Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\n
Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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The book discusses some of the specificities of the autonomic nervous system in terms of dendritic development in the sympathetic compartment, as well as a detailed description of noradrenergic groups and their key role in the modulation of all antinociceptive and autonomic responses elicited by painful or threatening situations. In the book, only those cases are mentioned that are closely related to disorders or changes of function of the autonomic nervous system. This book can evoke interest in many researchers who want to use the information for the advancement of their research towards a better understanding of the autonomic regulatory mechanisms.",isbn:"978-1-78984-191-6",printIsbn:"978-1-78984-192-3",pdfIsbn:"978-1-83881-720-6",doi:"10.5772/intechopen.73119",price:119,priceEur:129,priceUsd:155,slug:"autonomic-nervous-system",numberOfPages:142,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d95e7c43f124d1a6e39b88862a917fc1",bookSignature:"Pavol Svorc",publishedDate:"October 24th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6808.jpg",numberOfDownloads:7630,numberOfWosCitations:7,numberOfCrossrefCitations:11,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:18,numberOfDimensionsCitationsByBook:1,hasAltmetrics:0,numberOfTotalCitations:36,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 15th 2018",dateEndSecondStepPublish:"April 4th 2018",dateEndThirdStepPublish:"June 3rd 2018",dateEndFourthStepPublish:"August 22nd 2018",dateEndFifthStepPublish:"October 21st 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"169212",title:"Prof.",name:"Pavol",middleName:null,surname:"Svorc",slug:"pavol-svorc",fullName:"Pavol Svorc",profilePictureURL:"https://mts.intechopen.com/storage/users/169212/images/system/169212.jpg",biography:"Dr. Pavol Švorc is an Associate Professor, Doctor of the Natural Sciences, Philosophe Doctor. In 1982 he became a Doctor of the Natural Sciences from General Biology, Natural Faculty, Šafarik’s University in Košice. In 1995 he received a PhD. – Physiology and Patophysiology, Natural Faculty Šafarik’s University in Košice. In 2005 he became an Associate Professor from Normal and Patological Physiology, Medical Faculty, Šafarik’s University in Košice. From 1982 to 1983 Dr.Švorc worked as an independent specialist in the local museum in Poprad, Slovakia. In 1983 he started working as a lecturer at the Department of Physiology, Šafarik’s University in Kosice, Slovakia. From\r\n2011 until 2014 he was a Head of the Institute of Physiology and Pathophysiology, Medical Faculty, University of Ostrava, Czech Republic. His research interest includes:\r\nChronobiology of cardiovascular system, respiratory system and autonomic nervous system.",institutionString:"Pavol Josef Safarik University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Pavol Jozef Šafárik",institutionURL:null,country:{name:"Slovakia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"213",title:"Neurobiology",slug:"life-sciences-neuroscience-neurobiology"}],chapters:[{id:"63521",title:"Introductory Chapter: Autonomic Nervous System - What We Know About It",doi:"10.5772/intechopen.81026",slug:"introductory-chapter-autonomic-nervous-system-what-we-know-about-it",totalDownloads:1245,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"Pavol Svorc",downloadPdfUrl:"/chapter/pdf-download/63521",previewPdfUrl:"/chapter/pdf-preview/63521",authors:[{id:"169212",title:"Prof.",name:"Pavol",surname:"Svorc",slug:"pavol-svorc",fullName:"Pavol Svorc"}],corrections:null},{id:"61446",title:"Development of Human Pancreatic Innervation",doi:"10.5772/intechopen.77089",slug:"development-of-human-pancreatic-innervation",totalDownloads:1245,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Human pancreatic innervation is of particular interest due to its possible role in the pathogenesis of such diseases as diabetes mellitus, pancreatitis and pancreatic cancer. Despite the clinical importance, data concerning pancreatic innervation during human ontogeny and in various disorders are very limited. In this chapter, we present a review on human pancreatic autonomic innervation on the basis of the literature data and our previous results. Special attention is paid to the innervation of the endocrine pancreas. Gradual branching of neural network was seen during human pancreatic development. Innervation of the foetal pancreas is more abundant than in adults. In agreement with previous observations, we have revealed a close integration and similarity between endocrine cells and nervous elements in the developing human pancreas. Moreover, simultaneous interactions between the nervous system components, epithelial cells and endocrine cells were detected in the pancreas during prenatal human development. It has been suggested that pancreatic innervation plays an important role not only in regulation of endocrine and exocrine activity but also in normal islet morphogenesis.",signatures:"Alexandra E. Proshchina, Yuliya S. Krivova, Olga G. Leonova, Valeriy\nM. Barabanov and Sergey V. Saveliev",downloadPdfUrl:"/chapter/pdf-download/61446",previewPdfUrl:"/chapter/pdf-preview/61446",authors:[{id:"189522",title:"Dr.",name:"Alexandra",surname:"Proshchina",slug:"alexandra-proshchina",fullName:"Alexandra Proshchina"},{id:"242828",title:"Dr.",name:"Yuliya",surname:"Krivova",slug:"yuliya-krivova",fullName:"Yuliya Krivova"},{id:"242829",title:"Dr.",name:"Valeriy",surname:"Barabanov",slug:"valeriy-barabanov",fullName:"Valeriy Barabanov"},{id:"242830",title:"Prof.",name:"Sergey",surname:"Saveliev",slug:"sergey-saveliev",fullName:"Sergey Saveliev"},{id:"253374",title:"Dr.",name:"Olga",surname:"Leonova",slug:"olga-leonova",fullName:"Olga Leonova"}],corrections:null},{id:"61688",title:"Autonomic Nervous System and Neurocardiac Physiopathology",doi:"10.5772/intechopen.77087",slug:"autonomic-nervous-system-and-neurocardiac-physiopathology",totalDownloads:1287,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:0,abstract:"The autonomic nervous system regulates multiple physiological functions; how distinct neurons in peripheral autonomic and intrathoracic ganglia communicate remains to be established. Increasing focus is being paid to functionality of the neurocardiac axis and crosstalk between the intrinsic nervous system and diverse organ systems. Current findings indicate that progression of cardiovascular disease comprises peripheral and central aspects of the cardiac nervous system hierarchy. Indeed, autonomic neuronal dysfunction is known to participate in arrhythmogenesis and sudden cardiac death; diverse interventions (pharmacological, non-pharmacological) that affect neuronal remodeling in the heart following injury caused by cardiovascular disease (congestive heart failure, etc.) or acute myocardial infarction are being investigated. Herein we examine recent findings from clinical and animal studies on the role of the intrinsic cardiac nervous system on regulation of myocardial perfusion and the consequences of cardiac injury. We also discuss different interventions that target the autonomic nervous system, stimulate neuronal remodeling and adaptation, and thereby optimize patient outcomes.",signatures:"John G. Kingma, Denys Simard and Jacques R. Rouleau",downloadPdfUrl:"/chapter/pdf-download/61688",previewPdfUrl:"/chapter/pdf-preview/61688",authors:[{id:"244257",title:"Prof.",name:"John G.",surname:"Kingma",slug:"john-g.-kingma",fullName:"John G. Kingma"},{id:"253222",title:"Mr.",name:"Denys",surname:"Simard",slug:"denys-simard",fullName:"Denys Simard"},{id:"253223",title:"Dr.",name:"Jacques",surname:"Rouleau",slug:"jacques-rouleau",fullName:"Jacques Rouleau"}],corrections:null},{id:"62564",title:"Inflammation and Autonomic Function",doi:"10.5772/intechopen.79280",slug:"inflammation-and-autonomic-function",totalDownloads:1874,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Inflammation is generally a temporary and limited condition but may lead to a chronic one if immune and physiological homeostasis are disrupted. The autonomic nervous system has an important role in the short- and, also, long-term regulation of homeostasis and, thus, on inflammation. Autonomic modulation in acute and chronic inflammation has been implicated with a sympathetic interference in the earlier stages of the inflammatory process and the activation of the vagal inflammatory reflex to regulate innate immune responses and cytokine functional effects in longer processes. The present review focuses on the autonomic mechanisms controlling proinflammatory responses, and we will discuss novel therapeutic options linked to autonomic modulation for diseases associated with a chronic inflammatory condition such as sepsis.",signatures:"Ângela Leal, Mafalda Carvalho, Isabel Rocha and Helder Mota-Filipe",downloadPdfUrl:"/chapter/pdf-download/62564",previewPdfUrl:"/chapter/pdf-preview/62564",authors:[{id:"227590",title:"Prof.",name:"Isabel",surname:"Rocha",slug:"isabel-rocha",fullName:"Isabel Rocha"},{id:"253537",title:"Ph.D.",name:"Ângela",surname:"Leal",slug:"angela-leal",fullName:"Ângela Leal"},{id:"253581",title:"MSc.",name:"Mafalda",surname:"Carvalho",slug:"mafalda-carvalho",fullName:"Mafalda Carvalho"},{id:"253701",title:"Prof.",name:"Hélder",surname:"Mota-Filipe",slug:"helder-mota-filipe",fullName:"Hélder Mota-Filipe"}],corrections:null},{id:"63093",title:"Regulation of Dendritogenesis in Sympathetic Neurons",doi:"10.5772/intechopen.80480",slug:"regulation-of-dendritogenesis-in-sympathetic-neurons",totalDownloads:928,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"In postganglionic sympathetic neurons, the size of the dendritic arbor determines presynaptic convergence, which correlates with tonic activity, and aberrant dendritic morphology is associated with disease. There is, therefore, great interest in understanding how dendritic morphology is regulated in these neurons. Early studies established a role for target-derived nerve growth factor (NGF) in regulating the size of the dendritic arbor of sympathetic neurons in vivo. However, in vitro studies revealed that even in the presence of optimal concentrations of NGF, rat sympathetic neurons cultured in the absence of serum or non-neuronal cells survive and elaborate extensive axonal arbors, but fail to form dendrites. Subsequently, it was discovered that bone morphogenetic proteins (BMPs) trigger cultured sympathetic neurons to extend a dendritic arbor comparable to that of their in vivo counterparts. The goals of this chapter are to: (i) summarize these early experiments; (ii) discuss evidence substantiating a role for BMPs in glial-induced dendritic growth in vitro and regulation of dendritic growth in vivo; (iii) review what is known about the molecular mechanisms by which NGF, BMPs and other factors influence dendritic arborization of sympathetic neurons; and (iv) identify key data gaps in understanding of how dendrites are regulated in sympathetic neurons.",signatures:"Vidya Chandrasekaran and Pamela J. 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Noradrenergic ascending or descending pathways originating in the A5 or A6 noradrenergic cell groups are highly sensitive to stress and to other high-arousal states. These noradrenergic groups present extensive projections that play a key role in the modulation of all antinociceptive and autonomic responses elicited by painful or threatening situations. Depending on the locations of these projections, different possible roles for each noradrenergic cell groups are suggested. The A6 noradrenergic cell group might have the greatest effect on somatosensory transmission and the A5 group on sympathetic function. Consistent with this, stimulation of central noradrenergic pathways evokes an array of stresslike and antinociceptive effects, including changes in blood pressure, heart rate and respiratory rate. 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1. Introduction
Solid-state nuclear magnetic resonance (NMR) consists of several techniques, which are distinguished by different pulse sequences and generate different responses on the sample, allowing obtaining data on different time scales. This makes the development of new analytical methods for the study of polymer materials interesting. The solid-state analyses differentiate the solution by two main factors; the first is signal width. In the solid state, the signals are broader than solution, concerning to polymers due to the high-molecular weight and monomer ordination; among other factors, the signals are wider. The second point concerns the type of response obtained; in the solid state, the number of information obtained is greater than solution. When the material is insoluble or has soluble difficulties, the study of structure-property relation is of great interest because the search for responses with respect to homogeneity, phase dispersion, and intermolecular interaction between components is of great importance.
1.1. Nuclear magnetic resonance experiment
In the NMR experiment, a sample is placed in probe in a strong magnetic field, denominated Bo; if this sample presents magnetic moment (μ), its nuclear spins magnetize and at the excess of spin population, called magnetization (Mo), is applied for a radio frequency (RF) pulse by a radio frequency emission (B1) field, the magnetization is excited by transfer to the xy plane. When the RF emission is turned off, nuclear spins tend to return to the steady state since this state has less energy, occurring in a process called relaxation. In this process, two types of relaxation occur simultaneously: one denominated transverse or spin-spin relaxation, which occurs in the xy plane and has a time constant—T2, and the other called longitudinal or spin-lattice relaxation that occurs along the axis z and is characterized by the time constant—T1. The NMR signal is detected after the withdrawal of radio frequency, with a process of free induction decay (FID) of the radio frequency, which results from the free precession of the nuclear spins, upon its return to steady state.
