Numerous pathogens can be found in the soil.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6641",leadTitle:null,fullTitle:"Photosynthesis - From Its Evolution to Future Improvements in Photosynthetic Efficiency Using Nanomaterials",title:"Photosynthesis",subtitle:"From Its Evolution to Future Improvements in Photosynthetic Efficiency Using Nanomaterials",reviewType:"peer-reviewed",abstract:"This book is a compilation. It starts from the origins of the photosynthetic capacity of organisms with a summary of the evolution of photosynthesis. This is followed by a concise description of the photosynthetic process and a discussion of the role that light, nutrients, and cultivation play in the photosynthetic process using examples in each case. Finally, the book explains future improvements in the field by applying nanotechnology to improve photosynthetic productivity, explaining how crop productivity can be increased by engineering crop plants for tolerance against various environmental stresses and improving yield attributes, especially photosynthetic efficiency using nanomaterials.",isbn:"978-1-78923-786-3",printIsbn:"978-1-78923-785-6",pdfIsbn:"978-1-83881-610-0",doi:"10.5772/intechopen.71794",price:119,priceEur:129,priceUsd:155,slug:"photosynthesis-from-its-evolution-to-future-improvements-in-photosynthetic-efficiency-using-nanomaterials",numberOfPages:122,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a971df87e09f69a876c4f694108fc930",bookSignature:"Juan Cristóbal García Cañedo and Gema Lorena López Lizárraga",publishedDate:"September 19th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6641.jpg",numberOfDownloads:7927,numberOfWosCitations:11,numberOfCrossrefCitations:18,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:33,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:62,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 16th 2017",dateEndSecondStepPublish:"December 7th 2017",dateEndThirdStepPublish:"February 5th 2018",dateEndFourthStepPublish:"April 26th 2018",dateEndFifthStepPublish:"June 25th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"293413",title:"Dr.",name:"Juan Cristóbal",middleName:null,surname:"García Cañedo",slug:"juan-cristobal-garcia-canedo",fullName:"Juan Cristóbal García Cañedo",profilePictureURL:"https://mts.intechopen.com/storage/users/293413/images/system/293413.jpeg",biography:"3.5 year in the food industry in food processing and agriculture companies in the areas of quality assurance, product development, production, and commercialization. \r\n7 years of experience in investigation. 3-year of teacher experience. Presented in 4 international conferences as a speaker.\r\n3 publications in indexed journals and one book chapter on the production of carotenoids and lutein for visual health.",institutionString:"Bioproducts NN Research and Development",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"185868",title:"Dr.",name:"Gema Lorena",middleName:null,surname:"López-Lizárraga",slug:"gema-lorena-lopez-lizarraga",fullName:"Gema Lorena López-Lizárraga",profilePictureURL:"https://mts.intechopen.com/storage/users/185868/images/system/185868.jpeg",biography:"Gema Lorena López Lizárraga is a biochemical engineer specializing in foods, with Master’s and PhD degrees in Biotechnology. She has 5 years’ experience in the food industry, and in agricultural companies in the areas of food safety, quality assurance, and as a sales representative. She has 7 years’ experience in research with microalgae on carotenoid (asthaxanthin) and PUFA production using fed batch mode and 3 years’ teaching experience. Examples of lectures given are industrial chemical safety, multivariables analysis, reactor and bioreactors engineering, microbiology, mass and energy balances, process engineering, mathematics, and has lectured in a bioseparation process workshop.\r\nShe has presented three international conferences as a speaker and published in three indexed journals and one book chapter on the production of carotenoids and omega 3 fatty acids for human health.",institutionString:"Bioproducts NN Research and Development",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"375",title:"Plant Physiology",slug:"agricultural-and-biological-sciences-plant-biology-plant-physiology"}],chapters:[{id:"63315",title:"Introductory Chapter: Evolution of Photosynthesis",doi:"10.5772/intechopen.80230",slug:"introductory-chapter-evolution-of-photosynthesis",totalDownloads:972,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Gema Lorena López Lizárraga and Juan Cristóbal García Cañedo",downloadPdfUrl:"/chapter/pdf-download/63315",previewPdfUrl:"/chapter/pdf-preview/63315",authors:[{id:"293413",title:"Dr.",name:"Juan Cristóbal",surname:"García Cañedo",slug:"juan-cristobal-garcia-canedo",fullName:"Juan Cristóbal García Cañedo"}],corrections:null},{id:"61678",title:"Photosynthesis and Carbon Metabolism",doi:"10.5772/intechopen.78031",slug:"photosynthesis-and-carbon-metabolism",totalDownloads:987,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Photosynthesis takes place in chloroplasts of green plants and algae and results in the conversion of radiant energy into chemical energy. Water and carbon dioxide are the raw materials; plants can produce sugars by using chlorophyll and light energy. During the first reaction of photosynthesis, ATP and NADPH are produced from light energy. Oxygen and hydrogen are released from water broken during the light reaction. In the dark reaction, CO2 is converted into glucose by consuming energy that comes from first step of photosynthesis.",signatures:"Nimir Eltyb Ahmed Nimir and Zhou Guisheng",downloadPdfUrl:"/chapter/pdf-download/61678",previewPdfUrl:"/chapter/pdf-preview/61678",authors:[{id:"231123",title:"Assistant Prof.",name:"Nimir",surname:"Nimir",slug:"nimir-nimir",fullName:"Nimir Nimir"},{id:"250472",title:"Prof.",name:"Zhou",surname:"Guisheng",slug:"zhou-guisheng",fullName:"Zhou Guisheng"}],corrections:null},{id:"60304",title:"Growth and Photosynthesis under Pulsed Lighting",doi:"10.5772/intechopen.75519",slug:"growth-and-photosynthesis-under-pulsed-lighting",totalDownloads:1516,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"The effects of pulsed irradiation based-LEDs on the growth and photosynthetic light utilization efficiency of lettuce leaves were studied. Plants were grown under different pulse-cycled irradiations of 0.5–500 Hz, and 1–20 kHz frequencies, at PPFD of 200 μmolm−2 s−1 with 50% duty ratio (illuminated duration/cycle). The photosynthetic rate (Pn) was maintained relatively constant over the range of measurements at pulsed light at 80 PPFD. At 200 PPFD, Pn gradually decreased by lowering frequency below 2.5 Hz of pulsed light. Pn under pulsed light was slightly higher than that under continuous light. Chlorophyll fluorescence (Fv/Fm, Fv’/Fm′, qP) showed no significant difference between under pulsed light and continuous light except at the lowest frequency (0.2 Hz). The similar quantum yield (ØPSII) and electron transport rate (ETR) of PSII were obtained in a wide range of frequency of pulsed light, which might be an effective illumination strategy for cultivating leaf lettuce by using LEDs. Flashing irradiation did not significantly change chlorophyll content. Results suggested the effectiveness of pulsed light at 50% duty ratio on the growth of leafy vegetables that were richly cultivated in a closed type plant factory with the possibility of saving electricity by using intermittent illumination system with LEDs.",signatures:"Michio Kanechi",downloadPdfUrl:"/chapter/pdf-download/60304",previewPdfUrl:"/chapter/pdf-preview/60304",authors:[{id:"234545",title:"Dr.",name:"Michio",surname:"Kanechi",slug:"michio-kanechi",fullName:"Michio Kanechi"}],corrections:null},{id:"61609",title:"Photosynthetic Pigments of Subtropical Plants",doi:"10.5772/intechopen.75193",slug:"photosynthetic-pigments-of-subtropical-plants",totalDownloads:1050,totalCrossrefCites:6,totalDimensionsCites:8,hasAltmetrics:0,abstract:"This chapter concerns the assessment of environmental and varietal affects on photosynthetic pigment groups. It is revealed that the dynamics of pigment accumulation in subtropical plants within the conditions of Russia’s damp subtropics is a complex process and depends on species plants. With this in mind, hazelnut maximum green pigments were achieved in May, and then in August, there was a decline associated with the onset of short periods of drought and increased temperatures. In Actinidia and tea plants, the highest content of green pigments is achieved in August, which is associated with the biology of these crops. However, regardless of species, with the onset of the dry period (July–August), plants increase their accumulation of carotenoids. The high content of carotenoids that accounts for stress during a period of water availability is evidence of their participation in the formation mechanism of subtropical plants’ resistance to adverse conditions.",signatures:"Oksana Belous, Kristine Klemeshova and Valentina Malyarovskaya",downloadPdfUrl:"/chapter/pdf-download/61609",previewPdfUrl:"/chapter/pdf-preview/61609",authors:[{id:"232452",title:"D.Sc.",name:"Oksana",surname:"Belous",slug:"oksana-belous",fullName:"Oksana Belous"},{id:"235548",title:"BSc.",name:"Kristine",surname:"Klemeshova",slug:"kristine-klemeshova",fullName:"Kristine Klemeshova"},{id:"235549",title:"Ph.D. Student",name:"Valentina",surname:"Malyarovskaya",slug:"valentina-malyarovskaya",fullName:"Valentina Malyarovskaya"}],corrections:null},{id:"62060",title:"Pilot Scale of Microalgal Production Using Photobioreactor",doi:"10.5772/intechopen.78780",slug:"pilot-scale-of-microalgal-production-using-photobioreactor",totalDownloads:1297,totalCrossrefCites:2,totalDimensionsCites:9,hasAltmetrics:0,abstract:"Microalgal gained much interest as a promising sustainable feedstock for the production of food, feed, bulk chemicals and biofuels. Pilot scale of microalgal is needed to bridge the gap between laboratory scale research and commercial application. Commercial applications of microalgal have been used for a wide array of functions including, pharmaceutical, health sector, nutraceutical, cosmetics and agriculture. Numerous photobioreactors (PBRs) of different volume and shapes have been designed. Cost of PBR has a major influence on production cost for large scale biomass. There are several ways to reduce production cost depends on the type of algal strain, type of PBRs, CO2 and the production technology of the biomass. Dilution rate is an important factor, which affects the biomass productivity, rate and ultimately what needs to be maximized.",signatures:"Farouk Kamel El-Baz and Hanaa H. Abd El Baky",downloadPdfUrl:"/chapter/pdf-download/62060",previewPdfUrl:"/chapter/pdf-preview/62060",authors:[{id:"227471",title:"Prof.",name:"Farouk",surname:"El-Baz",slug:"farouk-el-baz",fullName:"Farouk El-Baz"},{id:"241398",title:"Dr.",name:"Hanaa H.",surname:"Abdelbaky",slug:"hanaa-h.