as an isoform of decorin (DCN), mouse receptor tyrosine kinase-like orphan receptor 1 (ROR1), toll-like receptor 4 (TLR4) or adenylyl cyclase-associated protein 1 (CAP1) [5]. Furthermore, it is well known that resistin activates signaling pathways in different tissues like the phosphatidyl inositol 3′ kinase/ protein kinase B (Akt), mitogen-activated protein kinases (MAPK) (ERK1/2 and p38), signal transducer and activator of transcription 3 (Stat-3) and PPAR type gamma (PPARγ). Several studies have identified positive correlations between resistin levels and the pathogenesis of obesity, adipogenesis and insulin resistance [16].
\nVaspin, a member of the serine protease inhibitor family, has been identified in the visceral adipose tissue of Otsuka Long-Evans Tokushima fatty rats at an age when body weight and hyperinsulinemia peaked [20]. This adipokine was initially observed in mature adipocytes from epididymal, retroperitoneal, mesenteric and subcutaneous abdominal WAT from 30-week-old Otsuka Long-Evans Tokushima fatty (OLETF) rats [20]. Literature data indicates the involvement of vaspin in the development of obesity, insulin resistance or pathogenesis of the body’s inflammatory reactions [21]. Vaspin receptors remain unknown, but some data suggest that vaspin acts as a ligand for the cell-surface GRP78/voltage-dependent anion channel complex [22]. The vaspin gene was expressed in new born and adult bovines; in new born animals, vaspin is highly expressed in the heart, small intestine, skeletal muscle and fat, whereas in adults, it is expressed in the heart, liver, lungs and skeletal muscles. Vaspin increased the Akt phosphorylation protein and decreased the nuclear factor NF-κB level in pancreatic β cell and in cultured endothelial cells [23].
\nVisfatin was first discovered as a growth factor (PBEF) and then as a type II nicotinamide phosphoribosyltransferases (NAMPT). Visfatin structure showed a dimer organization separated by an active site. The visfatin gene is highly conserved among different species, such as mice, rats, humans and fish. The expression has been studied in many organisms and the porcine visfatin is ubiquitously expressed in tissues [24]. In a canine model, visfatin protein is expressed in various tissues like the liver, heart, brain, lungs and muscle [25]. In cows, mammary epithelial cells express visfatin [26]. In chickens, the full-length cDNA of visfatin gene has been cloned and sequenced. In the latter species, visfatin is highly expressed in muscles and it is involved in muscle growth [27]. Because of this characteristic, visfatin is also called myokine. No receptor has yet been identified for visfatin, but it is able to activate the insulin receptor. Besides muscle growth, visfatin is also involved in glucose and fatty acids metabolism and in reproductive functions. Moreover, in pancreatic β-cells, visfatin increases the glucose-stimulated insulin secretion.
\nThe ovary, by producing steroid hormones, has a key role in female reproduction. It ensures follicles growth and the timely release of fertilizable oocytes essential for pregnancy, by directing feedback mechanisms on the hypothalamus and pituitary. Disruption of this finely controlled network can lead to many clinical syndromes including premature ovarian failure, ovarian hyperstimulation syndrome, ovulation defects, poor oocyte quality and cancer. Generally, in domestic animals, the oestrus cycle is composed of four phases: proestrus, estrus, metestrus and diestrus [28]. Each of these stages is a subdivision of the follicular and luteal phases of the cycle. For example, the follicular phase includes proestrus and estrus, while the luteal phase includes metestrus and diestrus [28]. Proestrus is characterized by a significant rise in estradiol (E2) produced by developing follicles. When E2 reaches a certain level, the female enters behavioral estrus and then ovulates. Following ovulation, cells of the follicles are transformed into corpus luteum (CL) cells during metestrus. Next, diestrus is characterized by a fully functional CL and high progesterone (P4) concentration [28].
\nThe initiation of puberty is achieved when heifers reach 40 to 55% of their adult weight, which is strongly influenced by the nutritional level received during the prepubertal period [28]. At traditional high levels of energy intake, the onset of puberty may range from 7 to 10 months of age, 6 to 9 months earlier than for heifers of the same breed fed with a low energy nutritional intake [28]. Before the onset of puberty, the frequency of luteinizing hormone (LH) peaks increases leading to a brief P4 priming followed by the pubertal preovulatory surge of LH associated with behavioral estrus. The ovaries of heifers contain growing follicles that release steroidogenic hormones: P4 and E2 are regulated by the endocrine retro-control of the hypothalamus-pituitary-ovarian axis. In mature cows, waves of follicular oestrogens from granulosa cells (GC) activate gonadotropin releasing hormone (GnRH) and LH pulsation that induce a positive feedback on E2 secretion until it reaches the preovulatory peak of LH and triggers ovulation. In cattle, the wave-like pattern of follicle development is very well characterized with most estrous cycles comprising two or three waves [28] (Figure 2). In the absence of fertilization, the endometrium secretes prostaglandins and CL regress and become atretic. Conversely, when fertilization occurs, CL cells continue to secrete P4 that stop the progression of a new estrous cycle [28]. In bovines, the gestation lasts 9 months. In breeding, farmers and researchers often resort to hormonal stimulation to synchronize ovulation and artificial insemination (AI). Over generations, the genetic selection and the high management for milk production have led to drastic negative energy balance and decline of fertility [28]. “Fertil+” cows had a significantly higher success rate at the first AI than “Fertil−” cows, without variations of ovarian dynamics. Traditionally, a decrease in the pregnancy rate at first service and the increase in the calving intervals and calving to first AI interval are associated with prolonged postpartum anestrus (the first ovulation is delayed), abnormal estrous cycles or follicular cyst formation [28].
\nSchematic presentation of the pattern of follicle development during estrous cycles in cattle and pigs. In chickens, the pre-ovulatory release of LH can only be initiated between the beginning of the night and 1 hour after the sunrise. In addition, the ovulation is induced by a P4 peak under the control of LH.
Pigs reach puberty close to the 7th month of postnatal life (Table 1); animals with higher fat mobilization reach sexual maturity faster and have more estrous cycles compared to animals with lower fat mobilization [29, 30]. The ovary begins to form at the 24-26th week of prenatal life, and the first ovarian follicles appear about 70 days after fertilization. Primary ovarian follicles comprise an oocyte surrounded by a single flattened layer of GC outlined by a basement membrane. Secondary follicles have a higher volume and number of GC and follicular sheath is formed. Antral follicles formation depends on the follicular fluid accumulation, GC proliferation and theca cells (TC) differentiation. Preovulatory follicles are the final stage of the follicle before ovulation [29]. Swines do not show the wave-like pattern of follicle development that is so typical in ruminant species [28, 30]. While there is a coordinate development of follicles at the beginning of the luteal phase, there is continuous growth and atresia of ovarian cells during the rest of the luteal phase without evidence of dominant follicles or follicular waves (Figure 3) [29]. The outer wall of the ovarian follicle is the TC externa and the inner called TC interna. The TC externa implements an isolating function, while the TC interna function is secretory. The internal wall of the antral follicle is composed of GC, separated from the TC interna by the basement membrane. The last structure distinguished in the follicle is the oocyte, surrounded by the zona pellucida and corona radiata of granular cells [28]. The ovarian maturation is possible owing to the increasing number of follicle-stimulating hormone (FSH) receptors, which activates the aromatase complex involved in converting testosterone into E2. The secretion of E2, in turn, promotes the formation of the LH receptor in GC [29]. Pigs’ estrous cycle lasts 21 days and is distinguished at 4 periods: proestrus, oestrus, metaestrus and diestrus. In the ovarian cycle two phases are distinguished: follicular (7 days), in which ovarian follicles are recruited and matured, and the luteal phase (14 days). The phases are separated by ovulation. The luteal phase starts in the first day after ovulation, and continues until day 15 of the estrous cycle. The early follicular phase starts on day 16–17 [29]. During the oestrus cycle different hormonal profiles are observed: E2 and inhibin gradually increase after luteolysis, and peak in the periovulatory period, provoking the LH surge. LH influences the final oocyte maturation, ovulation and CL formation. In the luteal phase, CL takes over the production of steroid hormones and secretes P4, which prepares the endometrium for embryo implantation and maintaining pregnancy for the first 12 weeks [28]. Porcine CL remains insensitive to prostaglandin F2α up to day 12 of the cycle; prostaglandin F2α degrades the luteal capillaries and reduces P4 production, leading to CL death. When there is no fertilization, the CL changes to atretic CL [28, 30]. Luteolysis begins on the 13th day of the cycle when the endometrium releases F2α prostaglandins, P4 synthesis is inhibited and new follicles grow. The percentage of fertilizations ending in pregnancy in pigs is high and reaches to 90%. Pregnancy lasts 112–114 days, producing a litter of 8–12. CL is essential for maintenance of pregnancy in pigs [30].
\nAnimal | \nOnset of puberty | \nAge at first Service | \nEstrous Cycle | \nEstrus | \nGestation | \n
---|---|---|---|---|---|
Cows | \n1–2 yr | \n1–2 yr | \n21 d | \n18 h | \n282 d | \n
Pigs | \n7 mo | \n8–10 mo | \n21 d | \n2 d | \n114 d | \n
Chickens | \n12–18 wk | \n21 wk | \n24 h | \nno | \n21d | \n
Average ages or times for some reproductive parameters selected by species [28].
Ovarian follicles development and morphology. In cows, an early event in follicular selection is the acquisition of LH receptors in the GC of the presumptive dominant follicle. In pigs, multiple follicles acquire LH receptors in the GC at a less mature stage of follicular development; more preovulatory follicles are selected in pigs because more follicles have the capacity to survive during the transition from FSH to LH dependence. In reproductively active chickens, the ovarian cortex contains a hierarchy of follicles in all stages of development, from primordial follicles to large, yellow, yolk-filled pre-ovulatory follicles. AT gross inspection, the large follicles protrude from the surface of the ovary on short stalks while small follicles bulge from the surface.
