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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This is achieved with different degrees of detail, in a unique and actual resource, through the description of different approaches to this type of sensors. Understanding the design and the working principles of the sensors described here requires a multidisciplinary background of electrical engineering, mechanical engineering, physics, biology, etc. An attempt has been made to place side by side the most pertinent information in order to reach a more productive reading not only for professionals dedicated to the design of tactile sensors, but also for all other sensor users, as for example, in the field of robotics. 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\n\t\t\t
1. Introduction
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Hepatic veno-occlusive disease (HVOD): was described as a non portal cirrhosis occurring frequently in children and occasionally in adults. Now it is considered an important cause of non cirrhotic portal hypertension particularly in children [1].
\n\t\t\t
Rollins 1989 [2], stated that HVOD is a non-thrombotic obliteration of small intrahepatic veins by loose connective tissues. The venous occlusion may be progressive and lead to massive hepatocellular necrosis. However the precise pathogenesis is still obscure but also most likely relates to venous endothelial injury.
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Originally the syndrome was described in South Africa at 1920, but at present it is endemic in Jamaica, encountered in Afghanistan and India. The syndrome was described under different names, from Jamaica the disease was described under the term Jamaican veno-occlusive disease, in India the disease was given the term Indian childhood Cirrhosis (ICC), in Europe HVOD has been called endophlebitis obliterans of which sporadic cases were described, as in Germany. Hepatic veno- occlusive disease was examined by scanning electron microscopy (SEM). SEM correlated its histology and postmortem examination and disclosed microscopic occlusion of the centrilobular and sublobular veins in the liver, these veins were occluded partially or completely by intimal and medial thickening of their walls due to proliferation of collagen and reticulin fibers. In addition to venous obliteration, which had not been demonstrated by other techniques, frequent occlusion of the sinusoidal opening into the central veins was observed by SEM. [4], [5], [6].
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\n\t\t\t\t\t\t\tCauses of non cirrhotic portal hypertension\n\t\t\t\t\t\t
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\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\tIntrahepatic\n\t\t\t\t\t\t
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\n\t\t\t\t\t\t\tExtrahepatic\n\t\t\t\t\t\t
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Schistosomiasis\n\t\t\t\t\t\t
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Extrahepatic portal vein thrombosis
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Extrahepatic portal vein thrombosis
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Splenic vein thrombosis
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Biliary cirrhosis, primary and secondary
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Chronic veno-occlusive disease
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Chronic active hepatitis
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Congenital hepatic fibrosis
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Haemochromatosis
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Alcoholic fibrosis
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Sarcoidosis
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Nodular regenerative hyperplasia
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Idiopathic portal hypertension
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Non-cirrhotic portal fibrosis
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\n\t\t\t\t
\n\t\t\t
Hepatic veno-occlusive disease has been recognized as being due to the toxic effects of some remedies, recently pyrrolizidine alkaloids mostly involved, as in senecio (bush teas) and crotalaria (comfrey trees). It is also now seen as complication of high dose of anti-neoplastic chemotherapy, especially in the setting of bone marrow transplantation. HVOD may be familial, so the term “veno occlusive familial hepatic disease” [7], [8], [9].
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\n\t\t
\n\t\t\t
2. Hepatic veno-occlusive disease (HVOD) in Egypt: Overview
\n\t\t\t
In Egypt Hashem 1939 [7], gave the first reference to this syndrome, in his study of portal cirrhosis among Egyptian children. Since 1939 several reports pointed out the occurrence of a specific syndrome among Egyptian children who rapidly developed abdominal distention with ascites and hepatomegaly. In 1965, Safouh et al [11]; reported that 54 Egyptian children were studied and the term "Hepatic vein occlusion disease in Egyptian children" was applied. At the same year, El Gholmy 1956 [10], studied a group of patients and introduced the term “Infantile cirrhosis of Egypt”
\n\t\t\t
The different reports from Egypt, thereafter, describing the syndrome, the clinical picture, the pathology and the etiology revealed that HVOD is not uncommon among Egyptian infants and young children. They also have shown clearly for the first time that hepatic vein occlusion should be considered in the diagnosis of Egyptian children presenting with hepatosplenomegaly [11].
\n\t\t\t
Safouh 1965 [11], reported that the Egyptian hepatic vein occlusion is the result of enhanced thrombotic activity of the blood with the formation of fibrinous thrombi followed by organization and thickening or closure of the vessels, a finding which seems peculiar to the Egyptian cases and thus differs from the classical HVOD.
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\n\t\t
3. Clinical Picture of HVOD
\n\t\t
Clinical diagnosis is based on; hepatomegaly and/or right upper quadrant pain, ascites or unexplained weight gain and also jaundice may or may not present [7].
\n\t\t
The acute stage starts abruptly with abdominal discomfort or pain accompanied by hepatomegaly and ascites, nausea and vomiting are common. Histologically the liver shows an edematous endophlebitis of the central veins associated with centrilobular congestion, hemorrhage and necrosis. Mclean 1969 [12], has shown experimentally that the block occurs first at the outlets of the sinusoids. Patients surviving the acute stage may progress to the subacute stage with persistent hepatomegaly and ascites which then diminish if an adequate collateral circulation becomes established. The chronic stage is a centrilobular type of septal cirrhosis [7].
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\n\t\t\t\t\t\tClinical picture:\n\t\t\t\t\t
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Non febrile onset
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Mild continuous dragging pain in right hypochondrium
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Anorexia, nausea and vomiting
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Rapidly filling ascites
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\n\t\t\t\t
\n\t\t\t\t
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Distended veins over the abdomin
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Oliguria and pedal edema
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\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t
Hepatomegaly
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\n\t\t\t\t
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Splenomegaly in some cases
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\n\t\t\t\t\t
\n\t\t\t\t\t
Tandon 1977
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\n\t\t\t
\n\t\t
\n\t\t\t
4. Diagnosis of HVOD
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In the acute phase the diagnosis is usually readily made from the history and the characteristic clinical picture. In the sub-acute and chronic stages the diagnosis may be more difficult. In all stages the diagnosis is confirmed by the characteristic histopathological findings of liver biopsy in the absence of extrahepatic venous obstruction.
\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t4.1. Laboratory Studies:
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1. Safouh et al; 1965 [11] reported the following results:
\n\t\t\t\t
# Most of the cases showed some degree of anemia.
\n\t\t\t\t
# Total and differential leukocytic counts did not show any constant deviation from normal.
\n\t\t\t\t
# Liver function tests showed that : * Serum bilirubin was always below 3 mg/dl, * Serum AST varied between 20 and 60 units, * Serum ALT and alkaline phosphatase were found to be normal.
\n\t\t\t\t
# Erythrocyte sedimentation rate ( ESR ) was low in spite of advanced state of the disease.
\n\t\t\t\t
# The pattern of serum total proteins showed a state of hypoproteinemia ranging from 4-5 gm/dl and the albumen fraction is usually is decreased but globulin fraction may be increased.
\n\t\t\t\t
2. Millis and Bale 1976 [13], stated that a feature of their cases is the partial immune deficiency. However, such a state of hypogammaglobulinemia reported by them goes parallel with findings in the acute cases only, that their cases were quite a different group of patients suffering from genetic immunodeficiency as observed from the very early appearance of the syndrome in some of them being as early as days.
\n\t\t\t\t
3. Serum procollagen type III is an early and sensitive marker in VOD after BM transplantation, usually above 100 ng /ml.
\n\t\t\t\t
4. Serum protein S,C, liedin factor
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
4.2. Ultrasonographic scaning of the liver:
\n\t\t\t\t
It is of definite help in the diagnosis of this syndrome, it showed that the liver is enlarged especially the caudate lobe, splenic enlargement is usually of mild degree and ascites is always found in acute cases. Narrowing of inferior vena cava could be detected in 40% of cases. Examination of the terminal parts of the hepatic veins demonstrated their occlusion or attenuation, a finding which is considered a new and significant contribution to the early diagnosis of this syndrome [14].
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
4.3. Inferior vena cava angiogram:
\n\t\t\t\t
Presented as narrow or closed intra-hepatic portion of the inferior vena cava with marked collaterals [14].
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
4.4. Liver biopsy:
\n\t\t\t\t
In the acute stage it shows centrilobular hemorrhage, necrosis and sinusoidal dilatation. In the chronic stage it presents picture of micronodular cirrhosis with normal portal tracts [7].
The ascitic fluid is a main laboratory field of investigations. It usually shows protein values ranging between 1-3.5 gms/dl with occasional lymphocytes.
\n\t\t\t\t
Other sophisticated modules of investigations might be carried out : liver isotopic scanning, splenoportal venogram and arterio-venography of the portal system.
\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
5. Management of Hepatic veno-occlusive disease:
\n\t\t\t
No effective therapy until now especially in this type of Egyptian children. The target of available line is, may be, to reduce the complications, to reduce the stress of the patients and keep the patients in nearly comfortable life, but the following measures could be used safely [14].
\n\t\t\t
\n\t\t\t\t
5.1. Preventive measures:
\n\t\t\t\t
More investigation for the etiology of the disease especially pyrrolizidine alkaloids.
Encouraging the breast feeding for two years as Glorious Qura’n says. (Sorra El bakara ), regulation and careful inspection of diet after weaning [11].
Good nutrition of the mother
What about copper utensils ?? it suspected to play a role in indian cirrhosis !
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\n\t\t\t
\n\t\t\t\t
5.2. Conservative measures :
\n\t\t\t\t
Follow up, because a grossly abnormal scan of liver and spleen in a patient with HVOD has been normalized completely without any interference.
Colonic lavage to wash out the toxic metabolites.
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
5.3. Medical treatment:
\n\t\t\t\t
Low doses of heparin or anticoagulants, adapted dose of prostacyclin.\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\tAnti inflammatory or steroids.\n\t\t\t\t\t\t
Use of Vit C, use of Vit. E and Glutamine (source of glutathione) as antioxidants [15].
Use of recombinant tissue plasminogen activator (rtPA), especially in patients after BM transplantation, Urokinase especially in cases with bleeding diathesis leading to thrombotic HVOD [15], [16], [17].
\n\t\t\t\t\t\t\tDiuretics for ascites.
\n\t\t\t\t\t\t\tLarge doses of glucose together with insulin to aid glycogen deposition in the liver and so help its nutrition.
The first study re-evaluating paracentesis as a treatment of cirrhotic patients with ascites consisted of a randomized controlled trial comparing repeated large-volume paracentesis (4-6 l/day until the disappearance of ascites) plus intravenous albumin infusion (40g after each tap) with standard diuretic therapy (frusemide plus spironolactone) in I17 patients with tense ascites and avid sodium retention who were admitted to several hospitals in the Barcelona area. This study, later confirmed by two more trials performed in Milan and Barcelona, showed the following results:
\n\t\t\t
1. paracentesis was more effective than diuretics in eliminating ascites (96.5 versus 72.8%);
\n\t\t\t
2. paracentesis plus albumin infusion did not induce significant changes in hepatic and renal function, serum electrolytes, cardiac output, plasma volume, plasma renin activity and plasma concentration of noradrenaline and antidiuretic hormone.
\n\t\t\t
3. the incidence of hyponatremia, hepatic encephalopathy and renal impairment was much lower in patients treated with paracentesis.
\n\t\t\t
4. the duration of hospital stay was lower in patients treated with paracentesis.
\n\t\t\t
5. there were no significant probability of re-admission, probability of survival and causes of death between the two groups of patients.
\n\t\t\t
Tito et al., later investigated whether ascites can be safely mobilized by total paracentesis (complete removal of ascites by a single paracentesis) plus intravenous albumin infusion (6-8 g/l removed) in a one day hospitalization regime. The incidence of complications and the clinical course of the disease, as estimated by the probability of readmission to hospital, causes of re-admission, probability of survival and causes of death, were comparable to those reported by the same group of investigators in patients treated with repeated large-volume paracentesis.
