Depicting tests required for determination of iron metabolism anaemia.
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\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:"5804",leadTitle:null,fullTitle:"Fractal Analysis - Applications in Physics, Engineering and Technology",title:"Fractal Analysis",subtitle:"Applications in Physics, Engineering and Technology",reviewType:"peer-reviewed",abstract:'Fractal analysis has entered a new era. The applications to different areas of knowledge have been surprising. Let us begin with the fractional calculus-fractal geometry relationship, which allows for modeling with extreme precision of phenomena such as diffusion in porous media with fractional partial differential equations in fractal objects. Where the order of the equation is the same as the fractal dimension, this allows us to make calculations with enormous precision in diffusion phenomena-particularly in the oil industry, for new spillage prevention. Main applications to industry, design of fractal antennas to receive all frequencies and that is used in all cell phones, spacecraft, radars, image processing, measure, porosity, turbulence, scattering theory. Benoit Mandelbrot, creator of fractal geometry, would have been surprised by the use of fractal analysis presented in this book: "Part I: Petroleum Industry and Numerical Analysis"; "Part II: Fractal Antennas, Spacecraft, Radars, Image Processing, and Measure"; and "Part III: Scattering Theory, Porosity, and Turbulence." It\'s impossible to picture today\'s research without fractal analysis.',isbn:"978-953-51-3192-2",printIsbn:"978-953-51-3191-5",pdfIsbn:"978-953-51-4790-9",doi:"10.5772/65531",price:119,priceEur:129,priceUsd:155,slug:"fractal-analysis-applications-in-physics-engineering-and-technology",numberOfPages:294,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a3d42b4b44ba9d7d72f0e91442da7b4b",bookSignature:"Fernando Brambila",publishedDate:"June 14th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5804.jpg",numberOfDownloads:20293,numberOfWosCitations:26,numberOfCrossrefCitations:30,numberOfCrossrefCitationsByBook:6,numberOfDimensionsCitations:41,numberOfDimensionsCitationsByBook:11,hasAltmetrics:1,numberOfTotalCitations:97,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 3rd 2016",dateEndSecondStepPublish:"October 24th 2016",dateEndThirdStepPublish:"January 20th 2017",dateEndFourthStepPublish:"April 20th 2017",dateEndFifthStepPublish:"June 19th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"60921",title:"Dr.",name:"Fernando",middleName:null,surname:"Brambila",slug:"fernando-brambila",fullName:"Fernando Brambila",profilePictureURL:"https://mts.intechopen.com/storage/users/60921/images/5722_n.jpg",biography:"Fernando Brambila holds a PhD degree from UNAM, Mexico. His thesis on scattering theory was directed by Gunther Uhlmann at MIT. He obtained a postdoctoral position at ICTP, Italy, and has a diploma in Senior Technology Innovation Management at IPADE, Harvard.\r\nHis research areas are mathematical analysis, partial differential equations, vectorial tomography, and hydraulic engineering. More recently, he has done research on fractional calculus and fractal geometry and applications with his collaborators K. Oleschko (UNAM), C. Fuentes (IMTA), and C. Chavez (UAQ).\r\nHe is a full-time professor at the Mathematics Department of the School of Science at the National Autonomous University of Mexico, UNAM. He is a doctoral thesis advisor of F. Aceff, R. Mercado, J. Rico, B. Martinez, and C. Torres. Also, he is the former president of the Mexican Mathematical Society, and he is currently the president of AMITE (Mexican Association for Innovation in Educational Technology).",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"966",title:"Dynamical Systems Theory",slug:"dynamical-systems-theory"}],chapters:[{id:"54851",title:"Applications of Radial Basis Function Schemes to Fractional Partial Differential Equations",doi:"10.5772/67892",slug:"applications-of-radial-basis-function-schemes-to-fractional-partial-differential-equations",totalDownloads:2041,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"In modeling using diffusion equations, the relationship between fractal geometry and fractional calculus arises by modeling the conditions of the medium as a fractal whose fractional dimension determines the order of this equation. For this reason, it is very useful to have numerical methods that solve them and discretization of the domain is not determinant for the efficiency of the algorithm. In this work, it is proposed to show that meshless methods, in particular methods with radial basis functions (RBF), are an alternative to schemes in differences or structured meshes. We show that we can obtain numerical solutions to some fractional partial differential equations using collocation and RBF, over non equally distributed data.",signatures:"Carlos Alberto Torres Martínez and Carlos Fuentes",downloadPdfUrl:"/chapter/pdf-download/54851",previewPdfUrl:"/chapter/pdf-preview/54851",authors:[{id:"201199",title:"Ph.D. Student",name:"Carlos",surname:"Torres",slug:"carlos-torres",fullName:"Carlos Torres"}],corrections:null},{id:"55326",title:"Application of Fractional Calculus to Oil Industry",doi:"10.5772/intechopen.68571",slug:"application-of-fractional-calculus-to-oil-industry",totalDownloads:1853,totalCrossrefCites:5,totalDimensionsCites:6,hasAltmetrics:0,abstract:"In this chapter, we present a discussion about the practical application of the fractal properties of the medium in the mathematical model through the use of fractional partial derivatives. We present one of the known models for the flow in saturated media and its generalization in fractional order derivatives. In the middle section, we present one of the main arguments that motivate the use of fractional derivatives in the porous media models, this is the Professor Nigmatullin’s work. The final part describes the process for obtaining the coupled system of three equations for the monophase flow with triple porosity and triple permeability, briefly mentioning the method used for the first solutions of the system.",signatures:"Benito F. Martínez-Salgado, Rolando Rosas-Sampayo, Anthony\nTorres-Hernández and Carlos Fuentes",downloadPdfUrl:"/chapter/pdf-download/55326",previewPdfUrl:"/chapter/pdf-preview/55326",authors:[{id:"60920",title:"Dr.",name:"Carlos",surname:"Fuentes",slug:"carlos-fuentes",fullName:"Carlos Fuentes"},{id:"201272",title:"Prof.",name:"Rolando",surname:"Rosas-Sampayo",slug:"rolando-rosas-sampayo",fullName:"Rolando Rosas-Sampayo"},{id:"201279",title:"M.Sc.",name:"Benito Fernando",surname:"Martinez-Salgado",slug:"benito-fernando-martinez-salgado",fullName:"Benito Fernando Martinez-Salgado"},{id:"201282",title:"M.Sc.",name:"Anthony",surname:"Torres",slug:"anthony-torres",fullName:"Anthony Torres"}],corrections:null},{id:"54899",title:"Fractals in Antennas and Metamaterials Applications",doi:"10.5772/intechopen.68188",slug:"fractals-in-antennas-and-metamaterials-applications",totalDownloads:2346,totalCrossrefCites:12,totalDimensionsCites:14,hasAltmetrics:1,abstract:"Recently, telecommunication systems have been requiring more advanced features in the design and operation. Among others a smaller size of devices, which can be integrated for multiple mobile communication systems, applied in one user’s device board, such as PDA or smart phone. Moreover, the cost of mass production should be minimized as much as possible. To meet part of that request, the antennas of these devices should have small size, lower weight, operating in multiple frequency bands and/or be broadband. There are many research methods to achieve this goal, one of which is using the fractal geometries for the shape of antenna elements. In recent years, there are many fractal shapes that have been proposed for such applications, and the designed antennas have significantly improved antenna features such as smaller size, operating in multi-frequency bands, with improved power gain and efficiency. In recent years, the new approach for modern antenna the metamaterials, MTM, is adopted, and sometimes that based on the fractal geometry is adopted.",signatures:"Wojciech Jan Krzysztofik",downloadPdfUrl:"/chapter/pdf-download/54899",previewPdfUrl:"/chapter/pdf-preview/54899",authors:[{id:"198646",title:"Prof.",name:"Wojciech",surname:"Krzysztofik",slug:"wojciech-krzysztofik",fullName:"Wojciech Krzysztofik"}],corrections:null},{id:"54979",title:"ASCCC Fractal and Its Application in Antenna Miniaturization",doi:"10.5772/intechopen.68431",slug:"asccc-fractal-and-its-application-in-antenna-miniaturization",totalDownloads:1475,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In this chapter, ASCCC fractal is defined. The name “ASCCC” is based on the process that the fractal is built. It is made by adding and subtracting circles to the circumference of a circle. Then the necessary formulas to build up the first and higher orders of ASCCC fractal are derived. By calculating the perimeter of each order, it is shown that the ASCCC fractal has a great capability in antenna miniaturization. Based on first-order ASCCC fractal, a systematic approach is designed to miniaturize an antipodal dipole at any arbitrary frequency. Then the proposed method is applied at band LTE13 (746–787 MHz), which is controversy for mobile antenna, because it causes the size of a common antenna to become very large for a handheld mobile. It is illustrated that not only the ASCCC fractal is successful in miniaturization of dipole antenna, but also it is very good at improving the antenna’s efficiency in comparison with its counterparts like Koch dipole/monopole.",signatures:"Zeinab Eskandari, Asghar Keshtkar, Javad Ahmadi‐Shokouh and\nLeila Ghanbari",downloadPdfUrl:"/chapter/pdf-download/54979",previewPdfUrl:"/chapter/pdf-preview/54979",authors:[{id:"197205",title:"Dr.",name:"Zeinab",surname:"Eskandari",slug:"zeinab-eskandari",fullName:"Zeinab Eskandari"},{id:"199234",title:"Prof.",name:"Asghar",surname:"Keshtkar",slug:"asghar-keshtkar",fullName:"Asghar Keshtkar"},{id:"199237",title:"Dr.",name:"Javad",surname:"Ahmadi-Shokouh",slug:"javad-ahmadi-shokouh",fullName:"Javad Ahmadi-Shokouh"},{id:"199238",title:"MSc.",name:"Leila",surname:"Ghanbari",slug:"leila-ghanbari",fullName:"Leila Ghanbari"}],corrections:null},{id:"54664",title:"Application of Fractal Analysis While Designing of Family of Spacecraft for Needs of Space Industry",doi:"10.5772/67922",slug:"application-of-fractal-analysis-while-designing-of-family-of-spacecraft-for-needs-of-space-industry",totalDownloads:1311,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This paper deals with methods of fractal analysis, which allow creation of a line of spacecraft from different classes as addition to classical methods for needs of space industry. It is shown that the fractal analysis that widens opportunities of classical methods can become a base for solution of the modern problems of space technologies. Besides, the results of fractal analysis in this chapter are practically valued recommendations for designing of the line, algorithms of control over equipment to measure microaccelerations and of majority control over measuring data. It clearly demonstrates potential and applicability of methods of fractal analysis in practice.",signatures:"Andrew V. Sedelnokov and Ksenia I. Potienko",downloadPdfUrl:"/chapter/pdf-download/54664",previewPdfUrl:"/chapter/pdf-preview/54664",authors:[{id:"199081",title:"B.Sc.",name:"Ksenia",surname:"Potienko",slug:"ksenia-potienko",fullName:"Ksenia Potienko"},{id:"199082",title:"Dr.",name:"Andrew",surname:"Sedelnikov",slug:"andrew-sedelnikov",fullName:"Andrew Sedelnikov"}],corrections:null},{id:"54621",title:"Specific Emitter Identification Based on Fractal Features",doi:"10.5772/67894",slug:"specific-emitter-identification-based-on-fractal-features",totalDownloads:2191,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"If