The Revised Cardiac Risk Index (RCRI) can be used to risk-stratify patients prior to non-cardiac surgery with regard to the risk of serious cardiac complications. Adapted from Lee et al. Circulation 1999; 100:1043-1049.
\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"1040",leadTitle:null,fullTitle:"Updated Topics in Minimally Invasive Abdominal Surgery",title:"Updated Topics in Minimally Invasive Abdominal Surgery",subtitle:null,reviewType:"peer-reviewed",abstract:"Updated topics in minimally invasive abdominal surgery provides surgeons interested in minimally invasive abdominal surgery with the most recent techniques and discussions in laparoscopic surgery. 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The physiological basis of many neuropathic symptoms continues to pursue experts in this field, and in many of the pathological changes related to neuropathies. In the last few decades, there has been increasing interest in new tools applied to diseases involving nerves of the nervous system, which have changed this state of affairs. Microscopic studies, new quantitative histometric methods, and refined physiologic techniques have already expanded our knowledge of structure and function of nerves and rapidly advancing techniques in the fields of immunology and molecular genetics to clarify entire categories of polyneuropathy. Although polyneuropathy is among the most challenging categories of neurological diseases, effective forms of treatment for polyneuropathy have been introduced during the last few decades. 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The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500,000 to 900,000 of these patients experience perioperative cardiac death, nonfatal perioperative myocardial infarction (PMI) or cardiac arrest [1]. Over 300,000 surgical revascularization procedures are performed in the US annually as part of the treatment of expanding abdominal aortic aneurysms, critical limb ischemia, and severe carotid disease [2].
The preoperative assessment of a patient in need of elective non-cardiac surgery is often a difficult task. Current guidelines consider vascular surgery a high-risk operation with an anticipated risk of major postoperative cardiac complications in excess of 5% [3]. Although the reasons relate, in part, to the hemodynamic stresses associated with aortic procedures, the prevalence of atherosclerotic coronary artery disease (CAD) in patients undergoing vascular surgery exceeds 50% and therefore, may require special attention in the preoperative period [4].
Unlike spontaneous myocardial infarction the majority of postoperative, or type 2, myocardial infarctions (PMI) are thought to result from an imbalance between oxygen supply and demand in the setting of severe, yet stable, coronary artery disease [5]. Several studies using continuous electrocardiographic monitoring in high-risk vascular patients undergoing surgery have shown that tachycardia-related ST-segment depression is common in the postoperative period and is associated with in-hospital as well as long-term mortality [6-7]. Peak troponin elevation correlates well with duration of ST-segment depression [8].
Angiographic and Autopsy Data: In a landmark angiographic study Hertzer et al. showed that only 8% of patients with peripheral arterial disease in need of major vascular surgery have normal coronary arteries [4]. In the CARP trial, among 1048 patients undergoing coronary angiography within 6-months of a high-risk vascular operation, the extent and severity of CAD were predictors of long-term mortality (Figure 1) [9].
Extent of Coronary Artery Disease and Survival
The prevalence of angiographic chronic total occlusions in patients with PMI or cardiac death is 81% as opposed to only 29% of matched control patients without PMI or cardiac death [10]. On average patients with postoperative cardiac complications have 2 ±1.4 critical (>70%) coronary stenosis in contrast to patients without postoperative complications who have less disease burden (0.7 ±1.2). Two small autopsy studies reported conflicting data on the incidence of coronary plaque rupture in patients with fatal PMI [11-12]. Dawood et al. found plaque rupture in only 7% of 42 autopsied patients [11]. In contrast, Cohen et al. reported in a smaller study a higher incidence of plaque rupture (46%) [12]. Differences between studies could be explained on the basis of timing of the autopsy relative to occurrence of PMI.
Stepwise approach to preoperative risk assessment:
The approach to assessing the potential cardiac risk associated with any patient scheduled for elective non-cardiac operation includes the nature of the operation, the risk of associated coronary artery disease and the functional capacity of the patient. The initial evaluation requires an assessment of a prior history of cardiac problems and/or risk factors along with either classical angina or unusual symptoms such as shortness of breath or atypical chest pains. Attention should be given to clinical risk variables such as age >70 years, angina, history of congestive heart failure, prior myocardial infarction, prior cerebrovascular accident (CVA) or transient ischemic attack (TIA), history of ventricular arrhythmias, diabetes mellitus (particularly insulin dependent), and abnormal renal function (Creatinine >2.0 mg/dl) [13] (Table 1). The physical examination also provides key insight into high risk variable and include a chronic debilitated state, increased jugular venous distention, edema, S3 gallop, significant aortic stenosis while the 12-lead electrocardiogram provides prognostic information related to the presence of abnormal Q-waves or heart rhythms other than normal sinus. Assessing the functional capacity of patients undergoing elective operations is an important ingredient to determining whether a patient can withstand the rigors of a prolonged operation. In those patients who are unable to achieve a 4-MET demand, a level compatible with routine daily activities, there is increased risk of postoperative events and additional testing may be warranted (i.e. stress test). The presence of multiple ischemic segments indicative of either multivessel coronary artery disease or left main disease is considered high risk and is associated with an increased risk of perioperative cardiac complications and reduced long-term survival [14]. Ultimately, a combined approach of utilizing clinical variables associated with stress-imaging tests is most cost-effective.