\n\t\t\t
In conclusion, these studies demonstrate that mobilization of ascites by paracentesis associated with intravenous albumin infusion does not impair systemic haemodynamics and renal function in patients with cirrhosis and tense ascites. Therapeutic paracentesis should be the treatment of choice for cirrhotic patients admitted to hospital with tense ascites, because it is more effective in mobilizing associated with a lower incidence of complications and reduce the duration of hospitalization. To avoid re-accumulation of ascites, patients treated with paracentesis require dietary sodium restriction and administration of diuretics after the procedures.
\n\t\t\t
Subsequently, a trial was performed to establish whether intravenous albumin infusion is necessary in cirrhotic patients with tense ascites treated with repeated large-volume paracentesis. It was observed that paracentesis plus intravenous albumin does not induce significant changes in standard renal function testes, plasma renin activity and plasma aldosterone concentration. In contrast, paracentesis without albumin was associated with a significant increase in blood urea nitrogen, a marked elevation in plasma renin activity and plasma aldosterone concentration, and a significant reduction in serum sodium concentration. The number of patients developing hyponatremia and renal impairment was remarkably higher in patients treated with repeated large-volume paracentesis without intravenous albumin infusion. There are two detailed investigations assessing the effects of large-volume paracentesis without albumin infusion on systemic haemodynamics vasoactive hormones and renal function. A significant increase in cardiac output was observed 1 hour after treatment in both studies. Some hours later, however, a significant drop below baseline values was observed in cardiac output, pulmonary wedge capillary pressure and central venous pressure. Plasma renin activity increased and plasma atrial natriuretic peptide concentration decreased. The adverse effects observed after complete mobilization of ascites by paracentesis without albumin expansion did not occur in patients in whom ascites was only partially mobilized by paracentesis without colloid replacement. In conclusion, these studies demonstrate that complete mobilization of ascites by paracentesis without plasma volume expansion is followed by a reduction in effective intravascular volume, which leads to activation of the renin-aldosterone system and may impair renal function. The infusion of intravenous albumin is an important measure to prevent these abnormalities in cirrhotic patients with tense ascites treated with large-volume or total paracentesis.
\n\t\t\t
Five randomized controlled trials and one prospective study aimed at investigating whether albumin can be substituted by less expensive plasma expanders (dextran-70, dextran-40, Haemaccel 5% and isotonic saline) have recently been reported. It has been observed that total or repeated large-volume paracentesis associated with intravenous administration of dextran-70 or Haemaccel is not associated with significant changes in renal and hepatic function. The incidence of hyponatremia, renal impairment and hepatic encephalopathy in patients receiving dextran-70 or Haemaccel was comparable with that in patients receiving albumin. In one study, patients treated with dextran-70 showed a significant increase in plasma renin activity and aldosterone concentration. In a more recent study, however, therapeutic paracentesis plus intravenous dextran-70 administration was not associated with significant changes in plasma renin activity, which was measured 24 and 96 hours after the treatment. Cabrera et al., in one study including 14 patients, have suggested that intravenous isotonic saline infusion can also be a safe and cost effective alternative plasma expander in cirrhotics with tense ascites treated with paracentesis. Further studies are obviously needed to confirm their findings. It seems that dextran-40 is not as effective as albumin in preventing renal and electrolyte complications after therapeutic paracentesis, as renal impairment and/or hyponatremia developed after treatment in a relatively high proportion of patients.
\n\t\t\t
Recently, a multicenter randomized trial comparing therapeutic paracentesis with PVS in cirrhotic patients with refractory or recurrent ascites has been published. More than 40 patients were included in each group. Both treatments were equally effective in mobilizing the ascites during the first hospital stay, although the duration of hospitalization was significantly longer in the shunt group. There were also no significant differences between both groups in the number of patients who developed complications or died. The number of re-admissions for any reason or for ascites, was significantly higher, and the time to first re-admission for any reason and for ascites significantly shorter in the paracentesis group than in the shunt group. The total time in hospital during follow-up, however, was similar in the two groups. The probability of shunt obstruction was 40 % at 1 -year follow-up. The probability of survival was similar in both groups. In conclusion, this trial shows that, although the LeVeen shunt was better than paracentesis in the long-term control of ascites, it did not reduce the total time in hospital nor prolong survival. On the other hand, patients treated with PVS required frequent re-operations due to obstruction of the prosthesis. Therapeutic paracentesis is therefore an alternative treatment to LeVeen shunt in cirrhotic patients with refractory ascites.
\n\t\t
\n\t\t
\n\t\t\t
7. Peritoneovenous Shunting
\n\t\t\t
In 1974 LeVeen [19], and colleagues developed a pressure-activated one-way valve for use in a peritoneovenous shunt (PVS). This device consists of a perforated intra-abdominal tube connected through a one-way pressure sensitive valve to a silicone tube that traverses the subcutaneous tissue up to the neck, where it enters one of the jugular veins (usually the internal jugular vein). The tip of the intravenous tube is located in the superior vena cava, near the right atrium or in the right atrium itself. The shunt produces a sustained circulating blood volume expansion by continuous passage of ascitic fluid to the general circulation. Flow in the shunt is maintained if there is a 3-5 cm H2O pressure gradient between the abdominal cavity and the superior vena cava. A loss of this gradient causes the valve to close, preventing blood from flowing back into the tubing. Two additional shunts have been introduced Denver and Cordis-Hakim. These latter shunts include a pumping mechanism that allows flow to be increased or a partially occluded shunt to be cleared.
\n\t\t\t
The intravenous infusion of ascitic fluid through the shunt is associated with an increase in circulating blood volume and cardiac output. Since arterial pressure does not rise, there is a concomitant reduction in peripheral vascular resistance. These hemodynamic changes are associated with an increase in the plasma concentration of atrial natriuretic factor and a suppression of plasma levels of renin, aldosterone, noradrenaline and antidiuretic hormone. Urine volume and free water clearance increase in most patients. However, there is significant natriuresis in less than half of the patients, demonstrating that the PVS does not completely correct the abnormal sodium-retaining state associated with cirrhosis. Finally, in cirrhotic patients with moderate FRF, the PVS may improve renal blood flow and glomerular filtration rate. These hemodynamic and hormonal changes persist in most cases and a significant proportion of patients remains with minimal or no ascites despite a moderate sodium restriction and low diuretic dosage. There are also two studies that suggest that PVS has a positive effect on the nutritional status of patients in whom the shunt functions for a prolonged period of time. Despite these positive effects of PVS, there are a large number of complications, which may occur early in the postoperative period or at any time during follow-up [19], [20].
\n\t\t\t
The role of PVS in the management of cirrhotic patients with ascitcs is still not well established. Only one prospective study showed that PVS is superior to conventional medical therapy in the management of ascites and in improving survival. By contrast, four randomized studies have failed to demonstrate a longer survival time in cirrhotic patients with ascites treated with PVS compared with medical therapy. Of these studies, that which was performed by Stanley et al., 1989 [22], is worth mentioning. They compared PVS with medical treatment (diuretics and occasional paracentesis) in 299 patients with cirrhosis and refractory or recurrent ascites. Although early mortality and probability of survival after randomization were similar in both therapeutic groups, PVS was more effective in the management of ascites than was conventional medical therapy, as indicated by shorter duration of first hospitalization, longer time to recurrence of ascites, and lower diuretic requirements during follow-up. However, these results are not surprising, because PVS was compared with a treatment that by definition was known to be ineffective.
\n\t\t\t
The effect of PVS on survival in patients with FRF has also been studied in a randomized controlled trial. The treated patients had some improvement in renal function, but their survival was unaffected. Several studies have shown that morbidity and survival of cirrhotic patients treated with PVS correlate with the degree of impairment of liver and renal function. Therefore, the best results with this procedure should be expected to occur in those few patients with diuretic-resistant ascites and preserved hepatic function [23].
\n\t\t\t
\n\t\t\t\t
7.1. Early complications of peritoneovenous shunting
\n\t\t\t\t
Acute bacterial infection is the most serious early complication. Staphylococcus aureus is a frequent isolate and represents the operative contamination of the shunt in some cases. The prosthesis is usually colonized and the infection cannot be eradicated in most cases unless the shunt is removed a high mortality can be expected. The prophylactic administration of anti-staphylococcal antibiotics 24 hours before and 48 hours after surgery reduces the incidence of early postoperative infection. Biochemical disseminated intravascular coagulation (DIC) is seen in practically every cirrhotic patient treated with PVS in the early postoperative period. Bleeding caused by DIC develops most commonly in those patients with severe liver disease, but is now very uncommon, because many surgeons remove the ascitic fluid before inserting the shunt and replace it with normal saline. DIC is thought to develop because of infusion of factors present in ascitic fluid that activate coagulation (thromboplastin, activated clotting factors, endotoxin, collagen, plasminogen activator and fibrin split products). Postoperative fever, probably related to the passage of endotoxin contained in the ascitic fluid to the general circulation, is almost a constant and disappears spontaneously within the second postoperative week. Rapid expansion of the plasma volume is associated with a rise in portal pressure and may increase the risk of variceal haemorrhage. This complication can also be prevented by removing most ascitic fluid before the insertion of the shunt [24].
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
7.2. Long-term complications of peritoneovenous shunting
\n\t\t\t\t
Obstruction of the shunt is the most common complication during follow-up. It occurs in more than 30% of patients and is usually due to deposition of fibrin within the valve or the intravenous catheter, thrombotic obstruction of the venous limb of the prosthesis, or thrombosis of the superior vena cava or right atrium initiated at the venous end of the shunt or damaged endothelium. Shunt obstruction is generally associated with ascites re-accumulation. Shunt patency can be assessed by Doppler ultrasound or by technetium 99m scintigraphy using intraperitoneal radioisotope injection. If the obstruction is confirmed, a shuntogram after the injection of contrast into the proximal limb of the shunt may identify the site of obstruction. Venography or digital angiography is necessary in the case of obstruction of the venous tip of the shunt. Superior vena cava syndrome secondary to total obstruction of the vein and pulmonary embolism are much less common. It is not clear that the insertion of a titanium tip into the venous end of the LeVeen shunt prevents thrombotic obstruction and the development of superior vena cava thrombosis. Finally, another long-term complication of PVS is small-bowel obstruction, which occurs in approximately 10% of patients and is due to intraperitoneal fibrosis [25].
The feasibility of intrahepatic portosystemic shunting was first demonstrated by Rosch and colleagues 1969 in pigs. Colapinto et al; 1982 [27] reported the first application of this technique to humans. This was attempted following transhepatic obliteration of varices in 20 severely ill patients with variceal hemorrhage. The authors inflated a balloon catheter in the intrahepatic track and left it there for 12 hours. In an initial report all six shunts studied were patent 12 hours after the procedure and one was still patent at autopsy 6 weeks late.
\n\t\t\t
Many demonstrated prolonged patency of the shunt for up to 10 months and ease of recanalizing the radiopaque shunt when occlusion occurred. This expandable stent was then used successfully in patients with portal hypertension. Similar good results were soon reported with the self-expanding Wall stent. Percutaneous portography was used in the early cases to facilitate transjugular portal vein puncture. With increasing experience this has been replaced by ultrasound guidance in most centers [28].
\n\t\t\t
There is now an increasing array of equipment available for transjugular intrahepatic portosytemic shunt (TIPS) insertion. The most widely used needles are a standard transjugular biopsy needle with a straight or reversed bevel (Cook Ltd) or the Richter needle which has a tapered tip and a blunt obturator (Angiomed, Karlsruhe, Germany). Another set with a blunt cannula, through which is passed a sharp style is also available (Cook). There is also a wider choice with regard to the type and dimensions of metal stent. In addition to the original Palmaz and Wall stents, there is the Strecker stent and the Memotherm stent (Angiomed, Karlsruhe, Germany). Claimed advantages for these new stents are increased radioopacity (Strecker stent) and improved delivery systems (Memo stent) [29].