Firstly, in birds, the sexual chromosomes are different from mammals. The female is the heterogametic with the chromosomes Z and W, while the male is homogametic with two Z chromosomes [31]. Then, in almost all species of birds, only the left ovary is functional. In hens, it develops after 16 weeks of age. It is organized in a single hierarchy consisting approximately of 6 preovulatory follicles. F1 is the largest preovulatory follicle and F6, the most recently selected from the cohort [31] (Figure 3). In domestic hens, sexual maturation occurs at about 5 months of age and is closely linked to the photoperiod. The follicular growth is associated with the formation of the TC interna layer. The preovulatory follicles rapidly grow and can reach more than 40 mm in diameter. The process of follicular selection is based on the ability of the FSH receptor to initiate cell signaling via cyclic adenosine monophosphate specifically in the GC [31]. Like mammal species, the preovulatory surge of LH is the first stimulus for the germinal vesicle breakdown and for ovulation. In avian species, the LH peak precedes ovulation by 4–6 hours. The largest preovulatory follicle produces a greater amount of P4 during the LH surge. This production is related to high levels of STAR in the GC of the F1 follicle [31]. Contrary to mammal species, there is no apparent increase in circulating FSH corresponding to the LH peak. Following the ovulation, the steroid production decreases and the regression of the postovulatory follicle is related to apoptosis, inducing the production of immune cells and cytokines. In birds, TC expresses aromatase and synthetize estrogens from androgens precursors, which are localized in TC. However, P4, pregnenolone and androgen precursors are produced almost exclusively within the TC interna, while GC produces P4 from cholesterol. These cells are able to convert P4 to testosterone but not to oestrogens [31]. Moreover, the hen oviduct is able to store sperm for a prolonged period in specialized sperm storage tubules (SST), located in the utero-vaginal junction of the oviduct. Only the “normal” spermatozoa enter the SST indicating that some process of selection occurs [31].
\nBased on the available data, it is known that adipokines and their receptors are expressed in the ovarian cells and can modulate ovarian physiology, especially steroidogenesis, cell proliferation, apoptosis and/or oocyte maturation in domestic animals like pigs, cows, chickens, goats, ewes and turkeys (Table 2).
\nAdipokines | \nOvarian function in domestic animals | \n||
---|---|---|---|
Cows | \nPigs | \nChickens | \n|
Adiponectin | \n↓ A4, LHR, CYP11A1, CYP17α1; ↑ IGF1-induced and basal proliferation; ↓ insulin-induced P4 and E2 | \nFollicles: ↑ expression of genes associated with periovulatory remodeling; ↑E2; CL: ↓ P4 cells | \n↑ IGF1-induced P4 ↓ LH and FSH-induced P4 | \n
Apelin | \n↑ IGF1-induced P4 and cell proliferation; ↓ IGF1-induced oocyte maturation and P4 from cumulus cells through MAPK ERK1/2 | \nFollicles: ↑ basal P4, E2; ↓ IGF1-, FSH-induced P4, E2; ↑ proliferation; CL: ↑ P4 and 3βHSD | \nnd | \n
Chemerin | \n↓ P4 and E2 at basal and in response to IGF1 or FSH through CMKLR1; ↓ StAR, CYP19 and MAPK-ERK1/2 | \nnd | \nnd | \n
Resistin | \n↑ FSH and IGF1-induced E2; no effect on IGF1- or insulin-induced P4 and A4 production by Tc or P4 production by Gc of large follicles; ↑ IGF1-induced P4 and E2 in small follicles; | \n↑ basal P4, T and A4; ↓ gonadotropin- and IGF1-induced P4, T, A4 and E2 by inhibition of 3βHSD, 17βHSD and CYP19A1; ↓ apoptosis; | \nnd | \n
Visfatin | \n↑ basal and IGF1-induced steroid secretion; ↑ StAR, 3βHSD, IGF1-R, MAPK ERK1/2 | \nnd | \n↓ IGF1-induced P4 | \n
Effect of adipokines on the ovarian physiology in domestic animals.
CL, Corpus luteum; IGF1, Insulin-like factor 1; FSH, Follicles stimulation hormone; P4, Progesterone; A4, Androstenedione; E2, Estradiol; IGF1, Insulin-like growth factor 1; CL, Corpus luteum; Tc, Theca cells; ↑, increased; ↓, decreased; nd, no data.
In cows, serum adiponectin decreases from 21 days before calving, reaches a nadir at calving, before rapidly decreasing upon advancement of lactation [32]. During the bovine oestrus cycle, serum adiponectin levels range between 27 and 32 μg/ml and were 1.6-fold lower in follicular fluid, but the concentrations in the serum and follicular fluid were not correlated [33]. The circulating levels of adiponectin were decreased when providing low energy diet to the cows, and were related to a delayed and abnormal luteal activity in lactating cows [34].
In pigs, adiponectin and its receptors expressions are observed in the ovary and a decrease of the 250 kDa adiponectin isoform has been reported in both follicular fluid and serum [35]. Adiponectin system is also expressed in the endometrium, myometrium and conceptuses and is dependent on the stage of the pregnancy. The highest level of adiponectin is observed on days 15 to 16 of the pregnancy and on days 10 to 11 of the cycle on the endometrium. The highest expression of AdipoR1 and AdipoR2 is detected on days 10 to 11 in the endometrium and on days 12 to 13 in the myometrium [36], around the period of the maternal recognition of pregnancy. The
In chickens, the adiponectin gene was found in the ovary, and it was 10- to 30-fold higher expressed in TC than in GC from each of the follicles (F1-F4) [40]. For the receptors, the AdipoR1 mRNA level is two-fold lower in TC than GC, while the AdipoR2 expression remained stable in both ovarian cells and during follicular development. Adiponectin exerts an autocrine or paracrine effect on ovarian steroidogenesis. In F2 and F3/4 follicles, adiponectin increased IGF1-induced P4 production. In F3/4 follicles, it decreases P4 production in response to LH and FSH [40].
\nIn turkeys, the adiponectin plasma profile is significantly lower at the end compared to the beginning of the laying period. Furthermore, the hexameric form is reduced by three-fold at the end in comparison to the start of this period [41].
\nIn bovine species, it has been shown that apelin and apelin receptor (APJ) mRNAs are expressed in the bovine follicle and CL [42]. In the CL, apelin expression increases during the early luteal stages and decreases at the end of the luteal phase and during CL regression [42]. Apelin expression is only higher during pregnancy [42]. Thus, the apelin/APJ system could be involved in vascular establishment, maturation and maintenance of the CL during the estrous cycle. In TC, the expression of apelin is increased by E2 (5–180 ng/ml) and LH (100 ng/ml), while the expression of APJ is only increased by LH. In GC, the expression of APJ is increased by P4 (10 ng/ml) and by FSH (100 ng/ml) [43]. In mature bovine follicles, the apelin/APJ is thought to play a crucial role during follicle selection and dominance. During an
In porcine, apelin concentration in the follicular fluid and its expression increases with ovarian follicular growth. Immunohistochemistry revealed the positive higher staining for apelin in membranes of GC, than TC [45]. Apelin was found to increase secretion and 3βHSD and CYP19 expression in co-culture of GC and TC as well as cell proliferation, while decrease IGF1- and FSH-induced steroidogenesis [45]. As a molecular mechanism of these observation, authors showed that AMPKα was involved in the action of apelin on P4 production but MAPK/ERK, AMPKα and Akt/PI3 mediated the proliferative effect of apelin [45]. In an
In bovine species, chemerin reduces
In chickens, chemerin and its receptors are higher in TC than in GC in both preovulatory follicle 1, follicle 3 and 4 [48]. Chemerin is negatively correlated with the rate of hatchability. In contrast, the weight of the preovulatory follicle F1 is positively correlated with the chemerin expression in GC. Finally, the P4 production in GC is negatively correlated with the chemerin expression in TC. In hens, the diet has a significant impact on the reproductive function [48]. Thus, restricted fed hens expressed lower chemerin mRNA expression in TC from preovulatory follicles 1 and 3 than ad libitum fed hens. A fish oil supplementation increases the mRNA level of CMKLR1 in TC of preovulatory follicle F1 but decreases it in TC of preovulatory follicle F3 [48]. The chemerin gene sequence is similar at 81% between chickens and turkeys. In turkeys, chemerin concentration in plasma decreases at the end of the laying and is negatively correlated with phospholipids, triglycerides and cholesterol levels during this period [41]. The role of chemerin in the different mechanisms of the reproduction remains to be considered.
\nResistin is widely expressed in differently sized bovine follicles (small <6 mm and large >6 mm), where it was demonstrated in oocytes, cumulus, TC and GC, as well as in the CL [49]. In cattle, resistin at 30 ng/ml weakly stimulated FSH plus IGF1-induced E2 production but had no effect on IGF1- or insulin-induced P4 or A4 production by TC or P4 production by GC of large follicles [50]. However, in GC from small follicles, resistin attenuated the stimulatory effect of IGF1 on P4 and E2 secretion. Moreover, it has been documented that, resistin stimulated Akt and p38-MAPK phosphorylation in bovine and rat GC, ERK1/2-MAPK phosphorylation in rats and had the opposite effect on the AMPK pathway [49].
\nIn pig ovaries, resistin levels and expression varies with the stage of cycle. Differences in the resistin expression and concentration in follicular fluid collected from small, medium, and large follicles have also been reported [19]. Interestingly, in contrast to prepubertal animals, resistin expression and concentration in adult estrous cycling pigs was independent of follicular size and/or development [5]. Moreover, several factors can influence ovarian resistin expression, which has shown to increase with gonadotropin and steroid hormones and decrease with IGF1 and rosiglitazone (a PPARγ-selective agonist) [5]. Resistin affected the ovarian steroidogenesis, decreasing gonadotropin- and IGF1-induced steroid hormone secretion by the inhibition of 3βHSD, 17βHSD and CYP19A1 protein expression [5]. In ovarian follicles resistin by direct effects on both death receptor- and mitochondria-mediated apoptosis protein, was described as an anti-apoptotic factor [5]. It has been proposed the activation of several signal transduction pathways, such MAPK/ERK1/2, Janus-activated kinases (JAK)/ STAT and phosphatidylinositol 3-kinase (PI3K) as a molecular mechanism of resistin action on cell survival [5]. These results suggest the involvement of resistin in ovarian apoptosis regulation and could regulate follicular development or atresia.
\nIn cumulus cells from “Fertil−” cows, visfatin mRNA expression was lower compared to “Fertil+” cows, especially after
In chickens, visfatin mRNA is higher in GC than in TC, and it regulates steroidogenesis in ovarian cells. During the folliculogenesis, the expression in TC decreases whereas it remains stable in GC. It inhibits IGF1-induced P4 production in GC. Moreover, the plasma level is significantly lower in adult hens than in juveniles [53]. In turkeys, visfatin mRNA level is higher in TC than in GC in follicles F1, F3 and F4, like chemerin and adiponectin expression. Moreover, visfatin concentrations in plasma decrease and are negatively correlated to plasma glucose during the laying period [41].
