Therapeutic efficacy between endovascular and open surgery groups [10].
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The patient received diagnosis of acute abdomen in the emergent department, and our general surgeon per- formed laparotomy, which found diffuse mesenteric necrosis. After emergent operation, the interven- tional cardiology team was consulted. Endovascular revascularization was performed by Dr. Mu-Yang Hsieh and Dr. Kuei-Chien Tsai. A coronary bare-metal stent was placed to revascularize SMA (superior mesenteric artery) (Integrity, bare-metal stent, 4.0 x 28 mm, Medtronics) (Figure 1).
The angiography found acute superior mesenteric artery occlusion. The flow was re-established after thrombosuction, balloon angioplasty, and stenting with a bare-metal balloon expandable stent (case 1).
On August 17, 2012, Dr. Mu-Yang Hsieh initiated a draft for Acute Mesenteric Ischemia Protocol. Be- tween 2013 and 2014, interventional radiologist Dr. Chih-Hon Wu provided valuable revision sugges- tions. In the following years, another seven patients received emergent endocvascular revascularization for acute mesenteric ischemia.
Initial goals: a definitive invasive angiography become a reasonable options for dignosis improvement. To have an in-hospital monitor program.
Intermediate goals: become a center for emergent treatment for acute mesenteric ischemia.
Longterm goals: to achieve better survival as reported from previous literatures. Make our one-year survival rate approximate 88%.
“Patients only have hours before irreversible gut ischemia ensues, followed by profound distributive shock, and death. (quoted from Moore and Ahn, Chapter 35).”
Bowel ischemia was diagnosed in around 0.1% of hospitalized patients [1]. But the mortality of acute mesenteric ischemia is quite high. In our hospital, about 95%mesenteric ischemia presented with acute abdomen.
Because the diagnosis of acute ischemic bowel is often difficult, we initiated a dedicated diagnosis pro- tocol to improve the patient outcomes. (Figure 2):
Emergent primary surgery with f/u angio: 4 patients, all received angio, with 2 SMA lesions fixed, survival 75% (3/4).
Emergent primary endovascular approach (with second look laparoscopy when indicated): 18 pa- tients, 5 failure, survival 0% (0/5), 13 success, survival 92.3% (12/13), 4 required laparoscopy/laparotomy.
Totally conservative management: 6 patients, survival 0% (0/6).
Our registry 2012–2020, 28 patients in the registry. Survival is categorized by treatment modalities.
A filling defect (clot) was found in the SMA (Figure 3):
Early invasive endovascular approach: 8 patients, survival 75% (6/8).
Conservative medical management: 5 patients, survival 0% (0/5).
The survival categoried by treatment methods after finding clot in the SMA.
Since 2016, there are numerous literature reported that endovascular is better than open surgery [2, 3].
In 2017, a guideline suggested for patients with acute mesenteric ischemia, emergent surgical or endovascular intervention is reasonable.6.
In the absence of RCTs, evidence is based on prospective registries. In the case of embolic occlusion, open and endovascular revascularizations seem to do equally well, whereas, with thrombotic occlusion, endovascular therapy is associated with lower mortality and bowel resection rates. The principles of damage control surgery are important to follow when treating these frail patients. This concept focuses on saving life by restoring normal physiology as quickly as possible, thus avoiding unnecessary time-consuming procedures. Although laparotomy is not mandatory after endovascular therapy in these patients with acute bowel ischaemia, it is often necessary to inspect the bowel. In this setting, second-look laparotomy is also indicated after open revascularization. Intra-arterial catheter thrombolysis of the superior mesenteric artery has been reported with good results. Severe bleeding complications were uncommon, except when intestinal mucosal gangrene was present [4].
The internal research board certification.
Guideline update in 2017 [
Acute mesenteric ischemia is one etiology among many causes of acute abdominal pain (< 1/1000) [5].
In reported literatures, the mortality is around 60–80% among patients with acute mesenteric ischemia [5, 6, 7, 8].
embolism
thrombosis
non-occlusive mesenteric ischemia
venous thrombosis
Current report addresses that non-occlusive mesenteric ischemia will lead to a worse prognosis.
Dr. Erben reported in 2018 that endovascular revascularization for acute mesenteric ischemia is cost-saving, with a lower rate of in-hospital mortality [9].
Similar good endovascular treatment results were also obtained in a cohort of Chinese population. A table comparing endovascular versus open surgery groups offer a good perspective on this topic (Table 1) [10].