\n\t\t\t\tRCRI\n\t\t\t | \n\t\t\t\n\t\t\t\tDerivation set (2893)\n\t\t\t | \n\t\t\t\n\t\t\t\tValidation set (n=1422)\n\t\t\t | \n\t\t||
\n\t\t\t | Events | \n\t\t\tRate, 95% CI | \n\t\t\tEvents | \n\t\t\tRate, 95% CI | \n\t\t
\n\t\t\t\t0\n\t\t\t | \n\t\t\t5/1071 | \n\t\t\t0.5 (0.2-1.1) | \n\t\t\t2/488 | \n\t\t\t0.4 (0.5-1.5) | \n\t\t
\n\t\t\t\t1\n\t\t\t | \n\t\t\t14/1106 | \n\t\t\t1.3 (0.7-2.1) | \n\t\t\t5/567 | \n\t\t\t0.9 (0.3-2.1) | \n\t\t
\n\t\t\t\t2\n\t\t\t | \n\t\t\t18/506 | \n\t\t\t3.6 (2.1-5.6) | \n\t\t\t17/258 | \n\t\t\t6.6 (3.9-10.3) | \n\t\t
\n\t\t\t\t≥3\n\t\t\t | \n\t\t\t19/210 | \n\t\t\t9.1 (5.5-13.8) | \n\t\t\t12/109 | \n\t\t\t11 (5.8-18.4) | \n\t\t
The Revised Cardiac Risk Index (RCRI) can be used to risk-stratify patients prior to non-cardiac surgery with regard to the risk of serious cardiac complications. Adapted from Lee et al. Circulation 1999; 100:1043-1049.
Therapies that have been proven to reduce PMI among patients undergoing non-cardiac surgery include beta-blockers and statins.
Beta-blockers:
Mangano et al. reported a 6% absolute risk reduction in cardiac events at 6 months with atenolol among 200 male veterans undergoing noncardiac surgery [15]. Poldermans et al. reported a more dramatic 30% absolute risk reduction with bisoprolol among 173 patients undergoing vascular surgery with evidence of myocardial ischemia on stress test [16]. However, subsequent larger studies with metoprolol yielded negative results [17-19] (Table 2). The landmark POISE trial, with over 8300 patients enrolled showed that although extended-release metoprolol 200 mg reduces PMI by 26%, it is associated with a higher risk of death and stroke. For every 1000 patients treated with extended-release metoprolol 15 non-fatal myocardial infarctions would be prevented but 5 strokes and 8 deaths would be caused by it [20]. Therefore, the POISE trial raised serious concerns about the safety of injudicious administration of high-dose beta-blockers in the perioperative period.
\n\t\t\t\tStudy\n\t\t\t | \n\t\t\t\n\t\t\t\tPatients\n\t\t\t | \n\t\t\t\n\t\t\t\tIntervention\n\t\t\t | \n\t\t\t\n\t\t\t\tFindings\n\t\t\t | \n\t\t
Mangano et al. [15] | \n\t\t\t200 Male veterans undergoing non-cardiac surgery | \n\t\t\tAtenolol begun in hospital | \n\t\t\tCardiac events at 6 months 0% (drug) vs. 8% (placebo) | \n\t\t
Poldermans et al. [16] | \n\t\t\t173 patients with ischemia undergoing vascular surgery | \n\t\t\tBisoprolol 30 days before surgery | \n\t\t\tCardiac events 3.4 % (drug) vs. 34% (placebo) | \n\t\t
Yang et al. [17] | \n\t\t\t496 vascular surgery patients | \n\t\t\tMetoprolol begun before surgery | \n\t\t\tCardiac events 10.2% (metoprolol) vs. 12% (placebo) (p=NS) | \n\t\t
Juul et al. [18] | \n\t\t\t921 patients with diabetes undergoing major non-cardiac surgery | \n\t\t\tMetoprolol XL 100 mg | \n\t\t\t21 % vs. 20% (p=NS) | \n\t\t
Brady et al. [19] | \n\t\t\t103 patients without previous MI undergoing infrarenal vascular surgery | \n\t\t\tOral metoprolol 50 mg bid | \n\t\t\t34 % vs. 30% (p=NS) | \n\t\t
Devereaux et al. [20] | \n\t\t\t8351 undergoing non-cardiac surgery | \n\t\t\tOral CR- metoprolol 200 mg/d for 30 days | \n\t\t\t5.8% (drug) vs. 6.9% (placebo). Reduction in MI but increased risk of stroke and mortality with metoprolol | \n\t\t
Summary of clinical trials assessing the role of beta-blockers prior to non-cardiac surgery.