we take into consideration the fact that the radar signal recognition and identification process is an integral part of contemporary combat operations, the importance of the fractal analysis increases significantly. For this reason, the fractal analysis is used in the process of radar sources identification on the contemporary battlefield. Radar Signal Recognition (RSR) with the use of classical methods, that is based on statistical analysis of basic measurable parameters of a radar signal, such as Radio Frequency (RF), Amplitude (A), Pulse Width (PW) or Pulse Repetition Interval (PRI) is not enough to carry out the distinction process of particular copies of the same radar type. Only by this approach, the identification process of particular copies in a set of the same type emitters can be carried out. As a result, it is possible to maximize Correct Identification Coefficient (CIC) in the final stage of the recognition process, which is realized in Electronic Warfare (EW) systems. One of the most important elements of the whole recognition and identification process, which is realized in ELectronic INTelligence (ELINT) battlefield system, is building a measurement data vector, then a radar's metrics and the same database. This approach is called Specific Emitter Identification (SEI).",signatures:"Janusz Dudczyk",downloadPdfUrl:"/chapter/pdf-download/54621",previewPdfUrl:"/chapter/pdf-preview/54621",authors:[{id:"197688",title:"Prof.",name:"Janusz",surname:"Dudczyk",slug:"janusz-dudczyk",fullName:"Janusz Dudczyk"}],corrections:null},{id:"55048",title:"Application of Fractal Dimension in Industry Practice",doi:"10.5772/intechopen.68276",slug:"application-of-fractal-dimension-in-industry-practice",totalDownloads:1744,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Today, industrial production lines commonly use off-line and automatic on-line quality monitoring and control. Monitoring and control units analyse data from a production process, and analysis should be able to obtain reliable information that correspond with the character of the data obtained. The character of the data set obtained from production processes or from products can be highly structured in all industrial areas. Structured surface, complex time series (topologically one dimensional signals), difficulty to describe dividing curves are much more common than it can be expected. For this kind of data set, a powerful tool for analysis of complexity —fractal geometry (especially a fractal dimension) should be used. The fractal dimension with a combination of statistical tools is an interesting and powerful tool for complex data quantification, for tracing the source of poor quality, production optimization and investigating the source of instability of production process subsystems in industrial applications. The methodology for evaluation of complex and irregular data was developed and applied in industrial practice. This methodology searches appropriated parameters for a complex evaluation of data. Only the chosen parameters are used for a complete analysis of the data in order to reduce processing time.",signatures:"Vlastimil Hotař",downloadPdfUrl:"/chapter/pdf-download/55048",previewPdfUrl:"/chapter/pdf-preview/55048",authors:[{id:"199387",title:"Ph.D.",name:"Vlastimil",surname:"Hotař",slug:"vlastimil-hotar",fullName:"Vlastimil Hotař"}],corrections:null},{id:"55169",title:"Factors Affecting Accuracy and Precision in Measuring Material Surfaces",doi:"10.5772/intechopen.68189",slug:"factors-affecting-accuracy-and-precision-in-measuring-material-surfaces",totalDownloads:1871,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The fractal dimensions of material surfaces are of interest because they can be related to material performance. Such surfaces include the fracture surfaces of broken specimens, surfaces abraded by airborne particles, and surfaces upon which coatings of another material have been applied. Scientists who study the fracture surfaces of failed medical implants stand to benefit greatly from fractal analysis. The origin of failure is often damaged or lost during retrieval of a failed implant, and evaluation of the undamaged portions of the fracture surface by relying on the self-similarity property of fractals may allow one to deduce the conditions that were present at the failure origin at the moment of failure. If the analysis of material surfaces will be used as an engineering tool, then it is important to identify the analysis methods that yield the most precise and accurate estimates of surface dimension. Eleven algorithms for calculating the surface dimension are compared. A method for correcting the bias of dimension estimates is presented. The sources of error involved in atomic force microscopy, optical microscopy, mechanical sectioning, and fabrication of specimen replicas are discussed.",signatures:"Jason A. Griggs",downloadPdfUrl:"/chapter/pdf-download/55169",previewPdfUrl:"/chapter/pdf-preview/55169",authors:[{id:"197787",title:"Prof.",name:"Jason",surname:"Griggs",slug:"jason-griggs",fullName:"Jason Griggs"}],corrections:null},{id:"55238",title:"On the Indicatrixes of Waves Scattering from the Random Fractal Anisotropic Surface",doi:"10.5772/intechopen.68187",slug:"on-the-indicatrixes-of-waves-scattering-from-the-random-fractal-anisotropic-surface",totalDownloads:1723,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Millimeter and centimeter wave scattering from the random fractal anisotropic surface has been theoretically investigated. Designing of such surfaces is based on the modifications of non-differentiable two-dimensional Weierstrass function. Wave scattering on a random surface is interesting for many sections of physics, mathematics, biology, and so on. Questions of a radar location and radio physics take the predominating position here. There are many real surfaces and volumes in the nature that can be carried to fractal objects. At the same time, the description of processes of waves scattering of fractal objects differs from classical approaches markedly. There are many monographs in the world on the topic of classical methods of wave scattering but the number of books devoted to waves scattering on fractal stochastic surfaces is not enough. These results of estimation of three-dimensional scattering functions are a priority in the world and are important in radar of low-contrast targets near the surface of the earth and the sea.",signatures:"Alexander A. Potapov",downloadPdfUrl:"/chapter/pdf-download/55238",previewPdfUrl:"/chapter/pdf-preview/55238",authors:[{id:"197044",title:"Prof.",name:"Alexander",surname:"Potapov",slug:"alexander-potapov",fullName:"Alexander Potapov"}],corrections:null},{id:"54730",title:"Fractal Geometry and Porosity",doi:"10.5772/intechopen.68201",slug:"fractal-geometry-and-porosity",totalDownloads:1978,totalCrossrefCites:5,totalDimensionsCites:8,hasAltmetrics:0,abstract:"A fractal is an object or a structure that is self‐similar in all length scales. Fractal geometry is an excellent mathematical tool used in the study of irregular geometric objects. The concept of the fractal dimension, D, as a measure of complexity is defined. The concept of fractal geometry is closely linked to scale invariance, and it provides a framework for the analysis of natural phenomena in various scientific and engineering domains. The relevance of the power law scaling relationships is discussed. Fractal characteristics of porous media and the characteristic method of the porous media are also discussed. Different methods of analysis on the permeability of porous media are discussed in this chapter.",signatures:"Oluranti Agboola, Maurice Steven Onyango, Patricia Popoola and\nOpeyemi Alice Oyewo",downloadPdfUrl:"/chapter/pdf-download/54730",previewPdfUrl:"/chapter/pdf-preview/54730",authors:[{id:"93463",title:"Prof.",name:"Maurice",surname:"Onyango",slug:"maurice-onyango",fullName:"Maurice Onyango"},{id:"169258",title:"Dr.",name:"Patricia",surname:"Popoola",slug:"patricia-popoola",fullName:"Patricia Popoola"},{id:"199472",title:"Dr.",name:"Oluranti",surname:"Agboola",slug:"oluranti-agboola",fullName:"Oluranti Agboola"},{id:"202204",title:"Dr.",name:"Opeyemi Alice",surname:"Oyewo",slug:"opeyemi-alice-oyewo",fullName:"Opeyemi Alice Oyewo"}],corrections:null},{id:"54554",title:"Analysis and Application of Decaying Turbulence with Initial Fractal Geometry",doi:"10.5772/67942",slug:"analysis-and-application-of-decaying-turbulence-with-initial-fractal-geometry",totalDownloads:1762,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"In this paper, we address high‐Schmidt‐number (Sc) scalar turbulent mixing that results from grid‐generated turbulence using the initial fractal geometry of the velocity profile. More specifically, as was proposed in our recent study, we adopt an initial flow field generated by a fractal grid and apply it to a water channel experiment based on a high‐Sc‐number scalar‐mixing layer in order to create grid‐generated turbulence, and thus solve our current research problem. The high‐Sc‐number scalar and velocity fields of the grid‐generated turbulence are then measured using planar laser‐induced fluorescence (PLIF) and particle image velocimetry (PIV), respectively. By means of fractal analysis, this study specifically addresses the turbulent mixing phenomena in which the fractal dimension of the mixing interface of an observed high‐Sc‐number scalar field is calculated. Additionally, we discuss the efficiency of using fractal grids as devices for enhancing high‐Sc‐number scalar turbulent mixing by observing turbulent intensities and dissipation by PIV.",signatures:"Hiroki Suzuki, Shinsuke Mochizuki, Yasuhiko Sakai and Koji Nagata",downloadPdfUrl:"/chapter/pdf-download/54554",previewPdfUrl:"/chapter/pdf-preview/54554",authors:[{id:"13266",title:"Prof.",name:"Koji",surname:"Nagata",slug:"koji-nagata",fullName:"Koji Nagata"},{id:"13992",title:"Prof.",name:"Yasuhiko",surname:"Sakai",slug:"yasuhiko-sakai",fullName:"Yasuhiko Sakai"},{id:"198300",title:"Dr.",name:"Hiroki",surname:"Suzuki",slug:"hiroki-suzuki",fullName:"Hiroki Suzuki"},{id:"199150",title:"Prof.",name:"Shinsuke",surname:"Mochizuki",slug:"shinsuke-mochizuki",fullName:"Shinsuke Mochizuki"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6254",title:"Fractal 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"69161",title:"Ultrasonic-Assisted Cathodic Plasma Electrolysis Approach for Producing of Graphene Nanosheets",doi:"10.5772/intechopen.89267",slug:"ultrasonic-assisted-cathodic-plasma-electrolysis-approach-for-producing-of-graphene-nanosheets",body:'Over the past decades, graphene is one of the hottest topics in many research fields. Up to date, a numerous of possible technological applications using graphene has been explored for energy, storage, optoelectronics, energy conversion, solar cell, flexible devices, and photonics [1, 2, 3]. Graphene is currently prepared by two typical top-down and bottom-up approaches with their advantages and drawbacks. For instance, chemical vapor deposition, classified as a chemical method, is an outstanding method because graphene can be obtained with high quality. However, it needs specific substrates, high temperature and vacuum, and limited transfer requirement while producing fewer quantities due to the slow process [4]. In terms of top-down technique, the most commonly used Hummer’s method for graphite chemical exfoliation requires concentrated acids and strong oxidants for pretreating and is then followed by a sonication step [5]. Unfortunately, this method has a key bottleneck such as graphene structure containing many defects or functional groups, being time-consuming, and harsh oxidation condition. Furthermore, electrochemical exfoliation is emergently proven to be promising as a sustainable and green method for large-scale graphene production since it provides a single step and is user-friendly at moderate conditions [6].