-abdelbaky",fullName:"Hanaa H. Abdelbaky"}],corrections:null},{id:"59769",title:"Mangroves in Contrasting Osmotic Environments: Photosynthetic Costs of High Salinity Tolerance",doi:"10.5772/intechopen.74750",slug:"mangroves-in-contrasting-osmotic-environments-photosynthetic-costs-of-high-salinity-tolerance",totalDownloads:878,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Mangrove trees of the salt secreting Avicennia germinans and the non-secreting Rhizophora mangle were investigated at the northern coast of Venezuela at a low salinity site (127 mmol kg−1) and two hypersaline sites (1600–1800 mmol kg−1). Leaf sap osmolality and mass/area ratio of both species were positively correlated, while size was negatively correlated with soil salinity. Leaf sap osmolality was always higher in Avicennia and exceeded soil solution osmolality. Salinity increased the concentration of 1D-1-O-methyl-muco-inositol (OMMI) in Rhizophora and glycinebetaine in Avicennia. The latter could make up to 21% of total leaf nitrogen (N). Nitrogen concentration was higher in Avicennia, but subtracting the N bound in glycinebetaine eliminated interspecific differences. Photosynthetic rates were higher in Avicennia, and they decreased with salinity in both species. Leaf conductance (gl) and light saturated photosynthesis (Asat) were highly correlated, but reduction of gl at the hypersaline sites was more pronounced than Asat increasing water use efficiency in both species. Lower values of 13C discrimination at the hypersaline sites evidenced higher long-term water use efficiency. Apparent quantum yield and carboxylation efficiency decreased with salinity in both species. Rhizophora was more sensitive to high salinity than Avicennia, suggesting that glycinebetaine is a better osmoprotectant than OMMI.",signatures:"Margarete Watzka and Ernesto Medina",downloadPdfUrl:"/chapter/pdf-download/59769",previewPdfUrl:"/chapter/pdf-preview/59769",authors:[{id:"237424",title:"Dr.",name:"Ernesto",surname:"Medina",slug:"ernesto-medina",fullName:"Ernesto Medina"},{id:"237529",title:"MSc.",name:"Margarete",surname:"Watzka",slug:"margarete-watzka",fullName:"Margarete Watzka"}],corrections:null},{id:"61202",title:"Plant Nanobionics and Its Applications for Developing Plants with Improved Photosynthetic Capacity",doi:"10.5772/intechopen.76815",slug:"plant-nanobionics-and-its-applications-for-developing-plants-with-improved-photosynthetic-capacity",totalDownloads:1227,totalCrossrefCites:6,totalDimensionsCites:11,hasAltmetrics:1,abstract:"In the present scenario, the ever-growing human population, a decreasing availability of land resources and loss of agricultural productivity are the major global concerns, and these possess a challenge for scientific community. To feed the increasing world population, an increase in the crop productivity with available land resources is one of the essential needs. Crop productivity can be increased by engineering the crop plants for tolerance against various environmental stresses and improving the yield attributes, especially photosynthetic efficiency. Nanomaterials have been developed with new functional properties like improved solar energy harvest. With these nanomaterials, nanobionic plants were developed by the facilitated kinetic trapping of nanomaterials within photosynthetic organelle, that is, chloroplast. The trapping of nanomaterials/nanotubes improved chloroplast carbon capture, that is, photosynthesis by improving chloroplast solar energy harnessing and electron transport rate. Besides improving photosynthesis, nanotubes like poly(acrylic acid) nanoceria (PAA-NC) and single-walled nanotube-nanoceria (SWNT-NC) decrease the amount of reactive oxygen species (ROS) inside extracted chloroplast and influence the sensing process in plants, and these are beneficial for a number of physiological processes. The nanobionic approach to engineer plant functions would lead to an era of plant research at the interface of nanotechnology and plant biology. In this chapter, nanobionic approach, transfer of nanomaterial to plants and their offspring and its potential applications to improve photosynthesis will be discussed.",signatures:"Kusum Khatri and Mangal S. 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Her work as an inventor has investigated three applied patents methods: a method of treating a bacterial infection using colostrum, a method of using clay suspension to prevent viral and phytoplasma diseases in plants, and a method of inhibiting plant virus using gold nanoparticles. She has made fundamental contributions to plant and medical viruses including publishing more than ninety-one journal articles and presenting at numerous conferences. Included topics are: \\"Detecting plant viral disease of stone fruit trees\\", \\"Engineering transgenic tomato plants Resistant to Tomato Yellow Mosaic Gemini Virus\\", \\"Radioprotective efficacy of zinc oxide nanoparticles on γ-ray-induced nuclear DNA damage in Vicia faba L. as evaluated by DNA bioassays\\", \\"Modulatory effect of zinc oxide nanoparticles on gamma radiation-induced genotoxicity in Vicia faba\\", \\"Bioactive Molecules from Dodder Cuscuta as a critical parameter in the management of plant virus disease\\", \\"Evaluation o Biological and Molecular Characterizations for Identification of a Phytoplasma Associated With Lemon Witches\\\'-Broom in Egypt\\", \\"Physiological parameters correlated with Tomato Mosaic Virus inducing a defensive response in Datura metel\\", \\"Interleukin 17 Level as a Prognostic Marker in Highly Active Antiviral Treated Human Immunodeficiency Virus (HIV) in Saudi Patients\\", \\"Lymphocyte subset and anti-HLA in AIDS Saudi patients\\", \\"Prevalence of HCV Genotypes and Viral Load in Saudi Arabia\\", \\"Correlation Between Phage Typing and Toxins Content as an Outbreak Tool in Staphylococcus aureus\\", \\"Olive Leaf Extract Trigger Defense Physiological Markers in Datura metel against Tobacco Mosaic Virus\\" \\"Correlation between Hepatitis B Surface Antigen Titers and Hepatitis B Virus DNA Levels\\" and etc. Over 91 journal articles have been published in these areas, and also numerous conference presentations made. She has collaborated with US, Indian, Saudi, Egyptian, German, French, and Taiwanese researchers. Previously, she was Professor of Virology, Molecular Virology, Faculty of Agriculture, Microbiology Department, Ain Shams University, Cairo, Egypt.',institutionString:"Ain Shams University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Ain Shams University",institutionURL:null,country:{name:"Egypt"}}},equalEditorTwo:null,equalEditorThree:null,productType:{id:"4",chapterContentType:"chapter",authoredCaption:"Authored by"}}],ofsBooks:[]},correction:{item:{id:"64730",slug:"erratum-spectrum-decision-framework-to-support-cognitive-radio-based-iot-in-5g",title:"Erratum - Spectrum Decision Framework to Support Cognitive Radio Based IoT in 5G",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/64730.pdf",downloadPdfUrl:"/chapter/pdf-download/64730",previewPdfUrl:"/chapter/pdf-preview/64730",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/64730",risUrl:"/chapter/ris/64730",chapter:{id:"63606",slug:"spectrum-decision-framework-to-support-cognitive-radio-based-iot-in-5g",signatures:"Ahmad Naeem Akhtar, Fahim Arif and Adil Masood Siddique",dateSubmitted:"February 8th 2018",dateReviewed:"August 18th 2018",datePrePublished:null,datePublished:null,book:{id:"7291",title:"Cognitive Radio in 4G/5G Wireless Communication Systems",subtitle:null,fullTitle:"Cognitive Radio in 4G/5G Wireless Communication Systems",slug:"cognitive-radio-in-4g-5g-wireless-communication-systems",publishedDate:"December 5th 2018",bookSignature:"Shahriar Shirvani Moghaddam",coverURL:"https://cdn.intechopen.com/books/images_new/7291.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"185038",title:"Dr.",name:"Shahriar",middleName:null,surname:"Shirvani Moghaddam",slug:"shahriar-shirvani-moghaddam",fullName:"Shahriar Shirvani Moghaddam"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"244896",title:"Dr.",name:"Ahmad Naeem",middleName:null,surname:"Akhtar",fullName:"Ahmad Naeem Akhtar",slug:"ahmad-naeem-akhtar",email:"ahmadnaeem.akhtar@mcs.edu.pk",position:null,institution:null}]}},chapter:{id:"63606",slug:"spectrum-decision-framework-to-support-cognitive-radio-based-iot-in-5g",signatures:"Ahmad Naeem Akhtar, Fahim Arif and Adil Masood Siddique",dateSubmitted:"February 8th 2018",dateReviewed:"August 18th 2018",datePrePublished:null,datePublished:null,book:{id:"7291",title:"Cognitive Radio in 4G/5G Wireless Communication Systems",subtitle:null,fullTitle:"Cognitive Radio in 4G/5G Wireless Communication Systems",slug:"cognitive-radio-in-4g-5g-wireless-communication-systems",publishedDate:"December 5th 2018",bookSignature:"Shahriar Shirvani Moghaddam",coverURL:"https://cdn.intechopen.com/books/images_new/7291.