Statins:
In the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiograpy (DECREASE-III) study high-dose fluvastatin reduced the composite of cardiovascular death and non-fatal myocardial infarction by 53% among 457 patients undergoing vascular surgery [21]. In a smaller trial involving 100 vascular patients randomly assigned to 20 mg of atorvastatin or placebo, statins reduced cardiac events from 26% to 8% at 6 months [22]. In a single center registry of patients undergoing vascular operations at our institution the use of perioperative statins was an independent predictor of long-term survival [23]. Statins may play a pivotal role in plaque stabilization by reducing circulating levels of inflammatory cytokines, increase expression of nitric oxide synthase, and reduced production of endothelin-1 and reactive oxygen species.
Role of coronary revascularization:
The Coronary Artery Prophylactic Revascularization trial (CARP) showed that a strategy of prophylactic revascularization was not superior to optimal medical therapy in preventing PMIs or improving long-term mortality among 510 Veterans undergoing elective major vascular surgery [24] (Figure 2). Despite high utilization rates of statins and beta-blockers in the CARP trial, 16% of patients suffered a PMI [24]. Moreover, among patients with multiple risk factors and/or evidence of myocardial ischemia on nuclear imaging test the incidence of PMI was 25% [25], which was unaffected by revascularization status (Figure 3). Similarly to CARP, the DECREASE-V pilot study failed to show any benefit with prophylactic revascularization among 101 patients with multivessel CAD and abnormal stress test prior to vascular surgery (death or MI at 1 year 49% vs. 44%) [26]. These high events rates despite optimal medical therapy highlight the need for additional interventions for risk reduction among high-risk patients.
Primary Outcome of the Coronary Artery Revascularization Prophylaxis (CARP) Trial
Impact of Revascularization According to Number of Risks Enumerated in the Revised Cardiac Risk Index
A joint ESC/ACCF/AHA/WHF Task Force has redefined myocardial infarction as an event characterized by ischemic symptoms (i.e. chest pain or dyspnea), a typical rise and fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit, and electrocardiographic (ECG) changes consistent with myocardial ischemia or imaging evidence of new loss of viable myocardium (i.e. new perfusion defect) or wall motion abnormality [27].
Although this definition is useful for distinguishing spontaneous coronary events (Type I MI) from events that arise at the time of coronary revascularization (Type 4 and 5 MIs), it does not take into account unique features of perioperative myocardial infarctions after noncardiac operations. First, the majority of coronary events that occur in the post-operative period are clinically silent as a result of sedation and analgesia. In a post-hoc analysis of the POISE trial 65.3% of all patients with an MI did not have any ischemic symptoms [28]. Second, the ECG is insensitive, relative to cardiac troponins, to detect myocardial ischemia in the post-operative period [29]. Finally, after vascular surgery the presence of ischemic ECG changes does not provide additional prognostic information regarding long-term mortality over and above that provided by a single peak troponin I measured within 48 hours after vascular surgery [30]. Our group, and others [31], has shown that cardiac troponins measured after surgery are independent predictors of 30-day and long-term mortality [32] (Figure 4).
Kaplan-Meier estimates of mortality after vascular surgery relative to peak cardiac troponin I levels within 72 hours post-surgery
Taken together, these observations emphasize the importance of widespread utilization of cardiac troponin in the perioperative period for the surveillance of myocardial infarction and risk-stratification.
Although robust data from randomized clinical trials is lacking small studies have shown that interventions aimed at improving oxygen delivery and minimizing myocardial oxygen consumption are beneficial in this setting. The main goals of therapy are to prevent, or minimize, wide fluctuations in blood pressure and heart rate through beta-blockade, analgesia, and fluid administration with the intention to preserve optimal coronary perfusion pressure during diastole.
