Risk factors for acute aortic dissection.
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These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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The land management in areas affected by soil erosion is a relevant issue for landscape and ecosystems preservation. In this book we collected a series of papers on erosion, not focusing on agronomic implications, but on a variety of other relevant aspects of the erosion phenomena. \nThe book is divided into three sections: i) various implications of land management in arid and semiarid ecosystems, ii) erosion modeling and experimental studies; iii) other applications (e.g. geoscience, engineering). The book covers a wide range of erosion-related themes from a variety of points of view (assessment, modeling, mitigation, best practices etc.).",isbn:null,printIsbn:"978-953-307-710-9",pdfIsbn:"978-953-51-4927-9",doi:"10.5772/1820",price:139,priceEur:155,priceUsd:179,slug:"soil-erosion-studies",numberOfPages:334,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"54b680a6a971eb10ae500071207ab86d",bookSignature:"Danilo Godone and Silvia Stanchi",publishedDate:"November 21st 2011",coverURL:"https://cdn.intechopen.com/books/images_new/1354.jpg",numberOfDownloads:65482,numberOfWosCitations:48,numberOfCrossrefCitations:22,numberOfCrossrefCitationsByBook:4,numberOfDimensionsCitations:55,numberOfDimensionsCitationsByBook:5,hasAltmetrics:1,numberOfTotalCitations:125,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 24th 2010",dateEndSecondStepPublish:"December 22nd 2010",dateEndThirdStepPublish:"April 28th 2011",dateEndFourthStepPublish:"May 28th 2011",dateEndFifthStepPublish:"July 27th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"313983",title:"Dr.",name:"Danilo",middleName:null,surname:"Godone",slug:"danilo-godone",fullName:"Danilo Godone",profilePictureURL:"https://mts.intechopen.com/storage/users/53849/images/system/53849.jpg",biography:"Dr. Danilo Godone holds a Ph.D. in 'Agriculture, Forest and Food Sciences”, with his doctorate’s topic being the cryosphere’s phenomena monitoring by innovative geomatic methodologies. Currently he is a Research Scientist in the Geohazard Monitoring Group (CNR IRPI), studying geomatic contribution in natural hazard monitoring and analysis. His main research interests are landslides, glaciers and, more generally, natural disasters. During his activities, he has developed skills in GIS, R programming, and land surveying with UAVs, GNSS, and LiDAR. He was also involved in several scientific expeditions in the Alps, Nepal, Chilean Andes, and Patagonia. He is a member of NATRISK - Research Centre on Natural Risks in Mountain and Hilly Environments, in Turin University.",institutionString:null,position:null,outsideEditionCount:null,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"National Research Council",institutionURL:null,country:{name:"Italy"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"120871",title:"Dr.",name:"Silvia",middleName:null,surname:"Stanchi",slug:"silvia-stanchi",fullName:"Silvia Stanchi",profilePictureURL:"https://mts.intechopen.com/storage/users/120871/images/system/120871.jpg",biography:"Silvia Stanchi holds a PhD in “Agriculture, Forest and Food Sciences”, with a focus on fractal theory approaches for the study of soil aggregation and structure. Currently, she is a PostDoc at Turin University working on soil hazards and vulnerability in mountain areas. Silvia Stanchi is a member of NATRISK - Research Centre on Natural Risks in Mountain and Hilly Environments, in the same University. She is actively involved in outreach and soil awareness raising activities targeting kids and the large public, and in international training activities focusing on mountain development and management.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"676",title:"Soil Degradation",slug:"soil-degradation"}],chapters:[{id:"23108",title:"Natural Potential for Erosion for Brazilian Territory",doi:"10.5772/23163",slug:"natural-potential-for-erosion-for-brazilian-territory",totalDownloads:3791,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:null,signatures:"Alexandre Marco da Silva, Clayton Alcarde Alvares and Claudia Hitomi Watanabe",downloadPdfUrl:"/chapter/pdf-download/23108",previewPdfUrl:"/chapter/pdf-preview/23108",authors:[{id:"50872",title:"Dr.",name:"Alexandre Marco",surname:"Da Silva",slug:"alexandre-marco-da-silva",fullName:"Alexandre Marco Da Silva"},{id:"52326",title:"MSc.",name:"Clayton",surname:"Alcarde Alvares",slug:"clayton-alcarde-alvares",fullName:"Clayton Alcarde Alvares"},{id:"52332",title:"Ms.",name:"Claudia",surname:"Watanabe",slug:"claudia-watanabe",fullName:"Claudia Watanabe"}],corrections:null},{id:"23109",title:"Soil Erosion Processes in Semiarid Areas: The Importance of Native Vegetation",doi:"10.5772/23211",slug:"soil-erosion-processes-in-semiarid-areas-the-importance-of-native-vegetation",totalDownloads:4756,totalCrossrefCites:2,totalDimensionsCites:13,hasAltmetrics:0,abstract:null,signatures:"Rebeca Vásquez-Méndez, Eusebio Ventura-Ramos, Klavdia Oleschko, Luis Hernández-Sandoval and Miguel Angel Domínguez-Cortázar",downloadPdfUrl:"/chapter/pdf-download/23109",previewPdfUrl:"/chapter/pdf-preview/23109",authors:[{id:"51105",title:"Prof.",name:"Rebeca",surname:"Vasquez-Mendez",slug:"rebeca-vasquez-mendez",fullName:"Rebeca Vasquez-Mendez"},{id:"51117",title:"Dr.",name:"Eusebio",surname:"Ventura",slug:"eusebio-ventura",fullName:"Eusebio Ventura"},{id:"51118",title:"Dr.",name:"Luis G",surname:"Hernandez-Sandoval",slug:"luis-g-hernandez-sandoval",fullName:"Luis G Hernandez-Sandoval"},{id:"51119",title:"Prof.",name:"Klavdia",surname:"Oleschko",slug:"klavdia-oleschko",fullName:"Klavdia Oleschko"},{id:"51120",title:"Dr.",name:"Migue A",surname:"Dominguez-Cortazar",slug:"migue-a-dominguez-cortazar",fullName:"Migue A Dominguez-Cortazar"}],corrections:null},{id:"23110",title:"Deforestation / Reforestation in Mediterranean Europe: The Case of Greece",doi:"10.5772/23466",slug:"deforestation-reforestation-in-mediterranean-europe-the-case-of-greece",totalDownloads:3293,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:1,abstract:null,signatures:"Olga G. 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In different research fields of science, now a day’s plasma physics have been one of the most important growing areas of research. Also the plasma instabilities are studied from several decades to understand the process of formation of small and big structures in interstellar medium in astronomy and astrophysics. The learning of thermal unsteadiness is suiting fashionable because this is the major development that agreements through outside warming and radiative codling in cosmological plasma environment and in the interstellar medium. The formation of a high amount of cosmological constructions given as interstellar clouds, solar eminences, concentrated organizations in planetary nebulae, etc., can be clarified by resource of thermal unsteadiness. Thermal unsteadiness occurs in an environment that can be developed into colder because of radiation and fluid reduction. Along with this, a reduction of temperature builds the environment unbalanced and directs to the configuration of novel arrangements because of density concentration (Parker [1] & Field [2]). In the unsteadiness, the serious length scale is lesser than that of the other dynamical unsteadiness’s such as the Jeans gravitational unsteadiness; i.e., an environment can be develop into thermally unbalanced still if the environment is steady beside the gravitational unsteadiness. So, it is clear that the substantial foundation of slighter-range configurations is because of thermal unsteadiness in spite of the dynamical unsteadiness. While the masses of these contained dense entities are lower than those needed for gravitational reduction, the situation of thermal unsteadiness gets gratify. Certainly, when the gravitational power of originally uniform plasma is comparatively tiny the solar eminences (Tandberg-Hanssen [3]; Priest [4]) and numerous kinds of interstellar clouds (Spitzer [5]; Hollenbach & Thronson [6]; & Burton et al. [7]) are structured because of the procedure of thermal strengthening. Thermal unsteadiness has been studied by several investigators for more than seven decades in astrophysical objects and plasma physics applications (Aggarwal and Talwar [8]; Bora and Talwar [9]; Fukue & Kamaya [10]; Prajapati et al. [11]; Kaothekar et al. [12]; Sharma and Jain [13]; Prajapati et al. [14]). More recently Kaothekar [15] has discussed the thermal instability of partially ionized viscous plasma with Hall effect FLR corrections flowing through porous medium. Thus, we find that a large number of studies are done for magneto-thermal and radiative plasma with different parameters under various assumptions.
