\r\n\tTo viable rural development has a vital role for rural communities. In the design of policies to be successful that affect them rural people have to decide and implement. According to this, it is a critical point to involve the poor and disadvantaged, along with related stakeholders, agricultural and rural development. Hence, for the sustainable development by international initiatives and all other institutions were searched and to be present the agricultural and related research results. To help support the effort, various governmental and non-governmental agencies established fundings for sustainable rural development research and fostered the development of human well-being goals in rural areas via national and international initiatives. In this context, most efforts resulted in successful cases. This book will intend to provide the reader with a comprehensive overview of the theory, approaches, strategies, and cases, and key elements and challenges of sustainable development, and Bioeconomy, Green and Circular economy for sustainability, and UN SDGs-Agenda 2030 and EU Green Deal.
\r\n
\r\n\tI believe that this work will be fundamental in the field of SDG, and it will be a guiding, idea-generating key for researchers, practitioners, rural community, and policy decision-makers, and I hope that together we will establish sustainable rural life and development around the world. \r\n\t
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He has been a visiting scientist for Postdoc, at Leibniz Hannover University, Institute of Horticultural Economics. He is a member of the Turkish Agricultural Economics Association, and Association for International Agricultural and Extension Education, Society of Agricultural Economics, Scientific Committee Member of the Turkish Foundation for Combating Soil Erosion.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"170206",title:"Prof.",name:"Dr. Orhan",middleName:null,surname:"Özçatalbaş",slug:"dr.-orhan-ozcatalbas",fullName:"Dr. Orhan Özçatalbaş",profilePictureURL:"https://mts.intechopen.com/storage/users/170206/images/system/170206.png",biography:"Dr. Orhan Özçatalbaş graduated from Çukurova University Agricultural Faculty at Adana, Turkey in 1986 and completed his PhD in Agricultural Economics in the same institution in 1994. 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1. CPR quality
1.1 Introduction
There are distinct anatomic and physiologic differences between children and adults that influence not only the etiologies of cardiac arrest but also how we manage these two populations. Children are more at risk for the development of respiratory failure than adults. The discussion of the anatomic reasons behind this is outside the scope of this chapter. Given these anatomic differences between the respiratory systems of adults and children, it is not surprising that the etiology of cardiac arrest in children is usually hypoxia from respiratory failure. In contrast, in adults, the etiology of cardiac arrest is usually secondary to cardiac decompensation [1, 2].
The differences in chest wall compliance between children and adults can also affect their responses to closed chest compressions during CPR. Proposed mechanisms of blood flow during closed chest CPR include compression of the heart between the sternum and spine as well as chest compression (CC)-induced increases in intrathoracic pressure, resulting in pressure gradients from the right heart to the pulmonary vasculature to the left heart and into the systemic vasculature. Based on these mechanisms, it is thought that better chest wall compliance leads to better cardiac output during CPR. This may explain why infants have better outcomes from cardiac arrest after in-hospital cardiac arrest (IHCA) than older children [1]. There are also differences in their myocardial function. Younger children have a limited ability to increase their stroke volume in the face of demand compared to older children and adults and thus are more dependent on heart rate to maintain cardiac output. For these reasons, in the setting of bradycardia with poor perfusion in children, it is imperative to start CPR. In fact, Nadkarni et al. published a multicenter analysis of IHCA from the National Registry of Cardiopulmonary Resuscitation in 2006 and showed that the incidence of initial rhythm of bradycardia with poor perfusion was significantly higher in children than adults. Children receiving CPR for bradycardia who maintain pulses have much higher rates of survival to hospital discharge (SHD) than those who had pulseless cardiac arrest [2].
The AHA guidelines for CPR in children were last updated in 2015. This book chapter section will cover the most recent recommendations, the basis behind these recommendations, and the research that has accrued since the 2015 guidelines (as summarized in Table 1). Approximately 15,000 hospitalized children each year undergo CPR with outcomes improving over time [3]. An analysis of over 7000 pediatric pulseless IHCA events between 2000 and 2018 in the Get With the Guidelines-Resuscitation (GWTG-R) registry showed a 19% absolute increase in SHD over time [3]. Unfortunately, the etiology of these improved outcomes has yet to be elucidated. There are many factors that may have led to the increase in SHD in pediatric IHCA over time. One of the factors that may contribute to improved outcomes is improved CPR quality. The AHA guidelines focus on delivering five components of high- quality CPR, which are delivery of chest compressions of adequate rate and depth, ensuring full recoil between compressions, minimizing interruptions in chest compressions, and avoiding excessive ventilation [4]. Despite these guidelines, there have been multiple studies showing difficulty in achieving these targets during CPR. A single center prospective observational study sought to compare CPR quality before and after the institution of the 2010 AHA guidelines. The authors found that while there was an increase in CC depth, rate, and chest compression fraction (CCF) after the 2010 guidelines, it was difficult to achieve the target goals for rate and depth [5]. In 2018, the Pediatric Resuscitation Quality (pediRES-Q) Collaborative, a large multicenter international pediatric resuscitation quality improvement network, published a landscape study characterizing CPR metrics for children with IHCA. They analyzed 112 events and found that guideline compliance for rate and depth in children is poor, with the most difficulty achieving compliance in younger children [6].
CPR quality marker
AHA pediatric recommendations
AHA adult recommendations
Most recent literature since AHA recommendations are released
Metric
Rate
100–120 beats/min
100–120 beats/min
80–100 beats/min
Depth
1/3 AP diameter of the chest or about 4 cm in infants, >5 cm in children >1 year, and >5 cm but <6 cm in adolescents
>5 cm but <6 cm
No association between depth and outcomes
Pauses
No more than 10 s
No more than 10 s
No literature associated with outcomes
CCF
At least 60%
At least 60%
No literature associated with outcomes
Ventilation
No advanced airway: chest compression to ventilation ratio 15:2 Advanced airway: 10 breaths/min
No advanced airway: chest compression to ventilation ratio 30:2 Advanced airway: 10 breaths/min
Higher rates (≥30 breaths/min in children <1 year old and ≥25 breaths/min in older children) associated with improved outcomes compared to lower rates
Duty cycle
50%
50%
No association between duty cycle and outcomes
Chest recoil
Full
Full
Physiologic markers
ETCO2
Reasonable to monitor, but no goals established
≥20 mm Hg
No association between ETCO2 and outcomes
Arterial blood pressure
Reasonable to monitor, but no goals established
≥25 mm Hg
DBP ≥ 25 mm Hg in infants and DBP ≥ 30 mm Hg in children was associated with improved outcomes
Coronary perfusion pressure
Insufficient evidence to make a recommendation
≥20 mm Hg
No new evidence
Table 1.
AHA recommendations for various CPR quality markers in children vs. adults as well as the recent literature since guidelines are released.
There has been a shift from the “provider”-centric to a “patient”-centric approach to CPR. Instead of targeting a standard depth, rate, and ventilation rate (provider centric), the “patient”-centric approach involves incorporating physiologic monitoring and adjusting CPR to the patient’s hemodynamic responses as assessed by more invasive monitors like arterial blood pressure and end tidal carbon dioxide (ETCO2) level. This hemodynamic-directed CPR approach could explain the poor compliance with AHA guidelines (which are “provider” centric) that has been described in the literature.
1.1.1 Chest compression metrics
1.1.1.1 Chest compression rate
The 2015 update to the AHA guidelines continues to recommend a chest compression rate of 100–120/min. As stated in the 2015 evidence summary, there is insufficient data in children for a systematic review for CC rate, and therefore the recommendations are based on evidence for adults. Given simplicity in CPR training and insufficient pediatric evidence, the recommendation was that it is reasonable to use the adult basic life support (BLS) CC rate of 100–120 for children [4]. Since the 2015 update was published, there has been one pediatric study published on this subject. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) is a network of seven pediatric ICUs that conducts investigations related to pediatric critical care practice. Between 2013 and 2016, the CPCCRN conducted the Pediatric Intensive Care Unit Quality of CPR (PICqCPR) study, a multicenter prospective observational study to evaluate the association between invasive arterial blood pressures during CPR and outcomes. Using the dataset, the primary aim of the study was to evaluate the association between CC rates and blood pressure and survival outcomes. The results of the study showed that when compared to AHA guidelines of 100 to <120, higher rate categories were associated with lower systolic (SBP); however, there was no correlation to survival. Also when compared to the AHA guidelines of 100 to <120, a CC rate of 80 to <100 was associated with a higher rate of SHD and survival with favorable neurological outcome (FNO) compared to CC rates within guidelines [7].