Variable | Endovascular group ( | Open surgery group ( | ||
---|---|---|---|---|
Symptom onset to treatment (h) | 20.8 ± 15.2 | 25.8 ± 11.3 | 0.35 | −0.96 |
Laparotomy required (%/ | 33.33 (6) | 58.33 (7) | 0.26 | |
Time to laparotomy (h) | 26.3 ± 16.8 | 18.0 ± 7.7 | 0.26 | 1.18 |
Bowel resection (cm) | 88 ± 44 | 253 ± 103 | 0.01 | 3.85 |
Thirty-day mortality (%/ | 16.7 (3) | 33.3 (4) | 0.68 |
Therapeutic efficacy between endovascular and open surgery groups [10].
Abbreviations: CA, celiac artery; CT; computed tomography; IMA, inferior mesenteric artery; MI, myocardial infarction; SMA, superior mesenteric artery.
Source: From Kirkpatrick ID, et al.: Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience.
Dr. Lim et al. reported in 2019 that for acute mesenteric ischemia, both open surgery and endovascular revascularization are viable options in the modern era [11].
Findings | Acute MI, n = 26 | Control, n = 36 | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|
Pneumatosis intestinalis | 11 | 0 | 42 | 100 |
SMA or combined CA and IMA occlusion | 5 | 0 | 19 | 100 |
Arterial embolism | 3 | 0 | 12 | 100 |
SMA or portal venous gas | 3 | 0 | 12 | 100 |
Focal lack of bowel wall enhancement | 11 | 1 | 42 | 97 |
Free intraperitoneal air | 5 | 2 | 19 | 94 |
SMA or portal venous thrombosis | 4 | 2 | 15 | 94 |
Solid organ infarction | 4 | 2 | 15 | 94 |
Bowel obstruction | 3 | 2 | 12 | 94 |
Bowel dilatation | 17 | 6 | 65 | 93 |
Mucosal enhancement | 12 | 7 | 46 | 81 |
Bowel wall thickening | 22 | 10 | 85 | 72 |
Mesenteric stranding | 23 | 14 | 88 | 61 |
Ascites | 19 | 24 | 73 | 33 |
Important CT image findings for acute mesenteric ischemia [11].
Abbreviations: CA, celiac artery; CT; computed tomography; IMA, inferior mesenteric artery; MI, myocardial infarction; SMA, superior mesenteric artery.
Source: From Kirkpatrick ID, et al.: Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience.
Author (Year) | Data Source | Morbidity | Mortality |
---|---|---|---|
Schermerhorn et al. (2009) | Nationwide Inpatient Sample | Length of stay: 9 days vs. 14 days | In-hospital: 16% vs. 39% |
Bowel resection: 28% vs. 37% | |||
Acute kidney injury: 11.4% vs. 18.4% | |||
Cardiac complication: 2.1% vs. 7.2% | |||
Respiratory complication: 1.1% vs. 5.7% | |||
Block et al. (2010) | Swedish Vascular Registry | Laparotomy: 55% vs. 100% | 30-day: 28% vs. 42% |
Bowel resection: 19% vs. 63% | |||
Second-look operation: 31% vs. 67% | 1 year: 39% vs. 58% | ||
Short bowel syndrome: 27% vs. 55% | |||
Arthur et al. (2011) | Single-Center Chart Review | Laparotomy: 69% vs. 100% | 36% vs. 50% |
Bowel resection: 52 cm vs. 160 cm | |||
Beaulieu et al. (2014) | Nationwide Inpatient Sample | Length of stay: 12.9 vs. 17.1 days | In-hospital: 24.9% vs. 39.3% |
Bowel resection: 14.4% vs. 33.4% | |||
TPN support: 13.7% vs. 24.4% | |||
Branco et al. (2015) | Nasional Surgical Quality Improvement Program | Transfusion: 3.7% vs. 19.3% | Odds ratio 0.4 (CI 0.2–0.9) |
Pneumonia: 22.2% vs. 27.8% | |||
Sepsis: 25.9% vs. 35.5% | |||
Arya et al. (2016) | Single-Center Chart Review | Bowel resection: 36.4% vs. 43.5% | 30-day: 45.4% vs. 34.8% |
Sepsis: 45.4% vs. 22.7% | |||
Re-exploration: 63.6% vs. 56.5% | |||
Major morbidity: 63.6% vs. 69.6% |
Summary of recent literatures (results are endovascular versus open revascularization, respectively) [ 11].