The NMR relaxation processes with time constants T1 and T2 are governed by fluctuating magnetic fields associated with molecular motion. The relaxation process that determines the T1 values involving energy absorption, since this process is enthalpic. The temporal evolution of the transverse relaxation is fundamentally different from longitudinal, and it corresponds to a loss of phase coherence between the individual magnetic moment process in it, and, thus an increase of entropy. In many cases, solid sample loss phase coherence initially created by B1 is due to direct interactions between the spin moments of individual [1–10].
1.2. High-field NMR
1.2.1. Solid-state NMR analyses
The solid-state NMR is constituted by several distinct pulse sequences, which generate different responses on the sample, allowing obtaining data on different time scales. This makes possible to develop new analytical methods for the study of complex solid materials [1–5], as polymer nanocomposites.
The analysis of the complex materials in the solid state differentiates the analysis in solution by two main factors: the first is the signal width. In the solid state, the signals are broader than in solution and especially for polymers due to their high molecular weight and mere ordination, among other factors, the signals become even wider. The second point concerns the type of response to be obtained in the solid state the number of information to be obtained is greater than in solution [11–14]. However, when the material is insoluble or has soluble difficulties, the study of the structure-property relation is of great interest because the search for responses with respect to homogeneity, phase dispersion, and interaction between the components is of great importance.
Nuclear magnetic resonance signal line width
Generally, the spectra obtained in solution generate narrow signals best resolved comparing to solid-state signals, due to the isotropy of the chemical shift, since all interactions as shielding, dipolar coupling, and indirect coupling depend on the orientation of the local environment in nuclear magnetic field Bo and when the samples are in solution, these effects are compensated. However, they are dependent on the nature of the sample and the external magnetic field strength applied [7–10].
In solids, there is usually little movement relative to the liquid. However, most samples (except single crystals) have a substantial molecular orientation range of line width. This fact comes from the anisotropy of the chemical shift as well as the strong dipolar interaction between the hydrogen nuclei and carbon-13. The nature of the sample and the type of nucleus to be observed are also two points of fundamental importance to the spectral resolution in solid state.
Solid-state nuclear magnetic resonance response
The type of answer you want to get on a specific material or on a polymeric system may be a reason why those must be analyzed by solid-state NMR. Information on the molecular dynamics is of great interest for answers about the correlation structure-molecular-dynamic property.
The problem of signal line width in NMR solid-state spectra led to the development of techniques that allow them to obtain signals in the solid state the narrowest possible, like liquids. Along with the information to be obtained on the material, different techniques are performed to analyze more different polymer systems.
1.2.1.1. High-resolution solid-state NMR basic theory
The Hamiltonian that governs the analysis involves a solid sum of different Hamiltonians, according to expression 1.
HNMR=HZ+HRF+HCSA+HD+HJ+HQE1
where HZ is the Zeeman effect; HRF is the radio frequency effect; HCSA is the chemical shift anisotropy; HD is the dipolar interaction between hydrogen nucleus and the carbon-13 nucleus; HJ is the coupling constant; and HQ is the quadrupolar moment.
When one observes spin nuclei ½, as carbon-13 (13C), for example, the Hamiltonian that promotes more interference in the signal enlargement are HCSA e HD. Improving the resolution of the signals in the NMR spectra obtained in the solid state requires techniques to eliminate factors that cause this signal enlargement [10–14]. Thus, techniques were developed using methods that mathematically eliminate these effects.
1.2.1.1.1. Magic angle spinning (MAS)
The strong dipolar interactions between hydrogen nuclei and carbon-13, facilitated by the internuclear distance between them and the restricted mobility of the chains and the anisotropy of the chemical shift generate signals in very wide solid, with line width of 20 kHz order. The elimination of the dipole-dipole interaction generates a decrease in the signal line width of 5 kHz, and the elimination of the anisotropy of chemical shift width of the signals decreases to 100 Hz, making possible the detection of signals. Both the dipolar interaction and the anisotropy of the chemical shift dependence have with the term 3cos2θ−1. The elimination of these two effects occurs when the solid analyzes are performed by rotating the sample at high rotational speeds (each nucleus suitable for a given magnetic field) in a sample introduction probe angle corresponding to the amount of 54.74°, able to eliminate the term 3cos2θ−1, aligned with a strong decoupling of the hydrogen nucleus generating a significant narrowing of the line width in spectrum.
The employed pulse sequence is simple:
hydrogendecouplingnucleus observed90°x→FID−tnE2
where t is the time interval between 90° pulses (delay) and n is the number of scans.
The time t is variable and it is directly related to the relaxation time of different types of nuclei that are analyzed. Thus, variations in this parameter allow studies that provide information about the molecular mobility of the sample and the time of spin-lattice relaxation.
All nuclei that undergo the phenomenon of resonance can be analyzed by this technique. However, for the observation of nuclei that have quadrupole moments, line widths are so large that the signals have no resolution. However, for nuclei having dipole moment, this technique generates high-resolution spectra. It should be considered that for high-molecular weight materials such as polymer, for example, the chemical structure can be defined by this technique. However, a fine or detailed microstructure structure cannot be observed as they are well resolved by the NMR solution techniques. Because in the carbon-13 solid state analysis the signals broadened comes from the dipolar interactions and the chemical shift anisotropy, generating large signals that contain all molecular information’s.
Note that using the MAS technique can obtain quantitative spectra solid. However, the long analysis time, comes from the high values of the spin-lattice relaxation times of the different nuclei, mainly rare spin. It makes this type of spectrum replaced by spectra expressing or representing only a portion of the sample. Therefore, variation in spectral parameters of this pulse sequence provides information about the increased mobility of a sample region, for example, a mixture of polymers, polymers, composites, amorphous, and nanocomposite materials. Thus, a greater number of applications of this technique can be obtained, when seeking information about the homogeneity, compatibility, and purity of polymers or any material samples.
The analysis of materials by the MAS technique using a small interval between pulses (ms) can detect only one region or the region that has the highest mobility. This variation in the MAS technique enables, in the case of amorphous polymers, that is, ethylene-co-vinyl acetate (EVA), identifies the region of increased molecular mobility, or distinguishes the mobility of different areas, which cause changes in the properties of the material [6–10].
Poly(ethylene-co-vinyl acetate) (EVA) is a random copolymer that has a distinct percentage of vinyl acetate, which promotes changes in their mechanical and thermal properties and consequently changes the processing conditions and materials. The monomer sequence of the random copolymer is shown in Figure 1.
Figure 1.
Poly(ethylene-co-vinyl acetate) (EVA) chemical structure.
Analyzing EVA containing 28% of acetate by carbon-13 (C-13) solid-state NMR basic techniques will be shown as an example of how useful is the application of solid-state techniques.
Figure 2 exhibits the powder EVA C-13 MAS NMR spectrum. Showing the highest signal located at 30.2 ppm referred to CH2 (the methylene group) long chains and a small signal detected at 14.3 ppm attributed to the methyl group of the acetate part. Two small signals were detected at about 21 and 25 ppm, which were assigned as CH2 from the ethylene branching [11, 12].
Figure 2.
Solid-state NMR C-13 MAS spectrum of powder EVA.
1.2.1.1.2. Cross-polarization and magic angle spinning angle (CPMAS)
The cross-polarization technique was developed aimed at detection of rare nuclei spins with the aim to minimize the analysis time because of the long relaxation times of these nuclei. This method relies on the transfer of polarization of a nucleus spin abundant, hydrogen nucleus (1H), for example, to rare spin nuclei (i.e., 13C), the cores 13C and 1H are in thermal contact for a stipulated period of time, called during the cross-polarization contact time at that time the nuclei are kept in contact due to precession frequencies of both nuclei are kept identical, in this case the nuclei are in a condition called condition Hartman-Hahn [1–5], which is an equality where the frequency precession of hydrogen nucleus versus magnetic field of hydrogen are equal to precession of carbon-13 nucleus versus magnetic field of carbon-13, in a period of time: ωHBH= ωCBC.
The combined cross-polarization technique with the rotation of the sample at the magic angle and strong hydrogen decoupling (CPMAS), generating NMR spectra of solid high-resolution rare spin nuclei with increasing signal strength in a shorter analysis time than the MAS, considering that the hydrogen nucleus controls the relaxation process [1–10, 13].
The pulse sequence used to obtain the spectra through CPMAS is the same for MAS, but with the inclusion of the condition Hartman-Hahn, which is inserted a contact time between the two nuclei for transferring the polarization between them. Thus, the combination of cross-polarization technique, magic angle spinning process, and strong hydrogen decoupling of carbon-13 nucleus technique informs about the compatibility of polymer blends at the molecular level. The changes in the widths of the lines of NMR and the values of the chemical shifts provide information about changes in mobility at the molecular level. Figure 3 shows the powder EVA CPMAS C-13 NMR spectrum, with 1 ms of contact time. It already showed two signals: one located at short chemical shift, centered at 30.7 ppm referring to mobile region and the other one located at 32.3 ppm due to the segments of rigid region.
Figure 3.
Solid-state NMR CPMAS C-13 NMR spectrum of powder EVA.
One type of solid-state NMR studies is to use a comparison between 13C NMR spectra obtained by techniques MAS and CPMAS, which can first show the different regions of the samples. One example was showed in the literature, which exhibits the MAS and CPMAS solid state NMR spectra of seed flour bourbon mango spectra [15, 16]. It shows that in these spectra have at least two segment areas of different molecular mobilities, and it may also a third due to the interaction of these two domains that may not be detected in this type of measurement.
1.2.1.1.3. Variable contact time (VCT) during polarization transfer
This technique generates a variation of contact times during the cross-polarization experiment, leading to a series of 13C CPMAS spectra with different contact times, and through this experiment, one can obtain some important information, such as heterogeneity of the sample, material stiffness, different types of domains, and the value of the hydrogen spin-lattice relaxation time in the rotating frame (T1ρH). This parameter can be obtained from the intensities decay of carbon-13 nucleus during the cross-polarization transfer experiment, according to the changes in the contact time, since the hydrogen nucleus is the one that controls this relaxation process. Figure 4 exhibits the variable contact-time experiment for powder EVA.
Figure 4.
Variable contact time experiment of powder EVA.
This experiment shows the decay of both resolved carbon types detected from CPMAS with contact-time variation, showing the rigid part of the sample and part of the mobile one with the increase in the signal related to the CH2 of the nonrigid phase.
2. Case study
2.1. Example of the determination of T1ρH for polymer nanocomposites based on poly(3-hydroxy butyrate) (PHB)
In this study, it was evaluated the T1ρH for the PHB/silica (PHB/S) systems contain different proportions of silica. All samples were obtained through solution casting, and the films after being dried were out into the rotor, the analyses were carried out at 30°C, and the values of this parameter are listed in Table 1.
Sample
T1ρH (ms)
C = O
CH2
CH
CH3
PHB
13
26
31
17
PHB/S 0.2
15
19
27
19
PHB/S 0.5
33
32
34
32
PHB/S 0.75
31
32
34
30
PHB/S 1.0
31
31
34
30
Table 1.
T1ρH data for the PHB/S systems, containing different proportions.
From the data listed in Table 1, just a small proportion of silica affects the polymer, promoting a formation of a new material. Therefore, the relaxation data for the samples containing 0.5 or more silica exhibit a similar behavior, promoting an increase in this parameter comparing to pure PHB indicating that a new material with good dispersion and distribution of the nanoparticle in the polymer was obtained. The limit of silica is 0.5%, and no more is needed since no change in the T1ρH for all carbons was detected. The evaluation of this parameter is not very much used for polymer nanocomposites yet. Therefore, studies have been already published by the group for other systems, as blends and composites [24], and show the behavior of these polymer materials [25].
3. Low-field NMR
In low-field NMR equipment due to low intensity and homogeneity of the magnetic field, the chemical shift cannot be used to discriminate between different molecules. The nuclear relaxation processes occurring in the nuclear magnetic resonance phenomenon inherent to spectroscopy are spin-lattice and spin-spin relaxation times; however, they provide detailed information about the molecular dynamics. These relaxation times influence from the structural and microstructural quantitative determination by the study of molecular dynamics. The relaxation processes are associated to the time constant for these processes: T1, spin-lattice relaxation time, and T2, spin-spin relaxation time. In the low-field NMR, the relaxation parameters T1 and T2 for the hydrogen nuclei that constitute the samples can be measured directly, using the pulse sequences for such experiments and are widely used to characterize the types of molecular segments present in the samples and the interactions between them [15–20]. The time T1 is associated with the return of the nucleus excited by the absorption of radiation to the equilibrium. While T2 relaxation is related to the inverse of the half-width of the signal and occurs due to the loss of phase coherence in the precession of the nucleus excited about the direction of the applied magnetic field [1–3].