\n\t\t\t
A recent randomized controlled study compared the Palmaz and Wall stent in 90 patients and found little difference in outcome. Early shunt thrombosis was more likely with the Wall stent (9%), whereas stenosis of the hepatic vein was more likely with the Palmaz stent (I3%). Experience with the other stents is limited.
\n\t\t\t
As yet the long-term expectations of TIPS have not been fulfilled in those clinical situations in which long-term efficacy is needed as prevention of variceal rebleeding, ascites, cirrhotic hydrothorax, Budd-Chiari syndrome, and long-term amelioration of clinical status before liver transplantation. All these indications need controlled trials against current best optimal management before TIPS is used routinely even for an individual patient. The high stent obstruction rate is the most important limiting factor, but change in stent shape, coating material or other technical aspects may overcome this [30].
\n\t\t\t
The complications of TIPS are significant if elective and long-term use is considered, thus the need for trials before new therapies are introduced. In an emergency situation the complications due to TIPS are an acceptable risk, but again information from controlled trials is needed. This is particularly true when TIPS is used as a short-term bridge to liver transplantation. TIPS will have a place in the treatment of cirrhotic patients. At present short-term rather than long-term indications appear to be where TIPS will have more beneficial effects [28].
\n\t\t
\n\t\t
\n\t\t\t
9. Liver transplantation: and hepatic venous obstruction
\n\t\t\t
Liver transplantation for Budd–Chiari syndrome: A European study on 248 patients from 51 centers ) [31]: The results of liver transplantation for Budd–Chiari syndrome (BCS) are poorly known and the role and timing of the procedure are still controversial. The aim of this study was to investigate the results of transplantation for BCS, focusing on overall outcome, on prognostic factors and on the impact of the underlying disease. Methods: An enquiry on 248 patients representing 84% of the patients transplanted for BCS in the European Liver Transplantation Registry between 1988 and 1999. Results: Of the 248 patients, 70.4% were female and 29.6% male. The mean age was 35.7 years. The overall actuarial survival was 76% at 1 year, 71% at 5 years and 68% at 10 years. 77% of deaths occurred in the first 3 months: 47% were due to infection and multiple organ failure, and 18% to graft failure or hepatic artery thrombosis. Late mortality (>1 year) occurred in nine patients, due to BCS recurrence in four of them. The only pre-transplant predictors of mortality on multivariate analysis (Cox) were impaired renal function and a history of a shunt.
\n\t\t
\n\t\t
\n\t\t\t
10. Conclusions
\n\t\t\t
Liver transplantation for BCS is an effective treatment, irrespective of the underlying cause, and should be considered before renal failure occurs [31].
\n\t\t
\n\t
Acknowledgments
\n\t\t\t
We would like to thank all the staff of pediatric department, at National Liver Institute, Menoufya University for supporting our work.
\n\t\t
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/38729.pdf",chapterXML:"https://mts.intechopen.com/source/xml/38729.xml",downloadPdfUrl:"/chapter/pdf-download/38729",previewPdfUrl:"/chapter/pdf-preview/38729",totalDownloads:2044,totalViews:151,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:2,impactScoreQuartile:1,hasAltmetrics:0,dateSubmitted:"March 31st 2012",dateReviewed:"June 13th 2012",datePrePublished:null,datePublished:"February 13th 2013",dateFinished:"August 31st 2012",readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/38729",risUrl:"/chapter/ris/38729",book:{id:"3164",slug:"hepatic-surgery"},signatures:"Elsayed Ibrahim Salama",authors:[{id:"154331",title:"Dr.",name:"Elsayed",middleName:"I.",surname:"Salama",fullName:"Elsayed Salama",slug:"elsayed-salama",email:"elsayedsalama5@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Menoufia University",institutionURL:null,country:{name:"Egypt"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Hepatic veno-occlusive disease (HVOD) in Egypt: Overview",level:"1"},{id:"sec_3",title:"3. Clinical Picture of HVOD",level:"1"},{id:"sec_4",title:"4. Diagnosis of HVOD",level:"1"},{id:"sec_4_2",title:"\n\t\t\t\t\t4.1. Laboratory Studies: ",level:"2"},{id:"sec_5_2",title:"4.2. Ultrasonographic scaning of the liver:",level:"2"},{id:"sec_6_2",title:"4.3. Inferior vena cava angiogram:",level:"2"},{id:"sec_7_2",title:"4.4. Liver biopsy:",level:"2"},{id:"sec_8_2",title:"4.5. Other tools of investigations [14]",level:"2"},{id:"sec_10",title:"5. Management of Hepatic veno-occlusive disease: ",level:"1"},{id:"sec_10_2",title:"5.1. Preventive measures:",level:"2"},{id:"sec_11_2",title:"5.2. Conservative measures :",level:"2"},{id:"sec_12_2",title:"5.3. Medical treatment:",level:"2"},{id:"sec_13_2",title:"5.4. Surgical treatment [18].",level:"2"},{id:"sec_13_3",title:"5.4.1. Treatment of ascites : ",level:"3"},{id:"sec_14_3",title:"5.4.2. Treatment of portal hypertension:",level:"3"},{id:"sec_15_3",title:"5.4.3. Liver transplantation:",level:"3"},{id:"sec_18",title:"6. Therapeutic paracentesis [21].",level:"1"},{id:"sec_19",title:"7. Peritoneovenous Shunting",level:"1"},{id:"sec_19_2",title:"7.1. Early complications of peritoneovenous shunting",level:"2"},{id:"sec_20_2",title:"7.2. Long-term complications of peritoneovenous shunting",level:"2"},{id:"sec_22",title:"8. Transjugular intrahepatic portosystemic shunt (TIPS) ",level:"1"},{id:"sec_23",title:"9. Liver transplantation: and hepatic venous obstruction",level:"1"},{id:"sec_24",title:"10. Conclusions ",level:"1"},{id:"sec_25",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAl\n\t\t\t\t\t\t\tHasany. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMohamed\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1970\n\t\t\t\t\tVeno occlusive disease of Liver in Iraq.\n\t\t\t\t\tArchives of disease in childhood\n\t\t\t\t\t45\n\t\t\t\t\t243\n\t\t\t\t\t722\n\t\t\t\t\t724\n\t\t\t\t\n\t\t\t'},{id:"B2",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRollins\n\t\t\t\t\t\t\tB. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1989\n\t\t\t\t\tHepatic Veno-occlusive Disease\n\t\t\t\t\tAm J of Med\n\t\t\t\t\t8\n\t\t\t\t\t297\n\t\t\t\t\n\t\t\t'},{id:"B3",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBras\n\t\t\t\t\t\t\tG.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tJeliffe\n\t\t\t\t\t\t\tD. B.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tStuart\n\t\t\t\t\t\t\tK. L.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1954\n\t\t\t\t\tArch Path, Chicago\n\t\t\t\t\t57\n\t\t\t\t\t285\n\t\t\t\t\n\t\t\t'},{id:"B4",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tStein\n\t\t\t\t\t\t\tH.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1957\n\t\t\t\t\tVeno-occlusive disease of the liver in African children.\n\t\t\t\t\tBr Med J\n\t\t\t\t\t1\n\t\t\t\t\t1496\n\t\t\t\t\n\t\t\t'},{id:"B5",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTandon\n\t\t\t\t\t\t\tB. N.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTandon\n\t\t\t\t\t\t\tR.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTandon\n\t\t\t\t\t\t\tH. D.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNarndrunat\n\t\t\t\t\t\t\tL.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tJoghi\n\t\t\t\t\t\t\tY. K.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1976\n\t\t\t\t\tAn epidemic of veno-occlusive disease of liver in central India.\n\t\t\t\t\tLancet\n\t\t\t\t\t271\n\t\t\t\t\t272\n\t\t\t\t\n\t\t\t'},{id:"B6",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tShirai\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNagashima\n\t\t\t\t\t\t\tK.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tIwasaki\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMori\n\t\t\t\t\t\t\tW.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1987\n\t\t\t\t\tA light and scanning electron microscopic study of hepatic veno-occlusive disease.\n\t\t\t\t\tActa Path Jpn\n\t\t\t\t\t37\n\t\t\t\t\t12\n\t\t\t\t\t1961\n\t\t\t\t\t711\n\t\t\t\t\n\t\t\t'},{id:"B7",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHashem\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1939\n\t\t\t\t\tEtiology and Pathology of types of liver cirrhosis in Egyptian children.\n\t\t\t\t\tJ Egypt Med Association\n\t\t\t\t\t22\n\t\t\t\t\t1\n\t\t\t\t\t36\n\t\t\t\t\n\t\t\t'},{id:"B8",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMohabbat\n\t\t\t\t\t\t\tO.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSrivastava\n\t\t\t\t\t\t\tR. N.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tYounos\n\t\t\t\t\t\t\tM. S.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSedio\n\t\t\t\t\t\t\tG. G.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMerzad\n\t\t\t\t\t\t\tA. A.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAram\n\t\t\t\t\t\t\tG. N.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1967\n\t\t\t\t\tAn outbreak of Hepatic Veno-occlusive Disease due to toxic Alkaloid in herbal tea in north western Afghanistan.\n\t\t\t\t\tLancet\n\t\t\t\t\t7950\n\t\t\t\t\t269\n\t\t\t\t\n\t\t\t'},{id:"B9",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWilmot\n\t\t\t\t\t\t\tF. C.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRobertson\n\t\t\t\t\t\t\tG. W.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1920\n\t\t\t\t\tSenecio disease and cirrhosis of liver due to senecio boisoning.\n\t\t\t\t\tLancet\n\t\t\t\t\t11\n\t\t\t\t\t848\n\t\t\t\t\t849\n\t\t\t\t\n\t\t\t'},{id:"B10",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEl Gholmy\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEl Nabaway\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKhatab\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAS\n\t\t\t\t\t\t\tShukry\n\t\t\t\t\t\t\tGabr. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEl Sibie\n\t\t\t\t\t\t\tB.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAidaro\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSoliman\n\t\t\t\t\t\t\tL.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1956\n\t\t\t\t\tInfantile liver cirrhosis of Egypt.\n\t\t\t\t\tGaz Egypt Ped Assoc\n\t\t\t\t\t4\n\t\t\t\t\t320\n\t\t\t\t\n\t\t\t'},{id:"B11",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSafouh\n\t\t\t\t\t\t\tM. A.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tShehata\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tElwi\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1965\n\t\t\t\t\tVeno occlusive disease in Egyptian Children.\n\t\t\t\t\tArch Path\n\t\t\t\t\t79505\n\t\t\t'},{id:"B12",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMc Lean\n\t\t\t\t\t\t\tE. K.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1969\n\t\t\t\t\tThe early sinusoidal lesion in experimental veno occlusive disease of the liver.