Abbreviations: CI, confidence interval; TPN, total parenteral nutrition.
For the suspected case of acute mesenteric ischemia, is following serum lactate level useful to confirm acute mesenteric ischemia?
It is not helpful to wait for evidence of increasing serum lactate levels to proceed with further testing; ideally, in fact, intervention would occur in patients with acute mesenteric ischemia before lactic acidosis develops, with the goal of saving additional intestine from full-thickness injury [5].
When the clinical suspicion of acute mesenteric ischemia is high, we should proceed with CT angiography. And in cases with equivocal CT findings, invasive angiography should be considered.
In the early phase of abdominal pain, is serum amylase or lipase diagnostic? In the first eight patients of our case series, amylase and lipase is not useful.
In the first CT study, for patients with no bowel necrosis but still have equivocal CT findings of acute mesenteric ischemia, the best diagnostic method is invasive angiography.
Only a few report focused on primary stenting for acute mesenteric ischemia. Dr. Forbrig reported in 2017 with a case series of 19 consecutive patients and demonstrated that endovascular revascularization has high clinical success rates [12].
Besides balloon angioplasty and stenting, for large thrombus burden, Dr. Miura reported in 2017 that using a stent retriever achieved rapid and good revascularization in a patient with SMA embolism [13].
Dr. Mendes reported in 2018 that using a distal protection device can redude the event of distal em- bolization [14].
Dr. Morbi reported a patient with acute mesenteric ischemia and the patient received emergent by-pass surgery utilizing an aorto-SMA bypass, with good-quality long saphenous vein and segmental small bowel resection [15].
SMA (superior mesenteric artery) dissection has been reported extensively, and the most common problem is when performing open surgery, it is difficult to perform re-entry into the true lumen. The resolution is retrograde open mesenteric stenting (ROMS). The ROMS is performed by opening distal SMA true lumen with placement of a sheath, then proceeding with retrograde wiring and stenting [16].
The proposed classification of SMA dissection (Figure 6).
The classification of SMA dissection. Slide courtesy to Dr. 李栋林浙江大学医学院附属第一医院血管外科.
For SMA dissection, Dr. Loeffler reported in 2017, that if there was no evidence of bowel necrosis, even in symptomatic SMA dissection, regular medical treatment with follow-up may avoid the necessity of open surgery or endovascular stenting [17].
Gobble et al. reported in 2009, included 9 patients (all isolated spontaneous SMA dissection). The treatment modality was variable, including expectant management (4 patients), anticoagulation (2 patients), and endovascular stent placement (3 patients). Among patients who received stenting, acute luminal gain is better [16].
Conservative management of symptomatic spontaneous isolated dissection of the superior mesenteric artery has been reported to be successful.
Systematic review and meta-analysis for patients with spontaneous isolated superior mesenteric artery dissection also suggested conservative treatment [17, 18, 19].
In our patient treated in December 2016, the patient had diffuse aorta atherosclerosis, with celiac trunk- hepatic artery and SMA ostial occlusion.
For patients with chronic mesenteric ischemia due to occlusion of both celiac trunk and SMA, SMA revascularization alone may be adequate to improve symptoms [20].
Severe reperfusion syndrome after acute mesenteric ischemia revascularization has been reported. But optimal medical treatment has not been established
After successful stenting and salvage for acute mesenteric ischemia, stent fracture has been reported. This issue needs further study to establish the best treatment algorithm. Currently, we suggest following patients with abdominal contrast-enhanced CT to evaluate the patency of the stent
The symptoms of acute mesenteric ischemia are described in most general text of most medical textbooks. We do not repeat the symptoms but wish to address the most common clinical challenges in the initial phase of diagnosis: after performing KUB plain film of CT angiography, it is still frequent to fail to proceed to invasive angiography due to multiple reasons: physicians do not familiar with invasive angiography, lack of staffs to perform emergent angiography, no bowel necrosis and surgeon wish to treat the patient conservatively. Following serum lactate level only detects the patients in irreversible bowel necrosis and is not beneficial providing chances of early salvage.
The axial, coronal, sagittal, and 3D reconstruction in advance is mandatory to be reviewed in the initial diagnostic phases. However, in patients with extensive aortic calcification and ostial calcification, care must be taken to interpret the lumen area and stenosis, because the lumen may be mis-interpretated as patent due to extensive ostial calficaition.