The relaxation times determined by NMR offer detailed information on the molecular mobility of a material. Thus, one could detect the formation of rigid and flexible segments, plasticization or antiplasticization process, and any other change in the molecular dynamics of the sample or comparing the variation of the molecular mobility of structures from the same type of material, but of different origin. The time of relaxation times T1H and T2H can be measured in a wide temperature range and identifying small differences in similar structures.
3.1. Determination of T1
The inversion-recovery pulse sequence is the most accurate technique for measuring the relaxation time spin–lattice process. The T1H relaxation time é measured in the frequency of magnetic field generated by the external magnetic field. This relaxation must do with the return of the excited nuclei to its ground state after removal of the excitation frequency, and therefore, it allows to evaluate the molecular mobility of a material, global compatibility and homogeneity, as well as processes and plasticization [1–3, 10–15]. In this process, the excess energy is emitted to the lattice in the form of dipole interaction since there is a lowering of the enthalpy of the nuclear spin system. The return to the magnetization to the equilibrium state is usually exponential, and is a first order process with constant speed, R1, and time constant T1.
The applied pulse sequence is described below:
Observed nuclei:180°X−τ−90°XnE3
where τ is a time interval between 90 pulses.
The relaxation time T1H reports on the molecular dynamics of materials. In the case of starches and starch flour, for example, this parameter is sensitive to the formation of domains or segments and structural changes in the range 15–50 nm.
3.2. Determination of T2
The proton spin-spin relaxation time, T2H, in principle, can be obtained by measuring the width of the NMR signal at half height. However, the inhomogeneity of the magnetic field causes the magnetization of the different nuclei processes at different rates when removing the RF and a time tau (τ) is needed to wait, which is chosen depending on the mobility of the sample; however, this inhomogeneity is refocused after an application of a 180° pulse, generating a single magnetization [1, 15, 16]. The pulse sequence normally used is Carr-Purcell-Meiboom-Gill (CPMG), which contains a train of pulses [1–5].
This relaxation time, and the time constant of spin-lattice relaxation reports about molecular mobility of materials in the molecular level, thereby assess overall molecular dynamics and segmental. The T2H parameter corroborates data obtained by T1H and sometimes can inform more detail of the material behavior under observation, if this have some regions or segments containing high-molecular mobility.
In several studies that involve the evaluation of molecular mobility of materials, specially using the NMR relaxometry, it was normally employed the measurements of relaxation times spin-lattice and spin-spin and evaluate the T1 and T2 times constants of both relaxation phenomena, respectively. This comes from the fact that these parameters are sensitive to dynamic processes that occur at different frequency ranges. Thus, T1 parameter measures the relaxation of the magnetization component parallel to the external magnetic field, being sensible to fast movements that are sensible to the movements of first order (MHz). The T1ρ relaxation parameter is measured in low frequencies in the range of tens of kilohertz [1, 7, 17–23].
4. Final comments
In the solids, there is a restricted molecular movement comparing to liquids. However, most of the samples range have a substantial molecular orientation of the line width. This fact stems from the anisotropy of the chemical shift as well as the strong dipolar interaction between the hydrogen and carbon-13. The nature of the sample and the type of nuclei to be observed are two points of fundamental importance to the spectral resolution. The type of answer you want to get on a specific material may be a reason why it must be analyzed by solid-state NMR. Information on the molecular dynamics is of great interest for answers about the correlation structure-molecular-dynamic property. The line width in NMR solid state spectra led to the development of techniques that allows obtaining signals in the solid state most narrow possible, like liquids. Along with the information to be obtained, different techniques are performed to analyze the more different polymer systems.
\n',keywords:"NMR, solid-state, polymer, nanomaterials, relaxation times",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/57186.pdf",chapterXML:"https://mts.intechopen.com/source/xml/57186.xml",downloadPdfUrl:"/chapter/pdf-download/57186",previewPdfUrl:"/chapter/pdf-preview/57186",totalDownloads:1406,totalViews:398,totalCrossrefCites:1,totalDimensionsCites:1,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:51,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"October 13th 2016",dateReviewed:"September 14th 2017",datePrePublished:null,datePublished:"December 6th 2017",dateFinished:"October 13th 2017",readingETA:"0",abstract:"The nuclear magnetic resonance (NMR) spectroscopy is a very powerful tool in the chemical characterization, both in solution and in solid state. With the development of NMR spectrometers more potent field, employing radio frequency pulse, provided the development of studies on materials, especially amorphous materials. Thus, there was a need to develop techniques to obtain spectra in solid state with high resolution in comparison to those obtained in solution. Therefore, the study of polymers and polymeric materials could be developed quickly as a result a lot of information about the structure-property could be obtained with more details. The use of NMR in the solid state has become particularly important in the study of amorphous materials, as well as in the study of crystal structures, and permits us to detect different constituents present in material. This chapter covers the basic solid-state NMR techniques that provide important information on sample molecular behavior because they are powerful and versatile tools to evaluate polymer and complex materials like nanomaterials.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/57186",risUrl:"/chapter/ris/57186",book:{id:"5857",slug:"spectroscopic-analyses-developments-and-applications"},signatures:"Maria Ines Bruno Tavares",authors:[{id:"195554",title:"Distinguished Prof.",name:"Maria Ines",middleName:null,surname:"Tavares",fullName:"Maria Ines Tavares",slug:"maria-ines-tavares",email:"mibt@ima.ufrj.br",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Federal University of Rio de Janeiro",institutionURL:null,country:{name:"Brazil"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1. Nuclear magnetic resonance experiment",level:"2"},{id:"sec_2_2",title:"1.2. High-field NMR",level:"2"},{id:"sec_2_3",title:"1.2.1. Solid-state NMR analyses",level:"3"},{id:"sec_2_4",title:"1.2.1.1. High-resolution solid-state NMR basic theory",level:"4"},{id:"sec_2_5",title:"1.2.1.1.1. Magic angle spinning (MAS)",level:"5"},{id:"sec_3_5",title:"1.2.1.1.2. Cross-polarization and magic angle spinning angle (CPMAS)",level:"5"},{id:"sec_4_5",title:"1.2.1.1.3. Variable contact time (VCT) during polarization transfer",level:"5"},{id:"sec_9",title:"2. Case study",level:"1"},{id:"sec_9_2",title:"2.1. Example of the determination of T1ρH for polymer nanocomposites based on poly(3-hydroxy butyrate) (PHB)",level:"2"},{id:"sec_11",title:"3. Low-field NMR",level:"1"},{id:"sec_11_2",title:"3.1. Determination of T1",level:"2"},{id:"sec_12_2",title:"3.2. Determination of T2",level:"2"},{id:"sec_14",title:"4. Final comments",level:"1"}],chapterReferences:[{id:"B1",body:'Komoroski RA. High Resolution NMR Spectroscopy of Synthetic Polymers in Bulk. Deerfield Beach: VCH Publishers; 1986'},{id:"B2",body:'McBrierty VJ, Packer KJ. Nuclear Magnetic Resonance in Solid Polymers. Cambridge: Cambridge University Press; 1993'},{id:"B3",body:'Schmidt-Rohr K, Spiess HW. Multidimensional Solid-State NMR and Polymers. New York: Academic Press; 1994'},{id:"B4",body:'Stejskal EO, Memory JD. High Resolution NMR in the Solid State. New York: Oxford University Press; 1994'},{id:"B5",body:'Bovey FA, Mirau PA. NMR of Polymers. New York: Academic Press; 1996'},{id:"B6",body:'Sandres JKM, Hunter BK. Modern NMR Spectroscopy: A Guide for Chemists. 2nd ed. Oxford: Oxford University Press; 1996'},{id:"B7",body:'Harris RK. NMR studies of solid polymer. In: Fawcell AH, editor. Polymer Spectroscopy. England: John Wiley & Sons; 1996'},{id:"B8",body:'Silva NM, Tavares MIB. Journal of Applied Polymer Science. 1996;60:663'},{id:"B9",body:'Costa DA, Oliveira CMF, Tavares MIB. Journal of Applied Polymer Science. 1998;69:129'},{id:"B10",body:'Harris RK. Recent advances in solid state NMR. The Fifth International Conference on Applications of Magnetic Resonance in Food Science, Aveiro, Portugal. 2000;I:1-11'},{id:"B11",body:'Tavares MIB. Polymer Testing. 2000;19:899'},{id:"B12",body:'Silva EO, Tavares MIB, Bathista ALBS, Filho NP, Nogueira JS. Journal of Applied Polymer Science. 2002;86:1848'},{id:"B13",body:'Souza CMG, Tavares MIB. Journal of Applied Polymer Science. 2002;86:116'},{id:"B14",body:'Tavares MIB. Journal of Applied Polymer Science. 2003;87:473'},{id:"B15",body:'Tavares MIB, Bathista ALBS, Silva EO, Filho NP, Nogueira JS. Carbohydrate Polymers. 2003;53:213'},{id:"B16",body:'Bathista ALBS, Silva EO, Tavares MIB, Prad RJ. Journal of Applied Polymer Science. 2012;126(S1):E132-E126'},{id:"B17",body:'Cheng HN. Modern Methods of Polymer Characterization. In: Barth HG, Mays JW, editors. Série Chemical Analysis. Vol. 113. 1991. p. 409-493'},{id:"B18",body:'Ebdon JR. In: Dawking JV, editor. Developments in Polymer Characterisation-2. London: Applied Science Published Ltd; 1980'},{id:"B19",body:'Silva MBR, Tavares MIB, Junior AWM, Cucinelli-Neto RP. Journal of Nanoscience and Nanotechnology. 2016;16:7606'},{id:"B20",body:'Sebastião PJO, Monteiro MSSB, Brito LM, Rodrigues E, Chávez FV, Tavares MIB. Journal of Nanoscience and Nanotechnology. 2016;16:7539'},{id:"B21",body:'Tavares MR, Menezes LR, Nascimento DF, Souza DHS, Reynaud F, Marques MFV, Tavares MIB. European Physical Journal Special Topics. 2016;225:779'},{id:"B22",body:'Monteiro MSSB, Tavares MIB, Sebastião PJO. Materials Scince and Applications. 2016;7:575'},{id:"B23",body:'Cunha APCB, Tavares MIB, Silva EO. Materials Sciences and Applications. 2016;07:380'},{id:"B24",body:'Preto M, Tavares MIB, Silva EP d. Polymer Testing. 2007;26:501'},{id:"B25",body:'Tavares MIB, Nogueira RF, San Gil RAS, Preto M, Silva EO, e Silva MBR, Miguez E. Polymer Testing. 2007;26:1102'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Maria Ines Bruno Tavares",address:"mibt@ima.ufrj.br",affiliation:'
Federal University of Rio de Janeiro, Professor Eloisa Mano Macromolecules Institute, Rio de Janeiro, Brazil
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1. Introduction
Biliary tract infections, such as biliary colic, cholangitis, cholecystitis, and cholelithiasis, are the most commonly encountered health disorders globally as a result of bile duct obstruction. Gallstones are relatively prevalent in the United States and many other industrialized countries, and they are usually asymptomatic. Gallstones are projected to affect 25 million adults in the United States (Everhart et al.) [1]. Bacterial infection of the bile can result in severe morbidity and mortality [Sifri and Madoff] [2]. Bile stasis, inflammation, and the loss of mechanical barriers can all lead to bacterial infection of the bile, which can end in severe morbidity and death. Obstruction is hypothesized to cause increased intraluminal pressure, impaired blood supply and lymphatic drainage, and acute inflammation in the presence of supersaturated bile (Indar and Beckingham) [3]. The pathogenesis of biliary tract infections, the microbial pathogens involved, and antibiotic treatment options are discussed in this article.
2. Current scenario
Gallstone disease is a substantial health problem in developed countries, according to existing literature. Gallstones are believed to affect 10–15% of the general population, with considerable variations across nations. Gallstone-related problems affect between 20 and 40% of individuals with gallstones, with an annual incidence of 1–3%; acute calculus cholecystitis (ACC) is the first clinical manifestation in 10–15% of cases [4].
3. Anatomy of biliary tract
The gallbladder is a part of the digestive system. The gallbladder is a thin-walled sac with three anatomic parts: the fundus, corpus, and infundibulum [1]. It is normally located between both hepatic lobes. Figure 1 depicts the gall bladder location in the human body, and Figure 2 represents the gall bladder anatomy. The gallbladder empties into the cystic duct, a passive conduit with a mucosa comprising spiral valves and with a diameter of about 7 mm in humans (Valves of Heister). This duct has no sphincteric structure and empties into the common bile duct. As it enters the duodenal wall and forms the ampulla of Vater, the common bile duct passes through the head of the pancreas, finishing in the sphincter of Oddi [6].
Figure 1.
Gallbladder lies beneath the lower liver edge at the bottom of the rib cage. (Jan Modric, 2017) [5].
Figure 2.
Gallbladder parts and bile ducts (Jan Modric, 2017) [5].