\nVaspin expression and roles on female reproduction remain unknown. In porcine ovarian follicles, our preliminary results evidenced mRNA and protein expression of vaspin, whose expression was decreased during ovarian follicle development. We also observed that protein expression of vaspin was lower in large follicles of low-fat mobilization pigs (
Taken together, this chapter summarizes the expression and direct role of different adipokines in ovarian follicle cells. These observations clearly documented that adiponectin, apelin, chemerin, resistin, visfatin and vaspin are expressed on mRNA and protein level in the ovarian GC, TC and CL, suggesting that the ovary is a target organ for adipokines production and secretion. It is interesting that several
This work was supported by the National Science Centre, Poland (HARMONIA project no: 2016/22/M/NZ9/00316). We sincerely appreciate Michel Khoury, PhD, for English grammar correction and Justyna Chmielińska for her technical support.
\nThe authors declare no conflicts of interest.
WAT | white adipose tissue |
HMW | high-molecular weight |
AdipoR1 | adiponectin receptor 1 |
AdipoR2 | adiponectin receptor 2 |
PPAR | proliferator-activated receptor |
APJ | apelin receptor |
GH | growth hormone |
TNF-α | tumor necrosis factor |
BMI | body mass index |
TIG2 | termed tazarotene-induced gene 2 protein |
RARRES | retinoic acid receptor responder protein 2 |
CMKLR1 | chemokine-like receptor 1 |
GPR1 | G protein-coupled receptor 1 |
CCRL2 | chemokine receptor like 2 |
cAMP | cyclic adenosine 3′,5′-monophosphate |
ERK1/2 | extracellular signal–regulated kinases |
ADSF | adipocyte secreted factor |
FIZZ | inflammatory zones |
DCN | decorin |
ROR1 | tyrosine kinase-like orphan receptor 1 |
TLR4 | toll-like receptor 4 |
CAP1 | adenylyl cyclase-associated protein 1 |
Akt | protein kinase B |
MAPK | mitogen-activated protein kinases |
Stat-3 | signal transducer and activator of transcription 3 |
OLETF | Otsuka Long-Evans Tokushima fatty |
NF-κB | nuclear factor kappa-light-chain-enhancer of activated B cells |
PBEF | pre b cells enhancing factor |
NAMPT | type II nicotinamide phosphoribosyltransferases |
E2 | estradiol |
CL | corpus luteum |
P4 | progesteron |
LH | luteinizing hormone |
GC | granulosa cells |
GnRH | gonadotropin releasing hormone |
AI | artificial insemination |
FSH | follicle-stimulating hormone |
TC | theca cells |
StAR | steroidogenic acute regulatory protein |
SST | sperm storage tubules |
A4 | androstenedione |
LHR | the luteinizing hormone receptor |
CYP11A1 | cytochrome P450, family 11, subfamily a, polypeptide 1 |
CYP17α1 | cytochrome P450, family 17, subfamily a, polypeptide 1 |
IGF-I | insulin-like growth factor-1 |
3βHSD | 3β-Hydroxysteroid dehydrogenase/Δ5–4 isomerase |
17βHSD | 17β-Hydroxysteroid dehydrogenases |
IGFi-R | insulin-like growth factor-1 receptor |
AMPKα | 5’AMP-activated protein kinase |
GV | germinal vesicle |
PI3K | phosphatidylinositol 3-kinase |
JAK | Janus-activated kinases |
Endovascular interventions have substituted surgical repair as the primary treatment of failing or thrombosed vascular access (VA). Endovascular and surgical techniques, however, are complementary. Optimizing endovascular interventions of VA malfunction is a crucial component for a successful vascular access program. The identification and early treatment of stenosis are essential to prevent access thrombosis and ultimate failure.
Despite recent advances in endovascular techniques and devices, angioplasty continues to be the primary method for the treatment of access-related stenosis. Not all stenosis needs to be treated. When timely applied, angioplasty is a fast, easy, and safe procedure that can extend the patency of a hemodialysis graft or fistula.
The
The VA constitutes the interface between chronic kidney disease (CKD) patient and machine (the dialysis monitor); its function is a key factor that affects most dialysis treatment quality indicators, such as dialysis dose and adequacy (Kt/V), substitution volume during hemodiafiltration, operating costs, and vital prognosis of the dialysis patient.
In this chapter, we deal only with long-term arteriovenous accesses:
The native AV fistula (nAVF), usually result from an end-to-side anastomosis of a vein to an artery, either at the wrist (distal fistula), most commonly a radio-cephalic fistula, or at the elbow/upper arm level (proximal fistula), in this position most commonly a brachiocephalic fistula, or a brachio-basilic fistula, this last one requiring a second procedure the transposition to the surface of the arterialized vein.
The arteriovenous graft (AVG), usually a second choice in patients not suitable for a nAVF fistula, has better mechanical strength, can be used earlier, and has lower primary failure rates when compared with nAVF, but has a much higher infection risk, a poorer primary long-term patency, and needs many more interventions to remain functional.
The VA dysfunction and its complications, such as low access flow (Qa), infection, loss of dialysis adequacy, or thrombosis, are the major single cause of hospitalization and morbidity requiring endovascular intervention, as well as one of the most important drivers of the total cost of an end-stage renal failure program.
Whenever a native arteriovenous fistula (AVF) can be built and is able to mature in no more than 8 weeks, it is considered the first and best choice as a vascular access. It results in higher long-term longevity and less thrombotic or infectious morbidity, needs fewer procedures for maintenance, and is overall a big life and money saver.
The nAVF, however, comes with its own set of disadvantages. There is a higher risk of primary failure (nonmaturation) up to 60% prior to cannulation, requiring frequent angiographic procedures to assist maturation [1, 2, 3]. Studies have shown that the primary failure rate is two times greater for fistulas (40%) than grafts (19%), with similar cumulative patency; in addition, the number of catheter days before AV access use was more than double in those using a fistula (81 days) than those with AV grafts (38 days); however, grafts require more angioplasties (1.4 vs. 3.2 events) and thrombolysis (0.05 vs. 0.98 events) interventions per 1000 patient-days [2, 4]. The risk of primary fistula failure is much higher for lower arm fistula (28%) than with upper arm fistula (20%), although these last ones produce more than 90% of all cephalic arch stenosis [1].
The secondary patency rates of AV grafts (total life span even if requiring several interventions to maintain its function) are on average around 3 years, all in all identical to AV fistulas, but those improved rates are achieved at the expense of three- to six-fold greater reintervention rates.
There has never been a randomized control trial (RCT) comparing different VA choices regarding mortality or other hard outcomes. All large observational trials compared accesses achieved as opposed to the accesses that were intended (as in intention to treat). As 25–60% of all AVFs created either fail or need several procedures to mature and the central venous catheter (CVC) group in most studies were people in whom AVF failed or CVC was chosen because of a predictable bad prognosis (age, congestive heart failure, short life expectancy, etc.), we really cannot answer the question on which VA is the best. If we exclude patients that begin hemodialysis urgently, mortality between nAVF and CVC patients becomes identical. Using a decision analysis model (fed with data extracted from DOPPS 2, the REDUCE FTM study, the DAC study, and CMS data) for choosing the best option for patients initiating hemodialysis (HD) with a CVC, a nAVF attempt strategy is associated with better survival and lower annual cost, but that advantage is progressively lost in patients above 60 years or diabetics [5, 6].
Access malfunction is a source of tremendous emotional and physical suffering, dialysis treatments loss, low treatment adequacy, urgent need for a central catheter as a substitution access, and referral for new angiography or surgical procedures at huge costs.
In this chapter, we basically describe our experience on VA management in our dialysis network treating approximately 5000 patients in our Vascular Access Center (VAC) that performs more than 1000 VA surgeries and more than 1600 endovascular interventions per year.
The most common VA complications are failure to mature, persistently low Qa, suboptimal dialysis adequacy, pain, aneurysms, rupture/hemorrhage, infection, and thrombosis. Endovascular stenosis is the underlying lesion and the direct culprit behind most of these complications.
Neointimal hyperplasia is the common pathogenic mechanism inducing stenosis, and stenosis is the underlying promoter of thrombosis. Stenotic plaques are composed of myofibroblasts (smooth muscle cells) surrounded by extracellular matrix and macrophages. This cell proliferation begins in the adventitia and migrates toward the lumen of anastomotic areas or endothelial segments exposed to several stresses, such as surgical trauma, shear stress, wall stress, diameter and compliance mismatch, uremic endothelial dysfunction, and wall lesion secondary to repeated needle punctures.
Stenosis is necessary for thrombosis, but it is not enough. Only 30% of stenosis above 50% of lumen compromise will cause thrombosis in the next 6 months; we just do not know which ones. On the other hand, angioplasty induces accelerated NH with recurrent stenosis [7]. In 20% of the cases, recurrent stenosis occurs in 1 week and in 40% in 1 month [8], and although stenosis stenting may delay stenosis recurrence, it did not reduce the incidence of thrombosis [9].
As in other vascular territories, we do not know and have no biomarkers to decide which stenosis will progress to cause thrombosis, which stenosis if dilated will prevent thrombosis, which stenosis once dilated will suffer early recurrence, which is the best option to prevent recurrence, and how to define the successful angioplasty.
In hemodialysis vascular access management, just as in general medicine, an early diagnosis of malfunction and prevention of definite failure is considered the best approach to diminish morbidity and costs. This axiom was strongly suggested in several seminal studies [10, 11] and is expressed in most guidelines of scientific societies in this field.
It is recommended that regular monitoring of access function should be performed, preferably by measuring vascular access flow (Qa), and when access stenosis is present, preemptive intervention should be performed percutaneously without further delay. In support of these level 2 recommendations, we can quote: “All types of pressure measurement should be abandoned in favor of access flow measurement,” and “Monitoring plus intervention reduces thrombotic rates, morbidity and costs” [11, 12].
Consensual recommendations for preemptive intervention in malfunctioning grafts are (a) Qa measurement <600 ml/min for grafts or <400 ml/min for native fistulas and (b) a Qa drop higher than 25% over two consecutive measurements [13].
However, recent and quite relevant information has questioned those recommendations, and scanning through recent prospective randomized controlled trials in this field reveals some discordant opinions.