CT findings of bowel necrosis: no enhancement of bowel loop, pneumatosis intestinalis, aeroportia (Figure 7).
The CT found extensive air within the portal venous system.
After our index case, an interventional cardiologist (Mu-Yang Hsieh) wrote a draft. The draft was reviewed and completed by an interventional radiologist (Chih-Horng Wu). The interventional radiologist trained the interventional cardiologist to perform selective bowel angiography to reduce time delay in the emergency scenario. The protocol was revised from the acute coronary syndrome protocol. For patients with evident bowel necrosis and peritoneal signs, direct consultation with a surgical team was mandatory (group 1 patients). The endovascular team was contacted after the surgical procedure. For patients with no evident bowel necrosis by CT, any team members can activate the protocol in the emergency department (group 2 patients). In suspected patients with possible CT findings (group 3 patients), the team votetd if proceeding with diagnostic angiography is beneficial to the patient Figures 8–10.
During operation, direct manual examination after laparotomy confirms acute mesenteric ischemia with bowel necrosis.
During emergent angiography, total occlusion SMA was confirmed. The occlusion was re- canalized with a 0.014-
Severe ostial stenosis of SMA. Treated with bare-metal stenting. The abdominal pain com- pletely resolved.
When the patient developed peritoneal signs or when bowel necrosis was evident by CT, the patient will be sent to the operation room first, and open thrombectomy 及 retrograde open mesenteric stenting (ROMS) should be considered
The flow chart of consultation process according to CT imaging findings.
Since 2016, we performed emergent angiography for case 9 and case 10 before the emergent open laparotomy. Direct stenting was performed on SMA. The potential benefit is to shorten the ischemic time
(Figures 12 and 13).
Case 10: revascularization first! It is better with improved flow to jejunum and proximal ileum than SMA proximal total occlusion. During bowel resection, resect the ileocecal junction to ascending colon for
Case illustration example. This illustration was made to make a thorough explanation to the patient and his family.
Treatment results (historical results) were provided to the patient family at the emergency department.
Angiographic (technical) success rate: 6/8 (75%)
Survival at 30 days: 75%
Survival at 7 days, In angiographic success patients: 100%
Survival at 7 days, In angiographic failure patients: 0%
Long-term follow-up survival at 2-year: 50% (due to multiple comorbidities) (Figure 14).
The drawing of disease explanation. All the drawing was made in the emergency department.
Poster prepared and mounted in the emergency department and at the waiting area of intensive care units (Figure 15).
The poster explaining the endovascular protocol for acute mesenteric ischemia. The poster was written in Chinese.
Abdominal angiography was performed emergently in the cath room (cardiology department) angiography room (radiology department). The vascular access was set with a 6-Fr sheath. To perform diagnostic angiography, a 5-Fr diagnostic catheter (RC-1 or JR) was used. In our protocol, the flow was rated using the coronary grading system: TIMI (thrombolysis in myocardial infarction) flow scale. Mesenteric artery disease was defined if there was diameter stenosis over 50%, and mesenteric artery occlusion was defined if there was 100% stenosis with 0 TIMI flow.
Thrombosuction, balloon angioplasty, and stenting were performed sequentially or by the discretion of the interventional cardiologist. First, the femoral sheath was changed to a 7-Fr sheath (10 cm), and a guiding catheter (7-Fr JR4 or IMA) was used according to the angle between of SMA ostium and aorta after reviewing the sagittal view on the CT. For ostial lesion, a guide catheter with side hole was used. We usually give a bolus of heparin (3000–5000 U) to achieve activated clotting time of at least 250 seconds. A workhorse 0.014-inch soft coronary wire was used to cross the lesion. With a dedicated coronary thrombosuction catheter, distal contrast injection can be done to confirm that true lumen was reached in cases with SMA occlusion. Thrombosuction was performed (Thrombuster, Terumo, Tokyo, Japan). Balloon angioplasty was done after successful establishment of antegrade flow. Ifpersistentt recoil or restenosis had been noted, the operator could perform bail-out stenting (usually with a coronary bare-metal stent. Thrombolytic agent was not used in our protocol because it was declined by our team (GI man). Because the National Health Insurance did not cover distal protection device in the treatment of acute mesenteric ischemia, the distal protection device was not used.