1.1.1.2 Chest compression depth
The 2015 update to AHA guidelines recommend to compress at least 1/3 of the anterior–posterior (AP) diameter of the chest, which is about 4 cm in infants, 5 cm in children, and greater than 5 cm but no more than 6 cm in adolescents [4]. Two single-center pediatric studies were reviewed for the 2015 update to the AHA guidelines. The first study was a case series of six infants after cardiac surgery who had CPR. In those infants, aged 0–7 months, attempting to compress the chest to ½ the AP diameter increased the SBP significantly compared to attempts to compress the chest to 1/3 the AP diameter [8]. The second study looked at 87 chest compression events in children >1 year and showed that AHA compliant guideline CC depths >51 mm were associated with improved 24-h survival compared to more shallow CC depths [9]. Since the 2015 update, there has been only one study published. This was a multicenter prospective observational study that looked at out-of-hospital cardiac arrests (OHCA). They looked at 153 pediatric events (children 1–19 years of age) with CPR metric data and found that there was no association with CC depth and return of spontaneous circulation (ROSC) [10].
1.1.1.3 Minimizing interruptions in chest compressions
The 2015 AHA guidelines continue to emphasize minimizing interruptions in chest compressions, in particular to less than 10 s. Ideally, these pauses should be coordinated so that a pulse check, rhythm check, and compressor switch occur at the same time and should only occur every 2 min. There should be a person assigned to the role of the pulse check, positioned with his/her finger on the pulse before the pause to minimize the pause duration. Chest compression fraction is defined as the time spent doing chest compressions during CPR. The 2013 AHA consensus statement on CPR quality recommended a CCF of at least 80% [11]; however, the 2015 AHA BLS guidelines recommend a CCF of at least 60% [12]. Observational studies of cardiac arrests often show that pauses can be more prolonged and more frequent than expected. In a single-center observational study in a pediatric emergency room, 33 cardiac arrests were analyzed. While the majority of pauses were <10 s in duration, 33% of pauses were >10 s. The number of coordinated pauses were rare, only 7% of the time [13]. A more recent observational study of CPR quality in two pediatric emergency departments analyzed 81 cardiac arrests. While median CCF was 91% with a median pause duration of 4 s, 22% of pauses were prolonged (>10 s). Again, the number of coordinated pauses were rare (6%) and prolonged with a median of 19 s [14]. Although the AHA guidelines recommend to switch providers performing CC every 2 min to prevent rescuer fatigue and therefore inadequate CPR quality, they also acknowledge that when a CPR feedback device is used, some individuals can go longer than 2 min [15]. A single-center observational study that sought to characterize causes for interruptions found that provider switch accounted for the majority of pauses. Individuals performing CC for at least 120 s compared to those switching earlier had less leaning, increased CC depth, and better compliance for depth with AHA guidelines [16]. While there is limited evidence in adults to support these guidelines on duration of pauses and CCF, these recommendations have been applied to children. There are no pediatric studies to date evaluating the association between CC interruptions and outcomes. In 2019, a single-center observational study was published that sought to evaluate the hemodynamic consequences of interruptions in CC. Thirty-two IHCA events were analyzed. The median duration of pauses was brief at 2.4 s; however, BPs before and after the pauses did not differ significantly [17].
1.1.1.4 Ventilation
For patients without an invasive airway at the time of cardiac arrest, BLS guidelines recommend a compression to ventilation ratio of 15:2 in children if there are two providers (in contrast to 30:2 for adults). Although there is no data to support the optimal compression to ventilation ratio in children, the recommended ventilation rate takes into account a higher baseline respiratory rate in children. For children without advanced airways in place at the time of arrest, there is often an emphasis on tracheal intubation during an IHCA given the most common etiology of IHCA is respiratory failure. The 2019 focused update on PALS reaffirms the 2010 recommendation that during a pediatric OHCA, the use of bag mask ventilation (BMV) is reasonable compared to an advanced airway. The update also specifies that no recommendation for or against an advanced airway could be made. These recommendations were made based on the review of 14 studies of airway interventions in children who had cardiac arrests [18].
In contrast to the recommendation for a higher ventilation rate without an advanced airway, when an advanced airway is in place, AHA guidelines recommend that ventilation rates of 10 breaths/min be applied to all age groups during CPR in order to simplify training. During CPR, cardiac output is usually about 25% of normal, and thus lower ventilation rates are recommended to match the lower output state, given the detrimental effects of positive pressure ventilation on venous return and right heart afterload. However, the etiology of cardiac arrest in children is usually asphyxia in nature compared to the primary cardiac origin of most adult cardiac arrests, and thus the recommendations of equal ventilation rates in children as to adults have been questioned. In 2019, the CCPCRN published the only study to date that has analyzed the association of ventilation rates in pediatric cardiac arrests and survival outcomes. As part of the PICqCPR study, the authors analyzed 52 events in patients with an invasive airway in place at the time of the cardiac arrest. No events were within the guideline ventilation rate (defined as 10 ± 2 breaths/min), and more than half of the events were considered high ventilation rates (defined as > or equal to 30 breath/min in infants <1 year and > or equal to 25 in children >1 year). In fact, higher ventilation rates were associated with higher odds of SHD [19].
1.1.1.5 Duty cycle
The term “duty cycle” refers to the amount of time spent in the compression phase of CPR. AHA guidelines for adult cardiac arrest recommend a duty cycle of 50% [20]. There have been no pediatric recommendations since 2005 on duty cycle. The only pediatric study to date on duty cycle was published in 2016. It was a single-center observational study that analyzed 97 pediatric events and found no association with duty cycle and survival [21].
1.1.1.6 Chest recoil
AHA guidelines recommend full chest recoil in between compressions, to avoid leaning. In 2009, a single-center prospective observational study sought to evaluate the prevalence of leaning and the effect of real-time feedback devices on leaning. They evaluated 20 pediatric cardiac arrests and found that leaning was common during pediatric CPR; however, leaning occurred significantly less when a feedback device was used [22]. In 2013, the same pediatric center published another prospective observational study looking at the quality of CPR in children 1–8 years of age with a real-time feedback device. In eight events, they found the percentage of CPR epochs (defined as 30-s periods of resuscitation) achieving the target goal of leaning <20% of compressions was 79%. In particular, the percent epochs achieving target leaning goals was better in the feedback group than in the no feedback device [23]. There are no studies to date evaluating the association with leaning and outcomes in children.
1.1.2 Physiologic monitoring
1.1.2.1 End tidal CO2
The 2015 PALS guidelines state that it is reasonable to use ETCO2 to guide the quality of CPR in children, although specific values to guide therapy in children have not been established [24]. These recommendations were made on extrapolation of adult and animal data since no pediatric literature at the time of these guidelines had been shown that ETCO2 monitoring improves outcomes. For adults, AHA recommendations are to titrate to an ETCO2 ≥ 20 mm Hg [11]. In 2018, using the PICqCPR data, the CCPCRN published the only pediatric study to date that evaluates the association of ETCO2 values and survival outcomes. Contrary to adult literature, the authors found that there was no association between ETCO2 ≥ 20 mm Hg and SHD [25].