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"185038",title:"Dr.",name:"Shahriar",middleName:null,surname:"Shirvani Moghaddam",slug:"shahriar-shirvani-moghaddam",fullName:"Shahriar Shirvani Moghaddam"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"244896",title:"Dr.",name:"Ahmad Naeem",middleName:null,surname:"Akhtar",fullName:"Ahmad Naeem Akhtar",slug:"ahmad-naeem-akhtar",email:"ahmadnaeem.akhtar@mcs.edu.pk",position:null,institution:null}]},book:{id:"7291",title:"Cognitive Radio in 4G/5G Wireless Communication Systems",subtitle:null,fullTitle:"Cognitive Radio in 4G/5G Wireless Communication Systems",slug:"cognitive-radio-in-4g-5g-wireless-communication-systems",publishedDate:"December 5th 2018",bookSignature:"Shahriar Shirvani Moghaddam",coverURL:"https://cdn.intechopen.com/books/images_new/7291.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"185038",title:"Dr.",name:"Shahriar",middleName:null,surname:"Shirvani Moghaddam",slug:"shahriar-shirvani-moghaddam",fullName:"Shahriar Shirvani Moghaddam"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"11994",leadTitle:null,title:"MXenes - Fabrications and Applications",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tThe innovation of layered graphene with unique physical characteristics has created a new avenue to develop two-dimensional (2D) materials. This research attention is also directed towards the various form of 2D materials such as layered metal di-chalcogenides, layered metal oxides, graphene composites, multi-, and single-walled carbon nanotubes, and so on. Recently, MXenes, one of the fast-growing members of the group of 2D materials, has attracted deep research interests. MXenes have a common formulation of Mn+1AXn, where M denotes transition metal; A represents IIIA or IVA group elements; X signposts the C and/or N, and n = 1 - 3. Owing to the distinguishing characteristics of high electrical conductivity, superior structural stability, and hydrophilic surfaces, MXenes are widely used in various applications such as water electrolysis reactions, energy storage devices, heavy metal adsorption, therapeutic devices, and membranes.
\r\n\tHence, this book is targeted to deliver the bundled characteristics and features of MXenes to transfer the various scopes and virtues to the research community.
The definition of soil according to the sciences of the earth and life points to the external part of the earth’s crust, which is biologically active and tends to develop on the surface of the rocks emerged by the influence of weather and living beings. It is also frequent that this concept includes a complex set of physical, chemical, and biological elements that make up the natural substrate in which life develops on the surface of the continents. The soil is the habitat of a specific biota of microorganisms (bacteria and fungi), plants, and small animals that constitute the edaphon.
In recent decades, there has been an increasing concern for soil biodiversity, on the basis that the interactions between microorganisms, animals, and plants provide an undoubted benefit to the well-being of mammalian species, including man [1]. This biodiversity conditions both the possibilities of feeding these species, oxygenation, as well as the control of the risk of certain diseases. For these reasons, it is not difficult to understand that soil biodiversity is directly affected by global changes caused by man, especially those related to land use, urbanization, agriculture, deforestation, and desertification, which leads to the logical conclusion that the careful and sustainable use of soils would guarantee their benefits.
Different studies have indicated that exposure to soil microorganisms decreases the prevalence of allergic diseases [2]; taking into account the predictions that around the year 2050 two-thirds of the world population will reside in cities, the stimulation of the immune system by soil organisms will be reduced, and therefore allergy cases will increase.
Other researches highlight the increase in the appearance of bacterial species resistant to most known antibiotics, and the same happens with some parasites, such as helminths. The use of remedies found in the soil, such as certain types of fungi, has not yet come to be considered as a solution to the aforementioned problems. It is interesting to know that some bacteria capable of synthesizing effective antibiotics against
Pathogenic organisms belong mainly to five main groups, viruses, bacteria, fungi, and parasites (protozoa, helminths, and ectoparasites) [8]. From an academic and disease control approach, the importance of soil lies in the fact that a significant number of pathogens are found in this habitat, and sometimes they are accidentally ingested by animals and people, causing important disorders. There are some organisms that do not require ingestion, being able to spread their pathogenicity through bites or penetrating the skin.
Table 1 summarizes different examples of pathogens present in the soil. It is important to note that most soil organisms do not constitute a health risk, and pathogenic species represent only a minority. Nor should we forget that some species are opportunistic (
Bacteria | ||
Fungi | ||
Protozoa | ||
Helminths | ||
Ectoparasites |
Numerous pathogens can be found in the soil.
The concept of
Soil provides a suitable habitat to different organisms as plants can grow and develop, serving as food for the survival of many living creatures (insects and micromammals). This environment enables mammals as herbivores to graze and carnivores to find their feeding.
Most known parasites associated to soil are defined as
Transmission of STHs involves that eggs are passed in the feces of infected individuals. Once in the soil, flatworms (trematodes and cestodes) need to complete several stages inside an intermediate host, to attain the infective stage.
Roundworms (
Numerous parasitic stages can be found in the soil (
Whipworms (
In the case of
It is well recognized that ticks need to suck blood from mammals for surviving, but sometimes it is forgotten that these ectoparasites develop part of their life cycle in the soil also. Gravid adult females drop off the final host to the ground to lay eggs. Under appropriate conditions, the egg hatches into a larva, which waits for an appropriate mammal to bite for feeding and then transform into nymph.
Appropriate conditions (moisture and temperature) must concur in the soil to improve the development of parasites to their infective stages. Nevertheless, evolution of parasites can be delayed until unfavorable circumstances appear, especially low temperatures. Some of them such as roundworms and whipworms are able to survive viable for long periods, even under temperatures below zero [15]. This resistance is conferred by their eggshells, composed of at least four layers, uterine (mucopolysaccharides), vitelin, chithinous, and lipidic (inner). Eggs of ticks can also survive in the environment unless the solar light falls directly on them.
Larval stages (first, second, or third) from nematodes exhibit a certain degree of resistance, and it has been reported they can subsist under snowy areas [16]. Dry soils in spite of very humid areas are preferred by immature hookworms [5], like sandy places. This explains the cutaneous infection of people enjoying outdoor activities on beaches, parks, etc. from touristic areas.
Human STHs are frequent in Asia, Africa, and South America, being absent in Western Europe and developed countries. Nevertheless, these diseases have reemerged due to immigration, travel, and business. Also in recent years, populations of ticks are increasing in urban areas, as well as orchards, parks, and gardens [17].
There are four main STHs affecting humans,
Dogs are the definite hosts for
By considering that a great number of pathogens develop in the soil, one interesting question refers to why mammals did not infect more frequently, or why low to moderate infections are usually detected. Infection depends on the density of pathogens and risky situations such as accidental ingestion or active passage through the skin (helminths) or walking by places with vegetation (ectoparasites). Then, it could be expected that exposure to natural environments might represent a great hazard, thus enjoying natural habitats should be avoided (or even forbidden).
As mentioned previously, a great number of fungal species can be found in the soil, together with many other organisms such as viruses, bacteria, earthworms, insects, etc. Some of these species are saprophytic and feed on organic matter, but in the presence of parasitic stages such as eggs or larvae, they shift to predatory agents. Hyphae develop and the mycelium grows toward the parasites in an attempt to take certain nutrients, nitrogen and carbon mainly [24]. Other fungal species feed on different species of fungi, as succeeds with some mites.
It has been demonstrated that certain soil saprophytic fungi such as
Filamentous fungi develop hyphal nets in the soil, and reproduce by spores
Based on experiments with plants, traditionally the fungal antagonists of parasites comprise nematode-trapping species (larvicidal), predacious agents, endoparasitic fungi, and egg parasitic fungi (ovicidal) [27]. In the last decades, this classification applies also for defining the activity of soil fungi against parasites affecting mammals (Table 2).