In addition to this, the problem of thermal instability of plasma flowing through porous medium has much significance in the learning of large and small astrophysical entities, such as comets, meteorites and interplanetary dust. More over the learning of flow via porous media is of considerable attention because of its diversity of applications in geophysical circumstances, magneto-hydrodynamics (MHD) flows, laboratories, industries and in petroleum and chemical engineering. A large amount of the pioneer work in the field of plasma flow via porous medium is analyzed by Nield and Bejan [16] and Vafai [17]. Many investigators have discussed the importance of porosity in thermal instability with different physical parameters in different plasma environments (Somerton & Catton [18]; Poulikakos [19]; Nield & Kuznetsov [20]; Shue [21]; Kumar [22]; Kaothekar & Chhajlani [23]; Nield & Kuznetsov [24]; Kaothekar [25]. More recently Nguyen-Thoi et al. [26] have discussed the magneto-hydrodynamic nano-fluid radiative thermal behavior by means of Darcy law inside a porous media. Thus we see that, porosity of the medium plays a crucial role in instability and stability examinations of the thermally magnetized plasma flowing through porous medium.
Along with this, in current days the significance of FLR in thermal instability and gravitational instability of plasma is important owing to its huge relevance in astrophysics. Many researchers (Jukes [27]; Roberts & Taylor [28]; Rosenbluth et al. [29]; Singh & Hans [30]; Herrnegger [31]; Sharma [32]; Chhonkar & Bhatia [33]; Devlen & Pekunlu [34]; Kaothekar & Chhajlani [35]; Kaothekar et al. [36]; Kaothekar [37]) have discussed the importance of FLR corrections in thermal instability with different parameters. More recently Kaothekar [38] has investigated the problem of Jeans instability of finitely conducting radiative rotating plasma with FLR corrections flowing through porous medium. Thus it is clear that FLR is a significant restriction in argument of thermal instability and Jeans-gravitational instability.
From the above study we discover that combined influence of the rotation, FLR corrections, radiative heat-loss function, thermal conductivity and porosity on the thermal instability is not taken. Thus remaining in brains the importance of rotation and FLR corrections in formation of astrophysical small and big structures, we attempt to argue the outcomes of rotation, porosity and FLR corrections on thermal instability of plasma with thermal conductivity and radiative heat-loss function.
This paper is organized in following ways. In Section 2 linearized equations are presented. Section 3 contains the dispersion relation which is derived by linearized perturbation equations and discussed mathematically for transverse wave propagation. Section 4 represents the linear growth rate of the dispersion relation in transverse wave propagation and finally Section 5 contains discussion of the presented problem and result.
We consider an infinite homogeneous, thermally conducting, radiating, porous plasma with FLR corrections in the presence of magnetic field
Suffix ‘0’ represents the initial equilibrium state, which is independent of space and time. L (
where
The parameter
We seek plain wave solution of the form
where
The components of Eq. (6) may be given
where
Using Eqs. (4), (5) and (9) we write
Using Eqs. (3)–(11) in Eq. (2), we may engrave the subsequent algebraic equations for the constituents of Eq. (2)
Taking divergence of Eq. (2) and using Eqs. (3)–(11), we obtain as
we have made following substitutions
The nontrivial solution of the determinant of the matrix gained from Eqs. (13)–(16) with
The dispersion relation (17) demonstrates the jointed influence of rotation, FLR corrections, radiative heat-loss function, thermal conductivity and porosity on the thermal instability of homogeneous plasma flowing through porous medium. The above dispersion relation is long and to learn the consequence of all parameter we now diminish the dispersion relation (17) for transverse mode of transmission.
In this situation the perturbations are in use to be vertical to the path of the magnetic field
This dispersion relation (18) provides the control of rotation, FLR corrections, radiative heat-loss function thermal conductivity and porosity on thermal unsteadiness of plasma for transverse mode of transmission. Now we discuss the dispersion relation (18) for rotation axis parallel and vertical to the magnetic field.
For the case of axis of rotation along the magnetic field, we put
Eq. (19) has two independent factors. The first factor of Eq. (19) gives
This dispersion relation symbolizes the consequence of direct addition of rotation, FLR corrections, radiative heat-loss function, thermal conductivity and porosity on the thermal unsteadiness of the organization. When constant term of Eq. (20) is less than zero this allows at least one positive real root which converses to the unsteadiness of the organization. The situation of unsteadiness obtained from steady term of Eq. (20) is specified as
Eq. (21) symbolizes the modified form of thermal instability criterion by enclosure of rotation, FLR corrections, radiative heat-loss function and thermal conductivity. From Eq. (21) we conclude that rotation and FLR corrections stabilize the radiative instability.
In nonappearance of FLR corrections
When constant term of Eq. (22) is less than zero this permits at least one positive real root which communicates to the instability of the system. The condition of instability attained from constant term of Eq. (22) is given as
The above situation of instability is the changed form of thermal condition by addition of rotation and magnetic field strength. From Eq. (23) we bring to a close that rotation and magnetic field stabilize the radiative instability.