1.1.2.2 Arterial blood pressure
Similar to the recommendation for ETCO2 monitoring, the 2015 PALS guidelines state that it is reasonable to use BP to guide CPR quality if an invasive arterial line is already in place; however, no specific values to guide therapy have been established [24]. At the time, these recommendations were based on animal data without any pediatric human literature. Since then, the CCPCRN has published three studies using PICqCPR data, evaluating the association of intra-arrest diastolic blood pressure (DBP) and post-arrest outcomes. The first study evaluated 164 events and showed that maintaining a mean DBP ≥ 25 mm Hg in infants and DBP ≥ 30 mm Hg in children was associated with SHD and survival with FNO. There was no association between SBP and outcomes [26]. The second study evaluated 77 survivors of the first study and sought to assess the association between intra-arrest BP and functional outcomes. Unlike the parent study which showed an association between DBP and FNO, there was no association between DBP and functional outcomes. Again, there was no association with SBP and functional outcomes [27]. The third study evaluated the subgroup of patients with cardiac disease. The authors analyzed the hemodynamic waveforms of 113 patients with cardiac disease and found an association with the same DBP goals and SHD in surgical patients but not medical patients. They also noted the majority of patients with single ventricles and open chest were able to attain the DBP goals. In patients who went on to have ECPR, approximately half were able to attain the DBP goals; however, there was no association between DBP goals and SHD [28].
1.1.2.3 Coronary perfusion pressure
Coronary perfusion pressure (CoPP) can be estimated by subtracting the right atrial (RA) pressure from the aortic DBP. While the 2013 AHA Consensus Statement on CPR quality recommends titrating CoPP to >20 mm Hg in adults if invasive arterial line and central venous catheter is in place, they state that there is insufficient evidence to make a CoPP goal for infants and children [11]. While no pediatric studies exist, one pediatric animal study showed improvement in a hemodynamic-directed approach to CPR. In a study with 4-week-old piglets, hemodynamic-directed CPR with compression depth titrated to SBP > 90 mm Hg and vasopressor administration to maintain CPP ≥ 20 mm Hg resulted in higher survival rate than standard care of CC depth 1/3 AP diameter [29].
1.1.3 CPR devices
The 2015 AHA guidelines state that it is reasonable to use audiovisual feedback devices during CPR to optimize CPR quality. As mentioned before, there have been studies showing improvement in pediatric CPR quality with the addition of a real-time CPR feedback device [22, 23]. However, a systematic review and meta-analysis of studies using real-time feedback devices has not shown improvement in patient outcomes [30].
While mechanical chest compression devices such as Autopulse and LUCAS have been used in adults, both devices are not intended for use in children [31, 32].
1.1.4 Debriefing
There have been multiple adult studies showing that the implementation of a debriefing program can lead to improved CPR quality and outcomes [33]. There are generally two approaches to debriefing, hot debriefs and cold debriefs. Hot debriefs occur usually within hours after a cardiac arrest with team members involved in the cardiac arrest and involve mainly the members’ recall of the events and their immediate reactions. Cold debriefs occur at a later time, within weeks of an event with a larger audience that includes the immediate team members but also other ICU staff. The cold debrief involves a more comprehensive review of the cardiac arrest and can include more objective measures such as defibrillator CPR data and physiologic monitor data [34]. Pediatric studies on debriefings have been limited. A study of the content and process of hot debriefs from the pediRES-Q collaborative revealed approximately half of all cardiac arrests are followed by hot debriefs. The content of the hot debriefs are usually about cooperation/coordination, communication, and clinical standards [35]. The association between hot debriefs and outcomes still needs to be determined. A single-center prospective interventional study sought to evaluate the effectiveness of the implementation of a cold debriefing program on survival outcomes in children. They found that implementation of their program was associated with improved CPR quality and survival with FNO [36].
1.1.5 CPR duration
Despite excellent quality CPR, many clinicians question whether continuing resuscitation is futile for prolonged cardiac arrests. An analysis of the GWTG registry aimed to examine the effect of CPR duration for pediatric IHCA on outcomes. The authors concluded that CPR duration was independently associated with SHD and survival with FNO. However, among survivors, survival with FNO was 70% in those arrests occurring <15 min and 60% for those patients with arrests >35 min. Compared to medical patients, surgical cardiac patients had the highest adjusted OR for SHD and survival with FNO [37].
1.2 Summary
The 2015 AHA guidelines on pediatric CPR are based on extrapolation of evidence from adult and animal studies. Since then there has been a growing amount of literature that supports transitioning CPR from a “provider”-centric to “patient”-centric CPR. Recent literature has shown no change or worse outcomes when providers follow “provider”-centric guidelines that use standardized targets. Chest compression rates lower than recommended have been associated with improved outcomes. There has been no association shown between CC depth and outcomes. Ventilation rates higher than 2015 AHA guidelines are associated with improved outcomes. More recent evidence is emerging that demonstrates targeting a patient’s physiologic response to CPR may be more beneficial. Evidence has shown that DBP greater than 25 mm Hg in infants and 30 mm Hg in older children are associated with improved outcomes. There are many CPR quality metrics to choose from to guide CPR. These metrics can help improve the quality of CPR from a system-wide standpoint.
2. Medications used in cardiac arrest
The 2015 PALS guidelines discussed three drugs used during resuscitation in children: epinephrine, amiodarone, and lidocaine [24]. Table 2 highlights these medications, comparing recommendations from the 2015 PALS update and most recent literature that has been published since then. The 2015 PALS guidelines state that it is reasonable to use epinephrine during cardiac arrest. This guideline was based on two pediatric observational studies that were inconclusive and one adult study showing increased ROSC and survival to admission but no change in SHD [24]. Since the 2015 guidelines, an analysis of nonshockable pediatric cardiac arrests in the GWTG registry showed a delay in epinephrine administration was associated with decreased likelihood of survival to admission, ROSC, SHD, and survival with FNO [38]. Another GWTG analysis looked at the intervals between epinephrine administration. Guidelines currently state to give epinephrine every 3–5 min during CPR. This study showed that compared to intervals of 1–5 min as the reference, longer intervals were associated with improved SHD [39]. For shock refractory VF or pulseless VT, the 2015 guidelines changed to state that either amiodarone or lidocaine was acceptable. Previous guidelines had recommended amiodarone as the preferred drug over lidocaine. This is based on pediatric retrospective data that shows lidocaine is associated with improved ROSC and 24-h survival; however, there is no change in SHD [24]. The 2018 update to the PALS guidelines continued to reaffirm the 2015 guidelines. No new pediatric data was available for the updated review; however, the committee did not consider extrapolated adult data [40].
Medication
2015 PALS guidelines
Most recent literature
Epinephrine
It is reasonable to give epinephrine at intervals every 3–5 min
Delay in epinephrine administration associated with worse outcomes
Longer intervals between epinephrine are associated with better outcomes
Amiodarone/lidocaine
Either amiodarone or lidocaine is equally acceptable for shock refractory VF or pulseless VT
2018 PALS update: no change
Table 2.
Medications used during pediatric cardiac arrest: Current guidelines vs. most recent literature.
3. Pediatric ECPR
3.1 History and current use of extracorporeal cardiopulmonary resuscitation (ECPR) in pediatrics
Extracorporeal membrane oxygenation (ECMO) use for cardiopulmonary resuscitation (CPR) in children was first described in the literature by del Nido in 1992 [41]. Since then, utilization of extracorporeal cardiopulmonary resuscitation has expanded in all pediatric age groups. The current definition of ECPR according to the Extracorporeal Life Support Organization (ELSO) is “the application of rapid-deployment venoarterial ECMO, to provide circulatory support in patients in whom conventional CPR is unsuccessful in achieving sustained return of spontaneous circulation (ROSC). Sustained ROSC is deemed to have occurred when chest compressions are not required for 20 consecutive minutes and signs of circulation persist” [42]. This definition has been used since ELSO updated its data definitions in 2018. Pre-2018, the ELSO definition of ECPR was “ECMO used for initial resuscitation from cardiac arrest” and did not include patients who had achieved ROSC when they were being cannulated for ECMO [43]. Apart from the ELSO definitions, the definition of ECPR varies in clinical studies, and this presents challenges with medical communication and synthesis of research.