A coronary system with 0.014-inch wire, balloon, and stents are used in our protocol. Usually, the vascular access is at the common femoral artery (7 Fr sheath). We used a JR4 diagnostic coronary catheter with 0.035-inch wire (Terumo GlideWire) to perform diagnostic angiography. During the intervention, a 0.014-inch coronary wire with length of 180 cm is used (Sion, BMW-U2).
The angle between SMA ostium and aorta can help to choose the suitable guide sheath or guiding catheter to engage SMA. The choices included angled sheath (6 or 7 Fr), IMA, or JR4 guide catheters.
Thrombosuction: we used coronary system, Thrombuster (6 Fr), or Export catheter.
Most commonly used balloons: Trek, Maverick, and Sapphire, with 6–8 atm.
Bail-out stenting should be considered: when thrombosuction, or balloon angioplasty failed, stenting may still be tried.
Before performing bail-out stenting, we should always use thrombosuction catheter to perform distal injection in order to confirm the adequate distal landing zone.
Rotational Thrombectomy Device can be considered and has reported successful to salvage patients with acute mesenteric ischemia in a single center study [21].
Surgery and revascularization are both mandatory to provide optimal survival chances in patients with extensive bowel necrosis.
For patients who received stenting to SMA before surgery, care must be taken not to manipulate the SMA forcefully to avoid inadvertent crush of the stent.
ICU care after the endovascular procedure is mandatory. The electrolyte, urine output, and arterial pressure are to be monitored. An infection specialist is consulted at the discretion of the critical care specialist. The general surgeon will check the abdominal physical exams to detect changes in peritoneal signs. As- pirin (100 mg) and clopidogrel (75 mg) are initiated if no bleeding is noted after overnight observation. For patients with atrial fibrillation, an oral anticoagulant is started at the discretion of the operator and the caring cardiologist.
Important definition: [22].
Primary clinical success was defined as complete resolution of symptoms.
Partial clinical success was defined as resolution of some or most of the symptoms, but persistence of some symptoms after the procedure.
Primary clinical failure was defined as the lack of any or minimal symptom relief.
Technical success: the successful revascularization of all arteries that were treated in which there was less than a 30% residual diameter stenosis.
Partial technical success per patient (who had multiple mesenteric arteries treated) was defined as at least one mesenteric artery treated successfully.
Technical failure was defined as the inability to treat at least one mesenteric artery per patient
Oral digestive decontamination: PO gentamicin 80 mg/day, PO metronidazole 1.5 g/day [23].
What Is the Role of Empiric Treatment for Suspected Invasive Candidiasis in Nonneutropenic Patients in the Intensive Care Unit?
Preferred empiric therapy for suspected candidiasis in non-neutropenic patients in the intensive care unit (ICU) is an echinocandin (caspofungin: loading dose of 70 mg, then 50 mg daily; micafungin: 100 mg daily; anidulafungin: loading dose of 200 mg, then 100 mg daily) (strong recommendation; moderate-quality evidence) [24].
Mandatory medical protocol: blood volume resuscitation, with mean arterial pressure > 65 mmHg, urine output >0.5 ml/kg/hour.
Curative unfractionated heparin therapy with aPTT 50–70 seconds.
IV proton pump inhibitors: IV pantoprazole 80 mg/day
Oxygen therapy
Food resting, PN if prolonged >5 days.
Antibiotics: empirical, not prophylaxis. Tazocin and possible Candida coverage (no evidence of presence)
No | Age | Sex | Comirbidities | CHADS2-VASc | Shock | Resting dyspnea | Food avoidance | Diarrhea | Nausea/vomiting | Ileus, diffuse | Ileus, localized | Lactate (mmol/L) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 79 | Female | Cirrhosis, gout | 2 | + | + | — | — | — | — | + | 8.8 |
2 | 61 | Male | PAOD, ESRD, DM, dyslipidemia, smoking | 2 | + | — | — | + | + | — | + | 2.5 |
3 | 74 | Female | HTN, dyslipidemia, gout | 2 | — | — | — | + | — | — | + | 1.7 |
4 | 72 | Female | DM, HTN | 3 | −+ | — | — | — | + | — | 7.4 | |
5 | 63 | Female | Afib, VHD, mechanical valve, CVA, DM, HTN, dyslipidemia | 5 | — | + | — | — | — | — | + | 2.4 |
6 | 74 | Female | CAD, old MI, PAOD, ESRD, DM, HTN, dyslipidemia | 4 | + | + | — | — | — | — | + | 5 |
7 | 86 | Male | CAD, Afib, VHD, DM, HTN | 3 | — | — | — | — | — | — | + | 2.6 |
8 | 80 | Female | CAD, ESRD, DM, HTN | 4 | — | — | + | — | — | — | + | 1 |
Demographics, clinical characteristics, and presentation of acute abdominal pain of the study participants.