Now Eq. (20) can be written in the following form
We have used
To investigate the effect of viscosity, porosity, rotation and radiative heat-loss functions on the growth rate of thermal instability, we solve Eq. (24) numerically. Therefore Eq. (24) can be written in non-dimensional form with the help of following dimension-less quantities as given in Field [2]
In astrophysical circumstances, instability of the organization is one of the most significant reasons of arrangement of entities. So we learn the consequences of medium porosity
Mathematical computations were executed to decide the roots of (
Growth rate (
Growth rate (
Growth rate (
Growth rate (
Growth rate (
In the case of axis of rotation perpendicular to the magnetic field, we put
This dispersion relation symbolizes the joint influence of FLR corrections, rotation, porosity magnetic field, radiative heat-loss function and thermal conductivity on the thermal instability of the considered organization. Eq. (28) has two independent factors. The first factor of Eq. (28) gives
In nonattendance of rotation
The situation of instability acquired from constant term of Eq. (29) is given as
In present case situation of instability and growth rate of instability both depend on FLR corrections and porosity.
In the above present problem we have approved out the consequence of rotation, porosity and FLR corrections on the thermal instability of plasma counting the effects of radiative heat-loss function and thermal conductivity. The general dispersion relation is attained, which is customized due to the attendance of calculated physical limitations. This dispersion relation is condensed for transverse wave propagation to the route of magnetic field, which is additional argued for rotation axis parallel and vertical to the route of magnetic field.
In the situation of transverse wave propagation to the direction of magnetic field with axis of rotation along magnetic field we gained two modes. The first one is a marginal stable mode. The second one represents the thermal mode amended by rotation, porosity, FLR corrections and radiative heat-loss function. It is concluded that the condition of thermal unsteadiness is modified due to the attendance of porosity, rotation, FLR corrections, radiative heat-loss function, and thermal conductivity. For the case of non-FLR medium, it is found that the condition of radiative unsteadiness and expression of critical thermal wave number both are amended due to the occurrence of porosity, rotation, and it explains the stabilizing influence. It is found that for non-FLR the condition of radiative unsteadiness and expression of critical thermal wave number both are amended due to the occurrence of porosity, rotation and magnetic field. It is self-governing of FLR corrections.
In the case of axis of rotation vertical to the magnetic field for transverse wave propagation, we obtained two modes. The first one is a marginal stable mode. The second one symbolizes the impact of porosity, rotation, FLR corrections, radiative heat-loss function and thermal conductivity on thermal unsteadiness of plasma. It is concluded that the condition of unsteadiness is sovereign of porosity, rotation and FLR corrections and it depends on radiative heat-loss function and thermal conductivity. But the growth rate of the organization is exaggerated by the attendance of rotation, porosity and FLR corrections. For the case of non-rotating medium, it is found that condition of radiative unsteadiness is amended by the presence of FLR corrections, porosity and magnetic field, and it demonstrates stabilizing authority.
Author (S.K.) is grateful to CA Avnish Gupta, Vice Chairman Prashanti Institute of Technology & Science Ujjain, for continuous support.
Type A aortic dissection is a life threatening condition requiring emergency surgical intervention. Statistics show an incidence of approximately three cases per 100,000 per year [1, 2]. Data analysis from the International Registry of Acute Aortic Dissections (IRAD) reported a predominant male patient population and a mean age of 63 years at presentation [3]. Surgical repair for Type A Aortic dissection is challenging, the complexity proportionate to the location and extent of aortic tissue dissected, cardiac complications and end organ ischemia. The current standard surgical approach includes replacement of the aortic root (Bentall technique) or valve sparing root replacement, isolated ascending aorta replacement, and hemi or full arch replacement. Recent advances include frozen elephant trunk (FET) technique, total aortic repair, endovascular and hybrid approaches and stenting. All of these surgical approaches, including classification, clinical presentation, risk factors, diagnosis, pre-operative preparation, cannulation strategies, and cerebral protection will be discussed in this review.
The Stanford classification (1970) is the most commonly used system (Figure 1) [4]. It does not classify the site of tear. It is more of a clinically useful classification to guide acute management. Stanford type A involves ascending aorta proximal to innominate artery, irrespective of involvement of aortic arch or descending aorta. Stanford type B dissection involves only the thoracic aorta distal to the left subclavian artery [5]. Intimal tears originating distal to left subclavian artery but dissecting retrogradely into ascending aorta will be type A. Intimal tears starting in the aortic arch and extending into ascending aorta are type A and extending into descending aorta are type B. If the intimal tear is restricted to aortic arch, then it is type non-A non-B.
Stanford and DeBakey classification.
The DeBakey type I involves ascending aorta and extends beyond the innominate artery. Type II involves only the ascending aorta. Type III involves thoracic aorta distal to left subclavian artery. It is more useful for long-term follow-up as it differentiates between proximal and distal aortic dissection extent (Figure 1) [4].
The Penn classification is a recently introduced method of classifying based on clinical presentation [6]. Class Aa—absence of branch vessel malperfusion or circulatory collapse; Class Ab—symptoms or signs of localised organ ischemia; Class Ac—circulatory collapse with or without cardiac involvement; Class Abc—combined localised and generalised ischemia.
Men form approximately 62–68% of all patients undergoing surgery [7]. The triad of hypertension (67–86% patients), smoking and atherosclerosis is an independent predictor of type A aortic dissection [8]. Data correlating the risk of aortic dissection in bicuspid aortic valve is limited and controversial. However, some centres advocate early prophylactic ascending aortic replacement in patients with aortas larger than approximately 5.0 cm in diameter or with a cross-sectional area to height ratio greater than approximately 10 cm2/m [9]. In the NORCAAD registry, 6% patients were reported to have bicuspid aortic valve [7]. The Marfan syndrome is present in around 4% of ATAAD patients in NORCAAD registry [10]. The patients typically have pear- shaped aneurysm of aortic root. Due to mutation in FBN1 gene, there is decreased strength and elasticity of elastin—rich tissue of aortic wall. Predominantly, medium and large sized arteries are involved in dissection (Table 1).
(1) Cardiovascular and life style factors |
Uncontrolled hypertension |
Age |
Smoking |
Dyslipidemia |
Cocaine |
Pregnancy |
(2) Congenital and connective tissue |
Bicuspid aortic valve |
Marfan syndrome |
(3) Iatrogenic |
Coronary catheterisation |
Arterial cannulation |
Aortic cross clamping |
IABP |
(4) Vascular inflammation |
Takayasu arteritis |
(5) Trauma |
Deceleration injury |
Risk factors for acute aortic dissection.
TAAD patients (85%) typically present with sudden intense central chest pain (ripping or tearing) radiating to the neck, back or abdomen. [11]. ECG abnormalities (50% patients) include ST/T wave changes, conduction defects, and arrhythmias. This sometimes leads to the misdiagnosis of myocardial infarction leading to fatal mistake of giving antiplatelet therapy or thrombolysis. This delays the diagnosis and increases peri-operative bleeding complications. Aortic regurgitation (70% patients) can occur through prolapse of right or non- coronary valve cusps and detachment of commissures. Pulmonary oedema may occur through acute dilation of the left ventricle. Haemorrhagic pericardial tamponade is a very strong predictor of aortic dissection. Reduced or absent femoral pulses are seen. Neurological sequlae include syncope, stroke. Mal-perfusion of spinal cord leads to paraplegia. Acute renal failure and mesenteric ischemia are seen if the dissection involves descending thoracic and abdominal aorta [12]. Rupture of the aneurysm is immediately fatal.