Based on ELSO registry data, there has been an increasing use of ECPR in pediatric patients over the years [44]. The overwhelming majority of pediatric ECPR use reported in the literature is for in-hospital cardiac arrest (IHCA) [44]. There are only few reports of ECPR deployed in pediatric patients for out-of-hospital cardiac arrest (OHCA); 2% of pediatric ECPR cases reported to ELSO were for OHCA according to the 2016 pediatric ELSO registry report [44, 45]. There is one case report of out-of-hospital ECMO deployment in a child (“pre-hospital ECPR”) [46].
From reported literature, the incidence of ECPR use varies from 5 to 27% of all pediatric IHCA cases between 2000 and 2016 [37, 47, 48, 49]. Of pediatric IHCA cases reported to the American Heart Association (AHA) Get With the Guidelines®-Resuscitation registry between the years 2000 and 2008, the incidence of ECPR use was 5–7% overall and 19–21% in patients with a cardiac diagnosis [37, 47]. More recently, the incidence of ECPR use was 27.2% in cardiac arrest patients reported to the Pediatric Cardiac Critical Care Consortium (PC4) registry between 2014 and 2016 [49].
The AHA had not included ECPR in Pediatric Advanced Life Support (PALS) guidelines until 2005 when guidelines were updated to include a consideration of ECPR in patients with a reversible cause of arrest or whose underlying condition could be treated by heart transplantation and who were located at an institution that could rapidly deploy ECMO, where effective conventional CPR had been started promptly [50]. Subsequent PALS updates have included this cautious recommendation to consider ECPR, particularly for cardiac patients with IHCA [18, 24, 51].
3.2 Cannulation procedure during CPR
Determination of a patient’s ECPR candidacy and feasibility of cannulation should preferably be done prior to cardiac arrest. Criteria for determination of candidacy may vary from center to center, and there are no universal guidelines for this. Though the AHA recommends considering ECMO for pediatric IHCA, there are no specific guidelines for the actual implementation of ECMO during CPR.
Site of cannulation varies in pediatrics and could be central or peripheral. Central (transthoracic) cannulation is more frequently performed in cardiac surgical patients, some of whom may already have an open sternum [52, 53, 54] . Peripheral cannulation could be via right neck vessels (internal jugular vein and carotid artery) or femoral vessels. Data is conflicting on the presence of a correlation between cannulation site and outcomes in pediatric ECPR [55, 56, 57, 58, 59, 60, 61, 62].
Questions also remain surrounding (i) the appropriate timing of initiating a request for ECMO implementation during CPR, (ii) the use of timed cycled interruptions of chest compressions to allow for cannulation, and (iii) the ongoing administration of epinephrine (adrenaline) during ECPR cannulation. From a review of the literature, clinical practice varies in regard to how long after the initiation of chest compressions that ECMO is requested for pediatric IHCA [57, 60, 63, 64, 65, 66]. A cross-sectional survey of pediatric cardiac intensive care practitioners published in 2018 showed that 38% of respondents reported activating ECMO after just one dose of epinephrine, while more than 80% called for ECMO after the second dose [67]. The timing of initiation of ECMO cannulation during CPR is important because it contributes to total CPR duration. Based on this, it would seem prudent to request ECMO early into the resuscitation effort. But caution must also be taken to avoid deployment prematurely, for example, if return of spontaneous circulation (ROSC) could have been achieved without ECMO. The effect of total CPR duration on survival and neurological outcomes after pediatric ECPR is unclear. In a recent large study using data from both ELSO and GWTG-R registries, a linear relationship was demonstrated between CPR duration and odds of death before hospital discharge [68]. Multiple single-center studies have also shown worse outcomes from pediatric ECPR if duration of CPR is longer [52, 60, 63, 64, 66, 69, 70, 71, 72]. However, still other studies have shown no correlation between ECPR duration and outcomes [37, 53, 57, 73, 74, 75, 76, 77, 78, 79]. The patient population possibly dictates the effect of ECPR duration on outcome. Compared to other illness categories, pediatric cardiac surgical patients have been shown to have a higher probability of favorable neurologic outcomes despite ECPR of prolonged duration [37].
The use of timed cycled interruptions of chest compressions to facilitate cannulation during ECPR is practiced in some centers, but there is no literature to show how widespread this practice is or whether it has positive effects on outcomes. Without timed cycled interruptions, chest compressions are paused randomly, usually at the discretion of the cannulating surgeon, and they are paused for varying amounts of time. With timed cycled interruptions, pauses in chest compressions are on a cycle—compressions are not paused unless a minimum time has passed (e.g., 2 min), and they are only paused for a maximum amount of time (e.g., 30–45 s). With the cycled method, the cannulating surgeon is only able to work in short bursts of time, and it is possible that overall CPR duration is therefore longer. However, it is also likely that CPR “no-flow” time is less. This is an area that needs to be studied.
Epinephrine administration for CPR during ECMO cannulation is also an area of research interest. Proponents of the cessation of epinephrine administration during ECMO cannulation for CPR argue that ongoing administration would only increase systemic vascular resistance (which would impede ECMO flow subsequently and hamper myocardial recovery) and is futile for ROSC since the decision would have already been made to cannulate. However, the 2009 study of 199 pediatric ECPR recipients from GWTG-R registry demonstrated no statistically significant difference between survivors and non-survivors in cumulative dose of epinephrine received during ECPR [73]. Also, in the cross-sectional survey of pediatric cardiac critical care clinicians published in 2018, only 19% of respondents reported limiting epinephrine to 1–3 doses during CPR before ECMO cannulation [67].
3.3 Elements of an ECPR program
Deployment of ECPR requires that a well-coordinated, streamlined, and efficient sequence of activities takes place. For success of an ECPR program, it is essential that clinical teams are always ready since time is of the essence. Important elements to a successful ECPR program include (i) prior identification of patients that would be offered ECMO in the case of cardiac arrest, (ii) prior establishment of a system of emergently notifying all required parties in the event of cardiac arrest (e.g., through paging), (iii) ready availability of primed ECMO circuits and blood products, and (iv) effectively trained and prepared team members [80, 81].
Some ECPR programs have crystalloid-primed or non-blood colloid-primed circuits always on standby [57, 76, 81, 82]. Sixty-five percent of 1828 pediatric ECPR cases reported to ELSO from 2011 to 2015 had an ECMO circuit primed with blood products [44]. Different considerations go into the choice of prime solution for rapid deployment. Blood-primed circuits are dependent on the rapid availability of blood products and cannot be stored long-term. Some programs do not keep pre-primed circuits if blood can be obtained quickly [83]. Crystalloid-primed circuits may be stored for up to 30 days but may require adjustment of pH and addition of blood prior to use [57, 76, 81]. Cost must also be considered in the decision to have pre-primed circuits on standby. For example, as published in 2017 by Erek et al., their pediatric ECPR program in Turkey avoids pre-primed ECMO circuits due to cost. Instead they emergently deploy cardiopulmonary bypass circuits for ECPR then transition to ECMO circuits later in the course [52].
Teams must be effectively trained and prepared. Simulation has proven to be an effective method for ECPR team training and has been used in many programs around the world with good results [84, 85, 86].
3.4 Pediatric ECPR outcomes
Survival after ECPR in pediatrics is around 43% in all age groups, according to ELSO [44]. Only a few pediatric studies have compared conventional CPR (CCPR) with ECPR [48, 87, 88]. In an analysis published in 2016 of almost 600 pediatric IHCA patients from the GWTG-R registry, there were increased odds of survival to hospital discharge for patients who received ECPR compared to CCPR only (adjusted OR 2.76; 95% CI 2.08–3.65; p < 0.0001) [87]. An earlier study published in 2013 did not demonstrate an association between ECPR and improved survival to discharge compared to CCPR, but that study had a small ECPR subgroup and was unable to match controls [48].