Martinez et al. randomized 80 patients with prolonged (≥ 20 minutes) ischemia after vascular surgery to beta-blockers, aspirin, nitrates and optimization of oxygen supply-demand balance or control. At 6 months, patients treated for ischemia had lower mortality relative to control patients (8% vs. 20%). In the post-operative period treated patients had lower median troponin values when compared to controls (3.3 ng/ml vs. 8.5 ng/ml) [33].
Anemia is an independent predictor of mortality after non-cardiac surgery in the elderly [34]. Blood transfusion improved survival in critically ill patients with CAD and hemoglobin < 10% [35]. This benefit was not seen among patients without CAD or among patients with a hematocrit > 25% with some studies reporting increased mortality and nosocomial infections associated with blood transfusions in [36].
Cardiac evaluation:
Although there is no consensus in the community with regard to the type (invasive angiography vs. imaging) and timing (in-hospital vs. 4-6 weeks after discharge) of cardiac evaluation after a PMI registry data suggest that only a minority of patients with elevated biomarkers receive cardiac work-up after the event [37].
Given the high-risk of bleeding immediately after non-cardiac surgery the use of emergency coronary angiography and stenting is usually reserved for patients with hemodynamic instability, ST-elevation or inability to control ischemic symptoms with medications. Among patients with coronary stents it is important to consider stent thrombosis in the differential diagnosis if ischemic symptoms develop after non-cardiac surgery, particularly if antiplatelet agents have been prematurely discontinued prior to the operation [38,39]. These patients have a high mortality rate and emergency coronary angiography with revascularization is appropriate.
Improving outcomes in this high-risk group of patients undergoing vascular surgery will require a paradigm shift from widespread use of cardiac imaging and procedures in the preoperative phase to rapid detection and management of cardiac complications in the post-operative setting with routine surveillance of cardiac troponins and targeted interventions.
Any optimization process is achieving by going through certain phases, i.e., Screening; where identification of significant and important factor is important [1]; Improvement; where factors need to be identified which is near to optimum, Response surface design [2]; where optimum or best product has been designing by response surface method (RSM) by quantifying the relationship between one or more measured responses and vital input factor [3]. It is always been a tedious tasks to choice a suitable experimental design, which can easily explain many response variables. Such variables often end as quadratic surface model. For such kind of interpretation central composite design can be an excellent choice. In the process of Optimization and finding the best possible product from the ongoing batches, an experimental design called the central composite design (CCD) concept has emerged [4]. The CCDmodel is an integral part of response surface mythology. The biggest advantage of this type of optimization model is, it is more accurate, and no need for a three-level factorial experiment for building a second-order quadratic model [5]. After excising the CCDmodel within the experiment, a linear regression model has been used to construct the model, and coadded values have been used [6]. The CCDmodel is otherwise called A Box-Wilson Central Composite Design. In this design, the center points are eventually augmented with the group of “star points” that allows estimation of curvature [7]. If the distance from the center of the design space to a factorial point is ±1 unit for each factor, the distance from the center of the design space to a star point is ± α with ׀α׀ > 1 [8]. The precise value of α depends on certain specific properties required for the design. Since there are many factors available in the CCD model, therefore, the possibility of more than two or many star points within the model is more palpable. The star points represent lower and higher extreme values. The CCD model allows to extends 2 level factors, which have been widely used in response surface modeling and Optimization. As far as pharmaceutical research is a concerned, much scientific research has been carried out in recent times in this direction. As per Krishna Veni et al (2020), environment-sensitive Eudragit coated solid lipid nanoparticles can be prepared using a central composite design (CCD) model [9]. In another study, Ye, Qingzhuo, et al.(2020) prepared puerarin nanostructured lipid carriers by central composite design, where 5 levels 3 factors central composite design was used to utilized to anticipate response variables and to constrats 3D plots [10].
However, in this book chapter, an attempt was made to highlight the basics of the CCD model and to corelate the concepts of CCD with suitable case studies, which could increase the readers’ inquisitiveness.
After necessary Screening, the various factors and subsequent interactions of the experiment were identified [11].
The priority was given to the established various level of characteristics
Upon Optimization, the best suitable model has been selected [12].
The appropriate model, which is ideal for experimental design, can also be chosen [13].
To performed experimental studies, it is necessary to incept tangible factors and values which are needed to analyze systematically [14]
The selected model can be validated
There is a provision where if the data are not satisfactory, then another model of the experimental equation and experimental design is preferred. While pursuing the study, the aforementioned point c,d, and f need to be repeated until a suitable model is obtained, which is an acceptable representation of the data [15].
If required, a graphical representation of the surface is generated.