\n\t\t\t\t\tBritish Journal of Experimental Pathology\n\t\t\t\t\t223 \n\t\t\t\t\t22\n\t\t\t\t\n\t\t\t'},{id:"B13",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMellis\n\t\t\t\t\t\t\tC.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBale\n\t\t\t\t\t\t\tP. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1976\n\t\t\t\t\tFamelial hepatic Veno occlusive disease with probable immune deficiency.\n\t\t\t\t\tJ Pediatrics\n\t\t\t\t\t88\n\t\t\t\t\t236\n\t\t\t\t\t242\n\t\t\t\t\n\t\t\t'},{id:"B14",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMc Dermott\n\t\t\t\t\t\t\tW. V.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRidker\n\t\t\t\t\t\t\tP. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1990\n\t\t\t\t\tThe Budd-Chiari syndrome and hepatic veno occlusive. Recognition and treatment.\n\t\t\t\t\tArchives of surgery\n\t\t\t\t\t125\n\t\t\t\t\t4\n\t\t\t\t\t525\n\t\t\t\t\t527\n\t\t\t\t\n\t\t\t'},{id:"B15",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNattakom\n\t\t\t\t\t\t\tT. V.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tCharlton\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWilmore\n\t\t\t\t\t\t\tD. W.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1995\n\t\t\t\t\tUse of Vitamine E. and glutamine in the successful treatment of severe VOD following bone marrow transplantation.\n\t\t\t\t\tNutritionin Clinical Practice\n\t\t\t\t\t10\n\t\t\t\t\t1\n\t\t\t\t\t16\n\t\t\t\t\t18\n\t\t\t\t\n\t\t\t'},{id:"B16",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tFogteloo\n\t\t\t\t\t\t\tA. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSmid\n\t\t\t\t\t\t\tW. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKok\n\t\t\t\t\t\t\tT.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tVan Der Meer\n\t\t\t\t\t\t\tJ.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tVan Imhoff\n\t\t\t\t\t\t\tG. W.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDaenen\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1993\n\t\t\t\t\tSuccessful treatment of veno occlusive disease of the liver with urokinase in a patient with non-hodgkin’s lymphoma.\n\t\t\t\t\tLeukemia\n\t\t\t\t\t7\n\t\t\t\t\t5\n\t\t\t\t\t760\n\t\t\t\t\t763\n\t\t\t\t\n\t\t\t'},{id:"B17",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSimpson\n\t\t\t\t\t\t\tD. R.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBrowett\n\t\t\t\t\t\t\tP. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDoak\n\t\t\t\t\t\t\tP. B.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPalmer\n\t\t\t\t\t\t\tS. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1994\n\t\t\t\t\tSuccessful treatment of veno occlusive disease with recombinant tissue plasminogen activator in a patient requiring peritoneal dialysis.\n\t\t\t\t\tBone Marrow Transplantation\n\t\t\t\t\t14\n\t\t\t\t\t4\n\t\t\t\t\t635\n\t\t\t\t\t636\n\t\t\t\t\n\t\t\t'},{id:"B18",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tCuenoud\n\t\t\t\t\t\t\tP. F.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMosiman\n\t\t\t\t\t\t\tF.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1992\n\t\t\t\t\tSurgical treatment of Budd-Chiari syndrome and VOD.\n\t\t\t\t\tHelvetica Chirurgica Acta\n\t\t\t\t\t58\n\t\t\t\t\t6\n\t\t\t\t\t805\n\t\t\t\t\t808\n\t\t\t\t\n\t\t\t'},{id:"B19",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tLe Veen\n\t\t\t\t\t\t\tH. H.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tChristoudias\n\t\t\t\t\t\t\tG.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMoon\n\t\t\t\t\t\t\tJ. P.\n\t\t\t\t\t\t\n\t\t\t\t\t\tet al.\n\t\t\t\t\t\n\t\t\t\t\t1974\n\t\t\t\t\tPeritoneovenous shunting for ascites.\n\t\t\t\t\tAnn Surg\n\t\t\t\t\t180\n\t\t\t\t\t580\n\t\t\t\t\t591\n\t\t\t\t\n\t\t\t'},{id:"B20",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tLe Veen\n\t\t\t\t\t\t\tH. H.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tVujic\n\t\t\t\t\t\t\t.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tD’Ovidio\n\t\t\t\t\t\t\tN. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHutto\n\t\t\t\t\t\t\tR. B.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1984\n\t\t\t\t\tPeritoneovenous shunt occlusion: Etiology. diagnosis, therapy.\n\t\t\t\t\tAnn Surg\n\t\t\t\t\t212\n\t\t\t\t\t223\n\t\t\t\t\n\t\t\t'},{id:"B21",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSalemo\n\t\t\t\t\t\t\tF.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBadalamenti\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tIncerti\n\t\t\t\t\t\t\tP.\n\t\t\t\t\t\t\n\t\t\t\t\t\tet al.\n\t\t\t\t\t\n\t\t\t\t\t1987\n\t\t\t\t\tRepeated paracentesis and IV albumin infusion to treat "tense " ascites in cirrhotic patients a safe alternative therapy.\n\t\t\t\t\t J Hepatol\n\t\t\t\t\t5\n\t\t\t\t\t102\n\t\t\t\t\t108\n\t\t\t\t\n\t\t\t'},{id:"B22",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tStanley\n\t\t\t\t\t\t\tA. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOchi\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tLee\n\t\t\t\t\t\t\tK. K.\n\t\t\t\t\t\t\n\t\t\t\t\t\tet al.\n\t\t\t\t\t\n\t\t\t\t\t1989\n\t\t\t\t\tPeritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites.\n\t\t\t\t\tN Engl J Med\n\t\t\t\t\t321\n\t\t\t\t\t1632\n\t\t\t\t\t1638\n\t\t\t\t\n\t\t\t'},{id:"B23",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tStanley\n\t\t\t\t\t\t\tM. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1985\n\t\t\t\t\tPVS in patients with cirrhotic ascites and end-stage renal failure.\n\t\t\t\t\t Am Kidney Dis\n\t\t\t\t\t6\n\t\t\t\t\t185\n\t\t\t\t\t187\n\t\t\t\t\n\t\t\t'},{id:"B24",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSmajda\n\t\t\t\t\t\t\tC.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTridart\n\t\t\t\t\t\t\tD.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tFranco\n\t\t\t\t\t\t\tD.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1986\n\t\t\t\t\tRecurrent ascites due to central venous thrombosis after peritoneojugular (LeVeen) shunt.\n\t\t\t\t\tSurgery\n\t\t\t\t\t100\n\t\t\t\t\t535\n\t\t\t\t\t540\n\t\t\t\t\n\t\t\t'},{id:"B25",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSale\n\t\t\t\t\t\t\tH. H.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDudley\n\t\t\t\t\t\t\tF. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMerret\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\tet al.\n\t\t\t\t\t\n\t\t\t\t\t1983\n\t\t\t\t\tCoagulopathy of peritoneovenous shunt studies on the pathogenic role of ascitic fluid collagen and value of antiplatelet therapy.\n\t\t\t\t\tGut\n\t\t\t\t\t24\n\t\t\t\t\t412\n\t\t\t\t\t417\n\t\t\t\t\n\t\t\t'},{id:"B26",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRosch\n\t\t\t\t\t\t\tJ.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHanafee\n\t\t\t\t\t\t\tW. N.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSnow\n\t\t\t\t\t\t\tH.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1969\n\t\t\t\t\tTransjugular portal venography and radiological portocaval shunt: an experimental study.\n\t\t\t\t\tRadiology\n\t\t\t\t\t92\n\t\t\t\t\t1112\n\t\t\t\t\t1114\n\t\t\t\t\n\t\t\t'},{id:"B27",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tColapinto\n\t\t\t\t\t\t\tR. F.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tStonell\n\t\t\t\t\t\t\tR. D.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBirch\n\t\t\t\t\t\t\tS. J.\n\t\t\t\t\t\t\n\t\t\t\t\t\tet al.\n\t\t\t\t\t\n\t\t\t\t\t1982\n\t\t\t\t\tCreation of an intrahepatic portosystemic shunt with a Gruntzig balloon catheter.\n\t\t\t\t\tCan Med Assoc\n\t\t\t\t\t126\n\t\t\t\t\t267\n\t\t\t\t\t268\n\t\t\t\t\n\t\t\t'},{id:"B28",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHaag\n\t\t\t\t\t\t\tK.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNoldge\n\t\t\t\t\t\t\tG.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSellinger\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOchs\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tGerok\n\t\t\t\t\t\t\tW.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRossle\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1992\n\t\t\t\t\tTransjugular intrahepatic portosystemic stent shunt (TIPS). Monitoring of function by color duplex sonography.\n\t\t\t\t\tGastroenterology\n\t\t\t\t\t102\n\t\t\t\t\t817\n\t\t\t\t\n\t\t\t'},{id:"B29",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPalmaz\n\t\t\t\t\t\t\tI. C.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSibbit\n\t\t\t\t\t\t\tR. R.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tReuter\n\t\t\t\t\t\t\tS. R.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tGarcia\n\t\t\t\t\t\t\tF.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTio\n\t\t\t\t\t\t\tF. O.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1985\n\t\t\t\t\tExpandable intraheptic portacaval shunt stents. Early experience in the dog.\n\t\t\t\t\tAm J Roentgenol\n\t\t\t\t\t145\n\t\t\t\t\t821\n\t\t\t\t\t825\n\t\t\t\t\n\t\t\t'},{id:"B30",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tConn\n\t\t\t\t\t\t\tH.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1993\n\t\t\t\t\tTransjugular intrahepatic portal systemic shunts: the state of the art.\n\t\t\t\t\tHepatology\n\t\t\t\t\t17\n\t\t\t\t\t148\n\t\t\t\t\t158\n\t\t\t\t\n\t\t\t'},{id:"B31",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tGilles\n\t\t\t\t\t\t\tMentha.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tGiostra\n\t\t\t\t\t\t\tEmiliano\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMajno\n\t\t\t\t\t\t\tPietro E.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBechstein\n\t\t\t\t\t\t\tWolf. O.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNeuhaus\n\t\t\t\t\t\t\tPeter.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tO’Grady\n\t\t\t\t\t\t\tJohn.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPraseedom\n\t\t\t\t\t\t\tRaaj. K.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBurroughs\n\t\t\t\t\t\t\tAndrew. K.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTreut\n\t\t\t\t\t\t\tYves. P.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKirkegaard\n\t\t\t\t\t\t\tPreben.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRogiers\n\t\t\t\t\t\t\tXavier.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEriczon\n\t\t\t\t\t\t\tGoran -Bo.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHockersted\n\t\t\t\t\t\t\tKrister.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAdam\n\t\t\t\t\t\t\tRené.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tJuergen\n\t\t\t\t\t\t\tKlempnaue.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2005\n\t\t\t\t\tLiver transplantation for Budd-Chiari syndrome: A European study on 248 patients from 51 centres\n\t\t\t\t\tSciences\n\t\t\t\t\t50\n\t\t\t\t\t3\n\t\t\t\t\t540\n\t\t\t\t\t546\n\t\t\t\t\n\t\t\t'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Elsayed Ibrahim Salama",address:"elsayedsalama5@yahoo.com",affiliation:'