Taeb et al. compared CPR quality between ECPR and CCPR in pediatric cardiac intensive care patients. They found that CPR duration was significantly longer for patients who received ECPR than those who received CCPR [30 min (9.5–33 min) vs. 5.5 min (4–12.5 min); p = 0.016]. Rate of ROSC, intensive care unit length of stay, and hospital length of stay were not different between the groups [88].
Neurological outcomes after ECPR are important metrics, but there is a general paucity of data on this topic. Multiple single-center and registry studies have reported on neurologic status at hospital discharge using the Pediatric Cerebral Performance Category (PCPC) scale [37, 57, 61, 64, 73, 81, 87, 89, 90, 91]. However, many of those studies have incomplete data, and designation of a patient’s PCPC is also subjective. In addition, the definition of favorable neurologic outcome scores using PCPC varies. All these make interpretation of the data somewhat difficult. In the 2019 study of merged ELSO and GWTG-R data, discharge PCPC was only available in 48% of 241 pediatric ECPR survivors; 93% of those had a PCPC ≤2 which was considered favorable [68].
There is limited data on functional and neurobehavioral status in pediatric ECPR patients beyond hospital discharge [60, 63, 92, 93, 94, 95]. Torres-Andres et al. assessed health-related quality of life after pediatric ECPR. Children with normal brain imaging at the time of ECMO decannulation had statistically higher quality of life scores compared to other children, and those with ischemic changes on brain imaging at decannulation had higher quality of life scores than those with hemorrhagic changes [96].
3.5 Transportation of pediatric cardiac arrest patients to ECMO centers
The decision to transport pediatric cardiac arrest patients with active chest compressions to a hospital that performs ECPR must be considered carefully. Literature on this subject is minimal. Prolonged CPR before ECMO cannulation has been shown in some studies to not result in worse mortality, especially in patients with cardiac diagnoses [77, 97, 98]. However, Eich et al. describe the outcomes of 12 pediatric patients who suffered near-drowning episodes between 1987 and 2005 and who were transported to a tertiary center in Germany for emergent cardiopulmonary bypass [45]. Only 5 of the 12 survived to hospital discharge, of which 3 were in a persistent vegetative state.
In deciding to transport pediatric patients receiving CPR, one must consider the following: etiology of cardiac arrest, origin of transport (i.e., out-of-hospital transport vs. interhospital transfer), the duration of “no-flow” time, the anticipated total duration of CPR, the physical distance to the ECMO center, effectiveness of CPR during transport, and safety of medical personnel performing compressions during transport. Safety and effectiveness of CPR during transport of children has not been studied [99].
3.6 Summary
In summary, ECPR use in pediatrics is on the rise. There is evidence of its positive impact, and it has been included in resuscitation guidelines for pediatric in-hospital cardiac arrest, in specific patients and where existing programs are available. It is important that hospitals establishing and running ECPR programs have detailed protocols and repeated training and rehearsing for ECPR.
4. Pediatric post-arrest care
4.1 Introduction
In 1966, the National Academy of Sciences published a consensus statement on CPR describing the ABCDs of resuscitation. In this document A denoted airway opened; B denoted breathing restored; C denoted circulation restored; and D denoted definitive therapy. Definitive therapy was described as therapy for the management of the cause(s) of the arrest and management of resulting pathology from the arrest [100]. Successful return of spontaneous circulation (ROSC) that is sustained often results in post-cardiac arrest syndrome (PCAS). PCAS is described in phases defined by time. The immediate post-arrest phase is described as the first 20 min after ROSC. This is followed by the early post-arrest phase which is described as between 20 min through 6–12 h after ROSC. The intermediate phase follows lasting up to 72 h following ROSC. Afterwards the recovery phase starts and lasts until disposition when the rehabilitation phase begins. These last two phases vary in duration [101].
Post-cardiac arrest syndrome encompasses (1) post-cardiac arrest brain injury, (2) post-cardiac arrest myocardial dysfunction, (3) systemic ischemia/reperfusion response, and (4) persistent precipitating pathology. The severity of illness from this pathology varies based on the extent of the ischemic insult, the cause of the cardiac arrest, and patient’s prearrest state of health. The mechanism of post-cardiac arrest brain injury is complex and includes excitotoxicity, disrupted calcium homeostasis, free radical formation, protease cascades, and activation of cell death signaling pathways. Post-cardiac arrest brain injury is also influenced by what is often hyperemic reperfusion and frequent failure to achieve adequate cerebral reperfusion. Post-cardiac arrest myocardial dysfunction describes the transient global dysfunction that is seen immediately after ROSC. The systemic ischemia/reperfusion response describes the whole-body ischemia/reperfusion that occurs with hypoxia-induced activation of immunologic and coagulation pathways that is seen with cardiac arrest. Clinically this appears as intravascular volume depletion, impaired vasoregulation, impaired oxygen delivery, and increased susceptibility to infection. The persistence of the precipitating cause of the cardiac arrest often complicates the pathology of post-cardiac arrest syndrome. Specific treatment of the cause must be aligned with treatment of the PCAS [101]. In 2019, the AHA scientific statement estimated that more than 1800 children and infants were at risk for PCAS annually [102]. The individual components of PCAS are potentially treatable, and this has led to an emphasis on post-cardiac arrest care (PCAC).
PCAC varies depending on the phase of post-cardiac arrest syndrome and the setting in which care is being delivered. PCAC requires multisystem support and must begin promptly after ROSC. The goal of the treatment is to support end-organ function, treat PCAS, and correct the causal factor for the arrest. PCAC begins with the initiation of monitoring as soon after ROSC as feasible. This monitoring includes continuous cardiac telemetry, pulse oximetry, continuous capnography, continuous temperature monitoring, blood pressure measurement, and monitoring of urine output. Laboratory analysis is also important and includes blood gases, serum electrolytes, serum glucose, and calcium. Other monitoring to consider includes arterial lactate, central venous oxygen saturation, chest x-ray, renal function, hemoglobin concentration, coagulation function, and monitoring for signs of inflammation. Neurologic monitoring is useful in a comatose post-cardiac arrest patient. The goal of neurologic monitoring is to prevent secondary neurological injury and aid in prognostication. This monitoring could include serial exams and electroencephalogram [103]. Appendix Figure A1 shows an example of a post-arrest care checklist.
4.2 Hemodynamics
There is no high-quality evidence to support a single strategy for providing optimal hemodynamic support in pediatric patients post-cardiac arrest. Post-cardiac arrest myocardial dysfunction treatment can be aided by monitoring arterial lactate and central venous oxygen saturation. Parenteral fluids, inotropes, and vasoactive medications are to be used as needed to provide hemodynamic support. Optimal use of parenteral fluids vs. vasopressors/inotropes has not yet been determined. At times hemodynamic stability will include management of arrhythmias. Medications to treat arrhythmias are dependent on the underlying cardiac pathology. Hemodynamic treatment should be adjusted to account for the patient’s PCAS and prearrest characteristics. At times extracorporeal membrane oxygenation is initiated during CPR as described earlier in the chapter. The efficacy of ECMO for hemodynamic support after ROSC is unclear [104].
4.3 Oxygenation and ventilation
Optimizing oxygenation and ventilation after ROSC is essential and may be hindered by the cause of the arrest and the ongoing PCAS. Providing oxygen is a common therapy in critically ill children. There is no consistent data on the usefulness of hyperoxia after cardiac arrest in children. Treatment with a goal of providing normal paO2 using the lowest possible fraction of inspired oxygen to maintain an oxygen saturation of 94–99% is the current strategy [102]. It is important to manage ventilation as both hypercarbia and hypocarbia have deleterious effects on cerebral perfusion. Current data suggest that it is appropriate to target normocapnia or a PaCO2 specific for the patient’s condition while minimizing hypercapnia and hypocapnia [24, 105]. While providing strategies to optimize oxygenation and ventilation, we must be mindful that therapeutic hypothermia can alter the arterial oxygen saturation and affect carbon dioxide production which will be reflected in the minute ventilation [106].