Category | No | Culprint vessel | Lesion | Diameter (mm) | Length (mm) | Calcification | Time from ER to angiography | Treatment | Stenting | Angio / Clinical success | Laparotomy required | Angio to Discharge (days) | F/U durations (days) | Survival at 30 days | Outcome at 12 montsh |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 1 | SMA | 100% occlusion, main trunk | 4 | 28 | Minimal | 24.5 | Aspiration/stenting | BMS | Yes/Yes | Yes (after stenting) | 45 | 33 | Yes | Moratlity |
1 | 6 | SMA | 50% stenosis, ostium | 4 | 5 | Moderate | 12.1 | Direct stenging | BMS | Yes/Yes | Yes (before stenting) | 21 | 166 | Yes | Moratlity |
2 | 4 | SMA | 100% occlusion, main trunk | 2.5 | 40 | Minimal | 16.3 | Aspiration only | NA | No/No | No | NA | 1 | No | Mortality |
2 | 5 | SMA | 100% occlusion, main trunk | 4 | 30 | Minimal | 3.4 | Aspiration/stenting | BMS | Yes/Yes | No | 2 | 341 | Yes | Survival |
2 | 7 | SMA | 100% occlusion, main trunk | 4.5 | 50 | Minimal | 5.5 | Aspiration/stenting | BMS | Yes/Yes | No | 3 | 187 | Yes | Survival |
3 | 2 | SMA & celiac trunk | 100% occlusion, from ostium | 3 | NA | Severe | 11.9 | Wiring only | NA | No/No | No | NA | 1 | No | Mortality |
3 | 3 | IMA | 80% stenosis, ostium | 3 | 15 | Minimal | 22.2 | Direct stenting | BMS | Yes/Yes | No | 2 | 465 | Yes | Survival |
3 | 8 | SMA | 90% stenosis, ostium | 4.5 | 8 | Moderate | 9 | Direct stenting | BMS | Yes/Yes | No | 2 | 90 | Yes | Survival |
Procedure details and outcomes, by group.
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\\n\\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\\n\\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\\n\\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\\n\\nCONFLICT OF INTEREST - REVIEWER
\\n\\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\\n\\nEXAMPLES OF CONFLICTS OF INTEREST:
\\n\\nFINANCIAL AND MATERIAL
\\n\\nNON-FINANCIAL
\\n\\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\\n\\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\\n\\nEXAMPLES:
\\n\\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\\n\\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\\n\\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\\n\\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\\n\\nPolicy last updated: 2016-06-09
\\n"}]'},components:[{type:"htmlEditorComponent",content:"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\nA Conflict of Interest can be identified at different phases of the publishing process.
\n\nIntechOpen requires:
\n\nCONFLICT OF INTEREST - AUTHOR
\n\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\n\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\n\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\nCONFLICT OF INTEREST - REVIEWER
\n\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\n\nEXAMPLES OF CONFLICTS OF INTEREST:
\n\nFINANCIAL AND MATERIAL
\n\nNON-FINANCIAL
\n\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\n\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\n\nEXAMPLES:
\n\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\n\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\n\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\n\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\nPolicy last updated: 2016-06-09
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The quality practices or quality management systems adopted by industries will further evolve due to the changes of quality concepts as time goes by. This chapter discusses the change of quality concepts and the related revolution of quality management systems in the past century. The quality concepts were gradually changed from the achievement of quality standards, satisfaction of customer needs, and expectations to customer delight. Since merely satisfying customers is not enough to ensure customer loyalty, the enterprises gradually focus on customers’ emotional responses and their delight in order to pursue their loyalty. The emotion of “delight” is composed of “joy” and “surprise,” which can be achieved as the customers’ latent requirements are satisfied. Thus, the concept of “customer delight” and the means to provide the innovative quality so as to meet the unsatisfied customers’ latent needs are elaborated on. Finally, a framework of innovation creation is developed that is based on the mining of customer's latent requirements. This outline will manifest the essential elements of the related operation steps.",book:{id:"5486",slug:"quality-control-and-assurance-an-ancient-greek-term-re-mastered",title:"Quality Control and Assurance",fullTitle:"Quality Control and Assurance - An Ancient Greek Term Re-Mastered"},signatures:"Ching-Chow Yang",authors:[{id:"11862",title:"Prof.",name:"Ching-Chow",middleName:null,surname:"Yang",slug:"ching-chow-yang",fullName:"Ching-Chow Yang"}]},{id:"62915",title:"Advanced Methods of PID Controller Tuning for