'}],corrections:null},book:{id:"3164",type:"book",title:"Hepatic Surgery",subtitle:null,fullTitle:"Hepatic Surgery",slug:"hepatic-surgery",publishedDate:"February 13th 2013",bookSignature:"Hesham Abdeldayem",coverURL:"https://cdn.intechopen.com/books/images_new/3164.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:null,printIsbn:"978-953-51-0965-5",pdfIsbn:"978-953-51-7090-7",reviewType:"peer-reviewed",numberOfWosCitations:22,isAvailableForWebshopOrdering:!0,editors:[{id:"72383",title:"Prof.",name:"Hesham",middleName:null,surname:"Abdeldayem",slug:"hesham-abdeldayem",fullName:"Hesham Abdeldayem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1145"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"42359",type:"chapter",title:"General Introduction: Advances in Hepatic Surgery",slug:"general-introduction-advances-in-hepatic-surgery",totalDownloads:3107,totalCrossrefCites:0,signatures:"J.H.M.B. Stoot, R.J.S. Coelen, J.L.A. van Vugt and C.H.C. Dejong",reviewType:"peer-reviewed",authors:[{id:"157264",title:"Mr.",name:"Jan",middleName:null,surname:"Stoot",fullName:"Jan Stoot",slug:"jan-stoot"},{id:"157295",title:"Prof.",name:"Kees",middleName:null,surname:"Dejong",fullName:"Kees Dejong",slug:"kees-dejong"},{id:"181922",title:"Dr.",name:"Jeroen",middleName:null,surname:"Van Vugt",fullName:"Jeroen Van Vugt",slug:"jeroen-van-vugt"}]},{id:"42361",type:"chapter",title:"Essential Functional Hepatic and Biliary Anatomy for the Surgeon",slug:"essential-functional-hepatic-and-biliary-anatomy-for-the-surgeon",totalDownloads:7670,totalCrossrefCites:0,signatures:"Ronald S. 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Jr. Lang",reviewType:"peer-reviewed",authors:[{id:"153090",title:"Dr.",name:"John",middleName:null,surname:"Lang",fullName:"John Lang",slug:"john-lang"}]},{id:"42855",type:"chapter",title:"Critical Care Issues After Major Hepatic Surgery",slug:"critical-care-issues-after-major-hepatic-surgery",totalDownloads:8894,totalCrossrefCites:1,signatures:"Ashok Thorat and Wei-Chen Lee",reviewType:"peer-reviewed",authors:[{id:"52360",title:"Prof.",name:"Wei-Chen",middleName:null,surname:"Lee",fullName:"Wei-Chen Lee",slug:"wei-chen-lee"},{id:"157213",title:"Dr.",name:"Ashok",middleName:null,surname:"Thorat",fullName:"Ashok Thorat",slug:"ashok-thorat"}]},{id:"39211",type:"chapter",title:"Strategies to Decrease Morbidity After Hepatectomy for Hepatocellular Carcinoma",slug:"strategies-to-decrease-morbidity-after-hepatectomy-for-hepatocellular-carcinoma",totalDownloads:2522,totalCrossrefCites:0,signatures:"Hiroshi Sadamori, Takahito Yagi and Toshiyoshi Fujiwara",reviewType:"peer-reviewed",authors:[{id:"40149",title:"Dr.",name:"Hiroshi",middleName:null,surname:"Sadamori",fullName:"Hiroshi Sadamori",slug:"hiroshi-sadamori"}]},{id:"41260",type:"chapter",title:"Experimental Models in Liver Surgery",slug:"experimental-models-in-liver-surgery",totalDownloads:3719,totalCrossrefCites:1,signatures:"M.B. 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Stragliotto",slug:"silvia-stragliotto"},{id:"150566",title:"Dr.",name:"Fabio",middleName:null,surname:"Canova",fullName:"Fabio Canova",slug:"fabio-canova"}]},{id:"28292",title:"Post-Transplant Lymphoproliferative Disease – PTLD",slug:"post-transplant-lymphoproliferative-disease-ptld",signatures:"Julio Wiederkehr and Barbara Wiederkehr",authors:[{id:"75743",title:"Prof.",name:"Julio",middleName:"Cesar",surname:"Wiederkehr",fullName:"Julio Wiederkehr",slug:"julio-wiederkehr"},{id:"83516",title:"Ms.",name:"Barbara A.",middleName:null,surname:"Wiederkehr",fullName:"Barbara A. Wiederkehr",slug:"barbara-a.-wiederkehr"}]},{id:"28293",title:"Metabolic Syndrome After Liver Transplantation",slug:"metabolic-syndrome-after-liver-transplantation",signatures:"Rocío González-Grande, Miguel Jiménez-Pérez, Ana Belén Sáez-Gómez and Juan Miguel Rodrigo-López",authors:[{id:"74262",title:"Dr.",name:"Ana Belén",middleName:"Saez",surname:"Sáez-Gómez",fullName:"Ana Belén Sáez-Gómez",slug:"ana-belen-saez-gomez"},{id:"77146",title:"Dr.",name:"Miguel",middleName:null,surname:"Jiménez-Pérez",fullName:"Miguel Jiménez-Pérez",slug:"miguel-jimenez-perez"},{id:"78000",title:"Dr.",name:"Rocío",middleName:null,surname:"González-Grande",fullName:"Rocío González-Grande",slug:"rocio-gonzalez-grande"},{id:"82946",title:"Dr.",name:"Juan Miguel",middleName:null,surname:"Rodrigo-López",fullName:"Juan Miguel Rodrigo-López",slug:"juan-miguel-rodrigo-lopez"}]},{id:"28294",title:"Autoimmune Hepatitis After Liver Transplantation",slug:"autoimmune-hepatitis-after-liver-transplantation",signatures:"Pierpaolo Di Cocco, Giuseppe Orlando, Katia Clemente, Lauren Corona, Vinicio Rizza, Linda De Luca, Maurizio DAngelo, Federica Delreno, Francesco Pisani and Antonio Famulari",authors:[{id:"40458",title:"Dr.",name:"Pierpaolo",middleName:null,surname:"Di Cocco",fullName:"Pierpaolo Di Cocco",slug:"pierpaolo-di-cocco"},{id:"40459",title:"Dr.",name:"Lauren",middleName:null,surname:"Corona",fullName:"Lauren Corona",slug:"lauren-corona"},{id:"40461",title:"Prof.",name:"Francesco",middleName:null,surname:"Pisani",fullName:"Francesco Pisani",slug:"francesco-pisani"},{id:"57837",title:"Dr.",name:"Vinicio",middleName:null,surname:"Rizza",fullName:"Vinicio Rizza",slug:"vinicio-rizza"},{id:"84932",title:"Dr.",name:"Maurizio",middleName:null,surname:"DAngelo",fullName:"Maurizio DAngelo",slug:"maurizio-dangelo"},{id:"84933",title:"Dr.",name:"Katia",middleName:null,surname:"Clemente",fullName:"Katia Clemente",slug:"katia-clemente"},{id:"125596",title:"Prof.",name:"Antonio",middleName:null,surname:"Famulari",fullName:"Antonio Famulari",slug:"antonio-famulari"},{id:"125597",title:"Dr.",name:"Giuseppe",middleName:null,surname:"Orlando",fullName:"Giuseppe Orlando",slug:"giuseppe-orlando"},{id:"128362",title:"Dr.",name:"Linda",middleName:null,surname:"De Luca",fullName:"Linda De Luca",slug:"linda-de-luca"},{id:"128363",title:"Dr.",name:"Federica",middleName:null,surname:"Delreno",fullName:"Federica Delreno",slug:"federica-delreno"}]},{id:"28295",title:"Bone Disease After Organ Transplantation with Special Regard of Post Transplantation-Osteoporosis After Liver Transplantation",slug:"bone-disease-after-organ-transplantation-with-special-regard-of-post-transplantation-osteoporosis-af",signatures:"Daniel Kaemmerer and Gabriele Lehmann",authors:[{id:"72935",title:"Dr.",name:"Daniel",middleName:null,surname:"Kaemmerer",fullName:"Daniel Kaemmerer",slug:"daniel-kaemmerer"},{id:"81922",title:"Dr.",name:"Gabriele",middleName:null,surname:"Lehmann",fullName:"Gabriele Lehmann",slug:"gabriele-lehmann"}]},{id:"28296",title:"Betaherpesviruses in Adult Liver Transplant Recipients",slug:"betaherpesviruses-in-adult-liver-transplant-recipients",signatures:"Ronaldo Thomasini, Fernanda Costa, Ana Sampaio, Sandra Bonon, Paula Andrade, Ilka Boin, Fabiana Pereira and Sandra Cecília Botelho Costa",authors:[{id:"59188",title:"Dr.",name:"Sandra Cecília Botelho",middleName:null,surname:"Costa",fullName:"Sandra Cecília Botelho Costa",slug:"sandra-cecilia-botelho-costa"},{id:"81175",title:"PhD.",name:"Ronaldo Luis",middleName:null,surname:"Thomasini",fullName:"Ronaldo Luis Thomasini",slug:"ronaldo-luis-thomasini"},{id:"84019",title:"MSc.",name:"Fernanda",middleName:null,surname:"Costa",fullName:"Fernanda Costa",slug:"fernanda-costa"},{id:"84020",title:"Dr.",name:"Sandra",middleName:null,surname:"Bonon",fullName:"Sandra Bonon",slug:"sandra-bonon"},{id:"84021",title:"MSc.",name:"Ana",middleName:null,surname:"Sampaio",fullName:"Ana Sampaio",slug:"ana-sampaio"},{id:"84022",title:"Dr.",name:"Ilka",middleName:null,surname:"Boin",fullName:"Ilka Boin",slug:"ilka-boin"},{id:"84023",title:"Dr.",name:"Fabiana",middleName:null,surname:"Pereira",fullName:"Fabiana Pereira",slug:"fabiana-pereira"},{id:"122609",title:"MSc.",name:"Paula",middleName:null,surname:"Andrade",fullName:"Paula Andrade",slug:"paula-andrade"}]},{id:"28297",title:"Donor-Derived Infectious Complications and Disease Transmission",slug:"donor-derived-infectious-complications-and-disease-transmission",signatures:"Kun-Ming Chan and Wei-Chen Lee",authors:[{id:"52360",title:"Prof.",name:"Wei-Chen",middleName:null,surname:"Lee",fullName:"Wei-Chen Lee",slug:"wei-chen-lee"},{id:"118007",title:"Dr.",name:"Kun-Ming",middleName:null,surname:"Chan",fullName:"Kun-Ming Chan",slug:"kun-ming-chan"}]},{id:"28298",title:"Physiotherapy in Liver Transplantation",slug:"physiotherapy-in-liver-transplantation",signatures:"Meric Senduran and Ufuk Yurdalan",authors:[{id:"81588",title:"MSc.",name:"Meric",middleName:null,surname:"Senduran",fullName:"Meric Senduran",slug:"meric-senduran"},{id:"83844",title:"Prof.",name:"Ufuk",middleName:"Saadet",surname:"Yurdalan",fullName:"Ufuk Yurdalan",slug:"ufuk-yurdalan"}]}]}],publishedBooks:[{type:"book",id:"967",title:"Liver Transplantation",subtitle:"Basic Issues",isOpenForSubmission:!1,hash:"d61ca05025c7154ff4579b2d6c95d7ae",slug:"liver-transplantation-basic-issues",bookSignature:"Hesham Abdeldayem and Naglaa Allam",coverURL:"https://cdn.intechopen.com/books/images_new/967.jpg",editedByType:"Edited by",editors:[{id:"72383",title:"Prof.",name:"Hesham",surname:"Abdeldayem",slug:"hesham-abdeldayem",fullName:"Hesham Abdeldayem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited 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Abdeldayem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"72404",title:"Treatment of Vasculitis: Beyond the Basics",doi:"10.5772/intechopen.92729",slug:"treatment-of-vasculitis-beyond-the-basics",body:'\n
\n
1. Introduction
\n
Vasculitis is a group of heterogeneous disorders that are characterized by inflammation, also sometimes necrosis of blood vessels that includes the veins, arteries and capillaries. Several different forms have been identified. The pathophysiology of vasculitis mainly involves the immune system of the body. In large vessel disease, particularly giant cell arteritis, it is a T cell-driven process activating the CD4 T cells which in turn promote the recruitment of macrophages and monocytes to the vessel wall causing vascular injury. This leads to release of various inflammatory markers and cytokines for example, Interleukin 1 and Interleukin 6, causing systemic inflammation [1]. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis involves the activation of neutrophils that release inflammatory cytokines. They also induce formation of neutrophil extracellular traps that are necessary constituent of innate immunity. These neutrophil traps are injurious to small vessels that not only cause vascular injury but also produce antineutrophil cytoplasmic antibody, therefore producing a vicious cycle [2].
\n
The aim of this chapter is to highlight the rising number of therapeutic options available to treat systemic vasculitis. Use of biologics has shown promising results, especially Rituximab and Infliximab while others remain in the pipeline. The recent emergence of these agents, that selectively targets the components of immune system, have brought an insurgence in treatment of systemic vasculitis. In this chapter we discuss the treatment of vasculitis beyond the prototype drugs (cyclophosphamide, azathioprine, mycophenolate mofetil, etc.), with biological agents.