4.4 Targeted temperature management (TTM)
The 2019 American Heart Association update for Pediatric Advanced Life Support included endorsement of post-cardiac arrest continuous maintenance of patient temperature, also referred to as TTM. In 2019 ILCOR pediatric CoSTR summarized evidence supporting the use of TTM (32–34°C) in infants and children after cardiac arrest [107]. Referring to their work, the American Heart Association recommends continuous measurement of core temperature during TTM. Additionally, for infants and children between 24 h of age and 18 years of age who remain comatose after out of hospital cardiac arrest or IHCA, it is reasonable to use TTM at 32–34°C followed by TTM at 36–37.5°C. Initiating hypothermia can be achieve in many ways including cooling blankets, surface cooling with ice packets, or gastric lavage. Electrolyte derangements including hyperglycemia, hypokalemia, hypophosphatemia, hypomagnesaemia, and hypocalcemia can occur during induction of hypothermia. This electrolyte instability can lead to arrhythmias. While maintaining hypothermia, careful monitoring is required. The ideal strategy for rewarming has not yet been identified. In children, the rewarming is usually done at a rate no faster than 0.5°C every 2 h. This reduces the risk of cerebral hyperperfusion, vasogenic edema, and acute systemic hypotension [102]. During PCAC, a temperature >37.5°C should be avoided and aggressively treated [108].
There was data suggesting that earlier timing of hypothermia was associated with better outcomes. Moler and colleagues developed a trial to investigate if shorter time to goal temperature was associated with improved outcomes at 1 year. Using data from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hosptial Trial (ThAPCA –OH), critically ill children from 38 pediatric intensive care units in the United States and Canada were randomized to therapeutic hypothermia or normothermia [109]. Median time to goal temperature in group 1 was 5.8 h and in group 2 was 8.8 h. However, outcomes between the groups did not differ. They concluded that earlier time to goal temperature was not associated with better outcomes [110].
4.5 Sedation
Similarly, to other critically ill children, children with PCAS will likely require treatment with sedatives, analgesics, and possibly neuromuscular blockade. There is insufficient data to describe optimal management of sedation and analgesia for pediatric patients with PCAS. With the use of TTM sedation, analgesia and neuromuscular blockade may be used to facilitate cooling and prevent shivering. Caution is advised when using neuromuscular blockade as this will hinder the clinical neurologic exam and will mask seizures.
4.6 Neurologic monitoring
Continuous EEG monitoring for pediatric patients who are encephalopathic following cardiac arrest and ROSC is recommended. This recommendation came forth from the recent consensus statement from the American Clinical Neurophysiology Society Critical Care Continuous EEG Guidelines Committee [111]. It is recommended that EEG monitoring be initiated as soon as possible and continue for 24–48 h. The recommendation also advises to continue monitoring for 24 h after patients treated with hypothermia are rewarmed to normothermia. There have not been studies to evaluate the effect of treatment of seizures in the post-cardiac arrest period on patient outcomes. Generally, most clinicians treat seizures as they can increase metabolic demand and contribute to secondary brain injury.
4.7 AKI and glucose control
The impact of the management of AKI and glucose control during PCAC is unclear. Data evaluating pediatric post-cardiac arrest AKI and glucose control management is scarce. AKI in critically ill children is associated with increased mortality and morbidity [112, 113]. It is important to monitor kidney function during PCAC as these patients are at risk to develop AKI. During PCAC, it is important to monitor for and treat hypoglycemia and hyperglycemia in post-cardiac arrest patients. Both hypoglycemia and hyperglycemia have been associated with poor outcomes in children [114]. There is no data that evaluates interventional studies of glucose control on PCAC pediatric patients.
4.8 Rehabilitation
Rehabilitation following cardiac arrest is vital. Children surviving cardiac arrest are at risk for alterations in their quality of life from physical, cognitive, and emotional disabilities. They are at risk for significant declines in neurobehavioral function across multiple functional domains [115]. There is also evidence that post-cardiac arrest patients are at risk for developing delirium [116]. There is little data on specific interventions during PCAC that will improve functional outcomes in children after cardiac arrest. More information is needed to identify specific rehabilitation interventions that can be used in PCAC that will improve outcomes for pediatric post-cardiac arrest patients [102].
4.9 Summary
To summarize, how we care for pediatric patients post successful ROSC after cardiac arrest critically influences their outcomes. Each component of post-cardiac arrest care requires focused management. This care is highly complex and time sensitive. Despite knowing how crucial this management is to the outcomes of patients post-cardiac arrest, significant gaps in knowledge remain. More work is needed to identify the most efficient approaches to provide this care for pediatric patients.
5. Conclusions
Many of the recommendations regarding CPR quality metrics in children are based on extrapolation of adult and animal data, given the scarcity of pediatric literature. Although current AHA guidelines focus on “provider”-centric CPR, the evidence for transitioning to a “patient”-centric guided CPR is growing. Along with CPR quality, the choice of the right medications and dosing intervals is critical during a pediatric cardiac arrest and is also a field of pediatric resuscitation that is lacking evidence. Despite good-quality CPR, there are many times when ROSC does not occur. Although PALS guidelines state that ECPR can be considered in certain circumstances, there are still gaps in the literature regarding cannulation strategies and resuscitation practices during ECPR. After successful ROSC or return of circulation after ECPR, the medical management of a child is critical to ameliorate the effects of PCAS and prevent further injury to vital organs, in particular the brain.
Appendix
Figure A1.
Post arrest care checklist.
\n',keywords:"CPR quality, ECPR, extracorporeal cardiopulmonary resuscitation, pediatric cardiac arrest, post-cardiac arrest care",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72241.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72241.xml",downloadPdfUrl:"/chapter/pdf-download/72241",previewPdfUrl:"/chapter/pdf-preview/72241",totalDownloads:628,totalViews:0,totalCrossrefCites:0,dateSubmitted:"January 17th 2020",dateReviewed:"April 5th 2020",datePrePublished:"May 19th 2020",datePublished:"November 19th 2020",dateFinished:"May 19th 2020",readingETA:"0",abstract:"This chapter will focus on four important topics in pediatric cardiac arrest. We will highlight recent developments in pediatric CPR quality, medications used in cardiac arrest, ECPR, and post-cardiac arrest care (PCAC) and discuss the existing literature behind AHA guidelines and gaps in knowledge. Optimization of CPR quality is critical during cardiac arrest. We will summarize literature regarding current guidelines which target provider-centered goals and discuss evidence behind patient-centered goals. We will also discuss the evidence behind drugs used in the PALS guidelines. In cases of refractory cardiac arrest, ECMO can be lifesaving; however, there are still many gaps in our knowledge of this field. We will summarize the literature regarding determination of candidacy, cannulation strategies, resuscitation practices during ECPR, and outcomes. After a cardiac arrest, PCAC is crucial to minimize further injury from post-cardiac arrest syndrome (PCAS). The main goals of PCAC are to prevent further brain injury, treat myocardial dysfunction, and systemic ischemia/reperfusion injury. 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Pediatric post-arrest care",level:"1"},{id:"sec_26_2",title:"4.1 Introduction",level:"2"},{id:"sec_27_2",title:"4.2 Hemodynamics",level:"2"},{id:"sec_28_2",title:"4.3 Oxygenation and ventilation",level:"2"},{id:"sec_29_2",title:"4.4 Targeted temperature management (TTM)",level:"2"},{id:"sec_30_2",title:"4.5 Sedation",level:"2"},{id:"sec_31_2",title:"4.6 Neurologic monitoring",level:"2"},{id:"sec_32_2",title:"4.7 AKI and glucose control",level:"2"},{id:"sec_33_2",title:"4.8 Rehabilitation",level:"2"},{id:"sec_34_2",title:"4.9 Summary",level:"2"},{id:"sec_36",title:"5. Conclusions",level:"1"},{id:"sec_38",title:"Appendix",level:"1"}],chapterReferences:[{id:"B1",body:'Berg MD et al. In-hospital pediatric cardiac arrest. Pediatric Clinics of North America. 2008;55(3):589-604, x'},{id:"B2",body:'Nadkarni VM et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. Journal of the American Medical Association. 