Effect | Species | Action against | |
---|---|---|---|
Ovicidal | Flatworms Roundworms (ascarids) Whipworms | ||
Larvicidal | Hookworms Roundworms (strongyles) | ||
Filamentous soil fungi antagonists of parasites in the soil.
In natural conditions, when the environment does not result altered by humans, soil albeits not only fungi but other microorganisms as viruses, bacteria, earthworms, insects… A number of filamentous fungi feed on organic detritus, certain coprophagous beetles participate in enriching the ground by decomposing organic matter as manure, some mites feed on fungi, and several fungi do it also. This means that an equilibrium situation takes place, where organisms are controlled mutually, and explains also why low risk of infection is usually observed. When agricultural procedures affecting the surface of the ground are performed, this habitat is transformed, and beneficial organisms drop or disappear. As a consequence, the density of pathogens increases, accordingly the risk of exposure among mammals increases and they can become infected.
Several investigations pointed the efficacy provided by some fungi to limit the viability of eggs of roundworms [28]. As drawn in Figures 3 and 4, the addition of spores of
Viability of eggs of
The soil filamentous fungus
A notable efficacy has been reported against larvae of hookworms by using trapping-nematode fungi such as
By taking into account that the aforementioned parasites are STHs, the use of ovicidal and larvicidal fungi could be strongly helpful to limit the development of parasites to infective stages in the soil. One interesting question refers to the proper way to spread the fungi to ensure their contact with the parasites. Because the eggs of parasites are shed by feces, the most useful procedure looks to try that fungi are in the feces at the same time, and for this purpose, oral administration could be appropriate. Several investigations demonstrated that the spores of
It has been explained that ectoparasites develop part of their cycle in the soil. After mating on the host, gravid female ticks engorge completely and drop to the ground, where thousands of eggs are laid mainly in places protected from sun and desiccation, with vegetation. Later than a variable period, depending on temperature and humidity, eggs hatch and larvae exit off, addressing to plants, pending of a host to attach and suck blood for molting into nymphae.
There is little information available concerning the possible effect of fungi on tick eggs in the soil. Figure 5 summarizes the results collected after the exposure of eggs of
Viability of eggs of the tick
Viability of ticks’ eggs decreased to 80% in the controls-untreated eggs, and to 38% in those exposed to the filamentous fungus. The hatching percentage was 45% in the controls, by 15% in the
Four phases have been described during the activity that the ovicidal fungus
Hyphae of
In view of the mentioned results, certain soil fungi seem very promising agents for limiting the viability and evolution of tick eggs in the soil, contributing to decrease the risk of infestation. One possible approach could rely on preparing aqueous solutions containing the fungal spores, and spreading by using airless sprayers. This would provide a solution to limit the risk of infestation in outdoor areas as waysides or the edge of grass along the roadsides, gardens, or even farms. Reduction in the presence of ticks in the soil also provides a sustainable and preventive tool to avoid damage to humans and animals.
Some strains of several soil fungal species have been isolated according to their ability to convert fungal oils into esters, providing thus a sustainable way to obtain biofuel [48, 49]. The interest of microbial oils has increased as they are now used as commercial sources of several nutritionally important polyunsaturated fatty acids [50].
Despite fungi being mostly considered responsible for fungal diseases that can range from nonsevere to mortal illnesses, fungal infections have become a serious health problem in immunocompromised patients largely.
Opposite to
Several reports indicated nosocomial infection by
Among animals, infection by
Until now, long-term assays comprising the frequent administration (daily or twice a week) of a blend of spores of
Until now, there have not been reported any problem with people producing and managing spores/mycelium for longer than 10 years.
Inasmuch as STHs are transmitted through soil, it seems essential to develop measures on the environment to avoid reinfection, and the abusive administration of parasiticides. Some STHs originate from animals (domestic and wild), and helpful actions to reduce the risk of transmission are also required. Besides public education and hygienic behaviors, other activities should be applied to limit the presence and survival of infective stages of parasites. There have been described several species of soil fungi antagonists of eggs or larvae of helminths and ticks. Although several cases of disease have been linked to soil fungi, the absence of disease among people managing them or among animals receiving fungal structures seems to reinforce their safety, unless the patients are immunocompromised. The use of soil fungi against infections transmitted across ground gives a sustainable measure to prevent damage to persons and animals, and might allow us to limit the administration of antiparasitic drugs to imperative situations only.
This work was partly supported by the Research Project CTM2015-65954-R (Ministerio de Economía y Competitividad, Spain; FEDER). Dr. María Sol Arias Vázquez is recipient of a Ramón y Cajal contract (Spanish Ministry of Economy and Competitiveness), and Dr. C.F. Cazapal-Monteiro is beneficiary of a postdoctoral research fellowship (Xunta de Galicia, Spain).
All authors declare the absence of any financial or personal interests that could inappropriately influence or bias the current work. The final chapter has been approved by all the authors.
In the past years, liver transplantation (LT) has made leaps and evolved from an endeavor in specialized centers to a worldwide definitive and gold standard treatment of the end-stage liver disease (ESLD), acute liver failure, and various cancer types [1, 2].
\nThe advances in perioperative management, including the improvement of surgical techniques, preservation solutions, perioperative management, and monitoring, as well as advances in immunosuppression and postoperative care have led not only to an increased number of transplantations but also to better outcomes [2]. According to recent studies in the United Kingdom, the 1- and 5-year survival rate for liver transplant recipients has reached 92 and 80%, respectively [3]. However, there are still certain challenges in LT. Scarcity of allografts and disparity between supply and demand has led the transplantation community to expand the donor pool by utilizing split grafts, allografts from living donors after cardiac death and including marginal donors of older age and with extended steatosis [4]. Additionally, recipients are sicker, given that priority of graft allocation is based on higher MELD scores, older and with co-morbidities such as metabolic syndrome, cardiac disease, and diabetes mellitus [5, 6]. Postoperative liver transplant patient care requires careful accounting of the recipient’s pre-existing pathophysiology, intraoperative events, and donor’s quality. Moreover, the implanted liver represents a unique biological entity that has undergone physiological changes and has to adapt to a new environment. This donor-recipient interaction is the key of a successful transplantation [7].
\nThe intensivist’s role is essential as a multifaceted approach is critical for optimal transplantation outcomes. The main hurdles to tackle are early recognition and immediate treatment of the hemodynamic and metabolic disorders, restoration of intravascular volume, avoidance of coagulation disorders, optimization of organs function affected by hepatic failure, prophylaxis and treatment of infections, early enteral nutrition, and evaluation of graft function. Technological advances offer the possibility of continuous cardiovascular and allograft function monitoring facilitating improved endpoint results.
\nThe aim of immediate postoperative support is the adequate O2 supply to tissues and graft by ensuring hemodynamic stabilization, fluid balance, restoration of diuresis, optimal ventilation, and supporting graft function. It should be noted that graft recovery depends primarily on the intrinsic hepatocyte recovery capacity and secondly on optimizing liver hemodynamics and preventing venous stasis.
\nThe primary goal of hemodynamic monitoring is to prevent inadequate cardiac filling and the subsequent tissue hypoperfusion, and also to avoid overloading leading to congestion of the lungs and sinusoids and hence allograft dysfunction [8]. The intravascular volume, cardiac output (CO), and systematic vascular resistance (SVR) are important parameters vital in determining the success of a LT. The treatment becomes even more complicated when renal and/or heart failure, portopulmonary hypertension, or hepatopulmonary syndromes are also present [9].
\nSuccessful management of patients with end-stage liver disease (ESLD) requires a complete understanding of their hemodynamic profile that is often characterized by high cardiac output (CO) with decreased systemic vascular resistance, depleted intravascular volume, and compensatory tachycardia with concomitant renal vasoconstriction and dilutional hyponatremia, due to excessive production of vasodilators during the development of hepatic failure [10]. Following LT, vasodilation and hyperdynamic circulation remain until the graft begins to function and excretes excess vasodilatory agents that are almost completely restored after 6 months [11].
\nUpon the arrival of a liver transplant recipient in the ICU, advanced monitoring, which estimates CO and volume status, additionally to standard hemodynamic monitoring, that is electrocardiogram, pulse-oximetry, and invasive blood pressure, are deemed essential [12].
\nHemodynamic depression may be the result of hypovolemia, prolonged reperfusion syndrome, cardiac dysfunction, either caused by pre-existing or emerging ischemic cardiomyopathy, and metabolic disorders such as acidosis, hypocalcaemia, hypothermia, vasodilation due to sepsis, or graft dysfunction.
\nThe assessment of the intravascular volume is of vital importance given that volume status can be affected by contradictory factors such hypovolemia or hypervolemia, both detrimental for graft and patient survival. Restoring volume status, a continually dynamic parameter, and achieving optimal CO are crucial in order to maintain the delicate balance between preload optimization and avoidance of pulmonary edema [13].