Chest X-ray of a patient with ATAD showing a widened mediastinum.
CT-scan of a patient with TAAD.
The following information may be provided from a CT-scan:
Detection of the true and false lumen in the dissected aorta
Identification of the site of the intimal tear The extent of the dissection
Arch vessel and thoracic and abdominal branch vessel involvement
Planning the site of cannulation
Limitations of CT-scanning include not providing information about dissection entry site and functional status of the heart.
5. Trans-oesophageal echocardiography (TEE; Figure 4)
TEE of a patient with ATAD.
TEE is portable, less invasive and has sensitivity and specificity approximately 100% [16]. It provides information about:
The dissection flap and false lumen in ascending aorta
The entry site of tear using colour Doppler
Coronary ostial obstruction due to the dissection
Dilation of aorta and left ventricle function
Pericardial effusion and tamponade
Aortic regurgitation and anatomy of aortic root
Has a better window than TTE to visualise aortic arch and descending aorta
Pleural effusion
Limitations include difficulty in visualisation of the proximal arch due to the interposition of bronchial air [17].
6.
MRI is an accurate investigative modality for acute aortic dissection (sensitivity and specificity, 98%) [18]. It is rarely used in the setting of TAAD where most of the patients are wheeled into operating room as soon as the diagnosis is made. It may have a small role in those patients allergic to iodinated contrast agents or in patients with acute renal failure who are stable enough to undergo MRI.
Blood pressure (BP) control: One of the most important pre-requisites of successful outcome is very strict control of BP. Systolic BP should be less than 110 mmHg. It can be lowered using intravenous beta blocker (esmolol) or combined alpha & beta receptor antagonists (labetalol) or glyceryl trinitrate. Intravenous adrenaline should be used in patients presenting with cardiogenic shock and cardiac tamponade. Anaesthetic induction is also another step where BP should be tightly controlled. Commonly used medications include Fentanyl, isoflurane and glyceryl trinitrate. Peri-operatively, a target systolic blood pressure of 90–110 mmHg, mean arterial pressure of 60 mmHg, and central venous pressure of 8–12 mmHg are recommended [21].
Coagulation status: Aortic dissection activates inflammatory, coagulation and fibrinolytic pathways leading to disseminated intravascular coagulation. Consumption coagulopathy is worsened in some patients by inadvertently prescribing aspirin, clopidogrel by misdiagnosing these patients as having acute coronary syndromes. Hence, adequate amounts of packed red blood cells, platelets, fresh frozen plasma and cryoprecipiate should be kept ready for use.
2 arterial lines (both arms) should be placed to monitor differential blood pressures.
Also include a femoral arterial line to monitor distal perfusion pressures
Cerebral oxygenation monitoring by near—infrared spectroscopy
Invasive monitoring of intracranial pressure by lumbar catheter (occasionally)
Femoral artery cannulation (Figure 5)
For many years, it has been the cannulation site of choice [22]. Allowing rapid access, it is usually used in hemodynamically unstable patients, especially with impending cardiac tamponade and aortic rupture. It is important to mark the femoral artery before skin preparation as it may be difficult to localise it during hypotension. Common femoral artery is situated medial and inferior to the midpoint of the inguinal ligament. An oblique or vertical incision may be used for exposure [23]. An open Seldinger technique is quick and can be performed with minimal dissection. Advantages of this approach include (i) cardiopulmonary bypass is established quickly, (ii) easy to access with a closed chest, (iii) less likely to be dissected, (iv) prevents aortic rupture in patients with cardiac tamponade. Disadvantages include (i) stroke and malperfusion due to dynamic obstruction and (ii) retrograde perfusion leading to embolic complications due to atherosclerotic emboli. The femoral artery with a dissection flap is not used for cannulation.
Axillary artery cannulation (Figure 6)
Introduced in 1990s [24], axillary artery cannulation is gaining greater acceptance among surgeons as they switch to an antegrade perfusion strategy. It is more commonly used in hemodynamically stable patients. Infraclavicular dissection exposes the first part of axillary artery [25]. The pectoralis major muscle is split. The neurovascular bundle is situated deep in the clavipectoral fascia. The deltopectoral approach exposes the second and third parts for cannulation [26]. The axillary artery can be directly cannulated or anastomosed with end to side 8 mm vascular graft. Advantages include (i) antegrade perfusion flow and (ii) can be used for antegrade cerebral perfusion by occluding innominate artery. Disadvantages of this approach include (i) takes more time than femoral cannulation especially in obese patients and (ii) technically more difficult and risk of injury to brachial plexus nerves.
Central aortic cannulation:
Locating a site where the chances of not entering into the false lumen is the most critical part. It can be done with TEE, CT or epiaortic scanning. Cannulation can be performed with Seldinger technique or directly. Advantages include (i) CPB established quickly in unstable patients and (ii) antegrade flow. Disadvantages include (i) rupture of cannulation site and (ii) false lumen perfusion [27].
Femoral artery cannulation.
Axillary artery cannulation.
An expeditious midline sternotomy should be done with SBP maintained around 100–110 mmHg. The dissected aorta is usually dilated, thinned out and blood seeping through adventitial layers (Figure 7).
Upon opening the pericardium, be prepared for free aortic rupture (Figure 8). To minimise the risk either (i) femoral arterial and venous cannula should be in place or (ii) if axillary artery cannulation is done, then the surgeon should be prepared to quickly place the two-stage cannula into right atrium.
Patient is cooled to a core temperature of 26–28°C. For hemi-arch replacement and short duration of total hypothermic circulatory arrest, 27°C temperature is optimum. If total arch replacement is planned, then the patient can be further cooled to 22–24°C.
After going on CPB, a left ventricular vent is placed to prevent left ventricular distension due to associated acute aortic regurgitation. Retrogarde cardioplegia catheter is placed to arrest the heart, as antegrade cardioplegic arrest may not be possible due to aortic regurgitation. After the cardiac arrest and upon opening the aorta, antegrade ostial cardioplegia can be administered.
If the patient is stable, innominate artery is carefully dissected and looped with a vascular loop before going on CPB. This can be occluded or clamped later to provide antegrade cerebral perfusion through the previously cannulated axillary artery.
After going on CPB, the aorta is dissected free from surrounding adhesions. When creating the plane between ascending aorta and main pulmonary artery, it is important to retain as much adventitial tissue on the aortic side.
It is important to identify right pulmonary artery and avoid injuring it, while dissecting ascending aorta.