Sonoelectrochemistry, an introduction of ultrasonic irradiation into electrochemical method, has become a potential approach for synthesizing nanomaterials owing to its simple step and being environmentally friendly [7]. Fundamentally, the generation of cavitation bubbles is initiated by the propagation of pressure waves in a fluid [8, 9], and the collapse of cavitation bubbles is rapidly happening (<μs) to create local “hot spots” with high local pressure (e.g., 10,000 atm) and temperature (e.g., up to 10,000 K) [10]. During this process, highly reactive radicals of H and OH· are engendered via homolysis of water as well as other surfactants or excited state species [11]. Due to the fact that bulk graphite involves several graphene sheets which are weakly bonded through van der Waals force, there is a great possibility for taking the advantage of a tremendous energy to break this force in graphitic structure. Although the electrochemical exfoliation [12, 13] and ultrasound-assisted exfoliation [14, 15] are extensively employed for preparation of graphene and its derivative, the review of ultrasound energy and cathodic electrochemical exfoliation process for high-yield graphene production has not been explored yet.
In this part, the experimental conditions and contemporary information for producing of graphene material are only considered, with a focus on combination of electrochemical exfoliation and sonochemistry approaches. In the following parts, we firstly present an overview of electrochemical exfoliation method, and the new technique consisting of cathodic exfoliation and sonochemistry will then be comprehensively discussed.
Electrochemical exfoliation is one of the top-down approaches using graphite electrode as graphene precursor, which can be categorized into anodic and cathodic methods based on the electric sign of the graphite electrode. Figure 1 displays the schematics of cathodic and anodic exfoliation mechanism. In both methods, the oppositely charged intercalating ions and the co-intercalating molecules were attracted when a charging process was generated at the working electrode [16].
Mechanism for exfoliation of graphite by cathodic and anodic methods [
In this method, layered carbon material is applied with a positive voltage, which drives the intercalation of negative ions existing in the electrolytic solution. Different solvents and electrolytes were employed for the exfoliation of graphene:
Using highly oriented pyrolytic graphite (HOPG) electrode, different protonic acids such as HCl, HBr, and H2SO4 were used for electrochemical exfoliation of graphene [6]. Among the mentioned acids, H2SO4 has proven to be an appropriate electrolyte due to the highest efficiency; however, the graphene nanosheets were produced with high defects/orders in their structure. In order to reduce this effect, the electrolyte was prepared by adding of 98% H2SO4 solution and 20% KOH solution into 10 ml water. The system was firstly applied with low voltage of +2.5 V for 1 min, and higher potential of switching between +10 and −10 V was then applied until sufficient exfoliated material is obtained. During the process, the voltage of +10 V activates the exfoliation and oxidizes the graphene flakes. The oxidized graphene is then reduced when the voltage changed back to −10 V. Figure 2 schematically illustrates the experimental setup, and the source of graphene acts as the anode for electrochemical exfoliation.
Experimental setup for exfoliation of graphite by electrochemical method.
In another work, H2SO4, H3PO4, and H2C2O4 were used as acidic electrolytes to synthesize graphene flakes using multiple electrochemical exfoliation (MEE) methods [13]. The process of synthesis graphene flakes from spent graphite rod is shown in Figure 3. In the electrochemical cell, the cathode platinum wire and the anode graphite rod were put at the top and the bottom, respectively. Upon applying a constant current at 0.1 A, the color of the solution changes gradually to black during the reaction time.
Experimental setup and mechanism for production of graphene by multiple electrochemical exfoliations [
Several mild acids (i.e., phosphoric, sulfuric, oxalic, acetic, and formic acids) were employed as electrolytes for exfoliation of graphite [13]. Meanwhile, no observable exfoliation was detected in formic and acetic acids, possibly due to its small anions (e.g., HCOO– and H3CCOO–), which results in delicate anion protection and weak expansion of graphite flakes due to ineffective intercalation of anion. Oxalic acid electrolyte is finally considered as the best choice because of its fast exfoliation and highly dispersed graphene in DI water. Furthermore, the product was easily purified by heating the exfoliated material in air.
There has been rare publication in electrochemical exfoliation of graphite in alkaline medium. A facile, environmentally friendly, and highly efficient exfoliation process was introduced by graphite electrolysis in a weak alkaline solution aqueous ammonium hydroxide (28–30 wt%) instead of acidic electrolyte or strong alkaline solution [17]. The graphite electrode was firstly subjected to an anodization treatment at 10 V for 30 min and subsequently treated by anodization at 10 or 5 V for 90 min. The exfoliation can be explained by the intercalation of nitrogen gas originating from the electrooxidation of ammonium hydroxide when electrolysis is performed in the alkaline electrolyte.
The formation of graphite intercalation compounds (GIC) was firstly done with sulfuric acid [6]; however, sulfate ions were then realized to play a decisive role as an intercalant because all neutral salts of (NH4)2SO4, Na2SO4, and K2SO4 exhibited pronounced exfoliation efficiency [12]. In addition, the superior activity of sulfate ions can be explained by its lower reduction potential to produce SO2 (i.e., +0.20 V). In contrast, ClO4− and NO3− ions have high reduction potentials of 1.42 and 0.96 V, respectively, to generate Cl2 and NO gases [12]. Therefore, it is suggested that graphite sheets are exerted with large and sufficient forces to isolate weakly bonded graphite layers from each other by SO2 and O2 gases generated in sulfate ion oxidation.
Due to very excellent intercalant role of sulfate anion, the organic derivatives of sulfate ion-sulfonates such as poly(sodium-4-styrenesulfonate), sodium dodecyl sulfate (SDS), and sodium dodecyl benzene sulfonate (SDBS) were also investigated for graphite exfoliation [18, 19, 20], which play a dual role of a surfactant as well as an intercalant. The additional advantage of using surfactants in the intercalation and exfoliation process is the stable graphene suspension production because surfactants can adsorb on the surface of produced graphene layers and prevent its reassembling [20]. Figure 4 describes how SDS with a concentration of 0.1M works during graphene intercalation from the anode of graphite and exfoliation from cathode of SDS-intercalated graphite [20].
Electrochemical method for graphene/SDS suspension production [
The cathodic exfoliation process for graphene production has been introduced by several groups [21, 22, 23, 24]. In this approach, the positive ions in electrolytes are intercalated into graphite interlayers by applying negative potential, which consequently facilitates their exfoliation. This process is accomplished by using either organic or aqueous solvents.
Wang et al. [21] used cathodic electrochemical exfoliation in liquid rechargeable lithium-ion batteries to prepare few-layer graphene flakes. They indicated that graphite interlayers can be intercalated by Li ions during the charging process. Subsequently, the complex was exfoliated to few-layer graphene flakes by sonication as shown in Figure 5A. They used a potential of −15 ± 5 V as cathodic charge in order to trigger off Li+ intercalation in graphite. The exfoliated graphene sheets had very low defects as confirmed by a small ID/IG ratio of 0.1 with of two to three layers of thickness and an average lateral size of 1–2 μm. Additionally, graphene nanosheets were directly obtained from electrochemical cathodic exfoliation under high negative voltages of 5–30 V using tetra-n-butylammonium (TBA) as organic electrolyte [22]. Yang et al. [22] have demonstrated that at the initial stage, the solvated TBA+ under highly negative voltage contributes to expand the layer spacing induced by the intercalation. The exfoliated graphene nanosheets exhibited high quality with the basal size of ~10 μm, three to six layers of thickness, and 0.34 nm of lattice spacing. In another example, a continuous of few-layer graphene production was developed by Abdelkader group [23] with mechanism displayed in Figure 5B. In their report, organic solvents and the electrolyte of lithium and alkylammonium ions (triethylammonium, Et3NH+) in dimethyl sulfoxide (DMSO) were used. Interestingly, they found that not only lithium ions but also Et3NH+ ions can be intercalated to enhance exfoliation efficiency. Furthermore, this cathodic exfoliation of graphite can avoid oxidation of graphite and decrease the defects, where few-layer graphene with no any oxidation and lateral size of 1–20 μm was produced without any sonication or centrifugation step, by using other kinds of intercalation ion such as AlCl4− and Al2Cl7−.
Schematics of (A) electrochemical cell for a continuous process [
Lei et al. [24] produced graphene from graphite cathode in AlCl3/EMImCl (1-ethyl-3-methylimidazolium chloride) ionic liquids using Al-ion battery. With voltage of >2.0 V, few-layer graphene can be achieved by cathodic electrolysis. The estimated mechanism for cathodic electrolytic exfoliation of graphite in ionic liquid is displayed in Figure 5C.
With a new term of direct cathodic exfoliation of graphite by plasma electrolysis, Thanh and his collaborators introduced a facile and rapid method to produce both graphite oxide and graphene nanosheets [25, 26]. Figure 6A shows the schematic of the experiment for producing plasma-electrochemically exfoliated graphene (PEEG) sheets, where high-purity graphite (HG) is employed for both the cathode and anode. The cathode tip is set above the aqueous electrolyte, while the anode is immersed in the electrolyte of KOH and (NH4)2SO4 solution. A voltage of 60 V is applied to the system by using a DC power when the tip of cathode is immersed about 1 mm in the electrolytic solution. It is noticed that the cathode has much smaller surface area contacting to the electrolyte than the anode. As a result, a high electric field is generated at the submerged cathode tip and produces hydrogen gas bubbles via hydrolysis of water. A plasma phenomenon around the cathode tip is formed by the instant ionization of hydrogen caused by high electric field surrounding the cathode tip.
(A) Experimental setup for plasma-electrochemically exfoliated graphene sheet production, (B) proposed PEEG formation mechanism, and (C) TEM image and Raman spectra of PEEG [
The mechanism for exfoliation of graphene sheets from graphite cathodic rod is displayed in Figure 6B, which attributed that the exfoliation process is cause by hydrolyzed hydrogen bubbles produced at the cathode. The explosion of hydrogen around the cathode tip expands its surface edge, which enables the insertion of hydrogen molecules into the interlayer of the graphite sheets to form intercalated graphite compounds. Simultaneously, the high temperature (e.g. ~2000°C) in instant time (e.g. nanosecond) on the cathode tip during the discharge process gives thermo-mechanical stresses on the graphite surface, which produces graphene nanosheets from graphite rod. On the other hand, graphene sheets can also be yielded from graphite rod by the electrochemical reaction occurring at the anode in a basic electrolyte medium. As a comparison, plasma-assisted electrochemical exfoliation process can produce graphene sheets with high efficiency of ~6 times faster than the conventional electrochemical method at applied voltage of 10 V. The produced material is graphene sheets with high quality as presented in the TEM image of Figure 6C. The structure transformation from graphite to graphene sheets can be confirmed by Raman spectra (Figure 6C), where the weak D band peak located at 1353 cm−1 is more pronounced than that in the spectrum of HG. Moreover, the 2D band peak of PEEG at 2706 cm−1 is shifted to lower frequency, while the intensity of PEEG is higher than that of HG. This confirms the produced graphene structure with ~2.5 μm in sheet lateral size and 2.5 nm in thickness. Interestingly, they also produced graphite oxide by this method in 2013 [25].