No matter if we are looking at native fistulas or PTFE grafts, using only Qa measurements, or its association with Doppler studies or dynamic venous pressure as surveillance techniques, it is believed that VA stenosis is now very effectively detected and responsible for a large increase in percutaneous vascular access procedures. Surprisingly, however, it has been found that all these diagnostic and therapeutic procedures fail to reduce the thrombosis rate or prolong access longevity, fueling an ongoing controversy regarding its beneficial effects, both in terms of overall access survival and associated costs [6, 8, 14, 15, 16, 17, 18, 19, 20].
All presently approved clinical guidelines recommend performing surveillance of vascular access quality and performance, aiming at early detection of access stenosis, which induced a global trend toward implementation of Qa-based monitoring programs in many dialysis units.
The recommended Qa thresholds for angiography referral are based on its putative predictive power of access malfunction and/or failure.
However, even before the final decision on the clinical relevance of periodic Qa determination, the quality and accuracy of the Qa measurements methods must be questioned, as most techniques have a good correlation among them, but high variation in absolute terms (±200 ml/min) [21, 22, 23, 24, 25, 26, 27, 28, 29, 30].
We are now in a position where we feel that we must do some form of VA surveillance, but do not know exactly which. Qa, although not perfect, with results that are hard to interpret and need specific calibration to fine tune appropriate alarm thresholds for each measurement technique, is probably the best hemodynamic parameter to follow.
In our unit, we evaluate monthly Qa, together with a trend analysis of other equally not perfect parameters, like physical examination [31], Kt/V in all dialysis treatments, recirculation, and maximum obtainable Qb with circuit arterial pressure above −250 mmHg, and then decide empirically, as physicians always do, when to refer to angiography.
A successful program of surveillance should reduce thrombosis rate by an amount identical to the angioplasty rate it induces. The key to measure surveillance effectiveness is avoidance of thrombosis; no other surrogate is acceptable.
As a matter of fact, absolute flow (Qa) and drop in flow, measured using several different flow indicators (ultrasound, thermal dilution, ionic dilution), are inaccurate predictors of thrombosis. Most thromboses are unpredictable, and interventions based on surveillance likely yield many unnecessary procedures at high cost.
We do not know if a vascular access defined by us as well functioning actually looks normal in angiography. Without that, it is difficult to really appreciate the specificity of our monitoring indicators and, most of all, the meaning of stenosis in the natural history of the VA.
Our data suggest that the presence of what we call a significant stenosis is not correlated with measured Qa and it might not be associated with early thrombosis deserving immediate intervention [20]. Further studies are needed to clarify the best surveillance protocol and the role of preemptive intervention in significant stenosis.
A proposal for surveillance could well include the following:
Each unit should perform sequential measurement and trend analysis of the parameters of their choice.
Physical examination done and recorded before each dialysis by the R.N., in an access without dressings and needles. Signs to be looked for include a pounding pulse, an intermittent thrill, arm swelling, increment in collateral veins, difficult hemostasis, a new or an enlarging aneurysm, and pain during treatment, reaching an agreement rate with angiogram to detect stenosis of 80% [31].
Access flow measurement (Qa) in:
High-risk grafts—Every 2 weeks.
Other grafts—Quarterly.
Native fistulas with a Qa < 1000 ml/min—Quarterly.
Native fistulas with a previous Qa ≥ 1000 ml/min—Once a year or whenever clinically indicated.
We consider high-risk grafts:
“Last” available vascular access site of that patient.
Frequent clotter.
Frequent recurrence of significant stenosis (less than 3 months apart).
Patients are referred from the dialysis unit to our VAC by their nephrologists, the indication for intervention is confirmed upon arrival, and an ultrasound/Doppler study will be performed if needed, to decide if it should be referred to the surgical or endovascular arm of the VAC and to help planning the endovascular approach localizing eventual stenotic lesions, their location, and preferred puncture site.
The techniques we perform in the angiography suite are (a) diagnostic angiography in no more than 7% of all cases, (b) percutaneous angioplasty (PTA) of stenotic lesions, (c) thrombolysis for thrombosed AVGs, and (d) stenting of elastic or frequently relapsed stenosis.
In our unit, prospective results of 1-year follow-up in 71 new AV grafts with monthly surveillance revealed the following:
A Qa < 600 ml/min had the same predictive value with that ΔQa of 25%, and dynamic venous pressure was useless.
After 1 year only 35% of PTFEs did not need any kind of intervention. We demonstrated then a sensitivity of 82% and a specificity of 90% to detect stenosis.
“Successful” PTA in 91% and Qa↑ on average 142%.
A sensitivity of 39% and a specificity of 21% to detect thrombosis.
A thrombosis rate—0.46 thru/pt. year.
In 60% of cases, previous monitoring was normal.
The initial treatment recommended for stenotic lesions in both nAVF and AVG is endovascular intervention, primarily angioplasty. Endovascular intervention is employed to maintain or even rescue AV access [32].
The recommendation within the K/DOQI guidelines is to treat hemodialysis access stenosis of more than 50% of the vessel lumen, if those are related with reduced flow rate and high venous pressure. PTA is considered a standard of care in failing hemodialysis access due to its high rates of success and satisfactory patency rate [33].
The stenotic lesions in an AV fistula can occur in any location of the access system, with a higher incidence in specific spots for each type of VA. This is the case of stenosis at the proximal “swing segment” (the vein segment immediately after the arteriovenous anastomosis of a nAVF, which was dissected and brought close to the artery to create the anastomosis) either in the upper arm in transposed brachio-basilic fistulas, or in the lower forearm, in radio-cephalic fistulas, which are relatively more frequent than lesions at any other site [34]. Another example is the cephalic arch region, in patients with brachiocephalic fistulas [32].
Below we describe some types of stenosis of the vascular circuit, selected for their particularities, namely, their frequency, risk of restenosis, and predictable danger of VA failure.
The proximal cephalic vein is characterized by a curved shape, which occurs as the cephalic arch passes though the coracoclavicular ligament, just before joining the subclavian vein.
Several reasons have been put forward to justify the development of cephalic arch stenosis, such as increased blood flow rates, hemodynamic factors associated with the vessel shape, external compression by the outer structures surrounding the vein, and hypertrophy of valves that are often present in the cephalic arch.
Although angioplasty is the accepted initial treatment of cephalic arch stenosis, it can be problematic because lesions in that location are more resistant to dilatation. When dealing with resistant stenotic lesions, it is shown that employing cutting balloons (see below) may improve outcomes. On the other hand, complications are more likely (vein rupture), and patency is reduced compared with other vein location. Stent placement in the arch is a delicate task because the stent should invade the subclavian vein lumen, which can result in its partial or total occlusion, impeding the future creation of an AVF or AVG using the basilic or axillary vein, thereby consuming vascular patrimony. In view of the recurrent problems with angioplasty of the cephalic arch, the stent placement can be an alternative to rescue the vascular access (Figure 1).
(a) and (b). Stenosis affecting cephalic arch; this lesion responded well to balloon angioplasty.
For several reasons, it is not possible to make any evidence-based recommendations on best practices for management of CAS (endovascular or surgical). There is profound heterogeneity in the studies retrieved, from their initial design to their presentation of data. Few studies were prospective, few studies involved more than one or two centers, and the lack of uniformity of outcomes is another weakness of current published studies. CAS is often managed alternatively by interventionists and surgeons, in our experience with identical success.
The prior placement of a central venous catheter is by far the most common cause of central vein stenosis (CVS) in dialysis patients. Transvenous wires of cardiac rhythm devices are more and more related with central veins stenosis in this population of high cardiovascular morbidity. Hemodialysis patients are, therefore, primary candidates for new wireless pacemakers or epicardial pacemaker leads.
The surgical approach to central vein stenosis is difficult because they can hide behind the bone structure. Therefore, endovascular intervention with angioplasty and/or stent placement becomes a logistically more receptive proposal for treatment of CVS. Still, anatomically and functionally, central veins have several specific characteristics including the diameter, angle, and elasticity that make treatment and maintenance of their patency after intervention difficult.
Some central vein stenoses are not symptomatic. Asymptomatic central veins stenosis, involving less than 50% of the vessel lumen, does not require treatment and is best managed by simple supervision [35].
Angioplasty with or without stent placement has been the recommended preferred approach to CVS. The guideline 20 NKF-K/DOQI suggests that the percutaneous intervention with transluminal angioplasty is the preferred treatment for CVS [36]. PTA has very high initial technical success rates, ranging from 70 to 90% [37, 38]. Primary and cumulative patency rates are widely variable and can range between 23 and 63% at 6 months and 12 and 50% at 12 months in the case of primary patency rate, as well as 29 and 100% at 6 months and 13 and 100% at 12 months in the case of cumulative patency rate (Figure 2) [36, 39, 40, 41, 42].
(a) Right brachiocephalic trunk stop flow. (b) PTA of stenosis with 12 mm balloon. (c) Final angiogram result.
Our cumulative experience shows that angioplasty and stent placement is undermined by frequent and rapid recurrence. It can also happen that an asymptomatic lesion can become symptomatic upon intervention. Indeed, one study showed that stenosis can progress faster after intervention [37]. The venous response may be worsening, and the stenosis process can be accelerated due to angioplasty.
Correction of CVS with endovascular approaches remains therefore limited and suboptimal and may even be harmful in certain cases. After angioplasty, more aggressive neointimal hyperplasia and proliferative lesions were found in restenosis areas than in the original stenotic lesions [38].
A major problem with lesions in the central veins is that many are quite elastic. For this reason, endovascular stents are used more frequently for central veins stenosis than for other types of dialysis access lesions. Cost considerations are highly relevant and also the fact that we are left without any option to treat effectively a restenosis inside a stent. Even if we extend 100% the half-life of a recurrent stenotic access (from a procedure every 3 months to every 6 months), it may look as an impressive achievement, but with little clinical relevance.
The vein immediately adjacent to the arteriovenous anastomosis (commonly referred to as juxta-anastomosis) is a common location of stenosis. This is in part due to injury, which occurred while “swinging” the vein to form the AV anastomosis. Some studies demonstrate that the frequency of juxta-anastomotic stenosis may be up to 55% [43].
Angioplasty and surgery are two treatment options. Percutaneous angioplasty has 1-year patency rates of 44–79% [44, 45, 46]. For surgery, 1-year patency rates are between 64 and 88% [45, 46, 47]. In this location, we usually need very high-pressure balloons to deal with very hard lesions. If we elect a surgical solution, we get better results at the expense of a few more centimeters of vascular territory. Regrettably, randomized studies comparing endovascular treatment and surgery for this lesion are not available (Figure 3).