The first-order model for the Optimization can be depicted as:
For quadratic or second-order model, if nonlinearity was reported, then the following equation was incorporated:
The factor must be very at level three while activating to fit the second-order model [16]. It was observed that, during the dictation of center point and two-level design, the quadratic terms can be identified, but it cannot be adequately estimated [17]. In Figure 1, the condition at which the Optimization can occur was explained, i.e., Optimization can be confirmed when second order model can be optioned from statistical outcomes and which coincide with the optimum value. During the factorial design experiment, it is preferable to avoid three-level designs as chances of an increase in the number of runs would be more [16].
Optimization condition.
For CCDDesign and Box–Behnken Design, second-order models are widely used. The analyzing aspect of these two designs can be explained by the following equation:
The above equation represents the quadratic model, which is near to the Optimization.
In this equation, Y = Dependent variables or Outcome variables or estimated responses, X1 = independent variables, b0 = overall mean response or intercept constant, b1 = regression model coefficients, K = number of independent variables, ϵ = error.
Put into words, a mathematical model to the observed values of the dependent variables y, that indicates:
Main effects for factor X1……. Xk
Their interactions (X1X2, X1X3…., Xk − 1, Xk)
Their quadratic components (X12,……Xk2). No assumptions are made concerning the levels of the factors, and you can analyze any set of continuous values for the factors.
Based on the outcomes and empirical models from various experimental design, the central composite design gives us a direction to logically think and exercised multivariable analysis [18]. Three design points are prerequisite to establishing a second-order polynomial equation in CCDmodel [19]. When two levels of fractional factorial design need to be established, then 2k should have possible +1 and − 1 levels of factors. In similar patterns, 2 k needs to be calculated, which can be otherwise called star points, and α forms the center to generate quadratic terms. The center point of the CCD., the model, provides an excellent independent estimation of experimental error.
Where N is the actual number of experiments, n is a number of repetition and k is the number of different factors which were incorporated within the study. Eventually, the CCD model can be best explained by the design of an expert (Version 11.0) software. The various steps involved in central composite design (CCD) was discussed in Figure 2.
Central composite design flow diagram.
To determine the local axial point, it is necessary to identify the alpha value in the CCD model. Depending on the alpha vale design can face cantered, rotatable, orthogonal. The alpha value can be calculated using the following equation:
If α value comes equals 1, the position of axial points stands within the factorial region. This is otherwise called a face-centered design, with three levels of factors that need to be kept in the design matrix. To calculate and analyze experimental results from response surface methodology, a polynomial equation needs to be implemented to study the correlation between dependent and independent variables.
The Box and Wilson design or CCD model comprising of factorial1, factorial2, and factorial3 design [20]. The star point outside the domine and the center point, representing the experimental domine, helps determine the response surface plot [21]. By estimating the precision of surface responses, the value of α can be determined; where star design is ± α. There are three types of CCD; the α can be determined according to the calculation possibilities and the required precision, which can be obtained from surface responses. The α value’s positioning determines the quality of the design or estimation. The rate by design is identified by determining the position of the points [22]. The precision of the estimation influence by the number of trials at the center of the domine. The quality by design approach is necessary to estimate the coefficients’ variability and responses [23]. One key aspect is rotatability or iso-variance per-rotation, which means that the prediction error is identical from all the points to the center points from the same distance [24]. Eventually, the center composite design was classified into three types:
In central composite design, the levels of the factors eventually stand on the edge.
The CCD model (Figure 3) is always magnate with corner points, which was represented in red dots. From the center point (blue), the extract points are constrained from the sides (green dots). In this CCD model, each factor would have 5 levels. The star points are establishing new extremes for the low and high settings for all factors. These designs having circular, spherical or hyperspherical symmetry and required 5 levels for each factor. Supplementing an already existing factor or factorial design with a start point can produce the design. The Circumscribed (CCC) was found to be a rotatable design [25].
CCDmodel.
When the limit is specified for factor settings, the CCI design utilized the factor setting as star points and created a factorial design within those limits [26, 27]. In other words, CCI design is a modified version of CCC design, where CCC design has been divided by α to generate the CCI model. Eventually, CCC and CCI were found to be a rotational model (Figure 4).
Comparison of the three types of central composite designs.
In this design, for each face of the factorial space, star points are the center point. Therefore. α = ±1. This variable requires 3 levels of each factor [28]. The face cantered designs (CCF) are a non-rotatable design (Figure 4).
In Figure 4, with two factors, three types of center composite design are used. From this design, one thing is clearly evidenced that; CCI explores the smallest process space, and CCC enjoys the largest process space. The CCC models looking like a sphere rotates around the factorial cube.