Approximately, 10% of individuals are estimated to have one or more biliary duct abnormalities; however, not all of them are difficult to identify during surgery. The so-called triple confluence, which is an abnormality defined by simultaneous emptying of the right posterior duct, right anterior duct, and left hepatic duct into the common hepatic duct [Mortele and Ros] [7], is a frequent variation of the major hepatic biliary branching. The right hepatic duct is almost non-existent in individuals with this variation. The right posterior duct and its union with the right anterior or left hepatic duct are two more common anatomic variations of the biliary tree branching.
As previously stated, the right posterior duct connects to the right anterior duct and unites it from the left to produce the right hepatic duct, which then connects to the left hepatic duct to form the common hepatic duct. The most prevalent anatomic variant of the biliary system is drainage of the right posterior duct into the left hepatic duct before its confluence with the right anterior duct.
Furthermore, various less common and usually more difficult anatomic variants of the bile ducts, which include both aberrant and auxiliary bile ducts, have been described. In a clinical setting, knowing the difference between an aberrant bile duct and an accessory bile duct is vital since an aberrant bile duct is the only bile duct draining a specific hepatic segment, whereas an accessory bile duct drains the same portion of the liver. Failure to recognize certain of these bile duct irregularities can lead to bile leakage and peritoneal membrane irritation (bile peritonitis). Endoscopic retrograde cholangiopancreatography is used to treat these leaks by inserting stents (ERCP). They can stop these leaks that arise from the common bile or cystic ducts [8, 9, 10].
4. The sphincter of Oddi: (anatomy and physiology)
The human sphincter of Oddi is approximately 10 mm in length and has a well-defined and strong musculature. The Oddi sphincter is physically and functionally distinct from the duodenum. Its myoelectrical and contractile patterns are distinct from those of the duodenum in terms of character and timing. The contractions of the human sphincter of Oddi occur at the same time; however, there may be minor variations in configuration that look peristaltic at times. Its principal function of serving as a bile flow resistor is compatible with the occurrence of synchronous contractions. Because of the sphincter of Oddi resistance, the constant hepatic production of bile is largely directed into the cystic duct and gallbladder during the fasting state, where it is stored and concentrated. During the diastolic phase, sphincter of Oddi phasic contractions and, during phase II, migrating motor complex occur when there is modest gallbladder contraction; hence, a tiny amount of bile escapes into the duodenum. The gallbladder contracts during digestion, emptying the majority of its contents, and bile is delivered to the duodenum via the cystic and common bile ducts, which pass via a relaxed sphincter of Oddi and duodenum. Bile salts help in fat digestion and absorption in the duodenum and jejunum (triglycerides, cholesterol and phospholipids, and liposoluble vitamins). Therefore, transportation of bile salts to the terminal ileum takes place; there, most of them were recycled as part of the enterohepatic circulation through an active transport mechanism found in the terminal ileum’s epithelial cells [6].
5. Sphincter of Oddi dyskinesia
Patients with sphincter of Oddi (SO) dyskinesia have biliary-like symptoms, which are frequently noticed after a cholecystectomy. The symptoms and signs of bile duct sphincter dysfunction are similar to those of temporary bile duct blockage, whereas pancreatic sphincter of Oddi dysfunction is linked to elevated pancreatic enzymes and even full-blown pancreatitis. Patients with sphincter of Oddi dysfunction are assessed with quantitative choledochoscintigraphy and/or sphincter of Oddi manometry tests to confirm the diagnosis, even if the preliminary investigation is defined by this functional entity by sphincter of Oddi manometry.
6. Chronic and acute cholecystitis
6.1 Pathogenesis
The most commonly stated hypothesis in the etiology of chronic and acute cholecystitis is that it is caused by gallstones migrating from the gallbladder obstructing the cystic duct or, in the event of big gallstones, that they intermittently obstruct the gallbladder’s neck (Jose Behar) [6]. The inability to see the gallbladder in patients with acute cholecystitis has been attributed to a cystic duct occlusion. This observation has been validated clinically and pathologically in up to 97% of individuals with acute cholecystitis [Pare and Shaffer et al.] [11].
However, other explanations for this failure are more likely that.
A cystic duct obstruction would be caused by the gallbladder’s acute inflammation and edema spreading to the cystic duct, or.
Because it is clogged with inflammatory fluids, an atonic gallbladder obstructs the entry of the bulk of the isotope-labeled agent. Furthermore, the severely inflamed gallbladder may be unable to distend passively due to edema or actively due to a faulty relaxation found in gallbladders with lithogenic bile containing high cholesterol contents [Xiao and Chen et al.] [12].
The appearance of cholecystitis associated only with lithogenic bile (acalculous gallbladder) or a single huge stone several times larger than the normal width of the cystic duct lumen further challenges the idea of cystic duct obstruction. Furthermore, the presence of acute inflammation on top of a chronically inflamed or atrophic fibrotic gallbladder has proven difficult to explain because it would imply recurring cystic duct obstruction events. It is more likely that the development of acute inflammation as a result of a chronic process had been in the works for a long time. Mucosal thickening, hypertrophic muscle layers, and macrophage infiltration of the lamina propria are common in gallbladders. In the absence of gallstones, chronic cholecystitis is commonly found histopathologically. They arise in people who are morbidly obese and have lithogenic bile but no gallstones. When compared with the normal mucosa in nonobese people, these gallbladders exhibit mucosal abnormalities consistent with chronic cholecystitis [Csendes et al.] [13]. The pathogenesis of chronic cholecystitis is shown in Figure 3. The gallbladder motility and cytoprotective functions are impaired by lithogenic hepatic bile with excess cholesterol, allowing the hydrophobic bile salts to induce chronic cholecystitis.
Figure 3.
Pathogenesis of chronic cholecystitis.
Finally, the results of the aforementioned human and animal studies strongly suggest that cholecystitis develops in the presence of lithogenic bile with high cholesterol concentrations, which creates a permissive environment for hydrophobic bile salts to increase oxidative stress levels and initiate the inflammatory process. Continuous entrance of hydrophobic bile salts into the diseased gallbladder is required for this inflammatory process [14].
7. Chronic cholecystitis clinical symptoms
Chronic cholecystitis patients may be asymptomatic or experience recurring episodes of epigastric and right upper quadrant (RUQ) discomfort that radiates often around the waist and toward the scapula. The pain is moderate to severe, and it is not postprandial but rather nocturnal in nature. It does not happen every day; instead, it happens every two to 3 weeks. Ultrasonography is usually used to make the diagnosis. Gallstones and gallbladder wall thickening can be detected using this test. Laboratory tests are normal. Gallstones are often asymptomatic, but because they are easily discovered in gallbladders by imaging investigations, they are blamed for a range of upper gastrointestinal problems. Gallstones are frequently blamed for nonspecific gastrointestinal symptoms such as persistent dyspepsia, gastroparesis, and irritable bowel syndrome. Patients with these functional disorders typically experience everyday upper gastrointestinal symptoms, which are often postprandial and triggered by fatty foods or large meals. Epigastric pain, nausea, and bloating are common complaints among these patients. Even while pathological investigations may indicate gallstones and histological evidence of persistent cholecystitis, cholecystectomy does not relieve these symptoms. Gallstones can go unnoticed for lengthy periods of time, according to several investigations, including autopsy studies. Most patients with asymptomatic gallstones remained symptom free for the whole 8-year follow-up period in a prospective Italian research [15, 16, 17, 18, 19].
8. Acute cholecystitis
In acute cholecystitis, chronic cholecystitis is the most prevalent risk factor. These patients often have abrupt onset of severe pain, which is commonly accompanied by nausea in 90% of instances and vomiting in 50% of cases.
Physical examination indicates epigastric, right upper quadrant, and positive Murphy sign pain, with rebound soreness in severe instances. However, doctors must rule out other acute abdominal diseases such as acute appendicitis, particularly with a retrocecal appendix, acute pancreatitis, localized perforated peptic ulcer, intestinal perforation, or ischemia before considering this diagnosis. These clinical entities exhibit comparable characteristics in terms of demographics and risk factors. Physical examination indicates abdominal pain that can be localized or widespread, as well as a significant decrease in bowel sounds, in these individuals who complain of severe stomach pain, nausea, and vomiting.
Acute cholecystitis is defined as an acute inflammation of the gall bladder. Chronic cholecystitis, acute pancreatitis, diverticulitis, colitis, appendicitis, Fitz-Hugh-Curtis syndrome, ureteral stone, and omental infarction are all illnesses that can cause acute right upper quadrant (RUQ) discomfort [20, 21]. It can occur abruptly in conjunction with gallstones (acute calculous cholecystitis) or less frequently without gallstones (acute calculous cholecystitis) (acalculous cholecystitis). Gallstones affect more than 80% of persons who are asymptomatic. Acute cholecystitis is a complication of gallstone disease that usually arises in people who have had symptomatic gallstones in the past. Delayed management can lead to increased morbidity, due to progression to severe cholecystitis, such as gangrenous change, abscess formation, and gallbladder perforation [4].
9. Microorganisms in biliary tract infections
The majority of cases of acute cholecystitis are caused by an impacted gallstone blocking the gallbladder outlet, resulting in an increase in intraluminal pressure, gallbladder distension, and wall edema, and eventually gallbladder necrosis. During the early stages of acute cholecystitis, bile is normally sterile, and infection occurs as a side effect.
Biliary tract infection is a prevalent cause of bacteremia and is linked to a high rate of morbidity and mortality, especially in elderly individuals with comorbid conditions or when diagnosis and treatment are delayed. Enterobacteriaceae, which climb from the gastrointestinal system, are the most prevalent infectious organisms. Complications such as acute renal failure and septic shock are more likely in patients with bacteremia.
9.1 Bacterial causes of biliary tract infections
The most frequently identified pathogens are Gram-negative microorganisms, primarily Escherichia coli, Salmonella enteritidis, Acinetobacter baumannii, Citrobacter freundii, Enterobacter cloacae, and Klebsiella species. Within Gram-positive microorganisms, Clostridium perfringens is most commonly observed. Previous research has linked biliary infection with gallstone development and indicated that bacteria may act as the nucleating factor initiating the formation of both pigment and cholesterol gallstones. Many studies [22, 23] had established the coexistence of biofilm-forming bacteria in bile and gallbladder/gallstones (Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, Enterococcus spp. and Acinetobacter spp.) in different combinations, and the presence of Capnocytophaga spp., Lactococcus spp., Bacillus spp., Staphylococcus haemolyticus, Enterobacter or Citrobacter spp., Morganella spp., Salmonella spp., and Helicobacter pylori.
All of the microbiological studies that led to the selection of these antibiotic regimens were carried out using standard culture methods. Recent studies of microbial detection by culture- vs. culture-free identification of microbial DNA by next-generation sequencing (NGS) for various purulent diseases have shown that traditional culture only identifies a portion of the bacteria present. Additionally, in some Asian countries, the presence of H. pylori has been detected infrequently in the gallbladder by PCR. Other molecular tools like RAPD fingerprinting, cagA gene detection, which represent a good marker for genome-sequencing projects, are available nowadays to detect the microbial strains causing infections in AC patients [24].
9.2 ESKAPE pathogens and role of bile in development of drug resistance
Bile has bactericidal activity. However, many pathogens are known to resist the bactericidal activity of bile and utilize this host component as a localization signal to regulate virulence gene expression and enhance infection. Furthermore, strategies employed by pathogens to resist bile align with antibiotic resistance mechanisms. The efflux pump genes, acrAB in E. coli, Salmonella, Shigella, Klebsiella, and other pathogens, resist both bile salts and antibiotics, thereby making it essential for survival under extreme environmental conditions [25, 26, 27, 28].
The ESKAPE group of pathogens (Enterococcus, Staphylococcus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter) represents a significant public health threat as antibiotic resistance rates rise from the acquisition of multiple resistance mechanisms involving the gene expression of BSH, Gls24, GlsB, EmrB/QacA, PrkC, LiaFSR, BsrXRS, MnhF, WTA, OxyR, CpxAR, KpnO, KpnEF, CadC, TdcA, Gal ET, pgaABCD, pqsABCDE, ExoU, T6SS genes or through biofilm production, etc. Many ESKAPE pathogens are not known to cause infection in the gastrointestinal system; nevertheless, isolation from bile, the gallbladder, pancreatic or biliary stent biofilms, and bile duct infections have been described, and antibiotic resistance is frequently identified. Given a previous research that found positive bile cultures in 22.2% of the cases following elective gallbladder removal surgery, the findings are not restricted to hospital-based infections. Enterococcus spp. was the most frequent bacterial isolate found in the bile samples, followed by E. coli, Klebsiella spp., Enterobacter spp., and Pseudomonas spp.; 22.7% of these isolates were antibiotic-resistant. Furthermore, bile exposure in the lungs of CF patients has been shown to affect Staphylococcus aureus, A. baumannii, and especially P. aeruginosa infection. Growth was either consistent or increased in the presence of human bile, respectively, for E. coli or Enterococcus faecalis. Furthermore, bile reduced the antimicrobial activity of ciprofloxacin, meropenem, and tigecycline for E. coli, while linezolid and tigecycline had reduced activity against E. faecalis [29].