(a) Severe stenosis in juxta-anastomotic radio-cephalic fistula. (b) Angiogram result after angioplasty with 7 mm PTA balloon.
There are several types of balloons that we can use in angioplasty: (i) “high-pressure,” (ii) “ultrahigh-pressure (UHP),” (iii) “cutting,” and (iv) “drug-eluting.”
High-pressure, noncompliant balloons (e.g., Conquest from Bard Peripheral Vascular Inc., Tempe, Arizona) have rated burst pressures of 20 to 24 atm and are used to treat dialysis vascular access stenosis.
Venous stenosis is characterized by extensive fibrosis and the need for ultrahigh-pressure balloon inflations [48] or cutting balloon atherotomy for optimal treatment [49, 50].
An UHP balloon is certified for a burst pressure of 27 atm, but higher inflation pressures are possible. Although those balloons do not provide better results in terms of permeability, when compared to conventional ones, it has been suggested that such devices may achieve better patency rates than traditional HP angioplasty balloons [51]. Its use is indicated in the treatment of symptomatic stenosis not responding to conventional high-pressure balloon. The high price of UHP balloon, the need for use thicker inserts, the difficulty of emptying, and its lower compliance and flexibility make it advisable that UHP balloons should not be a first choice in stenosis treatment.
Despite that, ultrahigh-pressure balloons have significantly reduced the incidence of “resistant” lesions [52].
The cutting balloons are special angioplasty balloons with three or four cutting edges (atherotomes) fixed longitudinally to its surface. The atherotomes expand radially with balloon inflation and provide longitudinal incisions into the lesion cutting into tenacious neointima. Using cutting balloons has the advantage that disruption of the lesion occurs in a more controlled manner and at lower balloon inflation pressure than with conventional angioplasty.
The use of a cutting angioplasty balloon (CAB) to treat resistant lesions can be found in several reports [49, 51]. Most of these reports are constrained because they are retrospective, lack control, or the size is too small to allow meaningful conclusions. Taking into account the data reported in the literature and also considering the authors experience, it can be stated that angioplasty with a cutting balloon is safe and can be considered as an alternative treatment for stenosis of hemodialysis AVFs that do not respond to conventional balloons.
There are serious methodologic limitations in the published reports describing the use of cutting balloon angioplasty to treat hemodialysis vascular access stenosis [53, 54, 55, 56]. Studies include the concurrent use of cutting and conventional balloon angioplasty, the use of a high-pressure balloon, or a combination with placement of a stent after cutting balloon angioplasty. In other studies, cutting PTA was used only after the failure of high-pressure balloon angioplasty. In these reports, the long-term patency rate does not reflect the results obtainable with cutting balloon angioplasty as a primary, stand-alone treatment. The cutting balloon was designed primarily to reduce vascular trauma, thereby diminishing neointimal hyperplasia, thereby improving hemodialysis access long-term patency. It should be noted that studies comparing cutting balloon and conventional balloon angioplasty in the treatment of vascular access stenosis are fraught with conflicting results.
Good results have been obtained with drug-coated balloon (DCB) angioplasty used to prevent restenosis in the treatment of arterial stenosis. This approach (using paclitaxel-coated balloons) was extended to the treatment of stenosis associated with hemodialysis AV access, with mixed results [57].
Drug-coated balloon endovascular technology merges the dilating properties of angioplasty with local drug delivery. Balloon surface excipients enable drug-eluting within the vessel wall, inhibiting cell proliferation, and reducing neointimal hyperplasia, while avoiding the use of permanent metal stents.
DCB angioplasty of vascular access stenosis seem to be safe and effective, providing superior reintervention-free intervals compared to conventional plain balloon angioplasty [58, 59, 60]. Recently, Yan and others published a meta-analysis that reveals that DCB is an effective and safe method that can significantly prolong 6-month and 1-year target lesion primary patency for failing hemodialysis access, as compared to conventional plain balloon angioplasty. However, their study was limited by the small number of patients enrolled in each trial, the diversity characteristics of the lesions, the vintage of the dialysis access, and the formulations of paclitaxel (different dose or excipients used). A very heterogeneous group of studies lumped together [61].
The reported number of dialysis patients treated with DCBs is low, and several concerns remain unanswered. First of all, it is uncertain which lesions will benefit from the use of this balloon device. Lesion preparation is another issue that deserves further investigation. Manufacturing companies suggest pre-dilation with a shorter balloon, with the same diameter, to promote drug diffusion within the deeper layers of the vessel wall and to improve the restenosis rate. However, in some RCTs published, pre-dilation was not even performed. Last but not least, although the long-term safety of PCBs in dialysis access treatment has been proven, preclinical and experimental studies in animal models are lacking; consequently, we have no available information on the posttreatment lesion pathology, degree of drug diffusion, and the extent of paclitaxel fixation within the venous wall.
It should be noted that the use of drug-eluting balloons is a novel medical device that aims to decrease the trauma in the endothelium of the vascular wall of a fistula. Although more expensive than the conventional balloon, it is much cheaper than a bare metal stent, and repeated procedures can be performed in case of recurrences. More trials are needed to find out if this more expensive material can really increase the patency of venous lesions.
Several challenges must be faced by resistant or recurrent stenosis throughout the access circuit in terms of providing optimal hemodialysis treatment. Those stenoses can be successfully treated by endovascular stent placement, although it usually requires multiple procedures to maintain patency.
Indeed, bare metal stents and covered stents have emerged as a potential additional therapeutic intervention in vascular access dysfunction. However, results are not encouraging. For example, bare stents are seldom used due to a high incidence of in-stent stenosis, and covered stents also have problems.
There are three mostly accepted indications for stent deployment: (i) a stenotic lesion that recurs within a 3-month period after initially successful balloon angioplasty in a patient with
We must take special care not to occlude important collateral veins with implanted stent, namely, the homolateral internal jugular vein, always required for future central vein catheters.
There are several reported complications associated with stent placement, such as stent migration, or stent fracture, which is usually seen on control angiograms. Infection is also a significant complication with potentially tragic outcomes. It should be noted that the combination of the immune-compromised status of patients with ESRD and repetitive cannulations for dialysis treatments is likely factors leading to infection. One unique complication is stent struts protrusion, which results from placing stents in cannulation sites [62]. Damage of the metal part of the stents (struts) can result from repetitive cannulation.
The high cost of stents has to be taken into account, raising the question whether the benefits obtained by placing stents at stenotic lesions outweigh the costs associated with such treatment [9]. One should reflect if the option of creating a secondary AVF should be considered as an alternative treatment for placing a stent (Figure 4).
(a) Stop flow at right BCT. (b) Placement of a stent. (c) Angiogram after 12 mm PTA balloon. (d) Final angiogram result.
Graft thrombosis occurs in one-third of all AVG per year, and of those that thrombose, 60% have more than two episodes per year. Ninety percent of all AVG thrombosis are associated with a stenotic lesion, most commonly in the venous anastomosis, but can occur in any location, in 36% of the cases in more than one site.
In our VAC, AVG thrombosis is primarily referred to interventional nephrology for endovascular thrombectomy, combining pharmaco-mechanical thrombolysis with a multiperforated catheter occluded at its tip, allowing high-pressure lateral injection of heparinized saline to dislodge wall adherent clots, followed by angioplasty with a 8 mm balloon of all stenotic lesions and finally embolectomy of the arterial anastomosis with a 4 French Fogarty catheter, to remove a more adherent, residual, fibrin “white” clot. Alternatively, some of us may use a mechanical device, the Arrow-Trerotola©, that combines clot fragmentation and aspiration, adding quite a substantial extra cost, without improving outcomes.
The procedure should not be performed if the AVG is suspected to be infected or a graft rupture is detected. At the end of the procedure, we must check AVG flow, the presence of residual clot inside the VA, and the most dreadful complication, symptomatic hand ischemia due to distal arterial embolization, which must be resolved with embolectomy in the angiographic suite or urgently referred to surgery.
The quality indicators achieved in our VAC include: (a) creation of a nAVF as first access in 80% of all patients and in 60% of subsequent accesses, (b) less than 40% primary failure of nAVF at 3 months, (c) less than 55% secondary failure of nAVF at 12 months, (d) less than 30% primary failure of AVGs at 3 months, (e) percent of functioning AVG post-thrombolysis >75% at 7 days and >50% at 3 months, and (f) no VA infections 15 days post-intervention. Regarding VA, the dialysis unit quality indicators are (a) percent of prevalent patients with nAVF >65%, (b) percent of patients with long-term tunneled catheters <20%, and (c) referral’s rate to the VAC <0.8/patient years.
The technical details of all procedures we perform in our VAC are thoroughly described in a recent textbook [63, 64].
The National Kidney Foundation (KDOQI) guidelines [65] define a successful angioplasty a residual stenosis <30%, with return to acceptable levels of the parameters used to place the indication for angioplasty. Initial success rates using anatomical criteria ranged from 80 to 98%, but in some reports, 20–30% of these patients with anatomical success fail to increase blood flow (residual stenosis, a missed lesion, or elasticity). Primary patency rates are 41–76% at 6 months and 31–45% at 1 year.
Long-term primary patency rates for thrombectomy are not as good as for angioplasty; therefore every effort should be made to prevent thrombosis by the prospective diagnosis and treatment of venous stenosis.
In a thrombosed access, the treatment must be timely to avoid catheters, done as an outpatient, venous stenosis must be detected and corrected, hemodynamic parameters should return to baseline, and patient should be evaluated for a secondary arteriovenous native fistula, created using upper arm veins that have become dilated because of the functioning graft.
In 2019, 139 surgical thrombectomies were performed in 127 patients (69 in nAVF and 70 in AVG). In 49.6%, no new intervention was required, and the average time until a new intervention was 46.7 days. Primary patency at 1 month was 66%, at 3 months 54.4%, and at 6 months 17.5%. In that same period, the angiography suite received 134 patients for 179 procedures (171 in AVGs, 8 with a nAVF), there was immediate success in 159 patients, the average time until a new intervention was 58.1-day, and primary patency at 1 month was 71.6% and at 6 months 42.5%. In our case, Qa average improvement is >50%, and we expect a Kt/V above 1.4.
The immediate success rate of thrombolysis should be 85% or greater according to the NKF/KDOQI guidelines and the primary (unassisted) patency goals at 3 months at least 40% (Tables 1 and 2).