Alpha (α) value can be defined as the calculated distance of each individual axial point (star point) from the center in the center composite design [29]. If Alpha (α) is less than 1, which indicates the axial point must be a cube, and if it is greater than 1, it indicates it is outside the cube. In central composite design, each factor has five levels, i.e., Extreme high or otherwise called a star point, higher point, center point, low point, and finally, extreme low star point. Figures 5 and 6 describe how to select the total number of experimental runs for the CCD model as well as how to design two factors factorial design (Table 1). Coming to the Alpha (α) determination; which can be determined by the following equation:
(A) Parts of CCD (B) Total number of experimental runs required in the CCDmodel; where K = number of variables and r = fraction of full factorial. Thus, two-factor central composite design, the number of experimental runs is; 22 + 2(2) +1 = 9.
Schematic presentation of two-factor central composite design.
Number of factors | α value related to ±1 |
---|---|
2 | ±1.414 |
3 | ±1.682 |
4 | ±2 |
5 | ±2.378 |
6 | ±2.828 |
Number of factors and α value.
α = (Number of factorial runs)1/4.
= (2k or 2k−r) ¼.
If K (number of factors) =2.
Alpha (α) = (22)1/4 = 22/4 = 21/2 = 1.414.
To determine the uncoded value α value, the following equation can be used:
uncoded value value = (Coated value x L) + C; Where, L = Length expressed in real units between centre points and + 1 value of factor and C = Centre point value expressed in real units.
For temperature:
Uncoded value of – α = (Coded value × L) + C.
= (−1.414 × 30) + 60 = 17.58.
Uncoded vale of + α = (Coded value× L) + C = (1.414 × 30) + 60 = 102.42 (Table 2).
Level of factor | The temperature in ° C | Pressure in bar |
---|---|---|
-α (Lowest) | 17.58 | 2.93 |
−1 (Lower) | 30 | 5 |
0 (Centre point) | 60 | 10 |
+1 (High) | 90 | 15 |
+α (Highest) | 102.42 | 17.07 |
α value of one experiment.
It turns out to be the extension of 2 level factorial or fractional factorial design [21]
To estimate nonlinearity of responses in the given data set
Helps to estimate curvature in obtained continuous responses
Maximum information in a minimum experimental trial
Reduction in the number of trials required to estimate the squared terms in the second-order model
They have been widely used in response to surface modeling and Optimization (Tables 3 and 4)
No. | Factor A | Factor B | |
---|---|---|---|
1. | Factorial runs 22 = 4 | −1 | -1 |
2. | 1 | -1 | |
3. | -1 | 1 | |
4 | 1 | 1 | |
5. | Axial or star point runs 2(2) = 4 | −1.44 | 0 |
6. | 1.414 | 0 | |
7. | 0 | −1.414 | |
8. | 0 | 1.414 | |
9. | Centre point | 0 | 0 |
Design matrix for 2 factors central composite design [30].
No. | Factor A | Factor B | Factor C | |
---|---|---|---|---|
1. | Factorial runs 23 = 8 | −1 | −1 | −1 |
2. | 1 | −1 | −1 | |
3. | −1 | 1 | −1 | |
4. | 1 | 1 | −1 | |
5. | −1 | −1 | 1 | |
6. | 1 | −1 | 1 | |
7. | −1 | 1 | 1 | |
8. | 1 | 1 | 1 | |
9. | Axial or star point runs 2(3) = 6 | −1.682 | 0 | 0 |
10. | 1.682 | 0 | 0 | |
11. | 0 | −1.682 | 0 | |
12. | 0 | 1.682 | 0 | |
13. | 0 | 0 | −1.682 | |
14. | 0 | 0 | 1.682 | |
15. | Centre point | 0 | 0 | 0 |
Design matrix for three factors central composite design [31].
It was observed that the star points are outside the hypercube, so the number of levels that have to be adjusted for every factor is five instead of three, and sometimes it is not easy to achieve the adjusted values of factors [32].
Depending upon the Design, the squared terms in the model will not be orthogonal to each other.
Inability to estimate individual interaction terms, i.e., linear by quadratic or quadratic by quadratic.
Same examples of CCDoptimization in recent experimental conditions are mentioned in Table 5.