Specified Performance",slug:"advanced-methods-of-pid-controller-tuning-for-specified-performance",totalDownloads:3476,totalCrossrefCites:10,totalDimensionsCites:16,abstract:"This chapter provides a concise survey, classification and historical perspective of practice-oriented methods for designing proportional-integral-derivative (PID) controllers and autotuners showing the persistent demand for PID tuning algorithms that integrate performance requirements into the tuning algorithm. The proposed frequency-domain PID controller design method guarantees closed-loop performance in terms of commonly used time-domain specifications. One of its major benefits is universal applicability for both slow and fast-controlled plants with unknown mathematical model. Special charts called B-parabolas were developed as a practical design tool that enables consistent and systematic shaping of the closed-loop step response with regard to specified performance and dynamics of the uncertain controlled plant.",book:{id:"6323",slug:"pid-control-for-industrial-processes",title:"PID Control for Industrial Processes",fullTitle:"PID Control for Industrial Processes"},signatures:"Štefan Bucz and Alena Kozáková",authors:[{id:"21933",title:"Ms.",name:"Alena",middleName:null,surname:"Kozakova",slug:"alena-kozakova",fullName:"Alena Kozakova"},{id:"213658",title:"Dr.",name:"Štefan",middleName:null,surname:"Bucz",slug:"stefan-bucz",fullName:"Štefan Bucz"}]},{id:"75699",title:"Data Clustering for Fuzzyfier Value Derivation",slug:"data-clustering-for-fuzzyfier-value-derivation",totalDownloads:292,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The fuzzifier value m is improving significant factor for achieving the accuracy of data. Therefore, in this chapter, various clustering method is introduced with the definition of important values for clustering. To adaptively calculate the appropriate purge value of the gap type −2 fuzzy c-means, two fuzzy values m1 and m2 are provided by extracting information from individual data points using a histogram scheme. Most of the clustering in this chapter automatically obtains determination of m1 and m2 values that depended on existent repeated experiments. Also, in order to increase efficiency on deriving valid fuzzifier value, we introduce the Interval type-2 possibilistic fuzzy C-means (IT2PFCM), as one of advanced fuzzy clustering method to classify a fixed pattern. In Efficient IT2PFCM method, proper fuzzifier values for each data is obtained from an algorithm including histogram analysis and Gaussian Curve Fitting method. Using the extracted information form fuzzifier values, two modified fuzzifier value m1 and m2 are determined. These updated fuzzifier values are used to calculated the new membership values. Determining these updated values improve not only the clustering accuracy rate of the measured sensor data, but also can be used without additional procedure such as data labeling. 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The fact that each component of the function has different effects requires assigning different weight coefficients to these components. In this study, the Bees Algorithm (BA) is used to determine the weights. Using the multi-objective function in BA, it has been tried to determine the weights that reduce the current values together with the speed error. Three different PI controllers have been designed to compare the MPC method. The coefficients of one of these are tuned with BA. Good Gain Method and Tyreus-Luyben Method were used in the other two. As a result of experimental studies, it has been observed that MPC can control PMSM more smoothly and accurately than PI controllers, with weights optimized with BA. With MPC, PMSM has been controlled with 15% settling time than other controllers and also with no overshoot.",book:{id:"10778",title:"Model-Based Control Engineering - Recent Design and Implementations for Varied Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10778.jpg"},signatures:"Murat Sahin"},{id:"78164",title:"Use of Discrete-Time Forecast Modeling to Enhance Feedback Control and Physically Unrealizable Feedforward Control with Applications",slug:"use-of-discrete-time-forecast-modeling-to-enhance-feedback-control-and-physically-unrealizable-feedf",totalDownloads:67,totalDimensionsCites:0,doi:"10.5772/intechopen.99340",abstract:"When the manipulated variable (MV) has significantly large time delay in changing the control variable (CV), use of the currently measured CV in the feedback error can result in very deficient feedback control (FBC). 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He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Prosthodontics and Implant Dentistry",value:2,count:2},{group:"subseries",caption:"Oral Health",value:1,count:6}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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