\n
\n
\n
2. Classification
\n
American College of Rheumatology (ACR) presented the classification criteria for vasculitis in 1990 (Table 1). According to this criteria vasculitis was classified into primary and secondary types. Both these types were dependent on the size of vessel involved. Vasculitis affecting the large arteries include giant cell arteritis (GCA) and Takayasu arteritis. Medium vessel vasculitis includes polyarteritis nodosa (PAN) and Kawasaki disease, while small vessel vasculitis contains granulomatosis with polyangiitis (GPA) formerly known as Wegener’s granulomatosis (WG), Churg-Strauss syndrome now known as eosinophilic granulomatosis with polyangiitis (EGPS), microscopic polyangiitis (MPA), Henoch Schonlein purpura and cryoglobulinemia. Secondary vasculitides encompass vasculitis secondary to rheumatoid arthritis and various infections (bacterial, viral and fungal) [3].
\n
\n
\n
\n
\n\n
\n
Dominant vessel
\n
Primary
\n
Secondary
\n
\n\n\n
\n
Large arteries
\n
Giant cell arteritis Takayasu arteritis
\n
Aortitis associated with rheumatoid arthritis, infections
\n
\n
\n
Medium arteries
\n
Classic polyarteritis nodosa Kawasaki disease
\n
Hepatitis B-associated, polyarteritis nodosa
\n
\n
\n
Small vessels and medium arteries
\n
Granulomatosis with polyangiitis, Churg-Strauss syndrome, microscopic polyangiitis
\n
Vasculitis secondary to rheumatoid arthritis, drugs
Infections affecting large arteries commonly include Staphylococcus, Salmonella, Streptococcus, coccidioidomycosis and treponema pallidum. Hepatitis B and C virus along with human immunodeficiency virus and Parvovirus B19 commonly affects medium sized vessels. Possible mechanism for infection related vasculitis includes (a) direct microbial invasion and (b) immune-mediated process either by humoral or cellular responses. Hepatitis B virus has firmly been seen with polyarteritis nodosa for more than 30 years. In France, the declining rate of hepatitis B infection has correlated with falling levels of hepatitis B-associated polyarteritis nodosa. There is a strong association between hepatitis C virus and mixed essential cryoglobulinemia. Vasculitis has been identified as a rare manifestation of human immunodeficiency virus. Multiple patterns have been described including polyarteritis nodosa, hypersensitivity vasculitis and large vessel disease [3].
\n
Course of rheumatoid arthritis can be complicated by medium to small vessel vasculitis. This is common in men and linked with positive RA factor. It may present in a variety of ways including distal arteritis, splinter hemorrhages, peripheral neuropathy with mononeuritis multiplex and aortitis [4].
\n
In year 2012 the International Chapel Hill Consensus conference adopted names for vasculitis on nomenclature of vasculitides as shown in Table 2. This classified vasculitis not only according to the size of vessel involved (as in ACR criteria) but also included a few other subtypes mainly, variable vessel vasculitis, single organ vasculitis, vasculitis associated with systemic diseases and vasculitis associated with probable etiology [5].
A wide range of drugs have been reported to cause a vasculitic reaction. ANCA-associated vasculitis has been attributed to use of various drugs including Hydralazine, Propylthiouracil, Allopurinol and Sulfasalazine. Leukotriene receptor antagonist, Montelukast and Zafirlukast, have been linked to Churg-Strauss syndrome. Acute vasculitis may be the presenting feature of an undiagnosed malignancy. Common malignancies associated with vasculitis are myelodysplasia, lymphoma and multiple myeloma [3].
\n
\n
\n
3. Treatment with biological agents
\n
\n
3.1 Rituximab
\n
It is a monoclonal antibody, which is directed against CD20 that is expressed on developing B cell. Although not clearly understood, this antibody can induce apoptosis of these developing B cells. In April 2011, Rituximab was the first agent to be approved by FDA for the treatment of vasculitis [6].
\n
In the Rituximab in ANCA-associated vasculitis (RAVE) trial, patients with GPA and MPA who were being given steroid therapy were randomized and received either oral cyclophosphamide or I/V Rituximab (four infusions). Patients who were given cyclophosphamide were switched to azathioprine after going into remission while those with Rituximab were switched to oral placebo. At the end of 6 months, Rituximab was found to be non-inferior to cyclophosphamide at inducing remission and was found to be superior to cyclophosphamide for patients with relapsing disease [6].
\n
Another study showed single course of Rituximab to be non-inferior to oral cyclophosphamide, which was followed by azathioprine for remission maintenance [7].
\n
In the Rituximab versus cyclophosphamide in ANCA-associated vasculitis (RITUXVAS) trial, where 44 patients were diagnosed with ANCA-associated vasculitis, patients were randomized to receive Rituximab along with only two infusions of cyclophosphamide. This was compared with patients who were given I/V cyclophosphamide for 3–6 months followed by azathioprine. The rate of sustained remission was similar in both groups [8].
\n
These studies indicate that Rituximab is comparable in efficacy to cyclophosphamide for remission induction. Moreover, Maintenance of remission under Rituximab in systemic ANCA-associated vasculitis (MAINRITSAN) trial 115 patients with either GPA or MPA were given either azathioprine or Rituximab in a dose of 500 mg IV × 2 doses (after achieving remission with cyclophosphamide). At the end of the study, major relapse rate was significantly lower in patients who received Rituximab [9].
\n
Rituximab has also shown remarkable results in patients with EGPA whose disease was refractory to usual treatments (e.g. cyclophosphamide). One of the largest case series showed nine patients with EGPA refractory to conventional therapy, when treated with Rituximab were either in total or partial remission at the end of 3 months [10].
\n
The safety and efficacy of Rituximab has been evaluated by Puechal et al. in patients with active systemic rheumatoid vasculitis (SRV). Out of 17 patients with active SRV who were treated with Rituximab, 12 patients achieved complete remission of their disease at the end of 6 months. The Birmingham Vasculitis Activity Score (BVAS) for rheumatoid arthritis dropped down from a baseline of 9.6 to 0.6 and the daily average dose of Prednisolone declined from 19.2 to 9.7 mg. After a year, 14 patients were in sustained remission [11].
\n
Rituximab works by acting over B cells, clearing them from the body. It is the most extensively studied agent that has proved to be efficacious in most forms of vasculitis, especially ANCA-associated vasculitis. It is now the preferred choice over cyclophosphamide in order to reduce the adverse effect profile. Also, Rituximab is considered a suitable therapeutic option for inducing remission in patients with active vasculitis associated with rheumatoid arthritis.
\n
\nTable 3 summarizes the clinical outcomes of different trials carried out using Rituximab as treatment for systemic vasculitis.
\n
\n
\n
\n
\n
\n\n
\n
Study
\n
Agent
\n
Disease
\n
Outcome
\n
\n\n\n
\n
RAVE trial
\n
Rituximab
\n
GPA and MPA
\n
Rituximab was found to be non-inferior to cyclophosphamide at inducing remission and superior to cyclophosphamide for patients with relapsing disease
\n
\n
\n
RITUXVAS trial
\n
Rituximab
\n
ANCA-associated vasculitis
\n
Rate of sustained remission were similar in patients taking Rituximab vs. those given cyclophosphamide alone
This is an IgG1, kappa monoclonal antibody specific for human tumor necrosis factor alpha. TNF alpha possesses multiple pro inflammatory properties for example, induction of Interleukin 1 and Interleukin 6, neutrophil activation etc. According to recent research, Infliximab is in phase 3 clinical development for treatment of Kawasaki disease [12].
\n
One clinical trial studied the role of Infliximab in granulomatosis with polyangiitis exclusively. These patients were followed even after the discontinuation of Infliximab to monitor the remission maintenance. The reduction of their Birmingham Vasculitis Activity Score was significant. Surprisingly no severe adverse effects, deaths or infections were noted [13].
\n
Use of TNF alpha inhibitors is not encouraged in giant cell arteritis. In a randomized controlled trial, some newly diagnosed patients with giant cell arteritis were given Infliximab along with corticosteroids (before tapering them). No significant difference was observed in patients who were successfully tapered off corticosteroids. Moreover, few subjects had a higher infection rate with the use of Infliximab [14].
\n
Use of Infliximab has shown great effectiveness in refractory Kawasaki disease [15]. Single-dose Infliximab (5 mg/kg) was given to seven patients who failed to achieve remission with the standard therapy. These patients showed improvement without any adverse effects [16]. In another study, good response was seen in two patients with Kawasaki disease when treated with Infliximab who had a relapse with the conventional therapy [17].
\n
This anti-TNF (tumor necrosis factor) agent has shown promising results in Wegener’s granulomatosis in reducing the disease as well as inducing remission. Use of Infliximab is encouraged in medium vessel vasculitis. Patients with Kawasaki disease, who failed to respond to conventional therapy and those who experienced a relapse, reacted well to this agent. Unfortunately its use in giant cell arteritis is not promoted as suggested by a clinical study (as discussed above) in which patients with giant cell arteritis were treated with Infliximab showed no significant response, instead resulted in a higher rate of infection.
\n
\nTable 4 summarizes the clinical outcomes of different studies and trials showing effectiveness of Infliximab in different types of vasculitis.
\n
\n
\n
\n
\n
\n\n
\n
Study
\n
Agent
\n
Disease
\n
Outcome
\n
\n\n\n
\n
Lamprecht et al.
\n
Infliximab
\n
WG
\n
Decrease in BVAS. No deaths, infections or adverse effects
\n
\n
\n
Randomized trial
\n
Infliximab
\n
GCA
\n
No significant difference. Increased rate of infection
\n
\n
\n
Burns et al.
\n
Infliximab
\n
KD
\n
Improvement in patients who failed to achieve remission by standard therapy/refractory disease
This is one of the most rigorously studied agent, which is also a tumor necrosis factor inhibitor. Its role has been studied in GPA and MPA for maintenance of remission. In WGET, 174 patients received methotrexate or cyclophosphamide for their remission and were then randomized to get Etanercept or placebo. Unfortunately, there was no significant difference in rate of sustained remission between Etanercept and placebo [18].
\n
Etanercept (25 mg twice weekly) was given to 20 patients with Wegener’s granulomatosis over a period of 6 months, in twice-daily dose. Out of these patients, 70% had never had remission of their disease. This drug was combined with either cyclophosphamide or methotrexate. During the treatment, 80% patients went into disease remission and their Birmingham Vasculitis Activity Score fell significantly. However, three patients experienced major flare despite the therapy [19, 20].
\n
The major drawback is the increased incidence of cancer in patients treated with Etanercept. Six of 92 patients developed a solid tumor. These tumors included mucinous adenocarcinoma of colon, metastatic cholangiocarcinoma, renal cell carcinoma and breast carcinoma [21].
\n
Wegener’s granulomatosis itself is also associated with increased risk of malignancy. The specific malignancies associated with it are bladder carcinoma, squamous cell carcinoma, leukemia and lymphomas [22].
\n
Use of these two agents (Infliximab and Etanercept) have shown promising results in Takayasu arteritis as demonstrated by a case series in which 15 patients with treatment resistant disease were treated with either of the drug. After introduction of these agents, the average dose of corticosteroid dropped from 20 mg (range 12.5–40 mg) to 0 mg (range 0–20 mg). Among these 15 patients 93% showed remarkable improvement and 67% experienced steroid free remission for up to 3 years [23].
\n
Etanercept is one of the most widely studied agents, which is also an anti-TNF drug, and has been seen to be beneficial not only in ANCA-associated vasculitis but also in large vessel vasculitis (Takayasu arteritis). The biggest disadvantage of this medication is the higher incidence of different types of cancers.
\n
\nTable 5 summarizes two trials showing clinical outcomes of Etanercept in patients with Wegener’s granulomatosis also known as granulomatosis with polyangiitis.
\n
\n
\n
\n
\n
\n\n
\n
Study
\n
Agent
\n
Disease
\n
Outcome
\n
\n\n\n
\n
WGET trial
\n
Etanercept
\n
WG
\n
No significant difference in rate of sustained remission between Etanercept and placebo
\n
\n
\n
Luqmani et al. and Stone et al.