Title of the research | Author and Year | Model utilized | Variables taken | Findings | References |
---|---|---|---|---|---|
Development and optimization of baicalin-loaded solid lipid nanoparticles prepared by coacervation method using central composite design | Jifu Hao .et.a.l (2012) | central composite design | A two-factor five-level central composite design (CCD) was introduced. | The composition of optimal formulation was determined as 0.69% (w/v) lipid and 26.64% (w/w) drug/lipid ratio. The results showed that the optimal formulation of baicalin-loaded SLN had entrapment efficiency (EE) of 88.29%, particle size of 347.3 nm and polydispersity index (PDI) of 0.169. | [33] |
Formulation, Development and Optimization of Propranolol Mucoadhesive Bilayer Tablets by Using Central Composite Design and its In Vitro Studies | Asif MASSUD | Angle of repose, compressibility index, bulk and tapped densities, Hausner’s ratio for powders and granules were performed. | Mucoadhesive tablets with adequate mucoadhesion by adopting a new oral drug delivery concept Power was successfully developed to prevent liver degradation and propranololol enhancement Bioavailability Availability | [34] | |
Statistical Analysis of the Tensile Strength of Coal Fly Ash Concrete with Fibers Using Central Composite Design | Barbuta Marinela, et al. (2015) | CCD, Response Surface Method (RSM.) | Length, percentage, The total number of tests were statistically established taking into account the number of independent variables, the type of analyze that was done and the type of experimental plan that was chosen | DOE is a structured, organized method that is used to determine the relationship between the different factors affecting a process and the output of that process. Analysis of variance (ANOVA) is a common method used to compare the relative strength of two related models | [35] |
Response surface modeling of lead (׀׀) removal by graphene oxide-Fe3O4 nanocomposite using a central composite design | Khazaei Mohammad et al. (2016) | CCD, RSM (Response Surface Methodology) | 4 independent variables: initial pH of Solution, nanocomposite dosage, contact time, initial lead ion concentration | Quadratic and reduced models were examined to correlate the variables with the removal efficiency of Magnetic Graphene Oxide. According to ANOVA, influential factors were pH and contact time. | [36] |
Optimization of ferulic acid production from banana stem waste using central composite design | Sharif Nurul Shareena Aqmar Mohd (2017) | CCD, RSM (Response Surface Methodology) | Ratio of water to Banana stem waste (BSW), incubation time (hrs) | The RSM-CCD method optimize the hydrolysis conditions for maximum ferulic acid production. Hence, B.S.W. is proven useful and highly feasible for producing good quality natural products. | [37] |
Central Composite Design Optimization of Zinc Removal from Contaminated Soil, Using Citric Acid as Biodegradable Chelant | Asadzadeh Farrokh et al. (2018) | CCD, RSM. | Citric acid concentration, pH, washing time | RSM based CCD is a promising tool for modeling and optimizing Zn removal from the contaminated soil using citric acid. It was found that pH and citric acid conc. Are the significant parameters in Zn removal process. | [38] |
Removal of reactive red-198 dye using chitosan as an adsorbent: Optimization by Central composite design coupled with response surface methodology | Haffad Hassan et al. (2019) | C.C.D., Langmuir isotherm model, pseudo-second-order equation | pH,Concentration, temperature | Chitosan material based shrimp cells have countless opportunities in use of waste water treatment. The major effect is played by pH | [39] |
Mixture optimization of high-strength blended concrete using central composite design | Hassan Wan Nur Firdaus Wan et al. (2020) | CCD, RSM. | Micro and Nano Palm Oil Fuel Ash (POFA.) | Mixture optimization of high-strength blended concrete using central composite Design, Run 1, containing 10% micro POFA and 2% nano POFA, showed the highest flexural strength | [40] |
Examples of CC demployed for the optimization.
As per S. Bhattacharya., (2020) studies [41] varius independent variables viz., entrapment efficacy percentage, zeta potential, particle size, percentage of calmative drug release of a polymeric nanoparticle formulation was evaluated and optimized using central composite design (CCD); which was interpreted by Design Expert (Stat-Ease; version 11.0) software. Upon considering the alpha point at 1.68179, in this 21 baches experimental design, 4 factors, and 2 levels were considered (Table 6). Based on the optimization surface plot batch with desired particle size, zeta potential, cumulative drug release (%) entrapment efficacy (%) were selected for further characterization studies. Table 7 indicating critical quality attributes and necessary process attributes that affect the outcomes of the nanoparticles. By using polynomial equations and a 3-dimensional surface plot, the effects of critical process parameters on essential attributes of quality were examined Figure 7.
S. No | Factors | Low Value | High Value |
---|---|---|---|
1 | Homogenization speed (rpm) | 10000 | 15000 |
2 | Homogenization Time (min) | 10 | 15 |
3 | Surfactant Concentration (%) | 1 | 1.25 |
4 | Polymer concentration (mg/mL) | 3 | 6 |
Critical process parameters that influence various critical quality attributes.