2006;295(1):50-57'},{id:"B3",body:'Holmberg MJ et al. Trends in survival after pediatric In-hospital cardiac arrest in the United States. Circulation. 2019;140(17):1398-1408'},{id:"B4",body:'Atkins DL et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S519-S525'},{id:"B5",body:'Sutton RM et al. Pushing harder, pushing faster, minimizing interruptions…but falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation. Resuscitation. 2013;84(12):1680-1684'},{id:"B6",body:'Niles DE et al. Characterization of pediatric In-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. 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Absence of rapid deployment extracorporeal membrane oxygenation (ECMO) team does not preclude resuscitation ECMO in pediatric cardiac patients with good results. ASAIO Journal. 2007;53(6):692-695'},{id:"B84",body:'Sawyer T et al. Impacts of a pediatric extracorporeal cardiopulmonary resuscitation (ECPR) simulation training program. Academic Pediatrics. 2019;19(5):566-571'},{id:"B85",body:'Puslecki M et al. BEST life-“bringing ECMO simulation to life”-how medical simulation improved a regional ECMO program. Artificial Organs. 2018;42(11):1052-1061'},{id:"B86",body:'Su L et al. Implementation of an extracorporeal cardiopulmonary resuscitation simulation program reduces extracorporeal cardiopulmonary resuscitation times in real patients. Pediatric Critical Care Medicine. 2014;15(9):856-860'},{id:"B87",body:'Lasa JJ et al. Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric In-hospital cardiopulmonary arrest is associated with improved survival to discharge: A report from the American Heart Association’s get with the guidelines-resuscitation (GWTG-R) registry. Circulation. 2016;133(2):165-176'},{id:"B88",body:'Taeb M et al. Comparison of pediatric cardiopulmonary resuscitation quality in classic cardiopulmonary resuscitation and extracorporeal cardiopulmonary resuscitation events using video review. Pediatric Critical Care Medicine. 2018;19(9):831-838'},{id:"B89",body:'Burke CR et al. Pediatric extracorporeal cardiopulmonary resuscitation during nights and weekends. Resuscitation. 2017;114:47-52'},{id:"B90",body:'Huang SC et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Critical Care Medicine. 2008;36(5):1607-1613'},{id:"B91",body:'Prodhan P et al. Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation. 2009;80(10):1124-1129'},{id:"B92",body:'Meert KL et al. Extracorporeal cardiopulmonary resuscitation: One-year survival and neurobehavioral outcome among infants and children with In-hospital cardiac arrest. Critical Care Medicine. 2019;47(3):393-402'},{id:"B93",body:'Meert KL et al. One-year survival and neurologic outcomes after pediatric open-chest cardiopulmonary resuscitation. The Annals of Thoracic Surgery. 2019;107(5):1441-1446'},{id:"B94",body:'Meert K et al. Paediatric in-hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later. Resuscitation. 2018;124:96-105'},{id:"B95",body:'Meert K et al. One-year cognitive and neurologic outcomes in survivors of paediatric extracorporeal cardiopulmonary resuscitation. Resuscitation. 2019;139:299-307'},{id:"B96",body:'Ahmed OZ et al. 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Journal of the American Medical Association. 1966;198(4):372-379'},{id:"B101",body:'Neumar RW et al. Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118(23):2452-2483'},{id:"B102",body:'Topjian AA et al. Pediatric post-cardiac arrest care: A scientific statement from the American Heart Association. Circulation. 2019;140(6):e194-e233'},{id:"B103",body:'Bongiovanni F et al. Standardized EEG analysis to reduce the uncertainty of outcome prognostication after cardiac arrest. Intensive Care Medicine. 2020'},{id:"B104",body:'Holmberg MJ et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review. Resuscitation. 2018;131:91-100'},{id:"B105",body:'Gill C, Kissoon N. Pediatric life support update: 2015 American Heart Association highlights. Pediatric Emergency Care. 2017;33(8):585-593'},{id:"B106",body:'Karnatovskaia LV et al. Effect of therapeutic hypothermia on gas exchange and respiratory mechanics: A retrospective cohort study. Therapeutic Hypothermia and Temperature Management. 2014;4(2):88-95'},{id:"B107",body:'Soar J et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: Summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation. 2019;140(24):e826-e880'},{id:"B108",body:'Duff JP et al. 2019 American Heart Association focused update on pediatric basic life support: An update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2020;145(1):e20191361'},{id:"B109",body:'Moler FW et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. The New England Journal of Medicine. 2015;372(20):1898-1908'},{id:"B110",body:'Moler FW et al. Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation. 2019;135:88-97'},{id:"B111",body:'Herman ST et al. Consensus statement on continuous EEG in critically ill adults and children, part I: Indications. Journal of Clinical Neurophysiology. 2015;32(2):87-95'},{id:"B112",body:'Soler YA et al. Pediatric risk, injury, failure, loss, end-stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: A prospective study. Pediatric Critical Care Medicine. 2013;14(4):e189-e195'},{id:"B113",body:'Alkandari O et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: A two-center retrospective cohort study. Critical Care. 2011;15(3):R146'},{id:"B114",body:'Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. The Journal of Pediatrics. 2005;146(1):30-34'},{id:"B115",body:'Slomine BS et al. Neurobehavioural outcomes in children after In-hospital cardiac arrest. Resuscitation. 2018;124:80-89'},{id:"B116",body:'Boncyk CS et al. In the ICU - delirium post cardiac arrest. Current Opinion in Critical Care. 2019;25(3):218-225'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Priscilla Yu",address:null,affiliation:'
University of Texas Southwestern Medical Center, Children’s Health Medical Center, Critical Care Division, USA
'},{corresp:null,contributorFullName:"Ivie D. Esangbedo",address:null,affiliation:'
University of Texas Southwestern Medical Center, Children’s Health Medical Center, Critical Care Division, USA
University of Texas Southwestern Medical Center, Children’s Health Medical Center, Critical Care Division, USA
'}],corrections:null},book:{id:"10124",type:"book",title:"Sudden Cardiac Death",subtitle:null,fullTitle:"Sudden Cardiac Death",slug:"sudden-cardiac-death",publishedDate:"November 19th 2020",bookSignature:"Peter Magnusson and Jo Ann LeQuang",coverURL:"https://cdn.intechopen.com/books/images_new/10124.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-070-3",printIsbn:"978-1-83880-069-7",pdfIsbn:"978-1-83962-854-2",isAvailableForWebshopOrdering:!0,editors:[{id:"188088",title:"Dr.",name:"Peter",middleName:null,surname:"Magnusson",slug:"peter-magnusson",fullName:"Peter Magnusson"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"106445",title:"Prof.",name:"Robert J. I.",middleName:null,surname:"Leke",email:"robertjleker@yahoo.fr",fullName:"Robert J. I. 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Leke",slug:"robert-j.-i.-leke",email:"robertjleker@yahoo.fr"},{id:"106471",title:"Dr.",name:"Philip",surname:"Njotang Nana",fullName:"Philip Njotang Nana",slug:"philip-njotang-nana",email:"njotangnanaphilip@yahoo.fr"}],book:{id:"1821",title:"Basic Gynecology",slug:"basic-gynecology-some-related-issues",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"29304",title:"Prof.",name:"Atef",surname:"Darwish",slug:"atef-darwish",fullName:"Atef Darwish",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/29304/images/1698_n.jpg",biography:"Dr. Atef Darwish graduated from Assiut School of Medicine in 1985 with an excellent grade with first class honors. He got his Master degree in 1989 with Excellent degree. Between 1992-1994, he spent 2 years at the Endoscopic Unit of Ulm University, Germany. Thereafter, he received his Medical Doctorate in 1995 through a combined program between the University of Ulm, Germany and the University of Assiut, Egypt with Excellent degree. He joined the Endoscopy Unit of Villach University Hospital in Austria, the Assisted Reproduction Unit in Düsseldorf University Hospital in Germany and the reproductive biology and minimally invasive surgery unit in the Cleveland Clinic Foundation, Clevland, Ohio, USA. Currently, he is a Professor of Obstetrics and Gynecology, Faculty of Medicine, Assiut University since July 2005. Moreover, he is a consultant of Obstetrics and Gynecology in three hospitals and he is the moderator and lecturer of many endoscopic societies. \nHe authored an internationally registered undergraduate book, presented 59 presentations in national and international meetings, delivered a lot of lectures in Egypt, some Arabian countries and the USA and published more than 40 papers in international medical journals, and 7 papers in national journals. He received some congress prizes and awards due to his work in the field of reproductive medicine since 1995. 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IMPORTANT: You must be a member or grantee of the listed funders in order to apply for their Open Access publication funds. Do not attempt to contact the funders if this is not the case.