Cathodic plasma electrolysis, a combination of conventional electrolysis and plasma processes under ambient condition, employs a voltage that is much higher than that of traditional electrochemical method between two electrodes in an aqueous solution. Surface of one electrode, active electrode (workpiece, regardless of its role as anode or cathode), must be much smaller than that of the other. The method can be separated into anodic and cathodic plasma electrolysis (CPE) based on the opposition of applied voltage to the workpiece. Most of the researches have focused on the anodic regime of plasma electrolysis while little on the cathodic one [27]. CPE is principally based on the reaction or vaporization of electrolyte and the electrical breaking of gaseous envelope, resulting in the formation of sparks around the active electrode [27, 28, 29]. The comprehensive reviews of plasma electrolysis can be found in some excellent reviews [15, 25, 26].
The cathodic process has been applied for producing nitride, carbon, and other metals such as zinc, zinc-aluminum, molybdenum, and titanium-based coatings on the metal substrate [27, 28, 29, 30, 31]. The nanocrystalline graphite films on titanium substrate have been deposited by the cathodic plasma electrolysis from a predominant ethanol liquid phase [32, 33]. In fact, each layer of graphene in the bulk graphite is bound by weak van der Waals interactions to other two adjacent layers of hexagonally close-packed C atoms. Upon the impact on the surface as thermal extension or ultrasonication, it is readily exfoliated into separated graphene nanosheets. As a result, the plasma electrolysis phenomenon for production of graphene flakes and its derivatives is believed to be caused by the breaking of graphene layers from its bulk structure with weak van der Waals force.
Typically, using a mechanical mean such as ultrasonic after electrochemical intercalation and expansion of graphite is essential. During ultrasonication with pressure oscillations, the cavitation and shear forces, as well as the collapse of the bubbles or voids on liquid, could activate both graphite intercalation and expansion, which leads to a complete exfoliation. A new ultrasonic-assisted cathodic electrochemical discharge approach has been developed to exfoliate graphene nanosheets from graphite rod by using a combination of ultrasonic energy and in situ plasma-induced electrochemical exfoliation [15]. Without expensive ionic liquid or acidic media, this method revealed broad benefits such as direct production of graphene at ambient pressure and low temperature as well as a facile, environmentally friendly, and fast process. Figure 7 displays the experimental setup and an actual figure for production of ultrasonic-assisted in situ plasma-induced electrochemical exfoliation graphene (UPEEG).
Experimental setup for production of UPEEG: (1) cathode, (2) anode, (3) vapor plasma envelope, (4) ultrasonic cleaner; inset is image of cathodic electrochemical discharge phenomenon [
The formation of plasma at high voltage of 60 V is initiated by the reduction to from hydrogen gas at cathode (Eq. 1) and the oxidation to form oxygen at anode (Eq. 2):
At appropriate voltage, the electrolyte near graphite cathode is vaporized because of the high electric field created by sharp point of cathode. This releases vigorous hydrogen around the graphite cathode tip and forms plasma zone between the cathode tip and the electrolytic solution.
Results from XPS and Raman analyses (Figure 8A–C) show the successful production of graphene via this method. It is believed that the positive ions surrounding the interface of electrolyte and HG tip could be speeded up directionally toward the cathode surface to implode on expanded position and to instantly exfoliate graphite at this point for graphene formation. In addition, the proposed mechanism for UPEEG formation from graphite is related to the expansion of the graphite tip in the plasma zone, where the graphene sheets were formed under the ultrasonic-assisted condition (Figure 8D). The extremely high-temperature outermost cathodic tip in the plasma zone leads to the expanding and cracking of graphite surrounding with weakening van der Waals forces. In this case, the violent fluctuation in the vapor plasma envelope and the cavitation from the sonication are the main reasons for exfoliation of expanded layers. At first, the shear and shock wave in ultrasonic exfoliating fluid and the thermal expanded or cracked surface are engendered. Subsequently, the cavitation bubbles formed during sonication prompted the disturbance and pulling at the expanded and cracked points in the exfoliating fluid media. Next, the enlarged shear forces appear between neighboring layers and weaken van der Waals forces between layers. Finally, the expanded positions of the adjacent layers are penetrated and intercalated by the hydrogen atoms or ions, which consequently causes the breaking at these points and results in graphene exfoliation. Due to its high porosity of graphite lattice under high diffusion temperature, it can be diffused and intercalated by the hydrogen atoms. We think that this facile method will pioneer and create new possibilities for production of graphene sheets, graphite oxide, or doping graphene for a number of applications.
XPS C1s spectra of (A) HG and (B) UPEEG; (C) Raman spectra of HG and UPEEG; (D) proposed mechanism for the formation of graphene sheets [
Sonoelectrochemical exfoliation of graphite is a potentially scalable way to achieve high quality and high quantity of graphene production by using simple equipment that is almost available in all chemistry laboratories. From the point of technology view, the electrochemical exfoliation with the aid of ultrasonication is dual benefited not only to easy-to-break van der Waals forces but also to the effective inhibition of the agglomeration of produced graphene nanosheets. Moreover, the presence of ultrasonication herein can accelerate and promote the exfoliation process.
In this chapter, we discussed on the synthesis of high-quality graphene by direct ultrasonic-assisted cathodic electrochemical exfoliation process. Immense works have been done in order to control and enhance the yield and oxidation degree of graphene sheets. However, the yield of graphene sheets in a single layer is still relatively limited and requires long periods of sonication time with massive heat release into the environment. In the short run, the improvement and design optimization on reproducible protocol should be devoted to define the best condition for sonoelectrochemical exfoliation method. Besides, one might seem very presumably that the unreasonable reaction should be existed that taking into account for the formation and exfoliation of graphene nanosheets and their functional groups containing oxygen on the surface. The mechanism is still in its infancy and should be unveiled in the near future to pave the way for controlling of graphene production and its derivatives. Therefore, we hope this chapter will contribute critical insights for understanding the graphene synthesis and hence can open an alternative approach toward 2D materials in general and graphene material in specific.
For optimal erythropoietic function, oxidative metabolism and cellular immunity, iron is required. Cellular iron overload induces toxicity and cell death by producing free radicals and oxidising lipids, both of which are required for cellular metabolism and aerobic respiration. Due to the lack of active iron excretory mechanisms, dietary iron absorption (12 mg/day) is tightly regulated and closely balanced against iron loss. Dietary iron is found in two forms: haem (10%) and nonhaem (ionic, 90%), and both are absorbed in the apical surface of duodenal enterocytes through different mechanisms. Iron is exported via Ferroportin 1 (the only one). Absorbed iron crosses the enterocyte’s basolateral membrane into the circulation (possible iron exporter), where it binds to transferrin and is transported to utilisation and storage sites transferrin-bound iron enters target cells via receptor-mediated endocytosis, mostly erythroid cells but also immune and hepatic cells. Senescent erythrocytes are phagocytosed by reticuloendothelial system macrophages; haem is metabolised by haem oxygenase, and the freed iron is stored as ferritin. Later, iron from macrophages will be exported and transferred to transferrin. The erythropoiesis demands (20e30 mg/day) need this internal iron cycle. When transferrin becomes saturated in iron-overload scenarios, excess iron is transported to the liver, the other principal storage organ for iron, creating a risk of free radical generation and tissue damage [1].
The fact that iron’s redox pair (Fe(II)/Fe(III) may have potentials varying from −300 to 700 mV, depending on the nature of the ligands and the surrounding environment, contributes to its use. Iron is abundant on the planet’s surface; however, it is relatively inaccessible. This is an important aspect of iron metabolism. At neutral pH and in an oxidising environment, iron exists in the three valence state, which is seen in many common microbial environments. As a result, it is extremely difficult to dissolve. The presence of iron storage and transport proteins such as ferritin (FTN), lactoflavin (LFT) and lactoflavin (LFT) limits the amount of iron available to a microorganism residing in an animal host (LFT). Despite the fact that extremely low iron concentrations of 1 mmol (5) are usually sufficient for optimal growth yields, bacteria frequently find themselves in iron-deficient environments and must waste a significant amount of energy to acquire this metal. It is also worth mentioning that bacteria can become iron-overloaded, necessitating careful monitoring of iron intake [1, 2].
Increased iron demands, insufficient external supply and increased blood loss can contribute to iron deficiency (ID) and iron deficiency anaemia. An overabundance of hepcidin hinders iron absorption and recycling in chronic inflammation, leading to hypoferremia and iron-restricted erythropoiesis (functional iron deficiency), and finally, anaemia of chronic illness (ACD), which can advance to ACD with real ID (ACD + ID). Hereditary haemochromatosis (HH type I, caused by mutations in the HFE gene) and hereditary haemochromatosis (HH type II, caused by mutations in the hemojuvelin and hepcidin genes) can both be caused by low hepcidin expression. Changes in the transferrin receptor 2 generate HH type III, whereas mutations in the ferroportin gene induce HH type IV. All of these illnesses show signs of iron excess. In iron overload scenarios, non-transferrin bound iron develops when transferrin becomes saturated. A part of this iron (labile plasma iron) is very reactive, leading to the generation of free radicals. Free radicals induce the parenchymal cell damage associated with iron overload disorders [3].
The teeth, gingiva, oral tissues and muscles are all affected by these major metabolic anomalies of iron metabolism. These processes influencing the oral cavity must be well understood in order to block future advancement and create a comprehensive rehabilitation approach for such persons, taking into consideration the numerous consequences of improper iron metabolism [4].
Owing to certain specific mechanisms (as explained inFigure 1): (1) transport mechanisms were not required for iron absorption until relatively late in evolution when the environment became oxidising and iron became insoluble, and (2) a range of sources can function as iron providers, bacterial iron assimilation happens via a variety of routes. Many bacteria, in addition, have numerous iron absorption mechanisms. This allows them to acquire iron from a variety of settings and sources. Bacteria can get iron from a number of sources, but regardless of where it comes from, it must be delivered to the cytoplasm through numerous microbial surface layers. An outside membrane, a peptidoglycan layer, and an innermost intracellular membrane are the minimum layers for Gram-negative bacteria. The periplasm, or gap between the outer and inner membranes, is where the peptidoglycan cell wall is found. Gram-positive cells, on the other hand, may only have an exterior peptidoglycan cell wall that is thick and strongly cross-linked. On the basis of the iron source and the manner in which iron is mobilised, a wide range of iron transport systems may be differentiated, although they all follow a similar pattern. Passage across the outer membrane for iron complexed to a carrier requires the presence of an outer membrane receptor protein with a syntactic domain identical to that of the iron complexed to a carrier and is iron-controlled. A receptor protein is specialised for and binds to a certain iron-carrier complex, and it is occasionally generated in large quantities only when that iron complex is accessible [5].
Gram-negative bacteria’s generalised high-affinity iron transport mechanism.) The three fundamental components are shown: (a) an outer membrane receptor protein; (b) a TonB system for activating the receptor protein; and (c) a cytoplasmic membrane-based periplasmic binding protein-dependent ABC transporter. OM stands for outer membrane; PG is for peptidoglycan; and CM stands for cytoplasmic membrane.