\nHypovolemia, possibly due to continued bleeding, occult or overt, inadequate fluid replacement and/or loss in the third space, can lead to reduced preload and CO and hence hypoperfusion resulting in additional lesions in the newly transplanted liver [14]. The aim is to replace the intravascular fluid and maintain the circulating blood volume. There is still controversy over the type of fluids administered, with crystalloids gaining ground against the colloids (hydroxyl ethyl starches), which have been associated with renal injury and increased mortality in critically ill patients [15], a conclusion that is not supported by convincing evidence in LT. Nevertheless, the appropriate crystalloid should be carefully selected taking into account its special characteristics and based on its metabolism, electrolyte composition, pH and osmolarity, and considering patients’ status [16]. Albumin (Alb) administration as a replacement fluid has been a matter of debate. In some centers, a large amount of Alb is exogenously administered following the LT to support circulatory stability. Moreover, a concentration of 25 g/L is considered necessary for the immunosuppressive drugs to be effective [17]. Beneficial properties were attributed to Alb in recent studies; whereas, postoperative hypoalbuminemia has been linked to the development of acute kidney injury (AKI) [18]. It has been found that during LT there is translocation of Alb, probably to the interstitial space, which persists until the third postoperative day and whose role has not been clearly clarified [19]. Certain centers choose to replace two-thirds of the required fluids with crystalloids and one-third of drain losses with albumin [14]. Although, blood and blood products transfusion strategies vary between institutions, it is considered that postoperative hematocrit (Hct) values, ranging between 25 and 30%, are safe for adequately transporting O2 to the new graft [14]. The rational use of blood products depends on the monitoring of the coagulation mechanism. Whole-blood viscoelastic tests, such as thromboelastogram (TEG) and rotational thromboelastometry (ROTEM), that illustrate each step of thrombus formation and fibrinolysis are useful tools to guide transfusions and drug administration (anti-fibrinolytics, coagulation factors) [20, 21] by limiting the number of transfusions, as there has been an association between them and increased morbidity/mortality, prolonged stay in the hospital, postoperative sepsis, increased risk of acute rejection, and hepatic artery thrombosis [22, 23, 24].
\nHypervolemia occurs either from intraoperative over-resuscitation or coexistence of renal dysfunction. It can result in capillary leak syndrome with loss of fluids in the third space, further congestion and graft edema due to vascular permeability disorder, caused by ischemia/reperfusion injury (I/R) that is more pronounced in grafts with higher preservation injury, greater steatosis, or in older donors [7, 25]. Studies also indicate that massive administration of fluids and blood is a risk factor for complications of the respiratory system postoperatively and is correlated with increased mortality [26]. On the contrary, conservative resuscitation strategy and negative fluid balance during the first three postoperative days, if hemodynamic stability has been achieved, act protectively. Codes et al. [27] concluded that a continuous positive balance in the first 4 days after surgery correlates with the development of ΑΚΙ and the need for renal replacement therapy (RRT). Goal directed therapy (GDT) strategy, which has been successfully applied in major surgical interventions, is proposed. It aims at maintaining an adequate supply of O2 to the end organs by a bundle of measures including fluid titration in conjunction with blood transfusions as well as administration of vasopressors and/or inotropic agents [28]. The hemodynamic targets are predefined and specific variables are used to control fluid adequacy, improvement of CO, and tissue perfusion. GDT has beneficial effects compared to liberal fluid administration, reducing postoperative ileus, mechanical ventilation time, and respiratory system complications, as it has been indicated in relevant, although limited, studies [29]. Jiang et al. [30] suggests the individualization of fluid administration in the perioperative period as an optimal recovery strategy. They estimated that transfusions >100 ml/kg and fluid balance ≤−14 ml/kg during the first postoperative days result in prolonged mechanical ventilation, extubation time, and ICU stay. Prudent use of vasopressor agents is proposed since they increase arterial tone and improve perfusion pressure avoiding overload. Noradrenaline (0.01–1 μg/kg/min) with mixed α-β-adrenergic effects is most commonly administered to maintain CO and organ perfusion. Vasopressin (0.5–0.6 U/h) and terlipressin (1.5 μg/kg/h) have also been used in recent years because of their modifying effect on visceral circulation, where approximately 37% of the total blood volume is located in cirrhotic patients, and of their ability to reduce pressure in the portal vein [31, 32].
\nSince there has been no consensus on hemodynamic monitoring in LT yet, there is a number of invasive and noninvasive CO monitors available in order to evaluate hemodynamic fluctuations (Table 1) [13, 36].
\nMonitors | \nPrinciple | \nAdvantages | \nLimitations | \n
---|---|---|---|
PAC | \nThermodilution | \nAccurate continuous measures of CO Direct measures of PAP and RVEDVI Gold standard in POPH | \nInvasive CVP, PCWP static pressures measurement Unreliable indicators of volume status, SV and fluid responsiveness | \n
PiCCO | \nPulse contour analysis | \nLess invasive Continuous CO, SV measures ITBVI, EVLWI, PPV, SVV Reliable indicators of fluid responsiveness | \nNeed for recalibration in marked changes of SVR Inaccurate CO measures in Child-Pugh Band C stages in cirrhosis Requires sinus rhythm and certain ventilator setting | \n
LiDCO | \nPulse contour analysis | \nContinuous CO, SV measures comparable to PAC measures PPV, SVV Indicative of volume status | \nCalibration with lithium Inaccurate CO measures in Child-Pugh Band C stages in cirrhosis | \n
FlowTrac/Vigileo | \nPulse contour analysis | \nNo need for calibration Continuous CO, SV measures PPV, SVV, indicative of volume status | \nNot reliable in hyperdynamic circulation with very low SVR | \n
TEE | \nUltrasound, Doppler | \nLess invasive Direct visualization of cardiac function and volume status | \nAdvanced training is required Risk of rupture in 3rd or 4th grade of esophageal varices | \n
Hemodynamic monitoring in LT.
The pulmonary artery (PAC) catheter has traditionally been used for hemodynamic monitoring in LT. It provides the possibility of measuring the CO by the thermodilution method, which is considered the gold standard, but also the cardiac filling pressures, the CVP, and especially the PCWP for assessing the preload [33]. Numerous studies have shown that static preload measurements are indirect markers of the end diastolic volume and have a poor predictive value for fluid management, improvement of hepatic perfusion, and recovery guidance [34]. Although still under debate, current data favor the use of a modified pulmonary artery catheter, with an incorporated heating coil, that provide continuous measurement of CO (CCO) and right ventricular end diastolic volume (RVEDV) as the more reliable preload indicator. Patients with portopulmonary hypertension are highly benefited from PAC, as it is the method of choice for measuring and monitoring pulmonary artery pressures intraoperatively and directly postoperatively [13, 35].
\nIn recent years, interest has shifted to the dynamic parameters and expanding data yielded from existing monitoring of blood pressure to assess the CO, the preload and the afterload. There is technology available to accurately analyze pressure waveforms and sufficient knowledge to generate algorithms that are interpreted by the complex pulse wave morphology [36, 37].
\nThe PiCCO system (Pulsion Medical System, Munich, Germany) uses the method of transpulmonary thermodilution, single indicator technique, and arterial pulse contour analysis which by means of an algorithm can continuously calculate CO and preload markers: global end diastolic volume (GEDVI), extra vascular lung water index (EVLWI), and intrathoracic blood volume index (ITBVI) which is considered a reliable preload indicator in LT. In transplant patients, the CO measurements deriving from the PiCCO system are consistent with those of PAC [38, 39].
\nFurthermore, this system offers the capability of functional hemodynamic monitoring by detecting the changes in left ventricular pulse volume caused by changes in preload due to mechanical ventilation. Stroke volume variation (SVV) and pulse pressure variation (PPV) have been used successfully to assess the intravascular volume and fluid responsiveness in critically ill patients [12, 13, 40]. Certain LT studies have concluded that the SVV is a better indicator for RVEDVI than CVP, while a SVV greater than 9% is an indicator of low RVEDVI which means fluid responsiveness [41, 42]. However, there are always limitations deriving from the presence of arrhythmia and mechanical ventilation settings.
\nThe LiDCO system (LiDCO Plus, Cambridge, United Kingdom) is similar to the PiCCO system, but in its case the lithium indicator dilution technique is applied in order to calibrate the arterial waveform analysis algorithm [40].
\nThe Flowtrac/Vigileo system (Edwards Lifesciences, Irvine, CA United States) is a special energy converter that links the arterial line with a CO monitor and uses arterial waveform analysis with an algorithm for real-time CO measurement in conjunction with patient demographics without the need for calibration. However, a poor correlation has been found between findings of waveform analysis CO when compared to PAC thermodilution, mainly in patients with cirrhosis B and C according to Child-Pugh classification [43, 44]. Biais et al. came to the same conclusion, using the recent third generation, FloTrac system, pointing out that there was great discrepancy in cases of significantly low SVR [45, 46].