9.3 Rare cases of acute cholecystitis caused by microorganisms
Berinson et al. [30] reported one rare case of AC caused by Kosakonia cowanii, formerly known as Enterobacter cowanii, which is a Gram-negative bacillus belonging to the order Enterobacterales. The species is usually recognized as a plant pathogen and has only anecdotally been encountered as a human pathogen. A cholecystectomy confirmed the diagnosis of acute cholecystitis with partial gall bladder necrosis. By MALDI-TOF, 16S-rRNA analysis, and whole-genome sequencing, a surgical material produced pure cultures of Gram-negative rods that were clearly identified as K. cowanii.
Deering et al. [31] reported a rare case of acute cholecystitis caused by Streptococcus bovis biotypes (I & II), a Gram-positive, catalase-negative, anaerobic coccus found as a commensal inhabitant of the digestive system in 16% of healthy people. The patient was treated with tazobactam/piperacillin and later on subjected to laparoscopic cholecystectomy.
Vogt et al. [32] reported isolated Serogroup O1 Vibrio cholerae in an 83-year-old man suffering from AC. The Gram stain of the body fluid specimen demonstrated rare Gram-negative rods and many polymorphonuclear lymphocytes. The organism was positive for oxidase, and the results obtained using a Neg Breakpoint Combo Panel Type 41 (NBC41) and a MicroScan WalkAway Plus system (Siemens Healthcare Diagnostics, Deerfield, IL) identified the organism as V. cholerae, with 97.76% probability. The isolate was also tested using a manual API 20E Gram-negative identification panel (bioMerieux, Inc.,), which yielded a code of 5,347,124, giving a presumptive identification of V. cholerae at 99.9%.
9.4 Viral causes of biliary tract infections
In comparison with bacterial infections, viral infections of the biliary tract are less common and less discussed. Viral infections frequently occur as a result of a liver infection or as part of a systemic viral illness. Viruses seldom cause primary liver infection. Cholangitis, or inflammation of the bile duct, is a very frequent symptom. Despite the fact that hepatotropic viruses (A, B, C, and E) are commonly thought of as hepatocellular pathogens, cholangitic symptoms are now widely documented in conjunction with these disorders [10, 14, 23, 33]. Cholangitis is also due to systemic viral infections in different proportions to hepatitis. The human immunodeficiency virus (HIV) is linked to a variety of liver problems, including cholangitis. Other systemic viruses, most notably members of the herpes virus family, can induce hepatic illness in both immunocompromised and immunocompetent individuals, including cholangitis and potentially ductopenia [34].
9.5 Parasitic causes of biliary tract infections
Cholangitis can be caused due to a variety of reasons, including biliary calculi, strictures, parasites, post-endoscopic retrograde cholangiopancreatography (ERCP), postoperative, and so on. Biliary parasitoses, in contrast to other causes, are more prevalent in many nations. Ascaris lumbricoides, liver flukes, and Echinococcus are common parasites that affect the biliary system. The trematodes (flukes) that commonly infect the human biliary tract include Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, and Fasciola hepatica. The majority of patients are asymptomatic. While entering through the bile duct, they cause biliary colic and obstructive jaundice. The parasites reside in the intrahepatic bile ducts and, occasionally, in the extrahepatic bile ducts, gallbladder, and pancreatic duct. The result is mechanical obstruction, inflammatory reaction, adenomatous hyperplasia, and periductal fibrosis. The parasite can be examined through radiological findings of CT and MRI [35].
9.6 Diagnosis
The diagnostic criteria include examining for signs of local inflammation, such as Murphy’s sign, the presence of a mass, pain, or tenderness located in the upper right quadrant of the abdomen. The local inflammation is often accompanied by systemic inflammation, indicated by signs of fever, increased white blood cell (WBC) counts, and elevated levels of C-reactive protein. The severity of acute cholecystitis can range from mild and self-limiting to severe and potentially life threatening [36, 37]. Several imaging techniques such as ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT) are necessary to accurately diagnose both the typical and atypical cases of acute cholecystitis. Recently, Amini et al. had used high mobility group box protein 1 (HMGB1) biomarker for acute cholecystitis diagnosis [38].
9.6.1 Diagnosis of cholecystitis
For the consensus in diagnosis of cholecystitis in 2007, the Tokyo guidelines for the management of acute cholangitis and cholecystitis (TG07) were formed and widely adopted. In 2013, the updated Tokyo guidelines (TG13) for acute cholangitis and acute cholecystitis were released for severity grading of acute cholecystitis [37] (Table 1).
Local signs of inflammation, etc. Murphy’s sign RUQ Mass/pain/tenderness
Systemic signs of inflammation, etc. Fever Elevated CRP Elevated WBC count
Imaging findings Imaging findings characteristic of acute cholecystitis
Suspected diagnosis: One item in A + one item in B Definitive diagnosis: One item in A + one item in B + C
Acute hepatitis, other acute abdominal diseases, and chronic cholecystitis should be excluded. RUQ-right upper abdominal quadrant, CRP-C-reactive protein, WBC-white blood cell.
Table 1.
TG13 diagnostic criteria for acute cholecystitis.
9.6.2 TG07 severity assessment criteria
The severity assessment criteria were first presented throughout the world in TG07 by Hirota and Takada, [37] where the severity grading of acute cholecystitis was classified into the following three categories: “mild (Grade I),” “moderate (Grade II),” and “severe (Grade III).”
Mild (Grade I) acute cholecystitis occurred in a patient with no signs of organ failure and mild gallbladder illness, allowing cholecystectomy to be performed safely and with minimal risk. The severity score for these individuals in TG07 does not fulfill the criteria for “moderate (Grade II)” and “severe (Grade III)” acute cholecystitis.
Acute cholecystitis, in which the degree of acute inflammation is expected to be linked with greater operating difficulties in completing cholecystectomy, was classified as moderate (Grade II) acute cholecystitis [8, 9, 16].
Severe (Grade III) acute cholecystitis was defined as acute cholecystitis associated with organ dysfunction (Table 2).
Associated with dysfunction of any one of the following organ/systems
Cardiovascular dysfunction
Hypotension requiring treatment with dopamine >5 ub/kg per min, or any dose of norepinephrine
Neurologic dysfunction
Decreased level of consciousness
Respiratory dysfunction
Pa2O/FiO2 ratio < 300
Renal dysfunction
Oluguria, creatinine >2.0 mg/dl
Hepatic dysfunction
PT – INR > 1.5
Hematological dysfunction
Platelet count <100,000/mm3
Grade II (moderate) acute cholecystitis
Associated with any one of the following conditions: 1. Elevated white blood cell count ([18,000/mm3) 2. Palpable tender mass in the right upper abdominal quadrant 3. Duration of complaints (72 h) 4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, and emphysematous cholecystitis)
Grade I (mild) acute cholecystitis
Does not meet the criteria of “Grade III” or “Grade II” acute cholecystitis. Grade I can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure.
Acute cholecystitis is often treated promptly by cholecystectomy or percutaneous cholecystostomy and antibiotic therapy in high-risk patients. Antimicrobial treatment has a different role depending on the severity of the illness and its etiology. Because it is unclear if bacteria have a role in grade I acute cholecystitis, antimicrobial treatment is used to prevent infection before cholecystectomy. Antimicrobial treatment is therapeutic and necessary for grade II acute cholecystitis until the gallbladder is removed. Most patients with bacteremia might have clinical deterioration and can be classified as grade III acute cholecystitis and are therefore not suitable for surgery. A recent meta-analysis reported that cholecystography has the highest diagnostic accuracy for detection of acute cholecystitis [39].
Previous studies have found bile to be infected in 9–42% of patients who underwent elective laparoscopic cholecystectomy, but the incidence of culture-positive bile increased to 35–65% of patients with acute cholecystitis [40]. Antimicrobial treatment is critical for reducing both the systemic septic response and local inflammation following cholecystectomy in individuals with moderate-to-severe acute cholecystitis [41]. Those with septic shock should get appropriate antibiotic treatment within 1 hour of diagnosis, and patients who are less severely sick should receive it within 6 hours. Bile culture results, however, cannot be acquired promptly after admission, and bile culture necessitates percutaneous gallbladder puncture. As a result, the most successful empiric antibiotics described in the literature are used as the basis for first antimicrobial treatment [42].
Because most infections in acute cholecystitis are limited to the gallbladder, sampling should be done directly from the infection site in order to identify the true causative pathogen. Bile specimens collected from the biliary tract using percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD) are potentially associated with microbial contamination [43].
Bacterial infection is commonly reported in 50 to 90% of the cases. Most of the studies reported the involvement of polymicrobial infections in AC, which were often treated with antibiotic regimens with two or more antibiotics, but only one study had reported that monomicrobial growth was involved in AC. The most common presumptive antibiotics used in AC are ceftriaxone (2gm, IV, OD) or piperacillin/tazobactam (4.5 gm, IV, 8 hourly) or cefoperazone/sulbactam (3gm, IV, 12 hourly) for 7 to 10 days. The second-line or alternative antibiotics is imipenem (500 mg, IV, 6 hourly) or meropenem (1gm, IV, 8hourly) for 7 to 10 days. The most commonly isolated microorganisms among pathogens in positive bile cultures are Enterococci species, non-faecium enterococci (Enterococcus faecalis, Enterococcus gallinarum, Enterococcus casseliflavus, Enterococcus avium), Escherichia Coli, and Klebsiella species [44]. Gram-positive microbes, such as Enterococci, have become less common over time, whereas Gram-negative germs, particularly Enterobacteriales, have become more common and are most typically isolated among patients with acute cholecystitis. The results of local antimicrobial susceptibility tests, as well as information of the likely infecting microorganisms, pharmacokinetics/pharmacodynamics, and adverse reactions/effects of available medicines, must all be considered when making antimicrobial therapy decisions (local antibiogram). The severity of the illness and previous antimicrobial exposure are also important considerations in deciding the best course of treatment. β-lactam antibiotics or their derivatives, cephalosporins, carbapenems, fluoroquinolones, and other antibiotics diminish infection. For moderate and severe acute cholecystitis, empiric treatment with piperacillin/tazobactam or a cephalosporin with or without metronidazole is advised, regardless of whether or not there is growth on culture [45].
Broad-spectrum β-lactam and β-lactamase inhibitors, such as ampicillin-sulbactam, have been recommended as the first-line drugs to treat Enterococci and non-faecium enterococci infections. However, these microorganisms are reported to be resistant to most of the classes of antibiotics represented earlier. VREFM (vancomycin-resistant Enterococcus faecium) was reported for the first time in 2021 by Suk-Won et al. [46]. The authors found that the majority of the patients were suffering from Grade II acute cholecystitis (94.7%). Hence, they recommended other antibiotics, such as linezolid and tigecycline, which provide good coverage against VREFM, should be considered for patients with such advanced infections. Tigecycline can be used in several other cases because of its broad spectrum of effectiveness against Gram-negative microorganisms, including ESBL-producing bacteria. Tasina et al. [47] reported poor effectiveness of tigecycline toward a severely ill patient with AC.
Piperacillin-tazobactam and third- or fourth-generation cephalosporins are indicated as first-line antibiotics for Gram-negative bacteria, with fluoroquinolones and carbapenems as second-line antibiotics, depending on the severity of the infection and antimicrobial susceptibility patterns. According to Gomi et al. [48], most identified strains were resistant to ciprofloxacin due to widespread use of the antibiotic by the community, whereas 20% of pathogenic bacteria were resistant to ceftriaxone. As a result, in such circumstances, piperacillin-tazobactam or cefepime, which have larger spectra and lower resistance rates, are indicated. Carbapenem and tigecycline are advised for patients who are taking antibiotics on a regular basis. However, because of widespread medication resistance and associated high morbidity and mortality rates, carbapenem-resistant strains (CRE) species have emerged as major healthcare-related diseases [49].