\n
Etanercept
\n
WG
\n
80% patients went into disease remission and their BVAS fell significantly. Three patients developed major flare
This is a human IgG1 gamma monoclonal antibody specific for soluble human B lymphocyte stimulator protein, also known as B cell-activating factor. Surprisingly, this is the only drug in late stage development for microscopic polyangiitis [12].
\n
Currently this agent is in Phase 3 trial. Its efficacy and safety are being tested in a randomized, double blind study in combination with azathioprine. The dose given to patients is 10 mg/kg at days 0, 14, and 28 then after every 28 days till the study ends (clinical trials) [24].
\n
Belimumab is a relatively newer agent that is currently under trial but has shown positive results in treatment of microscopic polyangiitis.
\n
\n
\n
3.5 Mepolizumab
\n
Mepolizumab is an Interleukin 5 humanized monoclonal antibody that binds to free Interleukin 5. It causes arrest of bone marrow eosinophil maturation. This monoclonal antibody is directed against Interleukin 5, which is a cytokine critical for activation of eosinophils. Mepolizumab when administered in a dose of 300 mg subcutaneously every 4 weeks, proved to be effective in prolonging disease remission, reducing the use of steroid [25].
\n
Use of this agent has shown prompt normalization of peripheral eosinophil counts, as well as reduction in glucocorticoid usage. Two studies that showed use of Mepolizumab in EGPA, it led to decreased disease activity, normalization of eosinophil count and reduction of steroid use. However, cessation of this drug resulted in disease flare [26, 27].
\n
Mepolizumab works by halting activation of eosinophils, acting directly on them. This biological agent is recommended in treating Churg-Strauss syndrome, although it is still under various trials. The major drawback is the disease flare caused after discontinuing the medication.
\n
\n
\n
3.6 Tocilizumab
\n
Tocilizumab is a humanized monoclonal antibody that binds to membrane-bound and soluble Interleukin 6 receptors and inhibits Interleukin 6 signaling pathways [28].
\n
A study assessed eight patients who had refractory Takayasu arteritis. Two cases were refractory to Infliximab and three did not reach remission on steroids and methotrexate. Altogether eight patients received Tocilizumab and were followed for 18 months. Of these eight patients, seven achieved remission. This shows that Tocilizumab can be a potential therapy for patients with Takayasu arteritis refractory to anti-TNF alpha therapy [29].
\n
A retrospective study assessed the effectiveness of Tocilizumab in complicated large vessel vasculitis. Patients were treated with Tocilizumab out of which eight had giant cell arteritis, two had large vessel vasculitis associated with rheumatoid arthritis and one had Takayasu arteritis. These patients were followed for 23 months. At the end of duration, seven patients were in remission, one patient relapsed after discontinuing the drug, and one patient suffered from serious infective complication. Two patients died, although cause of death was not attributable to the use of Tocilizumab. Three relapses occurred but remission was regained by switching the usual subcutaneous administration of Tocilizumab to intravenous [30].
\n
Glucocorticoids are the conventional treatment for giant cell arteritis but adverse effects are common, so are the relapses, soon after tapering the steroids. Although the exact cause of death is not known, cytokines such as tumor necrosis factor alpha and Interleukin 6 have been implicated. A retrospective study included 134 patients from 40 different centers who were diagnosed with giant cell arteritis either by temporal artery biopsy or imaging techniques. All these patients had received high dose of steroids in past and majority of patients had been given biologic immunosuppressives such as Abatacept, Infliximab or Rituximab. Tocilizumab was given either intravenously (8 mg/kg 4 weeks apart) or subcutaneously (162 mg/week). At the end of 1 month the ESR and CRP had fallen and percentage of patients with anemia had decreased. Those who were followed for 2 years, amongst them 39 were seen in remission with acute phase reactants within normal limits and minimum steroid dose (0–5 mg/day). However, after an average follow up of 12 months, 32 patients reported an adverse infection because of which 17 patients had to discontinue the therapy [31].
\n
Tocilizumab works against the pro-inflammatory cytokine Interleukin 6 and has proven its efficacy in Takayasu arteritis that has failed to respond to Infliximab. Giant cell arteritis, non responsive to various other biological agents, has reacted remarkably to Tocilizumab by achieving disease remission in most of the cases. Despite all its applauding outcomes, life-threatening infection remains a serious complication.
\n
\nTable 6 shows outcomes of studies that have evaluated the effectiveness of Tocilizumab in different types of vasculitis.
\n
\n
\n
\n
\n
\n\n
\n
Study
\n
Agent
\n
Disease
\n
Outcome
\n
\n\n\n
\n
Mejla et al.
\n
Tocilizumab
\n
TA
\n
Seven out of eight cases refractory to either Infliximab or methotrexate achieved remission
\n
\n
\n
Toc in large vessel vasculitis (Marc Schmalzing)
\n
Tocilizumab
\n
GCA, RA vasculitis, TA
\n
After follow up of 23 months, seven were in remission, one relapse after stopping the drug, three relapses but regained remission
\n
\n
\n
IL-6 blocker exceeds (Nancy Walsh)
\n
Tocilizumab
\n
GCA
\n
Patients who were on follow up till 2 years, out of them 39 were seen in remission. These patients had already taken biologics including Abatacept, Infliximab and Rituximab
\nTable 7 summarizes the commonly used agents to treat systemic vasculitis, as discussed in this chapter, along with its mechanism of action and dosages.
\n
\n
\n
\n
\n\n
\n
Agent
\n
Mechanism of action
\n
Dosage
\n
\n\n\n
\n
Rituximab
\n
Monoclonal antibody directed against CD20
\n
500 mg intravenous
\n
\n
\n
Infliximab
\n
Anti-TNF alpha
\n
5 mg/kg intravenous
\n
\n
\n
Etanercept
\n
Anti-TNF alpha
\n
25 mg intravenous
\n
\n
\n
Belimumab
\n
Monoclonal antibody that inhibits B cell activating factor
\n
10 mg/kg intravenous
\n
\n
\n
Mepolizumab
\n
Monoclonal antibody directed against Interleukin 5
\n
300 mg subcutaneous
\n
\n
\n
Tocilizumab
\n
Monoclonal antibody directed against Interleukin 6
\n
8 mg/kg intravenous 162 mg subcutaneous
\n
\n\n
Table 7.
Commonly used biological agents in the treatment of systemic vasculitis.
\n
\n
\n
\n
4. Conclusion
\n
In recent times use of high dose corticosteroids, cytotoxic and immunosuppressant drugs has improved the prognosis of systemic vasculitis dramatically. However, some patients still do not respond to conventional therapy or may not achieve remission. Few of them would relapse and a large number of patients develop illness secondary to the adverse effects caused by long term use of these drugs. The advent of biological agents has not just let to a better understanding of pathophysiology of systemic vasculitis, but has also proved to be safe and efficacious. Among these agents, anti-TNF and anti-B cell therapy have been the first choice in many cases. Although clinical data are still insufficient, these agents seem to occupy most of the market in near future [32].
\n
\n
\n
5. Methods used for research of articles
\n
We collected information by systematic review of the PubMed, scientific abstracts and by searching textbooks of Rheumatology.
\n
\n\n',keywords:"vasculitis, granulomatosis with polyangiitis, ANCA-associated vasculitis, giant cell arteritis, Takayasu arteritis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, anti-TNF alpha, monoclonal antibody, rheumatoid arthritis",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72404.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72404.xml",downloadPdfUrl:"/chapter/pdf-download/72404",previewPdfUrl:"/chapter/pdf-preview/72404",totalDownloads:516,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 5th 2019",dateReviewed:"May 5th 2020",datePrePublished:"June 5th 2020",datePublished:"November 11th 2020",dateFinished:"June 5th 2020",readingETA:"0",abstract:"Vasculitis is the inflammation of blood vessels in the human body. It causes changes and remodeling in the walls of the vessels that include thickening, narrowing and scarring. As a result, the blood flow to the organs and tissues gets restricted leading to organ damage. The cause of primary vasculitis is not known; however, most cases are thought to be autoimmune. In the present era, it is getting difficult to treat vasculitis with conventional therapies, which includes cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil, with increasing rates of relapses. Since ever, corticosteroids and cytotoxic agents or immunosuppressants have been the mainstay for treating systemic vasculitis. However, the introduction of newer biological agents have bring about a revolution in the treatment of relapses and in cases where there is failure to induce and sustain remission.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72404",risUrl:"/chapter/ris/72404",signatures:"Muhammad Ishaq Ghauri and Muhammad Shariq Mukarram",book:{id:"8300",type:"book",title:"Vascular Biology",subtitle:"Selection of Mechanisms and Clinical Applications",fullTitle:"Vascular Biology - Selection of Mechanisms and Clinical Applications",slug:"vascular-biology-selection-of-mechanisms-and-clinical-applications",publishedDate:"November 11th 2020",bookSignature:"Marcelo",coverURL:"https://cdn.intechopen.com/books/images_new/8300.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-036-5",printIsbn:"978-1-83969-035-8",pdfIsbn:"978-1-83969-037-2",isAvailableForWebshopOrdering:!0,editors:[{id:"202594",title:"Dr.",name:"Marcelo",middleName:null,surname:"González",slug:"marcelo-gonzalez",fullName:"Marcelo González"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Classification",level:"1"},{id:"sec_3",title:"3. Treatment with biological agents",level:"1"},{id:"sec_3_2",title:"3.1 Rituximab",level:"2"},{id:"sec_4_2",title:"3.2 Infliximab",level:"2"},{id:"sec_5_2",title:"3.3 Etanercept",level:"2"},{id:"sec_6_2",title:"3.4 Belimumab",level:"2"},{id:"sec_7_2",title:"3.5 Mepolizumab",level:"2"},{id:"sec_8_2",title:"3.6 Tocilizumab",level:"2"},{id:"sec_10",title:"4. Conclusion",level:"1"},{id:"sec_11",title:"5. Methods used for research of articles",level:"1"}],chapterReferences:[{id:"B1",body:'\nGuillevin L, Dorner T. Vasculitis: Mechanisms involved and clinical manifestations. Arthritis Research & Therapy. 2007;9(Suppl 2)\n'},{id:"B2",body:'\nNakazawa D, Masuda S, Tomaru U, Ishizu A. Pathogenesis and therapeutic interventions for ANCA-associated vasculitis. Nature Reviews Rheumatology. 2019;15:91-101\n'},{id:"B3",body:'\nMahr AD, Watts RA. Eular Textbook on Rheumatic Diseases. 1st ed. London: BMJ Group; 2012. p. 616\n'},{id:"B4",body:'\nFirestein GS et al. In: Erickson AR, Cannella AC, Mikuls TR, editors. Kelley & Firestein’s Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017. p. 1181\n'},{id:"B5",body:'\nFirestein GS et al. In: Stone JH, editor. Kelley & Firestein’s Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017. p. 1513\n'},{id:"B6",body:'\nStone JH, Merkel PA, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. The New England Journal of Medicine. 2010;363:221-232\n'},{id:"B7",body:'\nSpecks U, Merkel PA, et al. Efficacy of remission-induction regimens for ANCA associated vasculitis. The New England Journal of Medicine. 2013;369:417-427\n'},{id:"B8",body:'\nJones RB, JWC T, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. The New England Journal of Medicine. 2010;363:211-220\n'},{id:"B9",body:'\nGuillevin L, Pagnoux C, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. The New England Journal of Medicine. 2014;371:1771-1780\n'},{id:"B10",body:'\nThiel J, Hassler F, et al. Rituximab in the treatment of refractory or relapsing eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome). Arthritis Research & Therapy. 2013;15:R133\n'},{id:"B11",body:'\nPuechal X et al. Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: Results from the autoimmunity and rituximab registry. Arthritis Care and Research. 2012;64(3):331-339\n'},{id:"B12",body:'\nFellner C. Biologics will pump up the vasculitis market. P&T Community. 2016;41(4):258-260\n'},{id:"B13",body:'\nLamprecht P et al. Effectiveness of TNF alpha blockade with infliximab in refractory Wegener’s granulomatosis. Rheumatology (Oxford). 2002;41:1303-1307\n'},{id:"B14",body:'\nHoffman GS et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis. Annals of Internal Medicine. 