S. No | Critical Quality Attributes | Desired constrained |
---|---|---|
1 | Particle Size (nm) | Finest |
2 | Zeta Potential (mV) | Finest |
3 | Cumulative drug release (%) | Moderately high |
4 | Entrapment efficacy (%) | Supreme |
Desired construction of critical quality attributes.
(A-D) represents the surface plot identifying the effects of critical process parameters on essential attributes of quality.
From this CCDmodel, the following polynomial equations can be derived:
By considering A as homogenization speed, B as homogenization time, C as surfacetant concentration (%) and D as polymeric concentration; respectively, the polynomial Eqs. 6, 7, 8, & 9 can be interpreted. From these polynomial equations, critical process parameters of qualifiable effects on essential attributes can be determined. It can easily predict from the polynomial Eq. 6, that particle size of the polymeric nanoparticles can be increased, when homogenization time & speed and surfactant concentration decrease. The elevated negative co-efficient in homogenization speed of polynomial Eq. 6, indicates it has a significant influence on particle size. Higher shearing stress during elevated homogenization time & speed could lead to mass transfer between the particles, ultimately resulting in nucleation and smaller particle size. From Eq. 7, it can be predict that homogenization time & surfactant concentration has antagonistic effects on zeta potential and homogenization speed has an agonistic effect on zeta potential. In a similar fashion equation, 8 shows homogenization speed & surfactant concentration has an agonistic effect on cumulative drug release (%) at 80th hours. From Eq. 9 it was clear that entrapment efficacy (%) increases with increases of homogenization speed, homogenization time & surfactant concentration.
As per Jaleh Varshosaz et al. (2010) [42] research, amikacin solid lipid nanoparticles can be prepared by using a central composite design. In this research, central composite design (CCD) was utilized to identify a suitable formula with minimum particle size; where, three independent variables were considered, i.e., the ratio of drug to lipid (A), amount of lipid phase (B), the volume of aqueous phase (D). The alpha value of the experiment was found to be −1.682; the alpha value helps in determining rotatability and orthogonality within this design. In this experiment, a total of 20 experimental designs have been incepted, along with 8 factorial points and 6 axial points were considered. The best-fitted model can be assumed after quadratic model analysis by ANOVA and F-value determination. From the Figure 8(II&III) it was clarly evident that, decrease concentration of drug to lipid ratio, aquous phase valume whould certlay decrease particle size; which indicates agonistic effects on particle size, where else, from the Figure 8(IV), it was evident that, increase concentration of cholesterol would increases the drug loading capacity. Therfore, by resolving all the polynomial equation obtained from Figure 8graph, it was identified that, at 0.5 drugs to lipid ratio, 314 mg cholesterol, 229 mL of aqueous phase an optimized formulation would possibly be constructed with lower particle size and higher drug loading efficacy (%). Therefore, At these levels of independent variables, predicted amikacin particle size and loading efficiency were calculated to be 153 nm and 86%.
(I) Normal probability plot for broadcast, the most critical variables are influencing the particle size. The ratio of drug to lipid (a), surfactant type (B), amount of lipid phase (C), and volume of aqueous phase (D). (II) the effect of drug-to-lipid ratio (a) and amount of cholesterol (C) on particle size. (III) the effect of drug-to-lipid ratio (a) aqueous-phase volume (D) on particle size. (IV) the impact of aqueous-phase volume (D) and the amount of cholesterol (C) on loading efficacy(%).
This book chapter’s main agenda was to enlighten the present approaches and recent optimization research activities based on the CCD model, as specially for pharmaceutical product development. The CCDmodel is useful for modeling and analyzing programs in which the response of interest influences several variables. The CCDmodel can be considered as a robust statistical tool for process optimization. The best part of CCDis, as compared to Plackett–Burman design, a limited number of experiments are required with less computational experience. The biggest challenge of the CCDmodel is finding the critical factor. Central composite designs are beneficial in sequential experiments because you can often build on previous factorial experiments by adding axial and center points.
The author is like to acknowledge the help and motivation of Dr. R.S. Gaud, Director, SVKM’s NMIMS. Deemed-to-be University, Shirpur Campus, for providing excellent research facilities and profound inspiration while drafting this book chapter. The author is also like to acknowledge his own original research publication entitled “Fabrication and characterization of chitosan-based polymeric nanoparticles of Imatinib for colorectal cancer targeting application”; for taking inputs from that article while drafting this book chapter.
The author declares that the author has no competing interests.
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