9.7.1 Empiric antibiotic treatment of community-acquired biliary tract infections (CA-BTI)
The most important approach in controlling the CA-BTI is the primary source controls such as biliary drainage, removal of biliary tract stones, and cholecystectomy. The primary source control can help the antibiotics to penetrate the biliary tract, resulting in a better bactericidal effect when biliary obstruction is present. While it comes to medical therapy, there are two crucial variables to consider when choosing empiric antibiotics. Administration of antibiotics is essential for the treatment of BTI, in addition to primary source control. As the BTI is caused by endogenous etiological agents, that is, gastrointestinal tract flora, such as Escherichia coli, Klebsiella spp., Enterococci spp., Bacteroides spp., antibiotics that are effective against these organisms are usually used empirically to treat BTI rather than definite therapy. However, the usage of inappropriate empiric antibiotics may also incur fatal outcomes. To elicit positive treatment responses, >80% of the presumed causative microorganisms should be sensitive to antibiotics, and for patients with septic shock, the susceptibility rates should even exceed 100% [50]. Next, the antibiotics must be present in adequate concentrations at the infection sites to have the desired antimicrobial action [51, 52]. Table 3 shows the antibiotics usually used to treat biliary tract infections based on their biliary penetration ability (indicated by the ratio of bile-to-serum concentrations [53, 54, 55].
Good penetration efficiency (>1)
Low-penetration efficiency (<1)
Antibiotics
Bile/serum
Antibiotics
Bile/serum
Tazocin
60
Cefotaxime
0.75
Tigecycline
38
Meropenem
0.75
Augmentin
30
Ceftazidime
0.5
Ciprofloxacin
30
Vancomycin
0.5
Unasyn
9
Amikacin
0.3
Ceftriaxone
5
Gentamycin
0.3
Levofloxacin
5
Cefipime
0.1
Penicillin G
5
Imepenem
0.01
Cefazolin
3
Clindamycin
3
Doripenem
1.17
Cefuroxime
1
Metronidazole
1
Table 3.
Antibiotics frequently used to treat biliary tract infections and their biliary penetration ability (indicated as the ration of bile to serum concentrations).
As a result, when choosing empiric antibiotics for the treatment of BTI, both susceptibility rates and the potential of biliary penetration should be taken into account. Table 3 lists the antibiotics often used to treat BTI, as well as their biliary penetration ability (measured as the ratio of bile-to-serum concentrations). Only individuals with a reasonable ratio (>1) of bile-to-serum concentrations (Table 3) could be candidates for empiric antibiotics for BTI, according to the criteria outlined earlier. The local antimicrobial susceptibility patterns of the usual causative agents for BTI should also be considered when prescribing appropriate empiric antibiotics. To ensure a positive outcome, only those with a 20% resistance rate should be used as empirical antibiotics.
Patients with severe cholecystitis are unfortunately difficult to identify effectively, both clinically and radiologically, because clinical presentations are unpredictable, and imaging findings are frequently ambiguous. However, there are significant differences in morbidity and fatality rates between patients with uncomplicated cholecystitis and those with severe cholecystitis. Preventing related consequences requires early detection and careful management of patients at risk of severe cholecystitis.
10. Conclusions
When acute cholecystitis is suspected, bile samples are taken for microbiology culture and sensitivity testing, and antibiotics are prescribed once the diagnosis has been established. The antibiotics of choice are parenteral cephalosporin or ampicillin, as well as aminoglycosides. The antibiotic regimen chosen is based on the severity of the clinical presentation. Because acute suppurative cholangitis with biliary blockage has a high pre- and postoperative mortality rate, comprehensive antimicrobial therapy is required following biliary decompression. Bile microbiological analysis is an expedient diagnostic tool for determining more suitable medication and generating local antibiotic guidelines for the treatment of biliary tract infections.
Conflict of interest
No potential conflict of interest was reported by the authors.
\n',keywords:"acute cholecystitis, bacteria, chronic cholecystitis, antibiotics, cholangitis",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/79601.pdf",chapterXML:"https://mts.intechopen.com/source/xml/79601.xml",downloadPdfUrl:"/chapter/pdf-download/79601",previewPdfUrl:"/chapter/pdf-preview/79601",totalDownloads:112,totalViews:0,totalCrossrefCites:0,dateSubmitted:"July 8th 2021",dateReviewed:"August 23rd 2021",datePrePublished:"December 8th 2021",datePublished:"May 11th 2022",dateFinished:"December 8th 2021",readingETA:"0",abstract:"Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with comorbid disease. The most common infecting organisms are Enterobacteriaceae ascending from the gastrointestinal tract, Gram-positive pathogens like Enterococci spp.; the infections are rarely caused by fungi, viruses, and parasites. The prime reason for biliary tract infections is the ascending infection due to the reflux of duodenal contents and also the blood-borne infection or infection spreading through the portal-venous channels. The other predisposing conditions causing biliary tract infections include critical illnesses such as trauma, burns, sepsis, HIV infection, immunosuppression, diabetes, non-biliary surgery, and childbirth. The infection is reduced by β-lactam antibiotics or their derivatives, cephalosporins, carbapenems, fluoroquinolones, etc. Empiric treatment with piperacillin/tazobactam or a cephalosporin with or without metronidazole is recommended for moderate and severe acute cholecystitis irrespective of whether there is growth by culture. Patients with severe cholecystitis are unfortunately difficult to identify properly, both clinically and radiologically, because clinical symptoms are unexpected, and imaging investigations are frequently ambiguous. However, there are significant differences in morbidity and death rates between individuals with mild cholecystitis and those with severe cholecystitis. Preventing related consequences requires early identification and effective therapy of individuals at risk of severe cholecystitis.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79601",risUrl:"/chapter/ris/79601",signatures:"Hema Prakash Kumari Pilli and Vijayalakshmi Payala",book:{id:"10718",type:"book",title:"Gallstones",subtitle:"Review and Recent Progress",fullTitle:"Gallstones - Review and Recent Progress",slug:"gallstones-review-and-recent-progress",publishedDate:"May 11th 2022",bookSignature:"Qiang Yan and Huaping Shen",coverURL:"https://cdn.intechopen.com/books/images_new/10718.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-676-7",printIsbn:"978-1-83880-675-0",pdfIsbn:"978-1-83880-677-4",isAvailableForWebshopOrdering:!0,editors:[{id:"247970",title:"Prof.",name:"Qiang",middleName:null,surname:"Yan",slug:"qiang-yan",fullName:"Qiang Yan"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"418972",title:"Prof.",name:"Hema Prakash Kumari",middleName:null,surname:"Pilli",fullName:"Hema Prakash Kumari Pilli",slug:"hema-prakash-kumari-pilli",email:"hemaprakashpilli@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"425006",title:"Dr.",name:"Vijayalakshmi",middleName:null,surname:"Payala",fullName:"Vijayalakshmi Payala",slug:"vijayalakshmi-payala",email:"vpayala@gitam.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"GITAM University",institutionURL:null,country:{name:"India"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Current scenario",level:"1"},{id:"sec_3",title:"3. Anatomy of biliary tract",level:"1"},{id:"sec_4",title:"4. The sphincter of Oddi: (anatomy and physiology)",level:"1"},{id:"sec_5",title:"5. Sphincter of Oddi dyskinesia",level:"1"},{id:"sec_6",title:"6. Chronic and acute cholecystitis",level:"1"},{id:"sec_6_2",title:"6.1 Pathogenesis",level:"2"},{id:"sec_8",title:"7. Chronic cholecystitis clinical symptoms",level:"1"},{id:"sec_9",title:"8. Acute cholecystitis",level:"1"},{id:"sec_10",title:"9. Microorganisms in biliary tract infections",level:"1"},{id:"sec_10_2",title:"9.1 Bacterial causes of biliary tract infections",level:"2"},{id:"sec_11_2",title:"9.2 ESKAPE pathogens and role of bile in development of drug resistance",level:"2"},{id:"sec_12_2",title:"9.3 Rare cases of acute cholecystitis caused by microorganisms",level:"2"},{id:"sec_13_2",title:"9.4 Viral causes of biliary tract infections",level:"2"},{id:"sec_14_2",title:"9.5 Parasitic causes of biliary tract infections",level:"2"},{id:"sec_15_2",title:"9.6 Diagnosis",level:"2"},{id:"sec_15_3",title:"Table 1.",level:"3"},{id:"sec_16_3",title:"Table 2.",level:"3"},{id:"sec_18_2",title:"9.7 Treatment",level:"2"},{id:"sec_18_3",title:"Table 3.",level:"3"},{id:"sec_21",title:"10. Conclusions",level:"1"},{id:"sec_25",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Everhart JE, Khare M, Hill M, et al. Prevalence and ethnic differences in gallstone disease in the United States. Gastroenteriology. 1999;117:632-639'},{id:"B2",body:'Sifri CD, Madoff LC. Infections of the liver and biliary system. In: Mandell GI, Je B, Dolin R, editors. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone Elsevier; 2010'},{id:"B3",body:'Indar AA, Beckingham JJ. Acute cholecystitis. BMJ. 2002;325:639-643'},{id:"B4",body:'Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR. Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterology Report (Oxf). 2017;5(1):36-42. DOI: 10.1093/gastro/gow015'},{id:"B5",body:'Jan Modric. Gallbladder Anatomy and Function. 2017. Available from: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.ehealthstar.com%2Fanatomy%2Fgallbladder&psig=AOvVaw0Bbqz_bOLIoCUjv1R7KeBM&ust=1625739131352000&source=images&cd=vfe&ved=2ahUKEwi4rNKs3NDxAhUHGCsKHfKRCRkQr4kDegQIARBc'},{id:"B6",body:'Behar J. 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From the RSNA refresher courses: Imaging evaluation for acute pain in the right upper quadrant. Radiographics. 2004;24:1117-1135'},{id:"B21",body:'Kim SW, Kim HC, Yang DM, et al. Cystic duct enhancement: a useful CT finding in the diagnosis of acute cholecystitis without visible impacted gallstones. AJR. American Journal of Roentgenology. 2015;205:991-998'},{id:"B22",body:'Lee CC, Chang IJ, Lai YC, et al. Epidemiology and prognostic determinants of patients with bacteraemic cholecystitis or cholangitis. The American Journal of Gastroenterology. 2007;102:563-569'},{id:"B23",body:'Flores C, Maguilnik I, Hadlich E, Goldani LZ. Microbiology of choledochal bile in patients with choledocholithiasis admitted to a tertiary hospital. Journal of Gastroenterology and Hepatology. 2003;18:333-336'},{id:"B24",body:'Backert S, Tegtmeyer N, Oyarzabal OA, et al. Unusual Manifestation of Live Staphylococcus saprophyticus, Corynebacterium urinapleomorphum, and Helicobacter pylori in the Gallbladder with Cholecystitis. International Journal of Molecular Sciences. 2018;19(7):1826. DOI: 10.3390/ijms19071826'},{id:"B25",body:'Pos KM. Drug transport mechanism of the AcrB efflux pump. Biochimica et Biophysica Acta. 2009;1794:782-793. DOI: 10.1016/j.bbapap.2008.12.015'},{id:"B26",body:'Seeger MA, Diederichs K, Eicher T, Brandstatter L, Schiefner A, Verrey F, et al. The AcrB efflux pump: conformational cycling and peristalsis lead to multidrug resistance. Current Drug Targets. 2008;9:729-749. DOI: 10.2174/138945008785747789'},{id:"B27",body:'Sistrunk JR, Nickerson KP, Chanin RB, Rasko DA, Faherty CS. Survival of the fittest: How bacterial pathogens utilize bile to enhance infection. Clinical Microbiology Reviews. 2016;29:819-836. DOI: 10.1128/CMR.00031-16'},{id:"B28",body:'Begley M, Gahan CG, Hill C. The interaction between bacteria and bile. FEMS Microbiology Reviews. 2005;29:625-651. DOI: 10.1016/j.femsre.2004.09.003'},{id:"B29",body:'Kevin Gipson S et al. The Great ESKAPE: Exploring the crossroads of bile and antibiotic resistance in bacterial pathogens. Infection and Immunity. 2020;88(10):5-19'},{id:"B30",body:'Berinson B, Bellon E, Christner M, Both A, Aepfelbacher M, Rohde H. Identification of Kosakonia cowanii as a rare cause of acute cholecystitis: Case report and review of the literature. BMC Infectious Diseases. 2020;20(1):366. DOI: 10.1186/s12879-020-05084-6'},{id:"B31",body:'Deering EM, Muravec Z, Castineira CF, O’Donoghue G. Streptococcus bovis-related cholecystitis. BML Case Reports. 2013;2013:bcr2013008581. DOI: 10.1136/bcr-2013-008581'},{id:"B32",body:'Vogt AP, Doshi RK, Higgins JE, Burd EM, Ribner BS, Kraft CS. Acute cholecystitis caused by nontoxigenic Vibrio cholerae O1 Inaba. Journal of Clinical Microbiology. 2010;48(3):1002-1004. DOI: 10.1128/JCM.02198-09'},{id:"B33",body:'Shivaprakasha S, Harish R, Dinesh KR, Karim PM. Aerobic bacterial isolates from choledochal bile at a tertiary hospital. Indian Journal of Pathology & Microbiology. 2006;49:464-467'},{id:"B34",body:'Gupta E, Anita C. Viral infections of the biliary tract. Saudi Journal of Gastroenterology. 2008;14(3):158-160'},{id:"B35",body:'Lim JH, Kim SY, Park CM. Parasitic diseases of the biliary tract. AJR. 2007;188:1596-1603'},{id:"B36",body:'Porter NL. Diseases of the gallbladder and bile ducts. Essentials. 2009;64'},{id:"B37",body:'Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. Journal of Hepato-Biliary-Pancreatic Surgery. 2007;14(1):78-82'},{id:"B38",body:'Amini M, Pakdaman A, Shapoori S, Mosayebi G. High mobility group box-1 (HMGB1) protein as a biomarker for acute cholecystitis. Reports of Biochemistry and Molecular Biology. 2019;7(2):204-209'},{id:"B39",body:'Pisano M et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World Journal of Emergency Surgery. 2020;15:161. DOI: 10.1186/s13017-020-00336-x'},{id:"B40",body:'Ruan H-Q, Liao G-L, Peng P, Liu S-Q, et al. Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy. Gastroenterology Research and Practice. 