Second, the cytoplasmic membrane proteins TonB, ExbB and ExbD are required for iron entry into the periplasm, whether it is complexed or free. Members of the ABC super transporter family are also engaged in cytoplasmic membrane transport. The transport components, in this case, include a peripheral cytoplasmic membrane, ATPase with two copies and a distinct ATP-binding site motif, as well as two hydrophobic cytoplasmic membrane proteins. In summary, an outer membrane receptor protein, a TonB system and an ABC transporter are required for iron entrance into the cytoplasm of Gram-negative bacteria. The proton-motive force and ATP, respectively, are required for passage across the outer and cytoplasmic membranes. TonB systems have broad specificity, whereas ABC transporters recognise several iron complexes if they are physically related. Outer membrane receptor proteins bind just one particular iron complex, whereas TonB systems have broad specificity [6].
The synthesis and secretion of tiny (600–1000 Da) iron-chelating molecules known as siderophores is a significant method by which bacteria acquire iron. Siderophores are made up of ordinary amino acids, nonprotein amino acids, hydroxy acids, and their production does not need ribosomes despite the presence of amide bonds. Instead, a thiotemplate technique is used, which is quite similar to the one used to make some peptide antibiotics. The mechanism of iron release from siderophores is unknown. Free siderophores, or modified forms, are discharged into the medium when ferrisiderophores enter the cytoplasm. Enzymatic reduction of iron is considered to be the release mechanism since siderophores: (1) bind Fe(II) less readily than Fe(III); and (2) the cytoplasm is a reducing environment [7].
Microbes that can live in oxygen-depleted habitats, such as swamps, intestines and marshes, or acidic environments, where reduced iron is stable and soluble, benefit from the ferrous iron transfer. Fe(II) may enter the periplasm through holes in the outer membrane, and bacteria can transport it through the inner membrane through a number of mechanisms. Some of these cytoplasmic membrane transporters have a broad transition metal selectivity but just a weak affinity for ferrous iron. There are, however, systems that exclusively work with Fe(II) as a substrate. The feo operon encodes one such mechanism that is important in certain bacteria (feoABC) [8]. Members of the OFeT (oxidase-dependent iron transporter) family, which were initially discovered in lower eukaryotes, are another widely dispersed group of Fe(II) transporter proteins. Finally, certain aerotolerant bacteria, such as the Gram-positive
The bulk of iron in animals is found intracellularly in the form of heme (Hm). Hm, in turn, is a prosthetic group of proteins that includes haemoglobin (Hb), myoglobin and Hm-containing proteins like cytochromes. Iron assimilation routes that detect free Hm are similar to those that identify iron–siderophore complexes; they need (1) a TonB-dependent outer-membrane receptor protein; and (2) an ABC transporter for cytoplasmic membrane crossing [10]. Hm can be removed from Hb by a variety of genera. TonB-dependent Hb-binding proteins are found in the outer membranes of Neisseria and Haemophilus spp. Surprisingly, both of these taxa contain additional TonB-dependent receptors that let them get iron from Hb–Hp complexes. These Hb–Hp receptors might be made up of two distinct proteins.
Iron trafficking exemplifies the cycle economy. During erythrocyte phagocytosis, the majority of iron (20–25 mg/day) is recycled by macrophages; only 1–2 mg of iron is absorbed daily in the stomach, compensating for a loss of the same amount (Figure 2) [13]. The duodenum is the location of controlled non-heme iron uptake; nonheme iron is imported from the lumen via the apical divalent metal transporter 1 after duodenal cytochrome B reductase converts ferric to ferrous iron (DCYTBH) (DMT1). There are no known mechanisms by which heme iron absorbs more than non-heme iron. Non-utilised iron in enterocytes is either retained in ferritin (and lost by mucosal shedding) or exported to plasma through basolateral membrane ferroportin (and lost with mucosal shedding) [14].
On the luminal side of the enterocyte, the metal transporter DMT1 takes up ferrous iron that has been reduced by DCYTB. After ferrous iron is oxidised to ferric iron by hephaestin, iron not utilised inside the cell is either stored in ferritin (FT) or exported to circulating transferrin (TF) by ferroportin (FPN) (HEPH). Local hypoxia stabilises hypoxia-inducible factor (HIF)-2, which promotes the expression of the apical (DMT1) and basolateral (FPN) transporters. Heme is transformed to iron by heme oxygenase once it enters the cell by an unknown process [
Iron availability influences the expression of genes that code for proteins required for high-affinity iron absorption. Fur is a crucial regulatory protein found in most Gram-negative and Gram-positive bacteria with low GC content DNA. Fur is an Apo-repressor, a short histidine-rich polypeptide that binds DNA in the presence of its corepressor Fe(II). Fur’s negative regulation of genes does not fully explain iron’s regulatory actions. Although Fur represses most iron-regulated genes under iron-rich environments, some are positively controlled by Fur, and others are only activated by iron in the absence of Fur (Figure 3) [15].
Main iron metabolism routes in animals (based on Munoz et al.2). Key: 1, ferrireductase; 2, divalent metal transporter (DMT1); 3, haem protein carrier 1 (HPC1); 4, haem oxygenase; 5, haem exporter; 6, ferroportin (Ireg-1); 7, hephaestin/caeruloplasmin; 8, transferrin receptor-1 (TfR1); 9, transferrin receptor-1 (TfR1) complex; 10, natural resistance macrophage protein-1 (Nramp-1); 11, mitoferrin; 12, mitochondrial haem exporter (Abcb6); 13, others: bacteria, lactoferrin, haemoglobinehaptoglobin, haemehaemopexin, and so on; 14, caeruloplasmin; 15, transferrin receptor-2 (TfR2).
Transferrin binds to iron in the bloodstream and distributes it to storage and use sites. Only 30–40% of transferrin’s iron-binding capacity is used in ordinary physiological circumstances; hence, transferrin-bound iron is only w4 mg, yet it is the most significant dynamic iron pool. Transferrin-bound iron penetrates target cells, predominantly erythroid cells, but also immune and hepatic cells, via a highly specialised method of receptor-mediated endocytosis (Figure 1). Patches of cell-surface membrane bearing receptor–ligand complexes invaginate to create clathrin-coated endosomes as distinct transferrin binds to transferrin receptor 1 (TfR1) at the plasma membrane (siderosomes) [16]. A ferrireductase reduces Fe3+ to Fe2+, which is subsequently transferred to the cytoplasm by DMT1, while TfR1 is recycled to the cell membrane and transferrin is lost. Mitoferrin, a mitochondrial iron importer, is important in providing iron to ferrochelatase for insertion into protoporphyrin IX and to produce haem (the penultimate step of mitochondrial haem production) within the erythroblast (Figure 1). There are some indications that iron might be transported straight from the siderosomes to the mitochondria in growing erythroid cells. Finally, haem exporters transport haem from mitochondria to cytosol and eliminate excess haem from erythroid cells (Figure 1) [16].
As senescent erythrocytes are phagocytosed by RES macrophages, haemoglobin iron turnover is high. Haem is metabolised by haem oxygenase within the phagocytic vesicles, and the liberated Fe2+ is transported to the cytoplasm by NRAMP1 (natural resistance-associated macrophage protein-1), a transport protein related to DMT1 (Figure 1). Macrophages may also acquire iron from bacteria and apoptotic cells, as well as from plasma via the actions of DMT1 and TfR1 (Figure 1) [17]. Iron may be stored in the cells in two ways: ferritin in the cytosol and haemosiderin in the lysosomes when ferritin is broken down. Haemosiderin is found in just a small percentage of normal human iron reserves, primarily in macrophages, but it rises substantially when the body is overloaded with iron. Iron storage in macrophages is also safe since it does not cause oxidative damage. Ferroportin 1, the same iron-export protein found in the duodenal enterocyte, and caeruloplasmin2 are largely responsible for iron export from macrophages to transferrin (Figure 1) [18]. Macrophage iron recycling provides the majority of the iron necessary for the daily synthesis of 300 billion red blood cells (20–30 mg). While a result, internal iron turnover is required to satisfy the bone marrow needs for erythropoiesis, as daily absorption (1–2 mg) only balances daily loss. 1–3 The liver is the other major iron storage organ, and the production of free radicals and lipid peroxidation products in iron-overload conditions can lead to hepatic tissue damage, cirrhosis, and hepatocellular cancer [19]. TfR1 and TfR2 mediate the liver’s absorption of transferrin-bound iron from plasma (Figure 1), however, it can also get iron from non-transferrin-bound iron (through a carrier-mediated mechanism similar to DMT1), ferritin, haemoglobine–haptoglobin complexes, and haeme–haemopexin complexes. Ferroportin 1 is thought to be the sole protein that mediates the export of iron from hepatocytes, which is then oxidised by caeruloplasmin and attached to transferrin2 (Figure 1). Heart failure is the primary cause of death in individuals with untreated hereditary haemochromatosis or transfusion-associated iron overload, thus iron storage in cardiomyocytes is of significant interest. Excess iron in cardiac cells can cause oxidative stress and impair myocardial function owing to DNA damage caused by hydrogen peroxide via the Fenton reaction [20].
Body iron reserves, hypoxia, inflammation and erythropoiesis rate all influence iron absorption by duodenal enterocytes. The crypt programming model and the hepcidin model are two regulatory models that have been presented as potential contributors to iron absorption control [21].
Enterocytes in the crypts of the duodenum take up iron from the plasma via TfR1 and TfR2, according to the crypt programming hypothesis. The interaction of cytosolic iron regulatory proteins (IRPs) 1 and 2 with iron-responsive elements is controlled by intracellular iron content (IREs). IRP1 binds to the IREs of TfR1, DMT1, and ferroportin 1 mRNA in the absence of iron, stabilising the transcript, allowing translation to occur and the proteins to be synthesised. As a result, increased IRP-binding activity indicates low body iron reserves, which leads to overexpression of these proteins in the duodenum, boosting dietary iron absorption. When IRPs attach to ferritin mRNA’s IREs, the transcript’s translation is interrupted and synthesis is halted. As a result, ferritin concentrations are inversely controlled, increasing in iron-rich states and decreasing in iron-deficient conditions [22].
The hepcidin model proposes that hepcidin is produced mainly by hepatocytes in response to the iron content of the blood. Then, hepcidin is secreted into the bloodstream and interacts with villous enterocytes to regulate the rate of iron absorption by controlling the expression of ferroportin 1 at their basolateral membranes. The binding of hepcidin to ferroportin 1 initially causes Janus kinase 2-mediated tyrosine phosphorylation of the cytosolic loop of the carrier protein, phosphorylated ferroportin 1 is then internalised, dephosphorylated, ubiquitinated and ultimately degraded in the late endosome/lysosome compartment. Ferroportin 1 molecules, present in macrophages and liver, also targets for hepcidin [23].