Procedures | At 30 days (%) | At 90 days (%) | At 180 days (%) |
---|---|---|---|
Diagnostic angiography | 83 | 55 | 45 |
Angioplasty | 92 | 60 | 45 |
Thrombolysis + angioplasty (AVG) | 86 | 51 | 40 |
Primary patency in our VAC at 30, 90, and 180 days, in line with most literature in the field.
In intervening in a nAVF, use when available ultrasound localization of stenosis to plan the best place and direction to puncture the access |
In intervening in a AVG, always puncture close to the arterial anastomosis in the direction of the flow toward the venous anastomosis |
Use a 7F sheath and a hydrophilic guide wire. It allows balloons up to 14 mm to be inserted more than once |
Do not miss any step even when it seems unnecessary. Always check AV anastomosis in nAVFs and arterial and venous anastomosis in AVGs, as well as central venous drainage |
Do not accept incomplete balloon dilation. If necessary, use high-pressure balloons or cutting balloons |
Avoid stents, only as a last resort |
In AVG thrombolysis, after dealing with the venous anastomosis, even if the graft is already working, do approach with a Fogarty the arterial anastomosis |
Always test flow at the end of a procedure. An eyeball test as the TIMI for cardiologists. If flow does not look great, it is because there is something else to fix |
Clinical pearls to take home.
In conclusion, we are still dealing with quite a number of known unknowns. There has been no RCT to elucidate which percentage of lumen compromise should dictate the indication for angioplasty, and most operators choose 50%. Not all stenotic plaques were created equal, and some will never progress, but we cannot guess which ones. We also have no proof that a successful PTA in a graft improves long-term patency rate [14], angiographic criteria to assess the success of angioplasty are not predictive of changes in blood flow, and there is no correlation between changes in blood flow and changes in the percent of stenosis post-PTA [66]. In an era characterized by less is more, under the imperative of being useful for our patients, creating long-term solutions at sustainable costs, we feel a desperate need for robust scientific evidence to support our decision process and the procedures we perform. Just because it can be done, does not mean it should be done, our intervention is no more a question of know-how, but of know-when.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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Conventional methods for the removal of metal ions such as chemical precipitation and membrane filtration are extremely expensive when treating large amounts of water, inefficient at low concentrations of metal (incomplete metal removal) and generate large quantities of sludge and other toxic products that require careful disposal. Biosorption and bioaccumulation are ecofriendly alternatives. These alternative methods have advantages over conventional methods. Abundant natural materials like microbial biomass, agro-wastes, and industrial byproducts have been suggested as potential biosorbents for heavy metal removal due to the presence of metal-binding functional groups. Biosorption is influenced by various process parameters such as pH, temperature, initial concentration of the metal ions, biosorbent dose, and speed of agitation. Also, the biomass can be modified by physical and chemical treatment before use. The process can be made economical by regenerating and reusing the biosorbent after removing the heavy metals. Various bioreactors can be used in biosorption for the removal of metal ions from large volumes of water or effluents. The recent developments and the future scope for biosorption as a wastewater treatment option are discussed.",book:{id:"6137",slug:"biosorption",title:"Biosorption",fullTitle:"Biosorption"},signatures:"Sri Lakshmi Ramya Krishna Kanamarlapudi, Vinay Kumar\nChintalpudi and Sudhamani Muddada",authors:[{id:"238433",title:"Associate Prof.",name:"Sudhamani",middleName:null,surname:"Muddada",slug:"sudhamani-muddada",fullName:"Sudhamani Muddada"},{id:"244937",title:"Mrs.",name:"S L Ramyakrishna",middleName:null,surname:"Kanamarlapudi",slug:"s-l-ramyakrishna-kanamarlapudi",fullName:"S L Ramyakrishna Kanamarlapudi"},{id:"244938",title:"Mr.",name:"Vinay Kumar",middleName:null,surname:"Chintalpudi",slug:"vinay-kumar-chintalpudi",fullName:"Vinay Kumar Chintalpudi"}]},{id:"53211",doi:"10.5772/66416",title:"Biofloc Technology (BFT): A Tool for Water Quality Management in Aquaculture",slug:"biofloc-technology-bft-a-tool-for-water-quality-management-in-aquaculture",totalDownloads:16966,totalCrossrefCites:65,totalDimensionsCites:148,abstract:"Biofloc technology (BFT) is considered the new “blue revolution” in aquaculture. Such technique is based on in situ microorganism production which plays three major roles: (i) maintenance of water quality, by the uptake of nitrogen compounds generating in situ microbial protein; (ii) nutrition, increasing culture feasibility by reducing feed conversion ratio (FCR) and a decrease of feed costs; and (iii) competition with pathogens. The aggregates (bioflocs) are a rich protein-lipid natural source of food available in situ 24 hours per day due to a complex interaction between organic matter, physical substrate, and large range of microorganisms. This natural productivity plays an important role recycling nutrients and maintaining the water quality. The present chapter will discuss some insights of the role of microorganisms in BFT, main water quality parameters, the importance of the correct carbon-to-nitrogen ratio in the culture media, its calculations, and different types, as well as metagenomics of microorganisms and future perspectives.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Maurício Gustavo Coelho Emerenciano, Luis Rafael Martínez-\nCórdova, Marcel Martínez-Porchas and Anselmo Miranda-Baeza",authors:[{id:"146126",title:"Dr.",name:"Maurício Gustavo Coelho",middleName:null,surname:"Emerenciano",slug:"mauricio-gustavo-coelho-emerenciano",fullName:"Maurício Gustavo Coelho Emerenciano"},{id:"186970",title:"Prof.",name:"Marcel",middleName:null,surname:"Martínez-Porchas",slug:"marcel-martinez-porchas",fullName:"Marcel Martínez-Porchas"},{id:"186971",title:"Prof.",name:"Anselmo",middleName:null,surname:"Miranda-Baeza",slug:"anselmo-miranda-baeza",fullName:"Anselmo Miranda-Baeza"},{id:"195101",title:"Dr.",name:"Luis Rafael",middleName:null,surname:"Martínez-Córdoba",slug:"luis-rafael-martinez-cordoba",fullName:"Luis Rafael Martínez-Córdoba"}]}],mostDownloadedChaptersLast30Days:[{id:"69568",title:"Water Quality Parameters",slug:"water-quality-parameters",totalDownloads:10165,totalCrossrefCites:14,totalDimensionsCites:36,abstract:"Since the industrial revolution in the late eighteenth century, the world has discovered new sources of pollution nearly every day. So, air and water can potentially become polluted everywhere. Little is known about changes in pollution rates. The increase in water-related diseases provides a real assessment of the degree of pollution in the environment. This chapter summarizes water quality parameters from an ecological perspective not only for humans but also for other living things. According to its quality, water can be classified into four types. Those four water quality types are discussed through an extensive review of their important common attributes including physical, chemical, and biological parameters. These water quality parameters are reviewed in terms of definition, sources, impacts, effects, and measuring methods.",book:{id:"7718",slug:"water-quality-science-assessments-and-policy",title:"Water Quality",fullTitle:"Water Quality - Science, Assessments and Policy"},signatures:"Nayla Hassan Omer",authors:null},{id:"58138",title:"Water Pollution: Effects, Prevention, and Climatic Impact",slug:"water-pollution-effects-prevention-and-climatic-impact",totalDownloads:21554,totalCrossrefCites:18,totalDimensionsCites:38,abstract:"The stress on our water environment as a result of increased industrialization, which aids urbanization, is becoming very high thus reducing the availability of clean water. Polluted water is of great concern to the aquatic organism, plants, humans, and climate and indeed alters the ecosystem. The preservation of our water environment, which is embedded in sustainable development, must be well driven by all sectors. While effective wastewater treatment has the tendency of salvaging the water environment, integration of environmental policies into the actor firms core objectives coupled with continuous periodical enlightenment on the present and future consequences of environmental/water pollution will greatly assist in conserving the water environment.",book:{id:"6157",slug:"water-challenges-of-an-urbanizing-world",title:"Water Challenges of an Urbanizing World",fullTitle:"Water Challenges of an Urbanizing World"},signatures:"Inyinbor Adejumoke A., Adebesin Babatunde O., Oluyori Abimbola\nP., Adelani-Akande Tabitha A., Dada Adewumi O. and Oreofe Toyin\nA.",authors:[{id:"101570",title:"MSc.",name:"Babatunde Olufemi",middleName:null,surname:"Adebesin",slug:"babatunde-olufemi-adebesin",fullName:"Babatunde Olufemi Adebesin"},{id:"187738",title:"Dr.",name:"Adejumoke",middleName:"Abosede",surname:"Inyinbor",slug:"adejumoke-inyinbor",fullName:"Adejumoke Inyinbor"},{id:"188818",title:"Dr.",name:"Abimbola",middleName:null,surname:"Oluyori",slug:"abimbola-oluyori",fullName:"Abimbola Oluyori"},{id:"188819",title:"Mrs.",name:"Tabitha",middleName:null,surname:"Adelani-Akande",slug:"tabitha-adelani-akande",fullName:"Tabitha Adelani-Akande"},{id:"208501",title:"Dr.",name:"Adewumi",middleName:null,surname:"Dada",slug:"adewumi-dada",fullName:"Adewumi Dada"},{id:"208502",title:"Ms.",name:"Toyin",middleName:null,surname:"Oreofe",slug:"toyin-oreofe",fullName:"Toyin Oreofe"}]},{id:"45422",title:"Urban Waterfront Regenerations",slug:"urban-waterfront-regenerations",totalDownloads:14203,totalCrossrefCites:4,totalDimensionsCites:12,abstract:null,book:{id:"3560",slug:"advances-in-landscape-architecture",title:"Advances in Landscape Architecture",fullTitle:"Advances in Landscape Architecture"},signatures:"Umut Pekin Timur",authors:[{id:"165480",title:"Dr.",name:"Umut",middleName:null,surname:"Pekin Timur",slug:"umut-pekin-timur",fullName:"Umut Pekin Timur"}]},{id:"24941",title:"Tsunami in Makran Region and Its Effect on the Persian Gulf",slug:"tsunami-in-makran-region-and-its-effect-on-the-persian-gulf",totalDownloads:7575,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"406",slug:"tsunami-a-growing-disaster",title:"Tsunami",fullTitle:"Tsunami - A Growing Disaster"},signatures:"Mohammad Mokhtari",authors:[{id:"52451",title:"Dr.",name:"Mohammad",middleName:null,surname:"Mokhtari",slug:"mohammad-mokhtari",fullName:"Mohammad Mokhtari"}]},{id:"66307",title:"Bio-hydrogen and Methane Production from Lignocellulosic Materials",slug:"bio-hydrogen-and-methane-production-from-lignocellulosic-materials",totalDownloads:2953,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"This chapter covers the information on bio-hydrogen and methane production from lignocellulosic materials. Pretreatment methods of lignocellulosic materials and the factors affecting bio-hydrogen production, both dark- and photo-fermentation, and methane production are addressed. Last but not least, the processes for bio-hydrogen and methane production from lignocellulosic materials are discussed.",book:{id:"7608",slug:"biomass-for-bioenergy-recent-trends-and-future-challenges",title:"Biomass for Bioenergy",fullTitle:"Biomass for Bioenergy - Recent Trends and Future Challenges"},signatures:"Apilak Salakkam, Pensri Plangklang, Sureewan Sittijunda, Mallika Boonmee Kongkeitkajorn, Siriporn Lunprom and Alissara Reungsang",authors:null}],onlineFirstChaptersFilter:{topicId:"12",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82465",title:"Agroforestry: An Approach for Sustainability and Climate Mitigation",slug:"agroforestry-an-approach-for-sustainability-and-climate-mitigation",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.105406",abstract:"Agroforestry Systems (AFS), or the association of trees with crops (or animals), is a strategy for land management and use that allows production within the sustainable development: (a) environmentally (production environmentally harmonic); (b) technically (integrating existing resources on the farm); (c) economically (increase in production), and (d) socially (equality of duties and opportunities, quality of life of the family group). As an intentional integration of trees or shrubs with crop and animal production, this practice makes environmental, economic, and social benefits to farmers. Given that there is a set of definitions, rather than a single definition of Agroforestry (AF) and AFS, it is justified to explore the historical evolution and the minimum coincidences of criteria to define them and apply them in the recovery of degraded areas. Knowing how to classify AFS allows us to indicate which type or group of AFS is suitable for a particular area with its characteristics. The greatest benefit that AFS can bring to degraded or sloping areas lies in their ability to combine soil conservation with productive functions. In other words, AF is arborizing agriculture and animal production to obtain more benefits including climate change adaptation and mitigation by ecosystem services.