2019;2019:1527328, 8 pages. DOI: 10.1155/2019/1527328'},{id:"B41",body:'Rello J et al. Critical Care Infectious Diseases Textbook. Kluwer Academic Publishers; 2001'},{id:"B42",body:'Galili O et al. The effect of bactibilia on the course and outcome of laparoscopic cholecystectomy. European Journal of Clinical Microbiology & Infectious Diseases. 2008;27:797-803. DOI: 10.1007/s10096-008-0504-8'},{id:"B43",body:'Van den Hazel SJ, Speelman P, Tytgat GN, Dankert J, van Leeuwen DJ. Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clinical Infectious Diseases. 1994;19:279-286. DOI: 10.1093/clinids/19.2.279'},{id:"B44",body:'Rhodes A et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine. 2017;43:304-377. DOI: 10.1007/s00134-017-4683-6'},{id:"B45",body:'Yun SP, Seo HI. Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy. Medicine. 2018;97:e11234. DOI: 10.1097/MD.0000000000011234'},{id:"B46",body:'Suh SW, Choi YS, Choi SH, et al. Antibiotic selection based on microbiology and resistance profiles of bile from gallbladder of patients with acute cholecystitis. Scientific Reports. 2021;11(1):2969. DOI: 10.1038/s41598-021-82603-8'},{id:"B47",body:'Tasina E, Haidich AB, Kokkali S, Arvanitidou M. Efficacy and safety of tigecycline for the treatment of infectious diseases: A meta-analysis. The Lancet Infectious Diseases. 2011;11:834-844. DOI: 10.1016/S1473-3099(11)70177-3'},{id:"B48",body:'Gomi H et al. Tokyo Guidelines 2018: Antimicrobial therapy for acute cholangitis and cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences. 2018;25:3-16. DOI: 10.1002/jhbp.518'},{id:"B49",body:'Tischendorf J, de Avila RA, Safdar N. Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review. American Journal of Infection Control. 2016;44:539-543. DOI: 10.1016/j.ajic.2015.12.005'},{id:"B50",body:'Bradley JS, Dudley MN, Drusano GL. Predicting efficacy of antiinfectives with pharmacodynamics and Monte Carlo simulation. The Pediatric Infectious Disease Journal. 2003;22:982e92'},{id:"B51",body:'Varghese JM, Roberts JA, Lipman J. Antimicrobial pharmacokinetic and pharmacodynamic issues in the critically ill with severe sepsis and septic shock. Critical Care Clinics. 2011;27:19e34'},{id:"B52",body:'Sharma S, Kumar A. Antimicrobial management of sepsis and septic shock. Clinics in Chest Medicine. 2008;29:677e87'},{id:"B53",body:'Cunha BA. Antibiotics essentials. In: Brogard JM, Pinget M, Arnaud JP, Dorner M, Lavillaureix J, editors. Biliary excretion of cefuroxime. Experimental and human study. Chemotherapy. 11th ed. Vol. 27. Burlington: Jones & Bartlett Learning; 2012, 1981. p. 526e718, 18e28'},{id:"B54",body:'Hukagawa H, Noga K. A study on the concentrations of levofloxacin in the gallbladder tissue and bile of patients. The Japanese Journal of Antibiotics. 1992;45:253e7'},{id:"B55",body:'Nielsen ML, Justesen T. Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile. Scandinavian Journal of Gastroenterology. 1977;12:1003-1008'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Hema Prakash Kumari Pilli",address:"hemaprakashpilli@gmail.com",affiliation:'
Department of Clinical Microbiology, GITAM Institute of Medical Sciences and Research, GITAM deemed to be University, Rushikonda, Visakhapatnam, India
Department of Clinical Microbiology, GITAM Institute of Medical Sciences and Research, GITAM deemed to be University, Rushikonda, Visakhapatnam, India
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and fun way in rehabilitation. Its first known use in rehabilitation published by Max North named as “Virtual Environments and Psychological Disorders” (1994). Virtual reality uses special programmed computers, visual devices and artificial environments for the clients’ rehabilitation. Throughout technological improvements, virtual reality devices changed from therapeutic gloves to augmented reality environments. Virtual reality was being used in different rehabilitation professions such as occupational therapy, physical therapy, psychology and so on. In spite of common virtual reality approach of different professions, each profession aims different outcomes in rehabilitation. Virtual reality in occupational therapy generally focuses on hand and upper extremity functioning, cognitive rehabilitation, mental disorders, etc. Positive effects of virtual reality were mentioned in different studies, which are higher motivation than non‐simulated environments, active participation of the participants, supporting motor learning, fun environment and risk‐free environment. Additionally, virtual reality was told to be used as assessment. This chapter will focus on usage of virtual reality in occupational therapy, history and recent developments, types of virtual reality technologic equipment, pros and cons, usage for pediatric, adult and geriatric people and recent research and articles.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Orkun Tahir Aran, Sedef Şahin, Berkan Torpil, Tarık Demirok and\nHülya Kayıhan",authors:[{id:"172938",title:"Prof.",name:"Hulya",middleName:null,surname:"Kayihan",slug:"hulya-kayihan",fullName:"Hulya Kayihan"},{id:"183079",title:"Ph.D.",name:"Sedef",middleName:null,surname:"Şahin",slug:"sedef-sahin",fullName:"Sedef Şahin"},{id:"196848",title:"M.Sc.",name:"Orkun Tahir",middleName:null,surname:"Aran",slug:"orkun-tahir-aran",fullName:"Orkun Tahir Aran"},{id:"197159",title:"Mr.",name:"Tarık",middleName:null,surname:"Demirok",slug:"tarik-demirok",fullName:"Tarık Demirok"},{id:"197312",title:"M.Sc.",name:"Berkan",middleName:null,surname:"Torpil",slug:"berkan-torpil",fullName:"Berkan Torpil"}]},{id:"61806",doi:"10.5772/intechopen.78312",title:"Executive Functions and Neurology in Children and Adolescents",slug:"executive-functions-and-neurology-in-children-and-adolescents",totalDownloads:1756,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"This chapter discusses the theoretical and methodological issues of creating a developmental perspective on executive function (EF) in childhood and adolescence. Focusing on school periods, this section outlines the development of the basic components of EF—inhibition, working memory, and attention. Cognitive and neurophysiological evaluations show that despite the emergence of EF in the first few years of life, it continues to grow significantly in childhood and adolescence. The components vary slightly according to their developmental sequence. The chapter links findings to long-standing developmental issues (i.e. developmental sequences and processes) and suggests the necessary research to establish a developmental framework covering early childhood throughout adolescence.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Gokcen Akyurek",authors:[{id:"197265",title:"Dr.",name:"Gokcen",middleName:null,surname:"Akyurek",slug:"gokcen-akyurek",fullName:"Gokcen Akyurek"}]},{id:"56049",doi:"10.5772/intechopen.69101",title:"Measurement of Participation: The Role Checklist Version 3: Satisfaction and Performance",slug:"measurement-of-participation-the-role-checklist-version-3-satisfaction-and-performance",totalDownloads:2820,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Participation in society is an area of interest to both clinicians and population researchers. Measurement of participation is therefore important, yet differences in definition, in terms of both content and scope, have made general agreement on one instrument tool elusive. What is recognized is the need for a theoretically based tool that captures both the insider and the outsider perspective. The outsider perspective, inclusive of the generally held views of a society, supports the utility for aggregating population data, whereas the insider perspective provides the internally held views of an individual needed for client-centered treatment planning. The Role Checklist Version 3 modifies one of the most commonly used assessment tools in occupational therapy practice, has good preliminary psychometric properties, and is theoretically consistent with both the ICF and the Model of Human Occupation. The Model of Human Occupation is the most widely used theoretical model in occupational therapy. This chapter provides an overview of the theoretical development, empirical testing, and implications for use of this participation measure by occupational therapists along with implications for population researchers.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Patricia J. Scott, Kelsey McKinney, Jeff Perron, Emily Ruff and Jessica\nSmiley",authors:[{id:"195495",title:"Dr.",name:"Patricia J",middleName:null,surname:"Scott",slug:"patricia-j-scott",fullName:"Patricia J Scott"},{id:"208801",title:"Dr.",name:"Kelsey G.",middleName:null,surname:"McKinney",slug:"kelsey-g.-mckinney",fullName:"Kelsey G. McKinney"},{id:"208802",title:"Mr.",name:"Jeffrey M.",middleName:null,surname:"Perron",slug:"jeffrey-m.-perron",fullName:"Jeffrey M. Perron"},{id:"208803",title:"Dr.",name:"Emily G.",middleName:null,surname:"Ruff",slug:"emily-g.-ruff",fullName:"Emily G. Ruff"},{id:"208804",title:"Dr.",name:"Jessica L.",middleName:null,surname:"Smiley",slug:"jessica-l.-smiley",fullName:"Jessica L. Smiley"}]},{id:"55024",doi:"10.5772/intechopen.68463",title:"Occupational Therapy in Oncology and Palliative Care",slug:"occupational-therapy-in-oncology-and-palliative-care",totalDownloads:2694,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Cancer is a chronic disease that may occur in both children and adults. Occupational therapy focuses on the activity limitations and participation problems in their life. Oncology rehabilitation involves in helping an individual with cancer to regain maximum physical, psychological, cognitive, social, and vocational functioning with the limits up to disease and its treatments in an interdisciplinary team concept. These treatment options are associated with the risk of some side effects, including fatigue, pain, cognitive problems, decrease in bone density and muscle endurance, weight loss, and stress- or anxiety-related psychosocial problems. Occupational therapy approaches are a holistic view in a client center and use training in activities of daily living, assistive technology, education of energy conservation techniques, and management of treatment-related problems, such as pain, fatigue, and nausea. In palliative and hospice care, occupational therapists support clients with cancer by minimizing the secondary symptoms related to cancer and its treatments. At the end of life, occupational therapy offers to identify the roles and activities that are meaningful and purposeful to the client with cancer and try to determine the barriers that limit their performance. Clients with cancer who have childhood cancer or adult cancer can face problems about body structure and functions, activity, and participation, which may limit their participation to their daily life.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Sedef Şahin, Semin Akel and Meral Zarif",authors:[{id:"183079",title:"Ph.D.",name:"Sedef",middleName:null,surname:"Şahin",slug:"sedef-sahin",fullName:"Sedef Şahin"},{id:"183078",title:"Dr.",name:"Burcu Semin",middleName:null,surname:"Akel",slug:"burcu-semin-akel",fullName:"Burcu Semin Akel"},{id:"198859",title:"Dr.",name:"Meral",middleName:null,surname:"Zarif",slug:"meral-zarif",fullName:"Meral Zarif"}]},{id:"70122",doi:"10.5772/intechopen.89360",title:"Parkinson’s Disease Rehabilitation: Effectiveness Approaches and New Perspectives",slug:"parkinson-s-disease-rehabilitation-effectiveness-approaches-and-new-perspectives",totalDownloads:2077,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Parkinson’s disease has been considered one of the most important and common neurodegenerative diseases in the world. Its motor and nonmotor signs determine a huge functional loss, leading the individuals to lose their independence. Although the treatment requires a pharmacological approach, physical therapy has confirmed its importance in this process. Today, neurorehabilitation is indispensable to increase many of the cardinal signs of the disease. Using traditional or technological approaches, physical therapy has reached good results in improving motor and nonmotor functions, as well as the quality of life of Parkinsonians. However, it is important to develop and to fortify the physical therapy approach so that we can provide stronger evidence about our practice.",book:{id:"7543",slug:"physical-therapy-effectiveness",title:"Physical Therapy Effectiveness",fullTitle:"Physical Therapy Effectiveness"},signatures:"Luciana Auxiliadora de Paula Vasconcelos",authors:[{id:"98546",title:"Dr.",name:"Luciana Auxiliadora",middleName:null,surname:"De Paula Vasconcelos",slug:"luciana-auxiliadora-de-paula-vasconcelos",fullName:"Luciana Auxiliadora De Paula Vasconcelos"}]}],mostDownloadedChaptersLast30Days:[{id:"55080",title:"Life Skills in Occupational Therapy",slug:"life-skills-in-occupational-therapy",totalDownloads:6076,totalCrossrefCites:4,totalDimensionsCites:1,abstract:"Occupational therapy is a health profession that uses the purposeful activities to achieve multiple and complex rehabilitation aims. The main goals of the occupational therapy are to support the reintegration of individuals in daily living skills as well as to increase their independence and autonomy. Interventions of occupational therapists have primarily focused on self-care, productivity, and leisure time activities. Since the life skills includes a wide range of abilities that enable a person to perform personal care and more complicated tasks such as traveling, shopping, community participation etc., occupational therapists provide life skills training programs to meet the needs of the clients. This chapter aims to contribute to the current understanding and practices of life skills from an occupational therapy perspective. The chapter starts with a brief discussion of the importance of life skills in occupational therapy. After this introduction, the first part takes a look at the definition of life skills and identifies core components of life skills. The second part describes assessment and interventions of life skills. The third one gives an overview about school life skills programs for children and adolescents. Finally, the last part explains some life skills programs in people with disadvantages.