The sensing process most likely includes local iron-induced synthesis of bone morphogenic proteins (BMPs) such as BMP6 within normal iron concentration limits. BMP6 interacts with hepatocyte cell surface BMP receptors (BMPRs) I and II, as well as the BMP coreceptor, haemojuvelin (HJV), triggering an intracellular signal by phosphorylation of small mothers against decapentaplegic (Smad) proteins. Before translocating to the nucleus and triggering hepcidin expression14, phosphorylated Smad1, Smad5 and Smad8 form a complex with the shared mediator Smad4 (Figure 2). The soluble form of HJV (sHJV), whose release (HJV shedding) is prevented by rising extracellular iron concentrations, is thought to compete with its membrane-anchored counterpart for BMPR binding, resulting in iron-sensitive hepcidin expression16 (Figure 2). Other mediators and modulators, including Smad6 and Smad7, may be stimulated by iron, and these mediators and modulators appear to dampen the signal for hepcidin activation (Figure 2) [24].
Cancer, rheumatoid arthritis, inflammatory bowel disease, congestive heart failure, sepsis and chronic renal failure are all known to induce persistent inflammation. This anaemia might be caused by the underlying process activating the immune system, as well as immunological and inflammatory cytokines such as tumour necrosis factor alpha (TNFa), interferon-gamma (IFNg), interleukins (IL) 1, 6, 8, and 10. Several pathophysiological processes (cytokines) may be implicated in anaemia of chronic disease (ACD) (Figure 3) [25]:
Dyserythropoiesis, red blood cell destruction, and increased erythrophagocytosis cause a reduction in red blood cell half-life (TNFa).
Inadequate EPO responses for the degree of anaemia in most, but not all, patients, such as those with juvenile chronic arthritis with systemic start (IL-1 and TNFa).
Erythroid cell response to EPO is impaired (IFNg, IL-1, TNFa, hepcidin).
Erythroid cell growth and differentiation are slowed (IFNg, IL-1, TNFa, and a1-antitrypsin).
Pathological iron homoeostasis caused by increased DMT1 (IFNg) and TfR (IL-10) expression in macrophages, decreased ferroportin 1 expression in enterocytes (inhibition of iron absorption) and macrophages (inhibition of iron recirculation), and increased ferritin production ‘(TNFa, IL-1, IL-6, IL-10) (increased iron storage) Inflammatory cytokines like IL-6’ activate Janus kinases, which phosphorylate Stat3 and activate it, which upregulate hepcidin transcription. Stat3 translocation to the nucleus and binding to the Stat response element in the proximal promoter of the hepcidin gene leads to enhanced hepcidin release. This element appears to be controlled by Smad activation, which is necessary for complete promoter activity, via the adjacent BMP-responsive element. The SmadeStat complex, which puts the distal and proximal areas of the hepcidin promoter into physical contact, is hypothesised to interact with a distal BMP responsive element location. As a result, it appears that Smad signalling is critical for the appropriate staging of the inflammatory response. Stat3 activation has also been demonstrated to modulate hepcidin levels without producing inflammation (for example, people with glycogen storage disease type 1a who had hepatic adenomas overexpressed hepcidin due to Stat3 activation)46 (Figure 2). Stress mechanisms signalling through the cellular endoplasmic reticulum unfolded protein response have also been shown to stimulate hepcidin production. The hepatic acute-phase response to LPS, IL-6 and IL-1b has been related to the unfolded protein response, suggesting that hepcidin gene expression may be regulated by another layer of endogenous regulation during inflammation (Figure 2). Low blood iron and reduced transferrin saturation are produced by iron diversion to the RES (functional iron deficit, FID), iron-restricted erythropoiesis, and mild-to-moderate anaemia, despite normal or high serum ferritin levels [26].
In the human body, there is a balance between iron absorption, iron transit and iron storage under physiological circumstances. ID and iron deficiency anaemia (IDA) can be caused by a combination of three risk factors: higher iron needs, restricted external supply and increased blood loss [27]. There are two types of ID: absolute and functional. Iron reserves are reduced in absolute ID; in functional iron deficiency (FID), iron stores are full but cannot be mobilised as quickly as needed from the RES macrophages to the bone marrow. Diagnostic tests with values are given in Table 1.
Laboratory tests | Conventional units |
---|---|
Serum Iron | 50–150 ug/dl |
Transferrin | 200–360 mg/dl |
Transferrin Saturation | 20–50% |
Ferritin (Ft) | 30–300 ng/ml |
Soluble transferrin receptors | 0.76–1.76 mg/l |
Ratio of sTfR to Serum Ft | <1 |
Haemoglobin | 12–16 g/dl (women); 13–17 g/dl (men) |
MCV | 80–100 fl |
Red Cell Distribution | 11–15 |
MCH | 28–35 pg |
Hypochromic red cells | <5% |
Reticulocyte haemoglobin content | 28–35 pg |
Depicting tests required for determination of iron metabolism anaemia.
Patients with low Hb (13 g/dl for males and 12 g/dl for women), TSAT (20%) and ferritin (30 ng/ml) concentrations but no indications of inflammation should be evaluated to have IDA. Instead of ‘mean corpuscular volume (MCV)’, the MCH has emerged as the most significant marker for red cells for identifying ID in RBCs, which are circulating (Figure 1). MCV is a generally available and reliable measurement, although it is a late indication in individuals who are not bleeding actively [28]. When MCV is low, thalassaemia must be considered a differential diagnosis. When there is a concurrent folate deficiency or vitamin B12, reticulocytosis post-bleeding, early response to oral iron therapy, alcohol use, or moderate myelodysplasia, individuals may present with IDA but no microcytosis. Human serum contains a shortened, ‘soluble version of the transferrin receptor (sTfR)’, whose concentration is proportional to the total number of cell surface transferrin receptors [29]. Although the amount is not defined and depends on which reagent kit is used, normal median values are 1.2–3.0 mg/l. Even during chronic illness anaemia, increased sTfR values suggest ID. Elevated erythropoietic activity without ID, during reticulocytic crises, and in congenital dyserythropoietic anaemias are all examples of increased sTfR levels. Lower sTfR levels, on the other hand, might indicate a reduction in the number of erythroid progenitors. Despite the fact that sTfR levels in simple IDA are generally high or extremely high, they are not usually necessary for diagnosis [30].
The following should be present in patients with chronic disease anaemia (ACD), also known as anaemia of inflammation: Hb concentration of 13 g/dl for men and 12 g/dl for women; a low TSAT (20%) but normal or increased serum ferritin concentration (>100 ng/ml) or low serum ferritin concentration (30e100 ng/ml) Evidence of chronic inflammation (e.g. elevated CRP); and a s ACD, like FID, is common in people with inflammatory illness but no visible blood loss (e.g. rheumatoid arthritis, renal failure or chronic hepatitis) [31].
Levels of Hepcidin are excessively lower-degree of overload of iron in idiopathic iron overload illness and primary haemochromatosis. This is due to mutations in the genes that code for ‘HFE (haemochromatosis type 1)’, ‘haemojuvelin (HJV; juvenile haemochromatosis 2a)’, and ‘transferrin receptor 2 (TfR2; haemochromatosis type 3)’; these mutations cause hepcidin synthesis to be dysregulated [32]. The only exceptions are mutations that disrupt hepcidin or ferroportin (juvenile haemochromatosis 2b) (haemochromatosis type 4). Low plasma hepcidin causes high ferroportin levels, allowing for greater iron absorption, hepatic iron overload and low iron levels in macrophages. In addition, non-transferrin bound iron emerges as transferrin gets saturated in iron-overload situations. A portion of this labile plasma iron is extremely reactive, resulting in the production of free radicals. Despite the fact that the HFE gene has at least 32 mutations, the most prevalent form of haemochromatosis type 1 is caused by the missense Cys282Tyr mutation. Haemochromatosis type 1 is a disease with a wide range of penetrance and heterogeneity, although the Cys282Tyr mutation is found in the great majority of people with the disorder. Because the Cys282Tyr mutant HFE protein is unable to bind b2 microglobulin, it does not reach the cell membrane, resulting in a misfolded, non-functional protein. Iron overload can be caused by mutations in the ferroportin gene (haemochromatosis type 4) that result in the loss of iron-export capacity, hyperferritinaemia with no increase in transferrin saturation, and macrophage iron overload, or a loss of hepcidin-binding activity, which has been linked to iron overload. Plasma hepcidin levels rise in cases of secondary iron overload-induced by persistent transfusion treatment (e.g. severe thalassemia, aplastic anaemia, etc.), prompting ferroportin breakdown. Increased amounts of diferric transferrin, which are elevated in iron overload, promote TfR2 expression at the hepatocyte membrane. When diferric transferrin binds to TfR2, HJV cleavage by furin is blocked, inhibiting the release of soluble HJV and resulting in enhanced cell-surface HJV-mediated response to BMPs and higher hepcidin levels. Iron absorption from the stomach is restricted, macrophage export is inhibited, and iron storage is increased when ferroportin levels are low [33].
Measurements indicating iron depletion in the body and measurements indicating iron-deficient red cell production are the two types of laboratory tests used to investigate ID (Table 1). The right mix of these blood tests will aid in determining the precise diagnosis of anaemia and ID status (Figure 1).
The first step in diagnosing iron overload is to suspect it (e.g. dark skin, fatigue, arthralgia, cardiomyopathy, hepatomegaly, endocrine disorder, etc). However, aberrant TSAT (>45 per cent) and/or elevated ferritin in serum (>200 ng/ml in women, >300 ng/ml in males) are commonly discovered. In practice, normal transferrin saturation can be used to rule out the possibility of iron overload. The sole exception is the occurrence of an inflammatory state, which might disguise an increase in TSAT, which is why CRP and transferrin saturation should be checked jointly. In non-iron-overload circumstances, such as significant cytolysis (eg. acute hepatitis), which raises plasma serum iron and/or hepatic failure, reduces plasma transferrin concentrations, elevated TSAT can be detected. Other causes of hyperferritinaemia should be checked out in the presence of elevated ferritin in serum but not increased TSAT (eg. cell necrosis, alcohol, inflammation, metabolic disorder, etc). The clinical context, as well as testing Hb (to rule out chronic inflammatory anaemia), transaminases, cancer and prothrombin index, can readily remove any difficulties in interpreting TSAT readings (to exclude hepatic disease) [34].
The second diagnostic step, particularly in Caucasian individuals, is to rule out HFE mutations in gene. Because further mutations in HFE are exceedingly rare, the HFE genotype is frequently regarded as ‘wild type’ in clinical practice, once the presence of the two most prevalent (Cys282Tyr and His63Gly) mutations has been ruled out. Nonetheless, the potential of a family problem should be addressed at all times: a dominant disorder is usually indicative of ferroportin disease [35].
Before beginning costly and time-consuming searches for mutations in additional genes, the third diagnostic step is to establish increased total body iron. The exact molecular diagnosis, which needs evidence of the nucleotide mutation at the DNA level, is the fourth stage. However, the efficacy of molecular diagnostics is frequently questioned because it is costly, time-demanding and, in certain situations, unable to produce a precise diagnosis [36].
The most prevalent kind of anaemia is iron deficiency anaemia (IDA), which affects more women than males. Due to persistent blood loss associated with heavy menstrual flow, it is estimated that 20% of women of reproductive age in the United States are iron deficient. Furthermore, 2% of adult males are iron deficient due to persistent blood loss caused by gastrointestinal illnesses including peptic ulcer, diverticulosis, or cancer [37].