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ricardo O. Russo"},{id:"82754",title:"Impact of Revegetation on Ecological Restoration of a Constructed Soil in a Coal Mining in Southern Brazil",slug:"impact-of-revegetation-on-ecological-restoration-of-a-constructed-soil-in-a-coal-mining-in-southern-",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.105895",abstract:"The main problems in the constructed soils are the generation of acid mine drainage promoted by the presence of coal debris in the overburden layer and the compaction of the topsoil promoted by the machine traffic when the material used in the overburden cover is more clayey. This book chapter aimed to show an overview of the impact of more than a decade of revegetation with different perennial grasses on the chemical, physical, and biological quality of constructed soil after coal mining. The study was carried out in a coal mining area, located in southern Brazil. The soil was constructed in early 2003 and the perennial grasses, Hemarthria altissima; Paspalum notatum cv. Pensacola; Cynodon dactylon cv Tifton; and Urochloa brizantha; were implanted in November/December 2003. In 11.5, 17.6 and 18 years of revegetation soil samples were collected and the chemical, physical, and biological attributes were determined. Our results show that liming is an important practice in the restoration of these strongly anthropized soils because this positively impacts the plants’ development, facilitating the roots system expansion. Biological attributes such as soil fauna and the microorganism’s population are the attributes that possibly takes longer to establish itself in these areas.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Lizete Stumpf, Maria Bertaso De Garcia Fernandez, Pablo Miguel, Luiz Fernando Spinelli Pinto, Ryan Noremberg Schubert, Luís Carlos Iuñes de Oliveira Filho, Tania Hipolito Montiel, Lucas Da Silva Barbosa, Jeferson Diego Leidemer and Thábata Barbosa Duarte"},{id:"82936",title:"Soil Degradation Processes Linked to Long-Term Forest-Type Damage",slug:"soil-degradation-processes-linked-to-long-term-forest-type-damage",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.106390",abstract:"Forest degradation impairs ability of the whole landscape adaptation to environmental change. The impacts of forest degradation on landscape are caused by a self-organization decline. At the present time, the self-organization decline was largely due to nitrogen deposition and deforestation which exacerbated impacts of climate change. Nevertheless, forest degradation processes are either reversible or irreversible. Irreversible forest degradation begins with soil damage. In this paper, we present processes of forest soil degradation in relation to vulnerability of regulation adaptability on global environmental change. The regulatory forest capabilities were indicated through soil organic matter sequestration dynamics. We devided the degradation processes into quantitative and qualitative damages of physical or chemical soil properties. Quantitative soil degradation includes irreversible loss of an earth’s body after claim, erosion or desertification, while qualitative degradation consists of predominantly reversible consequences after soil disintegration, leaching, acidification, salinization and intoxication. As a result of deforestation, the forest soil vulnerability is spreading through quantitative degradation replacing hitherto predominantly qualitative changes under continuous vegetation cover. Increasing needs to natural resources using and accompanying waste pollution destroy soil self-organization through biodiversity loss, simplification in functional links among living forms and substance losses from ecosystem. We concluded that subsequent irreversible changes in ecosystem self-organization cause a change of biome potential natural vegetation and the land usability decrease.",book:{id:"11457",title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg"},signatures:"Pavel Samec, Aleš Kučera and Gabriela Tomášová"},{id:"82828",title:"Vegetation and Avifauna Distribution in the Serengeti National Park",slug:"vegetation-and-avifauna-distribution-in-the-serengeti-national-park",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106165",abstract:"In order to examine the bird species changes within different vegetation structures, the variations were compared between Commiphora-dominated vegetations with those of Vachellia tortilis and Vachellia robusta-dominated vegetations, and also compared the birds of grassland with those of Vachellia drepanolobium and Vachellia seyal-dominated vegetations. This study was conducted between February 2010 and April 2012. A total of 40 plots of 100 m × 100 m were established. Nonparametric Mann-Whitney U-test was used to examine differences in bird species between vegetations. Species richness estimates were obtained using the Species Diversity and Richness. A total of 171 bird species representing 103 genera, 12 orders, and 54 families were recorded. We found differences in bird species distribution whereby V. tortilis has higher bird species richness (102 species), abundance, and diversity when compared with Commiphora with 66 species and V. robusta with 59 species. These results suggest that variations in bird species abundance, diversity, and distribution could be attributed to differences in the structural diversity of vegetation. Therefore it is important to maintain different types of vegetation by keeping the frequency of fire to a minimum and prescribed fire should be employed and encouraged to control wildfire and so maintain a diversity of vegetation and birds community.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ally K. Nkwabi and Pius Y. Kavana"},{id:"82808",title:"Climate Change and Anthropogenic Impacts on the Ecosystem of the Transgressive Mud Coastal Region of Bight of Benin, Nigeria",slug:"climate-change-and-anthropogenic-impacts-on-the-ecosystem-of-the-transgressive-mud-coastal-region-of",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.105760",abstract:"The transgressive mud coastal area of Bight of Benin is a muddy coastal complex that lies east of the Barrier/lagoon coast and stretches to the Benin River in the northwestern flank of the Niger Delta Nigeria. It constitutes a fragile buffer zone between the tranquil waters of the swamps and the menacing waves of the Atlantic Ocean. Extensive breaching of this narrow coastal plain results in massive incursion of the sea into the inland swamps with serious implications for national security and the economy. Climate change impacts from the results of meteorological information of the regions shows a gradual degradation in the past 30 years. Temperature, rainfall and humidity increase annually depict climate change, resulting from uncontrolled exploitation of natural resources is rapidly pushing the region towards ecological disasters. The ecosystem is very unique being the only transgressive mud coastal area of the Gulf of Guinea. The chapter describes the geomorphology, tidal hydrology, relief/drainage, topography, climate/meteorology, vegetation, economic characteristics, anthropogenic activities and their impacts on the ecosystem.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Patrick O. Ayeku"},{id:"82697",title:"Analyzing the Evolution of Land-Use Changes Related to Vegetation, in the Galicia Region, Spain: From 1990 to 2018",slug:"analyzing-the-evolution-of-land-use-changes-related-to-vegetation-in-the-galicia-region-spain-from-1",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106015",abstract:"Considering the complex dynamics, patterns, and particularities that the Galicia region present—e.g., the fragility, shown to achieve sustainable development and growth—a study that analyzes the Land-Use related to the vegetation of this region is seen as pivotal to identifying barriers and opportunities for long-term sustainable development. Using GIS (Geographic Information Systems), the present chapter enables us to identify the dynamics and patterns of the evolution of the Land-Use Changes related to vegetation in the Galicia Region from 1990 to 2018 (years 1990, 2000, 2012, and 2018 using CORINE (Coordination of Information on the Environment) data). This study permits us to reinforce that the Land-Use Changes related to vegetation in the Galicia Region have undergone multiple changes—marked by increasing and decreasing periods. Also, can be considered a surveying baseline for the comparative analysis of similar works for different Land-Use Changes related to vegetation trends in Europe or worldwide. Land-Use Changes related to vegetation studies are reliable tools to evaluate the human activities and footprint of proposed strategies and policies in a territory. This chapter also enables us to understand that the main actors should design development policies to protect, preserve and conserve these incomparable landscapes, environments, ecosystems, and the region as a whole.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Sérgio Lousada and José Manuel Naranjo Gómez"}],onlineFirstChaptersTotal:77},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:108,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:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,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. 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",coverUrl:"https://cdn.intechopen.com/series/covers/23.jpg",latestPublicationDate:"August 12th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"280770",title:"Dr.",name:"Katherine K.M.",middleName:null,surname:"Stavropoulos",slug:"katherine-k.m.