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Hatice Abaoğlu, Özge Buket Cesim, Sinem Kars and Zeynep Çelik",authors:[{id:"197551",title:"Dr.",name:"Hatice",middleName:null,surname:"Abaoğlu",slug:"hatice-abaoglu",fullName:"Hatice Abaoğlu"},{id:"205199",title:"Dr.",name:"Sinem",middleName:null,surname:"Kars",slug:"sinem-kars",fullName:"Sinem Kars"},{id:"205200",title:"Dr.",name:"Zeynep",middleName:null,surname:"Celik",slug:"zeynep-celik",fullName:"Zeynep Celik"},{id:"205203",title:"Ms.",name:"Özge Buket",middleName:null,surname:"Cesim",slug:"ozge-buket-cesim",fullName:"Özge Buket Cesim"}]},{id:"62493",title:"Occupational Therapy in Forensic Settings",slug:"occupational-therapy-in-forensic-settings",totalDownloads:2543,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"It is necessary for a person to comply with the expectations of society and the rules of law to which these expectations are secured. Offenders turn back to the community after the penalty was executed by isolating from society and some occupations. An occupational imbalance is seen in the individuals, during this penalty period and afterward, because of limited occupational participation. As an occupational being, this affects their physical, mental and psychological well-being. Imprisonment is an important practice in criminal law to punish criminals. This may be necessary for the protection of society from criminals, but successful integration into a community after exiting the prison is the most important factor in preventing recidivism. Occupational therapy focuses on health and well-being by using meaningful and purposeful occupations. Occupation involves any activity that people perform or participate in, such as giving care to themselves or others, working, learning, playing games, and interacting with others. From this perspective, the role of occupational therapists in forensic settings is to determine the abilities of these individuals to congregate their deprived freedoms and use them to train them for an independent and autonomous life; to provide a professional orientation, career counseling, and self-esteem; to gain some habits for physical, spiritual and moral life and to reinforce.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Esma Ozkan, Sümeyye Belhan, Mahmut Yaran and Meral Zarif",authors:null},{id:"70122",title:"Parkinson’s Disease Rehabilitation: Effectiveness Approaches and New Perspectives",slug:"parkinson-s-disease-rehabilitation-effectiveness-approaches-and-new-perspectives",totalDownloads:2083,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Parkinson’s disease has been considered one of the most important and common neurodegenerative diseases in the world. Its motor and nonmotor signs determine a huge functional loss, leading the individuals to lose their independence. Although the treatment requires a pharmacological approach, physical therapy has confirmed its importance in this process. Today, neurorehabilitation is indispensable to increase many of the cardinal signs of the disease. Using traditional or technological approaches, physical therapy has reached good results in improving motor and nonmotor functions, as well as the quality of life of Parkinsonians. However, it is important to develop and to fortify the physical therapy approach so that we can provide stronger evidence about our practice.",book:{id:"7543",slug:"physical-therapy-effectiveness",title:"Physical Therapy Effectiveness",fullTitle:"Physical Therapy Effectiveness"},signatures:"Luciana Auxiliadora de Paula Vasconcelos",authors:[{id:"98546",title:"Dr.",name:"Luciana Auxiliadora",middleName:null,surname:"De Paula Vasconcelos",slug:"luciana-auxiliadora-de-paula-vasconcelos",fullName:"Luciana Auxiliadora De Paula Vasconcelos"}]},{id:"62210",title:"Occupational Therapy’s Role in the Treatment of Children with Autism Spectrum Disorders",slug:"occupational-therapy-s-role-in-the-treatment-of-children-with-autism-spectrum-disorders",totalDownloads:2756,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Occupational therapists (OT) offer a wide range of therapies for individuals with ASD on the basis of specific deficits and difficulties. This chapter explores the role that OT plays, and the expertise, in relation to the interdisciplinary team. In addition, it discusses and presents empirical support for several therapeutic approaches commonly used by OTs working with individuals with ASD.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Bryan M. Gee, Amy Nwora and Theodore W. Peterson",authors:null},{id:"55049",title:"Community Participation in People with Disabilities",slug:"community-participation-in-people-with-disabilities",totalDownloads:2436,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Despite the fact that participation is an important building and a valuable target, the conceptualization, identification and measurement methods vary widely. This chapter tried to gain an insider’s perspective from the obstacles that summarize what meaning participation means, how to characterize it, and what prevents and supports participation. Participation is seen as a right and a responsibility attributed to and attributed to both the person and the community. Participation does not take place in a vacuum; the environment dynamically influences participation. The effects of this conceptual framework are discussed for change at the level of evaluation, research and systems to support the participation of the people with disability.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Gokcen Akyurek and Gonca Bumin",authors:[{id:"32431",title:"Prof.",name:"Gonca",middleName:null,surname:"Bumin",slug:"gonca-bumin",fullName:"Gonca Bumin"},{id:"197265",title:"Dr.",name:"Gokcen",middleName:null,surname:"Akyurek",slug:"gokcen-akyurek",fullName:"Gokcen Akyurek"}]}],onlineFirstChaptersFilter:{topicId:"198",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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He is on the editorial board of several international peer-reviewed journals and has published many papers. Additionally, he has participated in many international and national congresses, seminars, and workshops with oral and poster presentations. He is an active member of many local and international organizations.",institutionString:"İskenderun Technical University",institution:{name:"İskenderun Technical University",country:{name:"Turkey"}}},{id:"61139",title:"Dr.",name:"Sergey",middleName:null,surname:"Tkachev",slug:"sergey-tkachev",fullName:"Sergey Tkachev",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61139/images/system/61139.png",biography:"Dr. Sergey Tkachev is a senior research scientist at the Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia, and at the Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia. He received his Ph.D. in Molecular Biology with his thesis “Genetic variability of the tick-borne encephalitis virus in natural foci of Novosibirsk city and its suburbs.” His primary field is molecular virology with research emphasis on vector-borne viruses, especially tick-borne encephalitis virus, Kemerovo virus and Omsk hemorrhagic fever virus, rabies virus, molecular genetics, biology, and epidemiology of virus pathogens.",institutionString:"Russian Academy of Sciences",institution:{name:"Russian Academy of Sciences",country:{name:"Russia"}}},{id:"310962",title:"Dr.",name:"Amlan",middleName:"Kumar",surname:"Patra",slug:"amlan-patra",fullName:"Amlan Patra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/310962/images/system/310962.jpg",biography:"Amlan K. Patra, FRSB, obtained a Ph.D. in Animal Nutrition from Indian Veterinary Research Institute, India, in 2002. He is currently an associate professor at West Bengal University of Animal and Fishery Sciences. He has more than twenty years of research and teaching experience. He held previous positions at the American Institute for Goat Research, The Ohio State University, Columbus, USA, and Free University of Berlin, Germany. His research focuses on animal nutrition, particularly ruminants and poultry nutrition, gastrointestinal electrophysiology, meta-analysis and modeling in nutrition, and livestock–environment interaction. He has authored around 175 articles in journals, book chapters, and proceedings. Dr. Patra serves on the editorial boards of several reputed journals.",institutionString:null,institution:{name:"West Bengal University of Animal and Fishery Sciences",country:{name:"India"}}},{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.png",biography:"László Babinszky is Professor Emeritus, Department of Animal Nutrition Physiology, University of Debrecen, Hungary. He has also worked in the Department of Animal Nutrition, University of Wageningen, Netherlands; the Institute for Livestock Feeding and Nutrition (IVVO), Lelystad, Netherlands; the Agricultural University of Vienna (BOKU); the Institute for Animal Breeding and Nutrition, Austria; and the Oscar Kellner Research Institute for Animal Nutrition, Rostock, Germany. In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain.Dr. Satué is accredited as a Private University Doctor Professor, Doctor Assistant, and Contracted Doctor by AVAP (Agència Valenciana d'Avaluació i Prospectiva) and currently, as a full professor by ANECA (since January 2022). To date, Katy has taught 22 years in the Department of Animal Medicine and Surgery at the CEU-Cardenal Herrera University in undergraduate courses in Veterinary Medicine (General Pathology, integrated into the Applied Basis of Veterinary Medicine module of the 2nd year, Clinical Equine I of 3rd year, and Equine Clinic II of 4th year). Dr. Satué research activity is in the field of Endocrinology, Hematology, Biochemistry, and Immunology in the Spanish Purebred mare. She has directed 5 Doctoral Theses and 5 Diplomas of Advanced Studies, and participated in 11 research projects as a collaborating researcher. She has written 2 books and 14 book chapters in international publishers related to the area, and 68 scientific publications in international journals. Dr. Satué has attended 63 congresses, participating with 132 communications in international congresses and 19 in national congresses related to the area. Dr. Satué is a scientific reviewer for various prestigious international journals such as Animals, American Journal of Obstetrics and Gynecology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology, among others. Since 2014 she has been responsible for the Clinical Analysis Laboratory of the CEU-Cardenal Herrera University Veterinary Clinical Hospital.",institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"439435",title:"Dr.",name:"Feda S.",middleName:null,surname:"Aljaser",slug:"feda-s.-aljaser",fullName:"Feda S. Aljaser",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"423023",title:"Dr.",name:"Yosra",middleName:null,surname:"Soltan",slug:"yosra-soltan",fullName:"Yosra Soltan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"349788",title:"Dr.",name:"Florencia Nery",middleName:null,surname:"Sompie",slug:"florencia-nery-sompie",fullName:"Florencia Nery Sompie",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sam Ratulangi University",country:{name:"Indonesia"}}},{id:"428600",title:"MSc.",name:"Adriana",middleName:null,surname:"García-Alarcón",slug:"adriana-garcia-alarcon",fullName:"Adriana García-Alarcón",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428599",title:"MSc.",name:"Gabino",middleName:null,surname:"De La Rosa-Cruz",slug:"gabino-de-la-rosa-cruz",fullName:"Gabino De La Rosa-Cruz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428601",title:"MSc.",name:"Juan Carlos",middleName:null,surname:"Campuzano-Caballero",slug:"juan-carlos-campuzano-caballero",fullName:"Juan Carlos Campuzano-Caballero",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}}]}},subseries:{item:{id:"3",type:"subseries",title:"Bacterial Infectious Diseases",keywords:"Antibiotics, Biofilm, Antibiotic Resistance, Host-microbiota Relationship, Treatment, Diagnostic Tools",scope:"
\r\n\tThe era of antibiotics led us to the illusion that the problem of bacterial infection is over. However, bacterial flexibility and adaptation mechanisms allow them to survive and grow in extreme conditions. The best example is the formation of a sophisticated society of bacteria defined as a biofilm. Understanding the mechanism of bacterial biofilm formation has changed our perception of the development of bacterial infection but successfully eradicating biofilm remains a challenge. Considering the above, it is not surprising that bacteria remain a major public health threat despite the development of many groups of antibiotics. Additionally, increasing prevalence of acquired antibiotic resistance forces us to realize that we are far from controlling the development of bacterial infections. On the other hand, many infections are endogenous and result from an unbalanced relationship between the host and the microorganism. The increasing use of immunosuppressants, such as chemotherapy or organ transplantation, increases the incidence of patients highly susceptible to bacterial infections in the population.
\r\n
\r\n\tThis topic will focus on the current challenges and advantages in the diagnosis and treatment of bacterial infections. We will discuss the host-microbiota relationship, the treatment of chronic infections due to biofilm formation, and the development of new diagnostic tools to rapidly distinguish between colonization and probable infection.
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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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