\nIn recent years, the use of transesophageal echocardiography (TEE) has been gaining ground not only because it is considered a noninvasive method, but also because it provides the ability to directly visualize the contractility of the left and right heart, preload status, and differential diagnosis of various pathological conditions such as pulmonary embolism, pleural, or pericardial effusion [47]. The CO can be estimated with measurements of flow across the cardiac valve, left ventricular outflow tract, or the flow in the main pulmonary artery. The ability to instantly display real-time preload is considered its biggest advantage. The functional application of TEE is limited by the risk of rupture of the third or fourth grade esophageal varices, but it is considered a reliable hemodynamic monitoring method when used by experienced intensivists [12, 13].
\nAssessment of graft function is necessary and is performed by combining clinical parameters, laboratory values, and imaging examinations. The first positive signs of adequate function of the new liver can be evident by the correction of metabolic acidosis, coagulation disturbances, hemodynamic stabilization, and temperature normalization in addition to diuresis restoration. Continuous monitoring in the postoperative period is required for the immediate recognition of early, subtle findings of graft dysfunction which necessitate aggressive treatment. Traditionally, the evaluation of liver function involves static and dynamic tests [48].
\nStatic tests include hematology, coagulation, and biochemistry blood tests, in order to evaluate the main liver functions. The hepatic enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT), which rather indicate hepatocyte necrosis, display a rise postoperatively reaching their peak during the first 2 days before they finally start decreasing. Their elevation is attributed to preservation injuries and/or prolonged cold ischemia time (CIT). A persisting elevated value raises concerns about liver function and requires further investigation. The canalicular enzymes γ-glutamyl transferase and alkaline phosphatase increase after day four and usually five-fold before their decline begins. The synthetic function of the liver is evaluated by the prothrombin time or international normalized ratio (INR), which estimate the production of coagulation factors by the liver. Bilirubin levels define the liver excretory function while its metabolic function is assessed by glucose and lactate levels. A resistant to the treatment hypoglycemia is an indicator of graft dysfunction. The levels of lactates should also be carefully considered, if increased, due to the fact that such result may derive from peripheral tissue hypoxia.
\nThe dynamic tests express the ability of the liver to metabolize or excrete certain substances. The lidocaine conversion to monoethylglycinexylidide metabolite (MEGX test) assesses the metabolic capacity and the liver blood flow [48, 49].
\nThe indocyanine green (ICG) clearance test is routinely used in several centers. The functional activity of the graft is assessed by ICG dye administration, which is almost exclusively eliminated from the liver into the bile without undergoing enterohepatic circulation. Its removal from the blood depends on the hepatic blood flow, parenchymal cell function, and biliary excretion. It is expressed as half-life time, blood clearance, or plasma disappearance rate (ICG-PDR) smaller than 15% associated with a higher rate of primary dysfunction [50]. The bedside ultrasound imaging methods with hepatic blood vessel Doppler examination are usually performed on the day of surgery or on the first postoperative one in order to evaluate the patency of the hepatic artery, the portal vein, and the hepatic vein. It is particularly useful in the presence of intraoperative technical difficulties or when there is graft dysfunction, with a view to identify vascular abnormalities that could be treated [51].
\nRecovery of the graft is a combination mainly of the severity of the recipient’s condition, donor quality, intraoperative events, perioperative hemodynamic stability, and preservation injuries, while adequate blood flow to the organs and prevention of venous stasis in the new liver have to be ensured (Table 2) [49]. On the other hand, the risk of poor outcome is increased in case of ESLD-associated syndromes and co-morbidities coexistence, especially in sicker patients, as estimated by the MELD score [4, 7].
\nDonor related | \nRecipient related | \nIntraoperative events | \nAllograft related | \n
---|---|---|---|
Donor age Macrovesicular steatosis >30% High dose of vasopressors Hypernatremia Prolonged ICU stay Prolonged CIT Donation after cardiac death | \nESLD-associated syndromes Pretransplant HD/renal dysfunction Cardiovascular disease BMI < 18.5 kg/m2 | \nMassive transfusion Reperfusion syndrome High vasopressors dose | \nI/R Injury Graft inflow (Right HF, Hepatic vein stenosis/thrombosis) Graft outflow (Hepatic artery and portal vein patency) Small-for-size syndrome | \n
Factors related to graft function.
Donor quality has a major impact on the graft function since the use of marginal donors is now commonplace [4]. The prolonged time of cold ischemia for more than 12 h increases ischemia reperfusion injuries. Macrosteatosis greater than 30% reduces tolerances in such injuries, while the risk of rejection and PNF is increased. Grafts from donors older than 60 years of age are considered to be of higher risk for PNF or exhibit delayed recovery mainly owing to cholestasis, whereas grafts from donors older than 75 show reduced liver regeneration capacity [52, 53, 54]. Nevertheless, the results in the literature are contradictory; and in 2016, the donors older than 65 years old reached a percentage of 20.7%. In a recent study, Gilbo et al. concluded that older grafts can be safely used in older recipients without endangering their survival, if the remaining risk factors have been minimized [55]. The best practice for graft allocation is the use of scores that include donor and recipient data, such as the survival outcomes following liver transplantation (SOFT) and/or the BAR-score, which offer excellent prognostic ability for survival after transplantation and could lead to the final decision on using or rejecting the graft [56].
\nThe intraoperative use of short-acting anesthetics and neuromuscular blocking agents allows a prompt recovery of consciousness and facilitates the rapid release from mechanical support and early extubation (EE), which can occur in the operating theater or within the first three postoperative hours and is associated with shorter ICU and hospital stay. In a recent meta-analysis comparing early versus conventional extubation, the authors report a reduction in re-intubation rate, morbidity, respiratory complications, incidence of graft dysfunction, and ICU/hospital stay [57, 58, 59]. In a study published by Taner et al., it was exhibited that early extubation failed only in 1.90% of patients when performed on selected cases. According to these researchers, patients with HCC and low MELD score are appropriate candidates for EE [60].
\nProlonged mechanical ventilation (MV) remains a critical risk factor for infections development, especially ventilator-associated pneumonia, tracheal trauma, prolongation of neuromuscular recovery, graft venous congestion due to positive intrathoracic pressures, and reduced venous return to the inferior vena cava and hepatic veins [61, 62]. It has also been correlated by Yuan et al. with the recipient’s age, female gender, preoperative need for renal replacement therapy (RRT), ascites, higher MELD score, prolonged cold ischemia, and the number of transfusions [62].
\nEmphasis is placed on the fact that optimal selection criteria and timing of EE have not been clearly defined yet. Patients with encephalopathy, marked hypoxemia, obesity (BMI > 30), severe hemodynamic instability, pulmonary edema, cardiac or renal dysfunction, and multiple transfusions are not indicated for EE. The personalized and selective approach is likely to be the best strategy with a focus on avoiding delayed extubation, preserving hemodynamic stabilization, and ensuring graft functionality [63].
\nThe criteria of weaning from MV applied to liver transplanted patients in ICU conform to those of the rest patient groups [64]. Distinct sequelae may often arise from ESLD-related disorders such as encephalopathy, massive transfusions, graft dysfunction, preoperative nutrition disorders, volume overload, and postoperative respiratory complications including pulmonary edema, pleural effusions, or pneumonia. During MV, lungs and liver allograft interaction should be taken into account with the aim of improving oxygenation without impairing the outflow of the liver graft. Implementation of daily withdrawal of sedation combined with spontaneous breathing trial facilitates weaning from MV [63].
\nAcute respiratory distress syndrome (ARDS), one of the prominent respiratory complications following LT, is usually attributed to reperfusion syndrome, substantial blood loss and transfusions, prolonged operation time, and early postoperative infections and sepsis. Lung-protective ventilator strategies with low tidal volumes (6 ml/kg IBW), higher respiratory rate, and positive end-expiratory pressure (PEEP) are recommended to limit lung injury from shear forces and atelectasis [64]. There is debate about optimum PEEP in LT since some consider that higher PEEP values impair venous return and visceral blood flow leading to hepatic edema. Evaluation of transpulmonary pressure has been proposed to optimize PEEP titration [65]. Saner et al. concluded that PEEP up to 15 cm H2O affects neither blood flow to the liver, nor flow and velocity in the hepatic artery, right hepatic vein, and portal vein [66]. In refractory ARDS and persistent hypoxia, prone positioning, high frequency ventilation, and extracorporeal membrane oxygenation support have been utilized as rescue therapy [67, 68, 69].
\nThere are certain syndromes related to ESLD characterized by severe hypoxemia which require special management in the ICU such as hepatopulmonary syndrome and portopulmonary hypertension.
\nHepatopulmonary syndrome is caused by intrapulmonary capillary dilatation that leads to hypoxemia and shortness of breath. LT is considered the treatment of choice; however, in most cases, severe hypoxemia might persist for a 6–12 months period. In the ICU, fluids should be managed carefully and lung-protective strategies should be employed during MV. In persistent hypoxemia, high frequency ventilation and/or venovenous extracorporeal membrane oxygenation is recommended. Some authors suggest early extubation and the immediate application of noninvasive ventilation with high-inspired fraction of oxygen [70, 71].