Clamp the aorta somewhere in the mid-ascending aorta, which will be eventually resected while doing open distal anastomoses. This allows assessment of the site of the tear and of the aortic root and also minimises the total circulatory arrest time.
While excising the dissected ascending aorta, it is important to avoid injury to the main and right pulmonary artery.
While dissecting towards aortic root, left and right coronary ostia are identified and coronary buttons prepared (if aortic root replacement is planned).
The dissected ascending aorta.
Aortic rupture prior to establishing CPB.
Because of the low threshold tolerance to ischemia, brain protection is of paramount importance during aortic arch procedures. Hypothermia is an option to increase the ischemic time. However, there are limitations of hypothermia and hypothermic circulatory arrest. Protective effects of hypothermia last no more than 9 minutes at 30°, 14 minutes at 25°, 21 minutes at 2°, 31 minutes at 15° and 45 minutes at 10° [28]. Neurological deficits are seen in elderly patients subjected to hypothermic circulatory arrest exceeding 25 minutes.
Several cerebral perfusion techniques have been introduced to extend the safe period of arch repair without residual neurological deficits. Retrograde cerebral perfusion (RCP) in tandem with hypothermic circulatory arrest was introduced in 1990 by Ueda et al. [29] Because the cerebral venous sinuses have no valves, RCP was proposed to provide retrograde perfusion and cooling of central nervous system (CNS). It offered to back-flush air emboli and debris from the cerebral circulation. Neuroprotective effects were most likely related to cooling rather than true nutritive flow [30]. It was also found to provide limited benefit in patients with significant carotid stenosis and vascular anomalies (e.g. an incomplete Circle of Willis) [31].
Antegrade selective cerebral perfusion (SCP) was introduced by Jean Bachet and Daniel Guilmet in Europe [32] and by Teruhisa Kazui in Japan in 1986 [33]. This new perfusion method of “cold cerebroplegia” in combination with hypothermia significantly reduced neurologic complications. Antegrade selective perfusion can be established either by direct cannulation or by anastomosing a prosthetic graft. The options for locating such are (i) right subclavian artery, (ii) innominate artery, (iii) right common carotid artery. These may be combined with left common carotid artery cannulation to provide bilateral antegrade cerebral perfusion. Direct cannulation is limited by high risk of embolism due to plaque mobilisation from manipulation or by jet flow [34].
Axillary artery cannulation can be used to provide unilateral antegrade SCP during hypothermic arrest without manipulation of the arch vessels. This can be combined with balloon occludable perfusion catheter to left carotid artery to provide bilateral antegrade SCP. To avoid steal, an occlusive balloon catheter is inserted in left subclavian artery.
Unilateral antegrade SCP is sufficient for majority of patients with no pathology of the arch vessels and cerebral vessels. Adequate backflow from the contralateral carotid artery suggests good collateralisation. Near-infrared spectroscopy (NIRS) monitoring can also help to exclude contralateral malperfusion. Bilateral cerebral perfusion may be useful in patients with carotid artery stenosis, previous stroke or cerebrovascular anomalies (incomplete Circle of Willis). Malvindi concluded in his review that “While both unilateral and bilateral ASCP are acceptable, bilateral antegrade cerebral perfusion is safer, when the antegrade SCP time is more than 40-50 minute” [35].
Cerebral perfusion is performed at a rate of 8–12 cc/min/kg body weight, perfusion pressure of 40–60 mmHg at 23–28°C. Alpha stat pH management compared to pH stat management prevents “luxury perfusion” by marinating cerebral autoregulation decreasing the risk of embolization [35].
The aortic root is frequently involved with aortic valve rendered incompetent due to commissural dehiscence or annular dilation. Grade II and grade III aortic regurgitation was found in 40 and 23% patients, respectively, in German Registry for Acute Aortic Dissection type A (GERAADA) [36]. There are different surgical approaches for management of aortic root replacement—an aggressive or a more conservative approach.
According to the International Registry of Acute Dissection (IRAD), aortic root replacement compared with conservative root management is not associated with increased in-hospital mortality. In 1995 patients, 18 and 21.3% hospital mortality was found in root replacement and conservative root group respectively (OR 0.989; CI 0.710–1.379; p = 0.949). Mid-term results at 3 years showed a survival of 91.6+/1.3% and 92.5+/1.7% for conservative root management and root replacement group, respectively [37].
Indications to perform root replacement in a patient with ATAD include:
younger age
Marfan syndrome
bicuspid aortic valve
known aortic valve disease
moderate or severe aortic valve insufficiency
previous aortic valve replacement
large diameter aortic annulus, sinuses of Valsalva and ascending aorta
coronary artery involvement
aortic root as the most proximal site of dissection
Proximal reconstruction technical (Figures 9 and 10) details: After the excision of the dissected aortic root, aortic root reconstruction is done.
Aortic root replacement (right coronary ostial anastomosis).
Proximal anastomoses of aortic root.
Technical principles include:
Obliteration of false lumen.
To take the maximum possible adventitia in the anastomoses.
Needle should enter the tissue at right angle to avoid tearing of needle holes.
Sutures should be spaced uniformly and pulled just enough tight to prevent cutting through the fragile tissue.
To avoid distortion of the aortic valve, the planar relationship between the graft and sinotubular junction should be maintained.
The Bentall procedure [38] is a fairly standard procedure. It includes anastomosing the composite graft to the aortic annulus and reimplantation of coronary arteries. Patients with type A aortic dissection usually have normal aortic valve cusps, as the pathology is usually limited to the aortic wall.
Valve sparing root replacement is a viable option in hemodynamically stable young patients. But it is technically more complex than straight aortic root replacement. It involves replacing the aortic root by composite graft without replacing the aortic valve. The native aortic root must be dissected from surrounding structures to 2 mm below the nadir of the aortic annulus. Coronary ostia are reimplanted into the graft. It is used to treat aortic regurgitation due to annular enlargement. Contraindications include significant cardiomyopathy, malperfusion, coronary artery disease, >65 years age.
Results from Emory in a 43 patients showed operative mortality of 4.7%. Freedom from aortic valve replacement was 100% and freedom from more than mild aortic regurgitation was 94% at 9 years follow-up. No aortic root reinterventions were required in this series [39].
Conservative approaches to the aortic root (CRR)—In most of the patients presenting with TAAD, the most common pathology seen is a primary intimal tear in the ascending aorta with dissection flap extending to non-coronary cusp. Left and right coronary sinuses are relatively preserved. Any aortic regurgitation is due to unhinging of one of the aortic valve commissural posts. The dissected sinus segments are preserved and supported with resuspension of the native valve commissural posts or prosthetic ascending aorta replacement. The advantages are that it preserves the native sinus tissue, coronary ostia are not reimplanted, shorter ischemic time, avoiding life-long anticoagulation [40]. The most commonly used methods to fortify the aortic wall include Teflon felt and biologic glue. University of Pennsylvania in their series of 489 patients showed freedom from reoperation with this technique of 96, 92 and 89% at 1, 10 and 15 years respectively. The operative mortality was 11% [41].