-stavropoulos",fullName:"Katherine K.M. Stavropoulos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRdFuQAK/Profile_Picture_2022-05-24T09:03:48.jpg",biography:"Katherine Stavropoulos received her BA in Psychology from Trinity College, in Connecticut, USA and her Ph.D. in Experimental Psychology from the University of California, San Diego. She completed her postdoctoral work at the Yale Child Study Center with Dr. James McPartland. Dr. Stavropoulos’ doctoral dissertation explored neural correlates of reward anticipation to social versus nonsocial stimuli in children with and without autism spectrum disorders (ASD). She has been a faculty member at the University of California, Riverside in the School of Education since 2016. Her research focuses on translational studies to explore the reward system in ASD, as well as how anxiety contributes to social challenges in ASD. She also investigates how behavioral interventions affect neural activity, behavior, and school performance in children with ASD. She is also involved in the diagnosis of children with ASD and is a licensed clinical psychologist in California. She is the Assistant Director of the SEARCH Center at UCR and is a faculty member in the Graduate Program in Neuroscience.",institutionString:null,institution:{name:"University of California, Riverside",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"89",title:"Education",coverUrl:"https://cdn.intechopen.com/series_topics/covers/89.jpg",isOpenForSubmission:!1,editor:{id:"260066",title:"Associate Prof.",name:"Michail",middleName:null,surname:"Kalogiannakis",slug:"michail-kalogiannakis",fullName:"Michail Kalogiannakis",profilePictureURL:"https://mts.intechopen.com/storage/users/260066/images/system/260066.jpg",biography:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool Education, University of Crete, and an Associate Tutor at School of Humanities at the Hellenic Open University. He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. He has published over 120 articles in international conferences and journals and has served on the program committees of numerous international conferences.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorTwo:{id:"422488",title:"Dr.",name:"Maria",middleName:null,surname:"Ampartzaki",slug:"maria-ampartzaki",fullName:"Maria Ampartzaki",profilePictureURL:"https://mts.intechopen.com/storage/users/422488/images/system/422488.jpg",biography:"Dr Maria Ampartzaki is an Assistant Professor in Early Childhood Education in the Department of Preschool Education at the University of Crete. Her research interests include ICT in education, science education in the early years, inquiry-based and art-based learning, teachers’ professional development, action research, and the Pedagogy of Multiliteracies, among others. She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education. She also has the experience of participating in five Erasmus+ projects.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorThree:null},{id:"90",title:"Human Development",coverUrl:"https://cdn.intechopen.com/series_topics/covers/90.jpg",isOpenForSubmission:!0,editor:{id:"191040",title:"Dr.",name:"Tal",middleName:null,surname:"Dotan Ben-Soussan",slug:"tal-dotan-ben-soussan",fullName:"Tal Dotan Ben-Soussan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBf1QAG/Profile_Picture_2022-03-18T07:56:11.jpg",biography:"Tal Dotan Ben-Soussan, Ph.D., is the director of the Research Institute for Neuroscience, Education and Didactics (RINED) – Paoletti Foundation. Ben-Soussan leads international studies on training and neuroplasticity from neurophysiological and psychobiological perspectives. As a neuroscientist and bio-psychologist, she has published numerous articles on neuroplasticity, movement and meditation. She acts as an editor and reviewer in several renowned journals and coordinates international conferences integrating theoretical, methodological and practical approaches on various topics, such as silence, logics and neuro-education. She lives in Assisi, Italy.",institutionString:"Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:11,paginationItems:[{id:"83053",title:"Apologies in L2 French in Canadian Context",doi:"10.5772/intechopen.106557",signatures:"Bernard Mulo Farenkia",slug:"apologies-in-l2-french-in-canadian-context",totalDownloads:0,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Bernard",surname:"Mulo Farenkia"}],book:{title:"Second Language Acquisition - Learning Theories and Recent Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11480.jpg",subseries:{id:"89",title:"Education"}}},{id:"82903",title:"Walking Accessibility to Primary Healthcare Services: An Inequity Factor for Olders in the Lisbon Metropolitan Area (Portugal)",doi:"10.5772/intechopen.106265",signatures:"Eduarda Marques da Costa, Ana Louro, Nuno Marques da Costa, Mariana Dias and Marcela Barata",slug:"walking-accessibility-to-primary-healthcare-services-an-inequity-factor-for-olders-in-the-lisbon-met",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Social Aspects of Ageing - Selected Challenges, Analyses, and Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11479.jpg",subseries:{id:"90",title:"Human Development"}}},{id:"82622",title:"Contemporary Geographical Gerontology: Reconciling Space and Place in Population Ageing",doi:"10.5772/intechopen.105863",signatures:"Hamish Robertson",slug:"contemporary-geographical-gerontology-reconciling-space-and-place-in-population-ageing",totalDownloads:13,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Hamish",surname:"Robertson"}],book:{title:"Social Aspects of Ageing - Selected Challenges, Analyses, and Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11479.jpg",subseries:{id:"90",title:"Human Development"}}},{id:"82610",title:"Perspective Chapter: The Role of Learning Styles in Active Learning",doi:"10.5772/intechopen.105964",signatures:"Armando Lozano-Rodríguez, Fernanda Inez García-Vázquez and José Luis García-Cué",slug:"perspective-chapter-the-role-of-learning-styles-in-active-learning",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Active Learning - Research and Practice",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg",subseries:{id:"89",title:"Education"}}}]},overviewPagePublishedBooks:{paginationCount:0,paginationItems:[]},openForSubmissionBooks:{paginationCount:2,paginationItems:[{id:"11474",title:"Quality of Life Interventions - Magnitude of Effect and Transferability",coverURL:"https://cdn.intechopen.com/books/images_new/11474.jpg",hash:"5a6bcdaf5ee144d043bcdab893ff9e1c",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 7th 2022",isOpenForSubmission:!0,editors:[{id:"245319",title:"Ph.D.",name:"Sage",surname:"Arbor",slug:"sage-arbor",fullName:"Sage Arbor"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11473",title:"Social Inequality - Structure and Social Processes",coverURL:"https://cdn.intechopen.com/books/images_new/11473.jpg",hash:"cefab077e403fd1695fb2946e7914942",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 13th 2022",isOpenForSubmission:!0,editors:[{id:"313341",title:"Ph.D.",name:"Yaroslava",surname:"Robles-Bykbaev",slug:"yaroslava-robles-bykbaev",fullName:"Yaroslava Robles-Bykbaev"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:21,paginationItems:[{id:"83000",title:"Purine and Pyrimidine Pathways as Antimalarial Targets",doi:"10.5772/intechopen.106468",signatures:"Yacoba V.T. Minnow and Vern L. Schramm",slug:"purine-and-pyrimidine-pathways-as-antimalarial-targets",totalDownloads:0,totalCrossrefCites:null,totalDimensionsCites:null,authors:null,book:{title:"Malaria - Recent Advances, and New Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11576.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"83065",title:"Interventions and Practical Approaches to Reduce the Burden of Malaria on School-Aged Children",doi:"10.5772/intechopen.106469",signatures:"Andrew Macnab",slug:"interventions-and-practical-approaches-to-reduce-the-burden-of-malaria-on-school-aged-children",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Andrew",surname:"Macnab"}],book:{title:"Malaria - Recent Advances, and New Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11576.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"82804",title:"Psychiatric Problems in HIV Care",doi:"10.5772/intechopen.106077",signatures:"Seggane Musisi and Noeline Nakasujja",slug:"psychiatric-problems-in-hiv-care",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Future Opportunities and Tools for Emerging Challenges for HIV/AIDS Control",coverURL:"https://cdn.intechopen.com/books/images_new/11575.jpg",subseries:{id:"6",title:"Viral Infectious Diseases"}}},{id:"82827",title:"Epidemiology and Control of Schistosomiasis",doi:"10.5772/intechopen.105170",signatures:"Célestin Kyambikwa Bisangamo",slug:"epidemiology-and-control-of-schistosomiasis",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"New Horizons for Schistosomiasis Research",coverURL:"https://cdn.intechopen.com/books/images_new/10829.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"82817",title:"Perspective Chapter: Microfluidic Technologies for On-Site Detection and Quantification of Infectious Diseases - 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Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, 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:"1",type:"subseries",title:"Oral Health",keywords:"Oral Health, Dental Care, Diagnosis, Diagnostic Imaging, Early Diagnosis, Oral Cancer, Conservative Treatment, Epidemiology, Comprehensive Dental Care, Complementary Therapies, Holistic Health",scope:"\r\n\tThis topic aims to provide a comprehensive overview of the latest trends in Oral Health based on recent scientific evidence. Subjects will include an overview of oral diseases and infections, systemic diseases affecting the oral cavity, prevention, diagnosis, treatment, epidemiology, as well as current clinical recommendations for the management of oral, dental, and periodontal diseases.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/1.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11397,editor:{id:"173955",title:"Prof.",name:"Sandra",middleName:null,surname:"Marinho",slug:"sandra-marinho",fullName:"Sandra Marinho",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGYMQA4/Profile_Picture_2022-06-01T13:22:41.png",biography:"Dr. Sandra A. Marinho is an Associate Professor and Brazilian researcher at the State University of Paraíba (Universidade Estadual da Paraíba- UEPB), Campus VIII, located in Araruna, state of Paraíba since 2011. She holds a degree in Dentistry from the Federal University of Alfenas (UNIFAL), while her specialization and professional improvement in Stomatology took place at Hospital Heliopolis (São Paulo, SP). Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). Dr. Marinho's experience in Dentistry mainly covers the following subjects: oral diagnosis, oral radiology; oral medicine; lesions and oral infections; oral pathology, laser therapy and epidemiological studies.",institutionString:null,institution:{name:"State University of Paraíba",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,series:{id:"3",title:"Dentistry",doi:"10.5772/intechopen.71199",issn:"2631-6218"},editorialBoard:[{id:"267724",title:"Prof.",name:"Febronia",middleName:null,surname:"Kahabuka",slug:"febronia-kahabuka",fullName:"Febronia Kahabuka",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZpJQAW/Profile_Picture_2022-06-27T12:00:42.JPG",institutionString:"Muhimbili University of Health and Allied Sciences, Tanzania",institution:{name:"Muhimbili University of Health and Allied Sciences",institutionURL:null,country:{name:"Tanzania"}}},{id:"70530",title:"Dr.",name:"Márcio",middleName:"Campos",surname:"Oliveira",slug:"marcio-oliveira",fullName:"Márcio Oliveira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRm0AQAS/Profile_Picture_2022-08-01T12:34:46.jpg",institutionString:null,institution:{name:"State University of Feira de Santana",institutionURL:null,country:{name:"Brazil"}}}]},onlineFirstChapters:{paginationCount:26,paginationItems:[{id:"83087",title:"Role of Cellular Responses in Periodontal Tissue Destruction",doi:"10.5772/intechopen.106645",signatures:"Nam Cong-Nhat Huynh",slug:"role-of-cellular-responses-in-periodontal-tissue-destruction",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Periodontology - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11566.jpg",subseries:{id:"1",title:"Oral Health"}}},{id:"82654",title:"Atraumatic Restorative Treatment: More than a Minimally Invasive Approach?",doi:"10.5772/intechopen.105623",signatures:"Manal A. 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