\nPortopulmonary hypertension resulting from pulmonary vasoconstriction due to portal hypertension requires prevention of hypoxemia, maintaining oxygen saturation >90% and correcting factors involved such as acidemia, arrhythmia, and anemia. Administration of diuretics and/or renal replacement therapy is advised if volume overload cannot be avoided. MV can both compromise venous return from the allograft and increase pulmonary vascular resistance through alveolar overdistension; therefore, lung-protective ventilation is considered to be the most appropriate strategy. The use of pulmonary vasodilators, that can be both administered IV such as epoprostenol and orally, via nasogastric tube, such as phosphodiesterase V inhibitor or nonselective endothelin receptor antagonist, is recommended during ICU stay [71].
\nAdvances in immunosuppression have greatly impacted the survival of patients following LT. The initial endpoint was to prevent rejection; but in recent years, the interest has also been shifted to avoiding long-term complications from immunosuppressant agents and relapsing of the disease. In spite of the latest developments in this field, most centers commence immunosuppression with calcineurin inhibitors (CNIs) and corticosteroids with or without an anti-proliferative agent depending on protocols [72, 73].
\nMycophenolate mofetil has been widely used as an adjuvant and alternative immunosuppressive agent. It is a potential inhibitor of B- and T-cell proliferation. It is mainly utilized when a dose reduction or discontinuation of CNI is demanded due to certain adverse effects such as nephrotoxicity and neurotoxicity [72].
\nMammalian target of rapamycin (mTor) inhibitors, sirolimus, and everolimus, prevent B- and T-cell proliferation prompting the cell to arrest at G1 to S phase of the cell cycle. Although accounted for wound healing delay incidents, they can be administered as primary and rescue immunosuppression therapy with the advantages of being renal sparing as well as reducing the need for high doses of steroids. The newer IL-2 receptor-blocking antibody preparations daclizumab (Zenapax) and basiliximab (Simulect) are often used to initiate immunosuppression and avoid CNIs, and can also play a part in steroid-resistant rejection [72].
\nPrevention of infections is a major problem as they are the leading cause of death following LT [74]. The most common ones in the immediate postoperative period are of bacterial or fungal origin and include bloodstream, catheter related, surgical site, pulmonary, urinary tract,
Herpes family viral infections, due to immunosuppression mainly by administration of T-cell-specific agents, are adequately treated with acyclovir. Ganciclovir or valganciclovir is sufficient for CMV seronegative recipients with CMV-seropositive grafts, or after rejection treatment. In case of suspected infection during hospitalization, broad spectrum antimicrobial therapy is administered and reviewed according to cultures results [75].
\nPost-LT nutritional support in ICU is an essential adjunct to transplant recovery. Malnutrition, which characterizes many patients with ESLD being evident at rates of up to 80%, deteriorates with the progression of liver failure, and affects the patients’ outcome [80]. On the other hand, it is associated with prolonged ICU and hospital stay, infections, respiratory complications, graft impairment, and mortality. Sarcopenia, defined as severe muscle wasting, is also a determining factor of the outcome, and it can be easily diagnosed with bioelectrical impedance. Patients with cirrhosis often present carbohydrate, fat, and protein disorders, characterized by elevated levels of aromatic amino acids and methionine while lowering plasma levels of branched-chain amino acids are detected [81, 82]. The immediate postoperative energy demands are increased, especially in patients with a high MELD score [82]. Factors such as operational stress, release of catabolic hormones, administration of immunosuppressants, mainly corticosteroids, as well as ICU factors including mechanical ventilation and hemodialysis, contribute to increased metabolic needs. For the above reasons, the aim is to ensure adequate intake of protein and calories in addition to protein breakdown protection [81]. An increase in nonprotein calories, estimated at 25–35% kcal/kg per day, is recommended when indirect calorimetry is not available. It should always be in accordance with the metabolic and inflammatory status, and it should be reviewed in hemodynamically unstable patients [83]. Due to elevated protein catabolism, it is necessary to obtain 1.5–2 g/kg of protein. Enteral nutrition (EN) has the edge over the parenteral one, assisting in maintaining intestinal integrity, by supporting the diversity of the microbiome, and helping the immune and metabolic response. The rapid onset of EN even 12 h after LT is recommended by some authors. It has been reported to reduce viral infections and contribute to a better N2 balance. If postoperative encephalopathy remains, the amount of protein intake is not reduced but the type of nutrition is altered by the addition of branched-chain amino acid (BCCA) enriched formulae, while the administration of immunonutrition remains under discussion. Frequent screening of electrolytes is required to prevent and correct disorders, while re-feeding syndrome is also considered a risk factor for these disorders [83].
\nRenal impairment is a very common complication after LT. Its presence ranges from 19 to 64%. Even with the application of the RIFLE and AKIN criteria, the percentage reaches from 39 to 54% [84, 85]. In cases of living donors, acute kidney injury (AKI) has been estimated at around 23% [86]. AKI occurrence is complex and multifactorial in origin, depending on the existence of the preoperative hepatorenal syndrome as well as various intraoperative and postoperative factors. High MELD score, perioperative transfusions, hemodynamic instability, vasoactive agents, graft dysfunction, infections, and nephrotoxic agents are mainly accountable for renal function deterioration [87]. Systematic evaluation of renal function is required with close monitoring of urine output, fluid balance, and hemodynamic parameters [18]. The treatment is mainly supportive and includes: restoring CO with sufficient preload for optimization of renal perfusion, administering loop diuretics, and efforts to avoid nephrotoxic agents. Renal replacement therapy is recommended in cases of volume overload, electrolyte disturbances, and acidemia in an attempt to avoid pulmonary edema and hepatic congestion. Immunosuppressants, antibiotics, and contrast agents are commonplace nephrotoxic agents. The dosage of CNIs should be minimized or they should be converted into mTOR inhibitors combined with anti-proliferative agents. In ICU, CVVDHF is the renal replacement therapy of choice and favors the outcome of patients [88].
\nPrimary graft dysfunction (PGD) is a major complication after LT and is associated with prolonged hospital and ICU stay jeopardizing graft viability, being responsible for its high rejection rates as well as higher mortality and morbidity. It describes different degrees of graft impairment which begins intraoperatively, divided into early or initial poor function (IPF) and primary nonfunction (PNF) [89, 90, 91]. IPF represents the clinical phenotype of severe ischemia-reperfusion injury due to various donor and/or recipient-related factors. Expanding the criteria to marginal donors has increased the use of allografts with a higher likelihood of initial malfunction. It affects the survival of both graft and patient, whether the transplant comes from living or deceased donors. Dysfunction may be transient and possibly reversible with appropriate supportive treatment. There are no clear definitions, nevertheless, there are suggested scores, such as MEAF and LGrAFT, that could help in early detection and classification of early hepatic impairment [92, 93]. On the contrary, PNF is a catastrophic injury characterized by hepatic necrosis, aminotransferase elevation, coagulation disorders, lactate elevation, hemodynamic instability, persistent hypoglycemia, and respiratory and renal failure with an incidence ranging from 0.9 to 7%. The treatment is immediate re-transplantation. There are certain risk factors related to donors, recipients, intraoperative events, and allograft preservation [91] (Table 2).
\nAcute cellular rejection (ACR), usually mediated by T-cells, has decreased in recent years with the use of improved potent immunosuppressants, but still ranges from 15 to 25% and usually occurs 7–14 days after surgery [94]. Hyperacute liver rejection is controversial, but undoubtedly early accelerated rejection occurs in the first 7 days and is associated with preformed antibodies. Risk factors include adequacy, type, and level of immunosuppression, underlying immune disease, biliary complications, certain transplant-related features such as donor-negative recipient-positive CMV mismatch, sex mismatch with a female donor. ACR is not significantly associated with long-term graft failure unless it concerns HCV-positive patients in which case it may result in corticosteroid-resistant rejection and graft loss. Early ACR is associated with better graft outcomes [95]. It is even hypothesized that such activation of the immune system may be beneficial and may induce a degree of tolerance. Manifestations of ACR include elevated levels of aminotransferase, alkaline phosphatase, bilirubin, and fever in later stages. Hepatic artery or portal vein thrombosis, biliary leak, CMV infection, and delayed graft function should be excluded. Diagnosis is finally confirmed by percutaneous liver biopsy prior to initiation of treatment, which depends on patient severity and current immunosuppression [94]. Cyclosporine is converted to tacrolimus or the sub-therapeutic levels of tacrolimus are increased and/or mycophenolate mofetil is added. In moderate to severe ACR, high doses of corticosteroids, usually methylprednizolone, are administered as a first-line medicine in a dose ranging from 500 to 1000 mg for 1–3 days depending on the center protocol [94].
\nCirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with cirrhosis characterized by a blunted contractile responsiveness to stress and/or diastolic dysfunction and electrophysiological abnormalities in the absence of known cardiac disease [96]. Diagnostic features include a reduced ejection fraction (EF), an E/A ratio < 1, and electrocardiographic abnormalities such as a prolonged QTc interval. Diagnostic approaches involve transthoracic ultrasound, dobutamine stress echocardiography (DSE), as well as cardiac magnetic resonance (CMR). The concept of “ventriculo-arterial coupling” (VAC) has recently been suggested as a means of assessing cardiac function in ESLD. The VAC (ratio of ventricular elastance to arterial elastance) is measured conventionally by ultrasound and has been correlated with prognosis. Moreover, cardiac biomarkers such as troponin and brain natriuretic peptide (BNP) are deemed early markers [97].