The entry site of the dissection tear is usually found the ascending aorta, which is at very high risk of rupture. After excising the dissected portion of ascending aorta, supracommissural ascending aorta replacement can be performed. Open distal anastomoses can be done under hypothermic circulatory arrest after releasing the cross clamp. This facilitates inspection of the aortic arch and if required, arch repair can be undertaken. Also, it is technically much easier to construct a very distal ascending aortic anastomoses. Around 5.6% patients underwent ascending aorta replacement in GERAADA survey [42]. But this procedure also allows for subsequent aneurysmal dilation of the remaining portion of the aorta [43].
When the aortic arch is examined during hypothermic circulatory arrest to look for intimal or re-entry tears, a decision is made whether an aortic arch replacement has to be done. The pre-operative CT aortogram helps in localising the dissection and also on deciding the placement of the aortic cross clamp. If the tear is in the ascending aorta or start of the aortic curvature, then hemi-arch replacement is required. If the dissection is extends more distally, a total aortic arch repair should be performed (Figure 11a, b).
Total arch replacement. (a, b) Debranching of aortic arch vessels – innominate , carotid artery and left subclavian artery.
Indications for arch replacement include:
Pre-existing aneurysm of the arch
Primary intimal tear in distal arch or descending thoracic aorta
Secondary intimal tear in arch >10 mm
False lumen more than 22 mm
Descending thoracic aorta diameter more than 35 mm
A study of 188 patients by Kim et al. [44] showed that 5 year survival was lower in patients with total arch replacement compared to patients who had hemi-arch repair (65.8% vs. 83.2%, p = 0.013). Neurological complications were higher in total arch repair group compared to hemi-arch (56.9% vs. 24.8%, p < 0.001).There was a direct correlation between patent false lumen in aortic arch or descending aorta and re-intervention. The German registry for TAAD showed no significant difference in peri-operative outcomes between both groups [45]. This group suggested a more aggressive approach to reduce the rate of interventions.
The immediate post-operative results have improved post type A Aortic dissection repair. However, long-term results are guarded by the need for aortic re-interventions due to residual dissection and patent false lumen extending into descending thoracic aorta [46]. The frozen elephant trunk technique involves total arch replacement and per-procedural deployment of stent through the true aortic lumen. It is more complex and takes more time. However, there is 90% chance of false lumen obliteration and reduced rates of re-intervention and improved long-term survival [47]. Uchida et al. [47] showed improved survival in the FET group at 5 years (95.3% vs. 69%, p = 0.03) and 100% thrombosis of false lumen in FET group compared to 29% patent false lumen in the non-FET group. However, both groups had similar operative mortality. Caution should be exercised that it should be done in high volume centres and by experienced suregons.as the total duration of hypothermic circulatory arrest can be dramatically increased.
Deployment of stent in the descending thoracic aorta has its drawbacks. Stent induced false lumen thrombosis activated inflammatory markers like metalloproteinases and proinflammatory cytokines [48], which contribute in the progression of aneurysm by destruction of the extracellular matrix in the aortic wall and neo-angiogenesis. Risk factors for the late development of aneurysm include (i) patent false lumen, (ii) helicoidal flow distal to the endoprosthesis, (iii) aortic wall shear stress gets modified.
Matalanis [49] has introduced the concept of total aortic repair to prevent the above mentioned complication. Patients presenting with TAAD and a descending thoracic aorta diameter of more than 40 mm can benefited from this approach. The repair involves a “Branch first “total aortic arch repair and surgical ascending aorta repair. Second part included endovascular treatment of descending aorta. It includes covered stent graft deployment in the proximal part of descending aorta and rupture of the intimal flap for the last part of aorta. The rupture is managed with the deployment and dilation under balloon of uncovered stent graft. With this approach, aneurysmal dilatation of the false channel is avoided by the creation of this new aortic channel. But, currently there is no long-term follow-up of this approach.
Based on the NORCAAD registry [50].
Bleeding
Major bleeding −39 %
Reoperation for bleeding 22%.
Cardiac tamponade −15%
Neurological
Stroke 20%.
Coma 11%.
Transient ischemic attack 5%.
Infections:
Sepsis 10%.
Deep sternal wound infections 2%.
Pneumonia 19%
Renal
Acute kidney injury 39%.
Renal replacement therapy 12%
Malperfusion
Mesenteric ischemia 6%.
Myocardial infarction 6%.
Limb ischemia requiring surgery 4%
Reoperations of the aorta
Proximal reoperation.
1 year 0.8%.
5 years 2.1%
Distal reoperations.
year 0.8%
5 years 4.3%
Bleeding is one of the most feared complication from a surgeon’s point of view. When blood comes in contact with subendothelial tissue of false lumen, it leads to a coagulopathy. Consumption of coagulation factors and fibrinolysis leads to disseminated intravascular coagulation. Activation and consumption of platelets also contributes to mortality [51]. Patients with pre-operative cardiac mal-perfusion was found to be associated with 30-day mortality of 33% (47). Pre-operative cerebral malperfusion is associated with three-fold increase in risk of stroke. Post-operative stroke and coma occurred in 10–15% and 3–9% patients respectively in one series [46]. Acute kidney injury may occur in 40–55% [50].
Long-term post-operative survival in recent years at 5, 10 and 30 years is 84–85, 64–68, and 38%, respectively [52]. Health-related quality of life is lower compared to the general population. There is 32% incidence of depression and post-traumatic stress disorder [53]. Over 50% patients have resistant hypertension on follow-up.
As per the EACTS/ESC 2014 guidelines, a follow-up CT-scan of the aorta is recommended at 1, 6 and 12 months and annually thereafter [54]. There are no recommendations specific to the aortic valve or aortic regurgitation for follow-up. To follow general guidelines, one can perform follow-up echocardiography every 1–2 years for mild regurgitation and annually for moderate and asymptomatic severe regurgitation [55].
Type A Aortic dissection is an emergency requiring timely surgical intervention. With improved imaging techniques, an accurate diagnosis can now be made. Open surgical repair techniques have given good long-term results. Endovascular intervention is an emerging less invasive option which can be combined with a surgical approach to give excellent long-term results.