Atrophic glossitis (AG), extensive oral mucosal atrophy and pain or burning feeling of the oral mucosa are some of the oral symptoms and indicators. However, it is yet unknown if IDA patients may experience distinct oral signs and, if so, what percentage of IDA patients experience these oral manifestations. Burning sensation of the oral mucosa (76.0 per cent), lingual varicosity (56.0 per cent), dry mouth (49.3%), OLP (33.3 per cent), AG (26.7 per cent), RAU (25.3 per cent), numbness of the oral mucosa (21.3 per cent) and taste dysfunction (12.0 per cent) were the most commonly manifested oral manifestations. IDA patients had considerably greater rates of all oral symptoms, such as oral mucosa burning, lingual varicosity, dry mouth, oral mucosa numbness, and taste impairment than healthy controls.
Anaemia sufferers have low haemoglobin levels, which means they do not get enough oxygen to their mouth mucosa, causing it to atrophy. Iron deficiency can induce oral mucosa atrophy because iron is required for proper oral epithelial cell activity, and in an iron deficiency condition, oral epithelial cells turn over more quickly, resulting in an atrophic or immature mucosa. The health of the oral epithelium is linked to iron and vitamin B12.
In BMS patients, long-term dry mouth and iron or vitamin B12 deficiency may produce at least partial atrophy of the tongue epithelium, however, the change is so mild that clinical visual examination cannot detect it. As a result, spicy chemicals in saliva might readily permeate past the atrophic epithelium into the subepithelial connective tissue of the tongue mucosa, irritate free sensory nerve endings, and cause tongue burning and numbness. A minor sign of BMS was loss or malfunction of taste. Because the taste cells in taste buds can only sense dissolved compounds, the chemical components should be dissolved in saliva.
The majority of BMS patients were found to have xerostomia. In BMS patients, decreased saliva output leads to a loss or malfunction of taste. Oral candidiasis, vitamin B12 insufficiency, iron deficiency and medicine have all been linked to taste loss or malfunction. Femiano et al. have looked into the causes of taste disturbance in BMS patients. Of the 142 BMS patients, 61 had a documented history of drug use that interfered with taste perception, 35 had pathologies or a past history of drug use that were known to impact the gustatory system, and the other 46 had no related disease or regular drug use [38].
Varicosities are abnormally dilated, and convoluted veins are observed on the ventral surface of the tongue in elderly people due to a decrease in connective tissue tone that supports the veins. Furthermore, xerostomia is a prevalent issue that affects 25% of the elderly population. Xerostomia can be caused by a variety of developmental, iatrogenic, systemic and local causes. Older individuals, on the other hand, are more likely to develop xerostomia, as a result of pharmaceuticals, as they are more likely to use drugs that induce xerostomia to treat their systemic or psychotic diseases. The average age of 399 BMS patients in Wang Y et al’s research was 59.7 years. As a result, it is not unexpected that 92.5 per cent of 399 BMS patients had lingual varicosity and 75.7 per cent had dry mouth. Oral candidiasis is more common in persons with xerostomia because normal and adequate saliva can offer cleaning and antibacterial action. We believe that the candidiasis on the tongue surfaces of BMS patients is attributable, at least in part, to the high prevalence of dry mouth (75.7%).
In most therapeutic situations, oral iron supplementation is sufficient. In the absence of inflammation or severe continuous blood loss, oral iron, usually in the form of ferrous salts, can be used to treat anaemia if large dosages are tolerated. Although traditional knowledge holds that up to 200 mg of elemental iron per day is necessary to treat IDA, this is erroneous and lesser amounts can be effective as well.
Early research suggested that taking iron with vitamin C might help with iron absorption because more ferrous iron is kept in the solution. However, findings suggest that co-administration of these drugs might cause serious toxicity in the gastrointestinal tract. Furthermore, while taking oral iron away from meals is often suggested to increase absorption, it also increases gastric intolerance, which reduces compliance. Furthermore, some antibiotics (primarily quinolones, doxycycline, tetracycline, chloramphenicol, or penicillamine), proton pump inhibitors, and anti-acid medication (aluminium, bicarbonate, zinc, or magnesium salts), levodopa, levothyroxine, cholestyramine, phytates (high-fibre diets), soy products, ibandronate, etc.
Non-absorbed iron salts, on the other hand, can produce a variety of highly reactive oxygen species, such as hypochlorous acid, superoxides and peroxides, which can cause digestive intolerance, resulting in nausea, flatulence, abdominal pain, diarrhoea or constipation and black or tarry stools, as well as relapsed inflammatory bowel disease. As a result, smaller iron salt dosages (e.g. 50–100 mg elemental iron) should be advised. The Ganzoni method may be used to determine the total iron deficiency (TID): TID (mg) 14 weight (kg) 3 (ideal Hb e actual Hb) (g/dl) 3 0.24 + depot iron (500 mg). An individual, weighing 70 kg, with a haemoglobin level of 9 g/dl would have a body iron shortfall of around 1400 mg, according to this calculation.
Parenteral iron is traditionally used to treat intolerance, contraindications, or an insufficient response to oral iron. However, in circumstances when there is a limited time until surgery, severe anaemia, especially if it is accompanied by considerable continuous bleeding or the use of erythropoiesis-stimulating drugs, parenteral iron is now an effective therapy. Because they provide various benefits over oral supplements, modern intravenous iron formulations have emerged as safe and effective options for anaemia therapy. In normal persons, intravenous iron delivery allows for a fivefold erythropoietic response to substantial blood loss anaemia,19 Hb begins to rise after a few days, the percentage of responsive patients increases, and iron reserves are replenished. Increasing iron reserves is beneficial, especially for patients using erythropoiesis-stimulating drugs. In clinical practice, iron gluconate, iron sucrose, high molecular weight iron dextran (HMWID), low molecular weight iron dextran (LMWID), ferric carboxymaltose, iron isomaltoside 1000 and Ferumoxytol are the most commonly used products.
The link between oral microbiota and IE (infectious endocarditis) has long been known. Infectious endocarditis is caused by opportunistic infections in normal oral flora entering the circulation through everyday mouth washing or invasive dental treatments. In vitro iron deficiency causes a dramatic change in the oral microbiota community, with higher proportions of taxa linked to infective endocarditis. Iron deficiency anaemia is utilised as an in vivo model to evaluate the association between insufficient iron availability, oral microbiota, and the risk of IE, as well as to perform population amplification research. In a research by Xi R et al., 24 patients with primary iron deficiency anaemia (IDA) from the haematology department of West China Hospital, Sichuan University, and 24 healthy controls were included from 2015.6 to 2016.6. The dental plaque microbiota of 24 IDA (iron-deficiency anaemia) patients and 24 healthy controls were compared using high-throughput sequencing. Internal diversity in the oral flora is reduced as a result of iron shortage. Corynebacterium, Neisseria, Cardiobacterium, Capnocytophaga and Aggregatibacter had considerably greater proportions in controls, whereas Lactococcus, Enterococcus, Lactobacillus, Pseudomonas and Moraxella had significantly larger proportions in the IDA group (P 0.05). Lactococcus, Enterococcus, Pseudomonas and Moraxella relative abundances were substantially inversely linked with serum ferritin concentrations (P 0.05). In vivo iron shortage altered the organisation of the oral microbiome population. When compared to healthy controls, people with IDA had lower total bacterial diversity and different taxonomic makeup. The IDA group had greater proportions of the genera Lactococcus, Enterococcus, Pseudomonas and Moraxella, whose abundance was likewise statistically and adversely linked with serum ferritin levels. Because the IDA group has a high rate of penicillin resistance, the typical use of preventive penicillin may be ineffective. The findings of a disproportionate oral microbiota suggest that more targeted antibiotic usage with various groups may be required before dangerous oral surgeries.
Hemochromatosis is the abnormal accumulation of iron in parenchymal organs, leading to organ toxicity. It is the most common inherited liver disease in whites and the most common autosomal recessive genetic disorder. Genetic haemochromatosis (GH), which is related to the HFE gene p.Cys282Tyr mutation, is the most common form of inherited iron overload disease in European population descendants.
The classic tetrad of manifestations resulting from hemochromatosis consists of: (1) cirrhosis, (2) diabetes mellitus, (3) hyperpigmentation of the skin and teeth, and (4) cardiac failure. Clinical consequences also include hepatocellular carcinoma, impotence and arthritis (Figures 4 and 5) [9].
Tongue anomaly of iron deficiency anaemia.
Balding of tongue seen due to iron deficiency anaemia.
Symptoms can vary from burning mouth syndrome to bald and inflamed tongue [9].
Periodontitis is linked to an inflammatory response triggered by changes in the subgingival biofilm. Inflammation causes iron sequestration inside macrophages in healthy people, depriving bacteria of iron. Iron bioavailability in biological fluids, particularly those of the oral cavity, is enhanced in GH patients with excessively high TSAT, resulting in an increased risk of severe periodontitis. The existence of iron deposits in oral tissues of haemochromatosis patients has also been documented in the literature. The majority of people with haemochromatosis are now asymptomatic, and the skin and mucosal colouration caused by iron deposits have improved dramatically. The occurrence of asymptomatic iron deposits in oral tissues, however, cannot be ruled out [10, 11].
Iron is connected with transferrin in plasma, which increases its bioavailability for cells. The ratio between the total number of iron-binding sites on patient plasma transferrin and the number of binding sites occupied by iron is known as transferrin saturation (TSAT). TSAT is normally seen in the range of 20% to 45 per cent. Hepcidin regulates systemic iron metabolism, and its expression level is tuned to TSAT to regulate plasma iron levels. Hepcidin insufficiency is a symptom of GH, which is caused by a change in the HFE-linked transduction signalling pathway. TSAT levels rise as a result of the iron outflow from macrophages and enterocytes. Non-transferrin-bound iron (NTBI), an aberrant biochemical type of iron, arises in the plasma when TSAT surpasses 45 per cent. The liver and heart are particularly vulnerable to NTBI, which explains why the typical type of GH causes hepatic cirrhosis and diabetes. However, in the absence of cirrhosis or diabetes, the majority of GH patients remain asymptomatic or have chronic tiredness, abnormal serum transaminase levels, rheumatism, and osteoporosis. Cells manufacture ferritin to store excess iron in order to avoid iron toxicity. As a result, the tissue iron reserves are reflected in plasma ferritin levels. The standard treatment is phlebotomy therapy, which is used to take out excess iron and then prevent it from being reconstituted. The gold standard for both initial treatment and maintenance therapy, according to the leading international standards, is serum ferritin levels of less than 50 g/L [13].
Iron depletion would lessen or eliminate the risk of iron-mediated tissue harm, according to the earlier reasoning for blood removal in all patients with haemochromatosis. This may help to avoid or lessen the severity of some haemochromatosis problems after iron deficiency. Dyspnoea, pigmentation, weariness, arthralgia, or hepatomegaly may be reduced, and diabetes mellitus management and left ventricular diastolic function may be improved. The progression of hepatic cirrhosis, as well as the increased risk of primary liver cancer, hyperthyroidism and hypothyroidism, are largely unaffected.