\nIt is difficult to define the exact impact of CCM due to the fact that its clinical course is usually silent, especially in early stages, due to the profound vasodilatation in cirrhosis and offloading of the left ventricle. It only becomes apparent in conditions of stress and increased afterload. LT is a cause of significant cardiovascular stress since there are marked variations in preload and afterload, cardiac workload increases and the existing underlying cardiac dysfunction may become overt heart failure during LT or several days postoperatively. Complete recovery has been recorded at 6 months [98].
\nCardiac dysfunction and pulmonary edema are encountered in almost half of the patients within a week after LT. They have been identified as the third most important cause of mortality during the first year following the surgery. High MELD score and AKI have been considered as risk factors. Early diagnosis can prevent acute onset or deterioration of heart failure. An empirical and supportive therapeutic approach is applied which includes optimization of volume status and cardiac monitoring via echo and/or PAC [99, 100].
\nPrevalence of coronary artery disease (CAD) in cirrhosis reaches 5–26% and has been associated with poor prognosis. It has been correlated with a number of cardiac adverse events: myocardial infraction, arrhythmias, and cardiac death. LT can be postponed in cases with known CAD for medical optimization and/or revascularization [99, 100].
\nNeurological complications (NC) are still common after LT with a 15–30% incidence rate. In recipients from living donors, this percentage does not exceed 20% [101, 102]. Major neurologic complications immediately postoperatively include alterations of consciousness, seizures, hepatic encephalopathy, CNI neurotoxicity, cerebrovascular complications, central nervous system infections, and central pontine myelinolysis (CPM) [103]. They can delay recovery and make immunosuppression and patient management difficult. Rapid patient recovery requires daily evaluation of mental status and neurological assessment in the ICU.
\nImmunosuppression-related neurotoxicity can range from headaches and convulsions to posterior reversible encephalopathy (PRES). Immunosuppressants have the potential to reduce the seizure threshold that is enhanced by electrolytic disorders mainly hypomagnesaemia and hypophosphatemia. CNIs are mainly implicated while incidents of PRES have been reported even in treatment with sirolimus. The treatment is conservative involving reduction of dosage and/or interchange with CNI-sparing regimens. Neurotoxicity of corticosteroids can be manifested either in the form of convulsions or myopathy and behavioral disorders [103].
\nPost-transplant encephalopathy is responsible for 12% of NC. It relates closely to metabolic disorders, CNS infections and/or septic encephalopathy, cerebrovascular events, history of severe encephalopathy, and graft dysfunction [78]. Seizures are one of the most common postoperative neurological consequences and may be the effect of various factors, mainly drug toxicity and metabolic disorders. Correction of underlying causes and administration of anti-convulsive medicines are the appropriate treatment.
\nCentral pontine myelinolysis (CPM) represents a serious complication, with a low incidence of approximately 1–3.5% that may affect the postoperative course of patients. It has been associated with large fluid shift and rapid correction of prolonged hyponatremia. The indicated treatment is supportive and requires careful correction of severe hyponatremia (serum Na <125 mEq/L), which is encountered in approximately 17% of patients with ESLD, using sodium chloride and adjusting Na serum values to 8–10 mEq/L per day [104, 105].
\nIschemia-reperfusion injury is related with the degree of transaminitis and primary and/or delayed graft dysfunction. Mitochondria are more prone to I/R injuries with subsequent alterations that can lead to dysfunction or even to necrosis of hepatocytes following LT. Alternatively, machine reperfusion has been proposed to preserve the donor organ. It promises to restore energy balance, extend preservation time while offering the ability to “test” the organ performance [106, 107].
\nIn the early postoperative period, according to Parikh et al., 79.3% of patients are present with at least one complication with 62.8% of the recipients suffering severe complications. The incidence of those related to surgical techniques range from 5 to 10% and can be categorized into abdominal bleedings, vascular complications, and biliary complications. Treatment can be determined by the severity of each case and its spectrum includes simple surgical interventions, or even re-transplantation. The main complications are illustrated in Tables 3 and 4 along with diagnostic and therapeutic approaches [108, 109].
\nComplications | \nDiagnosis-treatment | \nTherapeutic approach | \n
---|---|---|
Abdominal bleeding | \nAnastomosis site Graft surface Diffusion bleeding | \nRe-operation | \n
Biliary Complications | \nBiloma, Hemobilia Bile leaks Anastomosis necrosis Anastomotic stricture | \nERCP, PTC, MRCP EUS-guided approach HIDA Digital Cholagiography or Surgical re-intervention | \n
Immediate surgical complications after LT.
Vascular complications | \nDiagnosis | \nTreatment | \n
---|---|---|
Hepatic artery thrombosis (HAT) 2.9% | \nDUS, CT Angiography | \nEmergent revascularization (endovascular or surgical) or re-LT | \n
Hepatic artery stenosis (HAS) 1–2% | \nDUS, CT Angiography | \nEndovascular intervention or surgical HA revision | \n
Hepatic artery rupture (HAR) 0.64% | \nAngiography None in emergency | \nEmergent surgical hemostasis and surgical repair | \n
Portal vein thrombosis (PVT) 5% | \nDUS, CT (portal phase) Venography | \nSurgical revision Endovascular intervention or re-LT | \n
Portal vein stenosis (PVS) 2% | \nDUS, CT (portal phase) Venography | \nEndovascular intervention | \n
Vascular complications after LT.
LT has been established as the gold standard treatment for patients with ESLD and following successful postoperative course, organs previously affected return to normal functionality in due time. Postoperative ICU stay is often imperative, especially in cases of adverse events during operation, delayed cardiovascular resuscitation, utilization of marginal donors, and distant organ dysfunction. Early recognition, evaluation, and treatment of hemodynamic instability, distant organ complications, impaired graft functionality, and use of optimal immunosuppressive agents are of paramount importance.
\nPrompt recognition and treatment of life-threatening sequelae following LT in addition with optimal management of immunosuppression are keys to successful postoperative care and have led to improved overall survival although recipients are in relatively worse condition and the use of marginal donors is more widespread.
\nFurthermore, overall survival of LT patients has improved dramatically in recent years due to the formation of LT specific centers and medical teams, which follow each patient from admission to the donor list up to the operation itself as well as during their postoperative course. Therefore, according to the authors, the creation of LT specific ICUs that provide a postoperative continuation of excellency in managing the intricacies of those patients is paramount. Those units will not only provide prompt treatment in cases of a complication but will also act as additional reinforcement against postoperative infections.
\nOur journals are currently in their launching issue. They will be applied to all relevant indexes as soon as they are eligible. These include (but are not limited to): Web of Science, Scopus, PubMed, MEDLINE, Database of Open Access Journals (DOAJ), Google Scholar and Inspec.
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She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. Her knowledge of English is at an advanced level.",institutionString:null,institution:null},{id:"332914",title:"Dr.",name:"Muhammad Saad",middleName:null,surname:"Shaikh",slug:"muhammad-saad-shaikh",fullName:"Muhammad Saad Shaikh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jinnah Sindh Medical University",country:{name:"Pakistan"}}},{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",slug:"feng-luo",fullName:"Feng Luo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sichuan University",country:{name:"China"}}},{id:"423519",title:"Dr.",name:"Sizakele",middleName:null,surname:"Ngwenya",slug:"sizakele-ngwenya",fullName:"Sizakele Ngwenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419270",title:"Dr.",name:"Ann",middleName:null,surname:"Chianchitlert",slug:"ann-chianchitlert",fullName:"Ann Chianchitlert",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419271",title:"Dr.",name:"Diane",middleName:null,surname:"Selvido",slug:"diane-selvido",fullName:"Diane Selvido",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419272",title:"Dr.",name:"Irin",middleName:null,surname:"Sirisoontorn",slug:"irin-sirisoontorn",fullName:"Irin Sirisoontorn",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"355660",title:"Dr.",name:"Anitha",middleName:null,surname:"Mani",slug:"anitha-mani",fullName:"Anitha Mani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"355612",title:"Dr.",name:"Janani",middleName:null,surname:"Karthikeyan",slug:"janani-karthikeyan",fullName:"Janani Karthikeyan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334400",title:"Dr.",name:"Suvetha",middleName:null,surname:"Siva",slug:"suvetha-siva",fullName:"Suvetha Siva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}}]}},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 This 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:"Dr.",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:null,institution:null}]},onlineFirstChapters:{paginationCount:1,paginationItems:[{id:"82310",title:"Knowledge of Intergenerational Contact to Combat Ageism towards Older People",doi:"10.5772/intechopen.105592",signatures:"Alice Nga Lai Kwong",slug:"knowledge-of-intergenerational-contact-to-combat-ageism-towards-older-people",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Social Aspects of Ageing - 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