TAAD | type A aortic dissection |
aSCP | antegrade selective cerebral perfusion |
RCP | retrograde cerebral perfusion |
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Grillet, Nicholas B. Wyatt and Lindsey M. Gloe",authors:[{id:"110676",title:"Dr.",name:"Anne",middleName:null,surname:"Grillet",slug:"anne-grillet",fullName:"Anne Grillet"},{id:"138225",title:"Dr.",name:"Nicholas",middleName:null,surname:"Wyatt",slug:"nicholas-wyatt",fullName:"Nicholas Wyatt"},{id:"138226",title:"Ms.",name:"Lindsey",middleName:null,surname:"Gloe",slug:"lindsey-gloe",fullName:"Lindsey Gloe"}]},{id:"48816",doi:"10.5772/60824",title:"Wettability and Other Surface Properties of Modified Polymers",slug:"wettability-and-other-surface-properties-of-modified-polymers",totalDownloads:3692,totalCrossrefCites:9,totalDimensionsCites:36,abstract:"Surface wettability is one of the crucial characteristics for determining of a material’s use in specific application. Determination of wettability is based on the measurement of the material surface contact angle. Contact angle is the main parameter that characterizes the drop shape on the solid surface and is also one of the directly measurable properties of the phase interface. In this chapter, the wettability and its related properties of pristine and modified polymer foils will be described. The wettability depends on surface roughness and chemical composition. Changes of these parameters can adjust the values of contact angle and, therefore, wettability. In the case of pristine polymer materials, their wettability is unsuitable for a wide range of applications (such as tissue engineering, printing, and coating). Polymer surfaces can easily be modified by, e.g., plasma discharge, whereas the bulk properties remain unchanged. This modification leads to oxidation of the treated layer and creation of new chemical groups that mainly contain oxygen. Immediately after plasma treatment, the values of the contact angles of the modified polymer significantly decrease. In the case of a specific polymer, the strongly hydrophilic surface is created and leads to total spreading of the water drop. Wettability is strongly dependent on time from modification.",book:{id:"5319",slug:"wetting-and-wettability",title:"Wetting and Wettability",fullTitle:"Wetting and Wettability"},signatures:"Nikola Slepickova Kasalkova, Petr Slepicka, Zdenka Kolska and\nVaclav Svorcik",authors:[{id:"144929",title:"Prof.",name:"Vaclav",middleName:null,surname:"Svorcik",slug:"vaclav-svorcik",fullName:"Vaclav Svorcik"},{id:"146297",title:"Dr.",name:"Petr",middleName:null,surname:"Slepicka",slug:"petr-slepicka",fullName:"Petr Slepicka"},{id:"147600",title:"Ph.D.",name:"Nikola",middleName:null,surname:"Slepičková Kasálková",slug:"nikola-slepickova-kasalkova",fullName:"Nikola Slepičková Kasálková"},{id:"153983",title:"Dr.",name:"Zdeňka",middleName:null,surname:"Kolská",slug:"zdenka-kolska",fullName:"Zdeňka Kolská"}]},{id:"30975",doi:"10.5772/36619",title:"Solution Properties of κ-Carrageenan and Its Interaction with Other Polysaccharides in Aqueous Media",slug:"solution-properties-of-k-carrageenan-and-its-interaction-with-other-polysaccharides-in-aqueous-media",totalDownloads:7583,totalCrossrefCites:5,totalDimensionsCites:32,abstract:null,book:{id:"1601",slug:"rheology",title:"Rheology",fullTitle:"Rheology"},signatures:"Alberto Tecante and María del Carmen Núñez Santiago",authors:[{id:"109087",title:"Prof.",name:"Alberto",middleName:null,surname:"Tecante",slug:"alberto-tecante",fullName:"Alberto Tecante"},{id:"109098",title:"Dr.",name:"Maria Del Carmen",middleName:null,surname:"Nunez-Santiago",slug:"maria-del-carmen-nunez-santiago",fullName:"Maria Del Carmen Nunez-Santiago"}]},{id:"48822",doi:"10.5772/60808",title:"Wettability of Nanostructured Surfaces",slug:"wettability-of-nanostructured-surfaces",totalDownloads:3117,totalCrossrefCites:11,totalDimensionsCites:31,abstract:"There are many studies in literature concerning contact angle measurements on different materials/substrates. It is documented that textiles can be coated with multifunctional materials in form of thin films or nanoparticles to acquire characteristics that can improve the protection and comfort of the wearer. The capacity of oxide nanostructures to inhibit fungal development and neutralize bacteria is a direct consequence of their wetting behavior [1–6]. Moreover, the radical modification of wetting behavior of nanostructures from hydrophilic to hydrophobic when changing the pulsed laser deposition (PLD) ambient will be thoroughly discussed.",book:{id:"5319",slug:"wetting-and-wettability",title:"Wetting and Wettability",fullTitle:"Wetting and Wettability"},signatures:"L. Duta, A.C. Popescu, I. Zgura, N. Preda and I.N. Mihailescu",authors:[{id:"17636",title:"Prof.",name:"Ion N.",middleName:null,surname:"Mihailescu",slug:"ion-n.-mihailescu",fullName:"Ion N. Mihailescu"},{id:"23532",title:"Dr.",name:"Andrei",middleName:null,surname:"Popescu",slug:"andrei-popescu",fullName:"Andrei Popescu"},{id:"174343",title:"Dr.",name:"Liviu",middleName:null,surname:"Duta",slug:"liviu-duta",fullName:"Liviu Duta"},{id:"174344",title:"Dr.",name:"Irina",middleName:null,surname:"Zgura",slug:"irina-zgura",fullName:"Irina Zgura"},{id:"174345",title:"Dr.",name:"Ligia",middleName:null,surname:"Frunza",slug:"ligia-frunza",fullName:"Ligia Frunza"}]},{id:"64392",doi:"10.5772/intechopen.80542",title:"Corrosion Inhibitors",slug:"corrosion-inhibitors",totalDownloads:3309,totalCrossrefCites:17,totalDimensionsCites:27,abstract:"Corrosion is a natural process driven by energy consideration. Inhibition is a preventive measure against corrosive attack on metallic materials. Corrosion inhibitors have been frequently studied, since they offer simple solution for protection of metals against corrosion in aqueous environment. Mineral acids like hydrochloric and sulfuric acids are most widely used in pickling baths to remove the metal oxides formed on the surface. The multidisciplinary aspect of corrosion problems combined with the distributed responsibilities associated with such problems only increase the complexity of the subject. Inhibitors are used in industrial and commercial processes to minimize both the metal loss and acid consumption.",book:{id:"7550",slug:"corrosion-inhibitors",title:"Corrosion Inhibitors",fullTitle:"Corrosion Inhibitors"},signatures:"Geethamani Palanisamy",authors:[{id:"253697",title:"Dr.",name:"Geethamani",middleName:null,surname:"Palanisamy",slug:"geethamani-palanisamy",fullName:"Geethamani Palanisamy"}]}],mostDownloadedChaptersLast30Days:[{id:"48768",title:"TiO2 -Based Surfaces with Special Wettability – From Nature to Biomimetic Application",slug:"tio2-based-surfaces-with-special-wettability-from-nature-to-biomimetic-application",totalDownloads:5010,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Super-wetting/antiwetting surfaces with extremely high contrast of surface energy and liquid adhesion have attracted a lot of interest in both fundamental research and industry. Various types of special wetting surfaces can be constructed by adjusting the topographical structure and chemical composition. In this chapter, recent advance of the super-wetting/antiwetting surfaces with special solid/liquid adhesion has been reviewed, with a focus on the biomimetic fabrication and applications of TiO2-based surfaces. Special