Standard therapy for most patients with haemochromatosis and iron overload is weekly blood removal to bring ferritin levels into the low reference range (20–50 ng/ml), followed by a life-long maintenance phlebotomy schedule to maintain ferritin levels at around 50 ng/ml, for preventing or treating iron overload. The number of units to be removed can be calculated using the following formula: 1 ng/ml ferritin corresponds to nearly 8 mg mobilisable iron in the absence of hepatic necrosis or another source of inflammation that causes hyperferritinaemia, and a 500 ml blood unit contains approximately 200 mg iron. To achieve iron depletion, a patient with serum ferritin of 1000 ng/ml will likely require the removal of 40 units of blood. Traditional phlebotomy or erythrocytapheresis can be used to remove blood. Traditional phlebotomy (250–500 mL once or twice weekly during the initial phase, depending on patient’s characteristics and level of iron overload, followed by 500 mL every 2–4 months for the rest of one’s life) is effective for iron depletion, but it necessitates normal erythropoiesis and frequent visits to a healthcare facility, and some patients report intolerance. Blood taken for therapeutic phlebotomy at blood donation facilities can be used to supplement the blood supply for transfusion, according to new US Food and Drug Administration rules (Title 21, Code of Federal Regulations, Section 640.120). (21 CFR 640.120). Isovolaemic, large-volume erythrocytapheresis, on the other hand, removes more blood erythrocytes each session than phlebotomy while leaving plasma proteins, coagulation factors, and platelets alone. As a result, therapeutic erythrocytapheresis is a quick and safe procedure that may be recommended in the early stages of treatment for individuals with significant iron excess. Although a single therapeutic erythrocytapheresis session is more expensive, the overall expenditures to cause iron depletion are comparable to or less expensive than therapeutic phlebotomy; yet, the treatment is only available in limited quantities (special apparatus and facilities, trained personnel, etc). Both treatments, however, have comparable side effects: transitory hypovolaemia; weariness (Hb levels should not go below 11 g/dl); enhanced iron absorption; citrate response (erythrocytapheresis alone); or iron insufficiency if proper monitoring is not performed. Iron chelation therapy, on the other hand, is seldom optimal for patients with haemochromatosis, unless they are unable to undertake phlebotomy therapy due to expense, probable toxicity and a lack of proof of benefits. Finally, while dietary restrictions (e.g. low meat consumption, abstinence from alcohol, restricted use of vitamin and mineral supplements, etc.) and medications to reduce iron absorption (e.g. proton pump inhibitors) appear to be reasonable options for patients with haemochromatosis, they have yet to be evaluated in prospective randomised clinical trials [14].
In patients with acquired iron overload (e.g. anaemia dependent on transfusion), iron-excess management and management of toxicity due to excess iron with chelation have been shown to lower iron burden and increase survival. Patients with serial serum ferritin levels more than 1000 ng/ml and a total infused red blood cell volume of 120 ml/kg of body weight or higher should be treated with chelation treatment, according to recent consensus recommendations. During chelation therapy, serum ferritin levels should be checked every three months to determine that the medication is effectively lowering iron levels. Deferasirox is cost-effective when compared to standard parenteral iron chelation therapy with deferoxamine, according to cost analyses conducted in the United Kingdom and the United States. This is primarily due to the quality-of-life benefits derived from the simpler and more convenient mode of oral administration. The first results from a phase I/II investigation of deferasirox in HFE-haemochromatosis show that a dosage of 5–10 mg/kg/day is sufficient to decrease iron burden, and a randomised trial comparing deferasirox to phlebotomy is now underway [32].
Although research on iron salts compounds and iron ions support the cariostatic concept, it is difficult to make definitive statements about iron loss owing to a range of chemicals and additives. In the context of a cariogenic diet, however, it appears that specific drops in iron content have a static effect on caries. In light of the current data, it is likely reasonable to state that if a kid consumes carbohydrates that are utilised by cariogenic bacteria, the cariostatic impact might be calculated based on iron drop intake (especially the form of ferrous sulfate. Ferrous Sulphate affects the most as proven in the literature) [33].
In a case–control study by Schroth et al. which aimed to contrast ferritin and haemoglobin levels between preschoolers with S-ECC and caries-free controls, it was concluded that children with S-ECC (severe early childhood caries) appear to be at significantly greater odds of having low ferritin status compared with caries-free children. Children with S-ECC appear to have significantly lower haemoglobin levels and appear to be at significantly greater odds for iron deficiency when compared with caries-free controls.
In the realm of microhardness, the presence of iron in combination with sucrose has resulted in a decrease in the microhardness changes of cow and human enamel. Furthermore, in both in vitro and in vivo conditions, adding iron to acidic liquids reduces demineralization. There is still debate over the mechanism of action of such an ion and its different forms, and this is a fascinating study subject.
Staining of teeth seen due to iron deficiency anaemia.
Consumption of iron-rich foods (eggs, vegetables, etc.) tends to promote the bacterial growth that produces colouration which is black in the teeth. It has been shown that children with black pigmentations have more calcium and phosphate in their saliva, which can boost the saliva’s buffering qualities and lead to a reduction in the occurrence and prevention rate of decay in the presence of pigmentation. However, the relationship between pigmentation, food, oral flora decay and has yet to be found. The combination of iron and sulphide ions produced by bacteria activity is mainly responsible for the iron drop’s colour. To justify no indication of colour change in all consumers, the colour change varies with varied iron drop consumption, which might be connected to the total quantity of iron accessible in each drop, the acidity and drops’ capacity to etch the surface of the tooth, any bacterial flora, individual’s diet and so on [39].
The study of microbial iron metabolism is gaining popularity. Initial research on the subject revealed the many ways in which bacteria get iron, began to unravel the crucial function of iron in bacterial metabolism and revealed the means and demand for precise iron absorption management. Iron’s role in bacterial pathogenesis has been well documented, and it is currently taken into account in all investigations of prokaryotic pathogens. Basic investigations using
IntechOpen - where academia and industry create content with global impact
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Therefore, rural people should make some strategy for the implementation of agroforestry model with suitable combination of trees and field crops, and this combination does not only generate income for the upliftment of socioeconomic value but also concerns the ecological and environmental stability on the sustained basis, i.e. emphasis should be more on scientific management of these models.",book:{id:"4757",slug:"precious-forests-precious-earth",title:"Precious Forests",fullTitle:"Precious Forests - Precious Earth"},signatures:"M.K. Jhariya, S.S. Bargali and Abhishek Raj",authors:[{id:"175133",title:"Dr.",name:"S. S.",middleName:null,surname:"Bargali",slug:"s.-s.-bargali",fullName:"S. S. 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The plant phenotype and ecology can be affected by the impact of the symbiotic microbes on the environment and competition for soil resources.",book:{id:"5877",slug:"plant-ecology-traditional-approaches-to-recent-trends",title:"Plant Ecology",fullTitle:"Plant Ecology - Traditional Approaches to Recent Trends"},signatures:"Ying-Ning Ho, Dony Chacko Mathew and Chieh-Chen Huang",authors:[{id:"198872",title:"Dr.",name:"Ying-Ning",middleName:null,surname:"Ho",slug:"ying-ning-ho",fullName:"Ying-Ning Ho"},{id:"199676",title:"Prof.",name:"Chieh-Chen",middleName:null,surname:"Huang",slug:"chieh-chen-huang",fullName:"Chieh-Chen Huang"},{id:"201133",title:"Dr.",name:"Dony",middleName:"Chacko",surname:"Mathew",slug:"dony-mathew",fullName:"Dony Mathew"}]},{id:"36984",doi:"10.5772/29590",title:"Individual-Based Models and Scaling Methods for Ecological Forestry: Implications of Tree Phenotypic Plasticity",slug:"individual-based-models-and-scaling-methods-for-ecological-forestry-implications-of-tree-phenotypic-",totalDownloads:2714,totalCrossrefCites:4,totalDimensionsCites:24,abstract:null,book:{id:"617",slug:"sustainable-forest-management-current-research",title:"Sustainable Forest Management",fullTitle:"Sustainable Forest Management - Current Research"},signatures:"Nikolay Strigul",authors:[{id:"78465",title:"Prof.",name:"Nikolay",middleName:null,surname:"Strigul",slug:"nikolay-strigul",fullName:"Nikolay Strigul"}]}],mostDownloadedChaptersLast30Days:[{id:"58228",title:"Pepper Crop under Climate Change: Grafting as an Environmental Friendly Strategy",slug:"pepper-crop-under-climate-change-grafting-as-an-environmental-friendly-strategy",totalDownloads:2189,totalCrossrefCites:9,totalDimensionsCites:17,abstract:"Pepper is an extremely important vegetable worldwide in socio-economic terms. However, persistent land use, monoculture, and intensified production processes have led to soil diseases. This, along with abiotic stress, and mainly salinity of soil and waters, water stress, and suboptimal temperatures, can lead to physiological disorders emerging in peppers, e.g., cracking and Blossom end rot, which induce plant senescence, and lower not only in yields, but also in product quality. Salinity and water shortage are the two main environmental problems that crops face in the Mediterranean Region. One way of overcoming stresses from an ecological or integrated crop management viewpoint is to use grafted plants as an adaptation strategy. Initially, grafting technology has expanded in Solanaceae and Cucurbitacea species to overcome biotic stress. Nowadays, grafts are being used as several approaches to cushion the impact of climate change on agricultural systems. Furthermore, grafts allow desirable varieties by organoleptic or productivity traits, but they are sensitive to abiotic stress and can be grown under abiotic stress. As far as we know, very few studies on grafted pepper plants under abiotic stress are available.",book:{id:"6171",slug:"climate-resilient-agriculture-strategies-and-perspectives",title:"Climate Resilient Agriculture",fullTitle:"Climate Resilient Agriculture - Strategies and Perspectives"},signatures:"Consuelo Penella and Angeles Calatayud",authors:[{id:"213492",title:"Dr.",name:"Angeles",middleName:null,surname:"Calatayud",slug:"angeles-calatayud",fullName:"Angeles Calatayud"},{id:"213498",title:"Dr.",name:"Consuelo",middleName:null,surname:"Penella",slug:"consuelo-penella",fullName:"Consuelo Penella"}]},{id:"65961",title:"The Disturbed Habitat and Its Effects on the Animal Population",slug:"the-disturbed-habitat-and-its-effects-on-the-animal-population",totalDownloads:1542,totalCrossrefCites:1,totalDimensionsCites:7,abstract:"Changes in the “habitat” may interfere with the normal functioning of all biological systems. 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In this chapter, a summary is given for all the technologies that have been used for forest fire detection with explanation of what parameters these systems looking for to understand the fire behaviour.",book:{id:"6304",slug:"forest-fire",title:"Forest Fire",fullTitle:"Forest Fire"},signatures:"Ahmad AA Alkhatib",authors:[{id:"215875",title:"Dr.",name:"Ahmad",middleName:null,surname:"Alkhatib",slug:"ahmad-alkhatib",fullName:"Ahmad Alkhatib"}]}],onlineFirstChaptersFilter:{topicId:"34",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:320,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:17,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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