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UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
Wellcome Trust (Funding available only to Wellcome-funded researchers/grantees)
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TME is a complex network composed of extracellular matrix (ECM), stromal cells, and immune/inflammatory cells that drive cancer cells fate from invasion to intravasation and metastasis. The stromal-inflammatory interface represents a dynamic space, in which exchange of numerous molecular information is associated with the transition into tumorigenic microenvironment. Recruitment, activation, and reprogramming of stromal and immune/inflammatory cells in the extracellular space are the consequences of a reciprocal interaction between TME and cancer cells. Recent data suggest that cancer development is influenced by TME and controlled by the host’s immune system, underlying the importance of TME components and immune biomarkers in the determination of prognosis and response to therapy. The immune classification has prognostic value and may be a useful supplement to the histopathological, molecular, and TNM classifications. Nevertheless, the complexity of quantitative immunohistochemistry and the variable assay protocols, stromal and immune cell types analyzed underscore the need to harmonize the quantified methods. 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Iancu and Irena Manov",authors:[{id:"38689",title:"Dr.",name:"Theodore",middleName:null,surname:"Iancu",slug:"theodore-iancu",fullName:"Theodore Iancu"},{id:"38699",title:"Dr.",name:"Irena",middleName:null,surname:"Manov",slug:"irena-manov",fullName:"Irena Manov"}]}],mostDownloadedChaptersLast30Days:[{id:"59286",title:"Surgical Approaches to the Temporomandibular Joint",slug:"surgical-approaches-to-the-temporomandibular-joint",totalDownloads:6905,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"The temporomandibular joint (TMJ) acts as a sliding hinge between mandible and temporal bone. Disorders of temporomandibular joint are intolerable for the patients in severe cases. Furthermore, surgical treatment of temporomandibular joint problems is a challenge for surgeons in some cases. In that order, it is critical for the surgeon to choose the best surgical approach in treating the temporomandibular joint diseases. There are several surgical approaches in the management of temporomandibular joint problems including some pros and cons. So, in this chapter, we aim to present a comprehensive review of surgical approaches to the temporomandibular joint.",book:{id:"6025",slug:"temporomandibular-joint-pathology-current-approaches-and-understanding",title:"Temporomandibular Joint Pathology",fullTitle:"Temporomandibular Joint Pathology - Current Approaches and Understanding"},signatures:"Mohammad Esmaeelinejad and Maryam Sohrabi",authors:[{id:"172188",title:"Dr.",name:"Mohammad",middleName:null,surname:"Esmaeelinejad",slug:"mohammad-esmaeelinejad",fullName:"Mohammad Esmaeelinejad"},{id:"240723",title:"Dr.",name:"Maryam",middleName:null,surname:"Sohrabi",slug:"maryam-sohrabi",fullName:"Maryam Sohrabi"}]},{id:"41355",title:"Ossifying Fibromas of the Craniofacial Skeleton",slug:"ossifying-fibromas-of-the-craniofacial-skeleton",totalDownloads:4790,totalCrossrefCites:5,totalDimensionsCites:6,abstract:null,book:{id:"2619",slug:"histopathology-reviews-and-recent-advances",title:"Histopathology",fullTitle:"Histopathology - Reviews and Recent Advances"},signatures:"Bruno Carvalho, Manuel Pontes, Helena Garcia, Paulo Linhares and Rui Vaz",authors:[{id:"140061",title:"Dr.",name:"Bruno",middleName:null,surname:"Carvalho",slug:"bruno-carvalho",fullName:"Bruno Carvalho"},{id:"142266",title:"Dr.",name:"Manuel",middleName:null,surname:"Pontes",slug:"manuel-pontes",fullName:"Manuel Pontes"},{id:"142267",title:"Dr.",name:"Paulo",middleName:null,surname:"Linhares",slug:"paulo-linhares",fullName:"Paulo Linhares"},{id:"142268",title:"Prof.",name:"Rui",middleName:null,surname:"Vaz",slug:"rui-vaz",fullName:"Rui Vaz"},{id:"142958",title:"Dr.",name:"Helena",middleName:null,surname:"Garcia",slug:"helena-garcia",fullName:"Helena Garcia"}]},{id:"58358",title:"Internal Derangements of the Temporomandibular Joint: Diagnosis and Management",slug:"internal-derangements-of-the-temporomandibular-joint-diagnosis-and-management",totalDownloads:3288,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Millions of individuals worldwide suffer from temporomandibular joint (TMJ) disorders and are characterized by pain and joint dysfunction. TMJ internal derangement (ID) is the most frequent type of temporomandibular disorders (TMDs). The ID of TMJ is defined as a joint dysfunction associated with an abnormal disc position. Identification and elimination of the causes of tissue breakdown of the TMJ that lead to ID are the key factors for successful treatment. The common causes for TMJ ID are trauma and parafunctional habits which lead to joint overload and degenerative changes in the articular structures, increased friction, and gradual disc displacement. Local and systemic inflammatory/degenerative arthropathies may also affect TMJ and cause ID. The aim of this chapter is to give comprehensive knowledge about the contemporary perspective of TMJ ID including diagnostic and therapeutic developments and innovations. Clinicians should establish the correct diagnosis and cause of the disease for appropriate management so that patients do not suffer from ineffective treatments. As an innovative development, TMJ replacements with alloplastic joint prosthesis and tissue-engineered structures hold promise for the future of management of TMJ ID.",book:{id:"6025",slug:"temporomandibular-joint-pathology-current-approaches-and-understanding",title:"Temporomandibular Joint Pathology",fullTitle:"Temporomandibular Joint Pathology - Current Approaches and Understanding"},signatures:"Ufuk Tatli and Vladimir Machon",authors:[{id:"203864",title:"Associate Prof.",name:"Ufuk",middleName:null,surname:"Tatli",slug:"ufuk-tatli",fullName:"Ufuk Tatli"},{id:"204401",title:"Dr.",name:"Vladimir",middleName:null,surname:"Machon",slug:"vladimir-machon",fullName:"Vladimir Machon"}]},{id:"61976",title:"Metabolic Alkalosis",slug:"metabolic-alkalosis",totalDownloads:1463,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Metabolic alkalosis is a disorder where the primary defect, an increase in plasma bicarbonate concentration, leads to an increase in systemic pH. Here we review the causes of metabolic alkalosis with an emphasis on the inherited causes, namely Gitelman syndrome and Bartter syndrome and syndromes which mimic them. We detail the importance of understanding the kidney pathophysiology and molecular genetics in order to distinguish these syndromes from acquired causes. In particular we discuss the tubular transport of salt in the thick ascending limb of the loop of Henle, the distal convoluted tubule and the collecting duct. The effects of salt wasting, namely an increase in the renin-angiotensin-aldosterone axis are discussed in order to explain the biochemical phenotypes and targeted treatment approaches to these conditions.",book:{id:"6790",slug:"fluid-and-electrolyte-disorders",title:"Fluid and Electrolyte Disorders",fullTitle:"Fluid and Electrolyte Disorders"},signatures:"Holly Mabillard and John A. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{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"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n
\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. 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He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. 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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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