super-wettability examples include lotus-leaf-inspired surfaces with low adhesion, rose-petal-inspired surfaces with high adhesion, spider silk bio-inspired surfaces with directional adhesion, fish-scale-inspired underwater superoleophobic surface, and artificial surfaces with controllable or stimuli-responsive liquid adhesion. In addition, we will review some potential applications related to artificial antiwetting surface with controllable adhesion, e.g., self-cleaning, antifogging/anti-icing, micro-droplet manipulation, fog/water collection, water/oil separation, anti-bioadhesion, micro-template for patterning, and friction reduction. Finally, the difficulty and prospects of this renascent and rapidly developing field are also briefly proposed and discussed.",book:{id:"5319",slug:"wetting-and-wettability",title:"Wetting and Wettability",fullTitle:"Wetting and Wettability"},signatures:"Jian-Ying Huang and Yue-Kun Lai",authors:[{id:"175512",title:"Prof.",name:"Yuekun",middleName:null,surname:"Lai",slug:"yuekun-lai",fullName:"Yuekun Lai"}]},{id:"64392",title:"Corrosion Inhibitors",slug:"corrosion-inhibitors",totalDownloads:3318,totalCrossrefCites:18,totalDimensionsCites:28,abstract:"Corrosion is a natural process driven by energy consideration. Inhibition is a preventive measure against corrosive attack on metallic materials. Corrosion inhibitors have been frequently studied, since they offer simple solution for protection of metals against corrosion in aqueous environment. Mineral acids like hydrochloric and sulfuric acids are most widely used in pickling baths to remove the metal oxides formed on the surface. The multidisciplinary aspect of corrosion problems combined with the distributed responsibilities associated with such problems only increase the complexity of the subject. Inhibitors are used in industrial and commercial processes to minimize both the metal loss and acid consumption.",book:{id:"7550",slug:"corrosion-inhibitors",title:"Corrosion Inhibitors",fullTitle:"Corrosion Inhibitors"},signatures:"Geethamani Palanisamy",authors:[{id:"253697",title:"Dr.",name:"Geethamani",middleName:null,surname:"Palanisamy",slug:"geethamani-palanisamy",fullName:"Geethamani Palanisamy"}]},{id:"68236",title:"The Arrhenius Acid and Base Theory",slug:"the-arrhenius-acid-and-base-theory",totalDownloads:1380,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Swedish Svante Arrhenius, in 1884 proposed the concept of acid and base based on the theory of ionization. According to Arrhenius, the acids are the hydrogen-containing compounds which give H+ ions or protons on dissociation in water and bases are the hydroxide compounds which give OH− ions on dissociation in water. This concept is only applicable to those compounds which dissolved in aqueous solution (or you can say where water is the solvent). It covers many common acids, bases and their chemical reactions, but there are also other compounds that have the characteristics of acids and bases but they do not fit into Arrhenius concept.",book:{id:"10050",slug:"corrosion",title:"Corrosion",fullTitle:"Corrosion"},signatures:"Shikha Munjal and Aakash Singh",authors:[{id:"290524",title:"Ms.",name:"Shikha",middleName:null,surname:"Munjal",slug:"shikha-munjal",fullName:"Shikha Munjal"}]},{id:"71924",title:"Technological Background and Properties of Thin Film Semiconductors",slug:"technological-background-and-properties-of-thin-film-semiconductors",totalDownloads:886,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Especially with the development of nanotechnology and polymer science, interest in research and production of both efficient and lower-cost semiconductor thin film materials is increasing day by day. The use of nano-structured thin films for efficient use of solar cells in production of n-type semiconductor materials is one of the most important sources of energy and new-generation energy. Considering the indicated trends and energy requirements, it has been important to transfer this technology in detail regarding the surface technologies related to the semiconductor materials produced with thin film technologies instead of bulk materials. With this aim, this book chapter “Technological Background and Properties of Thin Film Semiconductors” includes a brief story about semiconductors, band gap theory, thin film applications, and besides traditional thin film processing methods finally a new technology called aerosol deposition technique which allows room temperature processing of several materials for semiconductor applications, respectively. It is thought that it will make important contributions to the relevant field and bring a new perspective and direct scientific research in “process-structure–property-performance” relation.",book:{id:"10061",slug:"21st-century-surface-science-a-handbook",title:"21st Century Surface Science",fullTitle:"21st Century Surface Science - a Handbook"},signatures:"Orkut Sancakoglu",authors:[{id:"177188",title:"Dr.",name:"Orkut",middleName:null,surname:"Sancakoğlu",slug:"orkut-sancakoglu",fullName:"Orkut Sancakoğlu"}]},{id:"60426",title:"Applications of Viscoelastic Fluids Involving Hydrodynamic Stability and Heat Transfer",slug:"applications-of-viscoelastic-fluids-involving-hydrodynamic-stability-and-heat-transfer",totalDownloads:1331,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Rayleigh and Marangoni convection and rheology are linked in the thermal convection of viscoelastic fluids to some recent technological applications. Such technology developments as the ones presented here undoubtedly shall be based on interdisciplinary projects involving not only rheology or fluid mechanics but several other disciplines. Three practical applications which use Rayleigh or Marangoni convection in their working principle are presented along with some technical details. This contribution focus mainly on the physical mechanism and the involved hydrodynamics of some lab and industrial applications. Finally, a short discussion on the role play by the convective mechanisms is given in order to provide integration of the exposed ideas.",book:{id:"6702",slug:"polymer-rheology",title:"Polymer Rheology",fullTitle:"Polymer Rheology"},signatures:"Ildebrando Pérez-Reyes, René Osvaldo Vargas-Aguilar, Samuel\nBernardo Pérez-Vega and Alejandro Sebastián Ortiz-Pérez",authors:[{id:"183938",title:"Dr.",name:"Samuel",middleName:null,surname:"Perez-Vega",slug:"samuel-perez-vega",fullName:"Samuel Perez-Vega"},{id:"186659",title:"Prof.",name:"Ildebrando",middleName:null,surname:"Pérez-Reyes",slug:"ildebrando-perez-reyes",fullName:"Ildebrando Pérez-Reyes"},{id:"242858",title:"Prof.",name:"Rene Osvaldo",middleName:null,surname:"Vargas-Aguilar",slug:"rene-osvaldo-vargas-aguilar",fullName:"Rene Osvaldo Vargas-Aguilar"},{id:"242859",title:"Prof.",name:"Alejandro Sebastian",middleName:null,surname:"Ortiz-Perez",slug:"alejandro-sebastian-ortiz-perez",fullName:"Alejandro Sebastian Ortiz-Perez"}]}],onlineFirstChaptersFilter:{topicId:"160",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,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:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,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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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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