2007;146:621-630\n'},{id:"B15",body:'\nRodriguez M, Matamale MA, Segado AA. Infliximab as a novel therapy for refractory Kawasaki disease. Scandinavian Journal of Rheumatology. 2006;35:318-321\n'},{id:"B16",body:'\nBurns J et al. Immune monitoring in Kawasaki disease patients treated with infliximab and intravenous immunoglobulin. Clinical and Experimental Immunology. 2013;174:337-344\n'},{id:"B17",body:'\nBurns JC et al. Infliximab treatment for refractory Kawasaki syndrome. The Journal of Pediatrics. 2005;146:662-667\n'},{id:"B18",body:'\nWegener’s Granulomatosis Etanercept Trial Research Group. Etanercept plus standard therapy for Wegener’s granulomatosis. The New England Journal of Medicine. 2014;371:1771-1780\n'},{id:"B19",body:'\nLuqmani RA, Bacon PA, et al. Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. The Quarterly Journal of Medicine. 1994;87:671-678\n'},{id:"B20",body:'\nStone JH, Hoffman GS, et al. A disease-specific activity index for Wegener’s granulomatosis: Modification of the Birmingham Vasculitis Activity Score. Arthritis and Rheumatism. 2001;44:912-920\n'},{id:"B21",body:'\nMukhtyar C, Luqmani R. Current state of TNF alpha blockade in Wegener’s granulomatosis. Annals of the Rheumatic Diseases. Nov. 2005;64(Suppl 4):iv31-iv36\n'},{id:"B22",body:'\nKnight A, Askling J, Ekbom A. Cancer incidence in a population-based cohort of patients with Wegener’s granulomatosis. International Journal of Cancer. 2002;100:82-85\n'},{id:"B23",body:'\nKatoh H et al. Takayasu’s arteritis in a patient with Crohn’s disease: An unexpected association during infliximab therapy. Internal Medicine. 2010;49(2):179-182\n'},{id:"B24",body:'\nIdentifier NCT01663623, Belimumab in Remission of VASculitis (BREVAS). [Internet]. Bethesda (MD): National Library of Medicine (US); 18 April 2018. Available from: ClinicalTrials.gov.\nhttp://clinicaltrials.gov/ct/show/NCT01663623?\n\n'},{id:"B25",body:'\nFaverio P, Bonaiti G, Bini F, Pesci AVA. Mepolizumab as first targeted treatment for esinophilic granulomatosis with polyangiitis: A review of current evidence and potential place in therapy. Therapeutics and Clinical Risk Management. 2018;14:2385-2396\n'},{id:"B26",body:'\nKim S et al. Mepolizumab as steroid sparing treatment options in patients with Churg Strauss syndrome. The Journal of Allergy and Clinical Immunology. 2010;125:1336-1343\n'},{id:"B27",body:'\nMoosig F et al. Targeting IL-5 in refractory and relapsing Churg-Strauss syndrome. Annals of Internal Medicine. 2011;155:341-343\n'},{id:"B28",body:'\nHammoudeh M, Awadhi AA, Hasan EH, Akhlaghi M, Ahmadzadeh A, Abdollahi BS. Safety, tolerability and efficacy of tocilizumab in rheumatoid arthritis: An open-label phase 4 study in patients from the Middle East. International Journal of Rheumatology. 2015;2015:975028\n'},{id:"B29",body:'\nMejla M et al. Efficacy and safety of interleukin 6 receptor monoclonal antibody (tocilizumab) in Colombian patients with Takayasu arteritis. Journal of Clinical Rheumatology. 2014;20:125-129\n'},{id:"B30",body:'\nSchmalzing M, Gadeholt O, Gernert M, Tony H-P, Schwaneck EC. Tocilizumab in large vessel vasculitis—Different routes of administration. Open Rheumatology Journal. 2018;12:152-159\n'},{id:"B31",body:'\nWalsh N. IL-6 blocker succeeds in real-world vasculitis—Clinical and laboratory improvements seen with tocilizumab in refractory giant cell arteritis. MedPage Today. 2019;13\n'},{id:"B32",body:'\nPazzola G, Muratore F, Piptone N, et al. Biologics in vasculitides: Where do we stand, where do we go from now? Presse Médicale. 2015;44:e231-e239\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Muhammad Ishaq Ghauri",address:null,affiliation:'
Department of Medicine, Jinnah Medical College Hospital, Karachi, Pakistan
Department of Medicine, Jinnah Medical College Hospital, Karachi, Pakistan
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Professor Margarita Pesheva is the leader of the Laboratory of microbial genetics at the Department of Genetics, Sofia University. She received her M.Sc. From Sofia University, Bulgaria and Ph.D. From the University of St. Petersburg, Russia. Dr. Pesheva gives lectures and practical exercises in Genetics, specifically Bacterial Genetics and Genetics and selection of microorganisms. During the last years, the scientific interests of Dr. Pesheva have focused on construction of yeast strain Saccharomyces cerevisiae with gene modified Ty1 retro-transposon. 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IMPORTANT: You must be a member or grantee of the listed funders in order to apply for their Open Access publication funds. Do not attempt to contact the funders if this is not the case.
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UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
Wellcome Trust (Funding available only to Wellcome-funded researchers/grantees)
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MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4558,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81998",title:"Understanding the Neuropathophysiology of Psychiatry Disorder Using Transcranial Magnetic Stimulation",slug:"understanding-the-neuropathophysiology-of-psychiatry-disorder-using-transcranial-magnetic-stimulatio",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.103748",abstract:"Transcranial magnetic stimulation (TMS) is a safe and non-invasive tool that allows researchers to probe and modulate intracortical circuits. The most important aspect of TMS is its ability to directly stimulate the cortical neurons, generating action potentials, without much effect on intervening tissue. This property can be leveraged to provide insight into the pathophysiology of various neuropsychiatric disorders. Using multiple patterns of stimulations (single, paired, or repetitive), different neurophysiological parameters can be elicited. Various TMS protocol helps in understanding the neurobiological basis of disorder and specific behaviors by allowing direct probing of the cortical areas and their interconnected networks. While single-pulse TMS can provide insight into the excitability and integrity of the corticospinal tract, paired-pulse TMS (ppTMS) can provide further insight into cortico-cortical connections and repetitive TMS (rTMS) into cortical mapping and modulating plasticity.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Jitender Jakhar, Manish Sarkar and Nand Kumar"},{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:20,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"}],onlineFirstChaptersTotal:18},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:99,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:290,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:104,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:1,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"
\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems. \r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
",coverUrl:"https://cdn.intechopen.com/series/covers/25.jpg",latestPublicationDate:"April 13th, 2022",hasOnlineFirst:!1,numberOfOpenTopics:4,numberOfPublishedChapters:9,numberOfPublishedBooks:1,editor:{id:"197485",title:"Dr.",name:"J. Kevin",middleName:null,surname:"Summers",fullName:"J. Kevin Summers",profilePictureURL:"https://mts.intechopen.com/storage/users/197485/images/system/197485.jpg",biography:"J. Kevin Summers is a Senior Research Ecologist at the Environmental Protection Agency’s (EPA) Gulf Ecosystem Measurement and Modeling Division. He is currently working with colleagues in the Sustainable and Healthy Communities Program to develop an index of community resilience to natural hazards, an index of human well-being that can be linked to changes in the ecosystem, social and economic services, and a community sustainability tool for communities with populations under 40,000. He leads research efforts for indicator and indices development. Dr. Summers is a systems ecologist and began his career at the EPA in 1989 and has worked in various programs and capacities. This includes leading the National Coastal Assessment in collaboration with the Office of Water which culminated in the award-winning National Coastal Condition Report series (four volumes between 2001 and 2012), and which integrates water quality, sediment quality, habitat, and biological data to assess the ecosystem condition of the United States estuaries. He was acting National Program Director for Ecology for the EPA between 2004 and 2006. He has authored approximately 150 peer-reviewed journal articles, book chapters, and reports and has received many awards for technical accomplishments from the EPA and from outside of the agency. Dr. Summers holds a BA in Zoology and Psychology, an MA in Ecology, and Ph.D. in Systems Ecology/Biology.",institutionString:null,institution:{name:"Environmental Protection Agency",institutionURL:null,country:{name:"United States of America"}}},subseries:[{id:"38",title:"Pollution",keywords:"Human activity, Pollutants, Reduced risks, Population growth, Waste disposal, Remediation, Clean environment",scope:"
\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
",annualVolume:11966,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/38.jpg",editor:{id:"110740",title:"Dr.",name:"Ismail M.M.",middleName:null,surname:"Rahman",fullName:"Ismail M.M. Rahman",profilePictureURL:"https://mts.intechopen.com/storage/users/110740/images/2319_n.jpg",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorThree:null,editorialBoard:[{id:"252368",title:"Dr.",name:"Meng-Chuan",middleName:null,surname:"Ong",fullName:"Meng-Chuan Ong",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRVotQAG/Profile_Picture_2022-05-20T12:04:28.jpg",institutionString:null,institution:{name:"Universiti Malaysia Terengganu",institutionURL:null,country:{name:"Malaysia"}}},{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",fullName:"Mohamed Nageeb Rashed",profilePictureURL:"https://mts.intechopen.com/storage/users/63465/images/system/63465.gif",institutionString:null,institution:{name:"Aswan University",institutionURL:null,country:{name:"Egypt"}}},{id:"187907",title:"Dr.",name:"Olga",middleName:null,surname:"Anne",fullName:"Olga Anne",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBE5QAO/Profile_Picture_2022-04-07T09:42:13.png",institutionString:null,institution:{name:"Klaipeda State University of Applied Sciences",institutionURL:null,country:{name:"Lithuania"}}}]},{id:"39",title:"Environmental Resilience and Management",keywords:"Anthropic effects, Overexploitation, Biodiversity loss, Degradation, Inadequate Management, SDGs adequate practices",scope:"
\r\n\tThe environment is subject to severe anthropic effects. Among them are those associated with pollution, resource extraction and overexploitation, loss of biodiversity, soil degradation, disorderly land occupation and planning, and many others. These anthropic effects could potentially be caused by any inadequate management of the environment. However, ecosystems have a resilience that makes them react to disturbances which mitigate the negative effects. It is critical to understand how ecosystems, natural and anthropized, including urban environments, respond to actions that have a negative influence and how they are managed. It is also important to establish when the limits marked by the resilience and the breaking point are achieved and when no return is possible. The main focus for the chapters is to cover the subjects such as understanding how the environment resilience works, the mechanisms involved, and how to manage them in order to improve our interactions with the environment and promote the use of adequate management practices such as those outlined in the United Nations’ Sustainable Development Goals.
",annualVolume:11967,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",editor:{id:"137040",title:"Prof.",name:"Jose",middleName:null,surname:"Navarro-Pedreño",fullName:"Jose Navarro-Pedreño",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRAXrQAO/Profile_Picture_2022-03-09T15:50:19.jpg",institutionString:"Miguel Hernández University of Elche, Spain",institution:null},editorTwo:null,editorThree:null,editorialBoard:[{id:"177015",title:"Prof.",name:"Elke Jurandy",middleName:null,surname:"Bran Nogueira Cardoso",fullName:"Elke Jurandy Bran Nogueira Cardoso",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGxzQAG/Profile_Picture_2022-03-25T08:32:33.jpg",institutionString:"Universidade de São Paulo, Brazil",institution:null},{id:"211260",title:"Dr.",name:"Sandra",middleName:null,surname:"Ricart",fullName:"Sandra Ricart",profilePictureURL:"https://mts.intechopen.com/storage/users/211260/images/system/211260.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}}]},{id:"40",title:"Ecosystems and Biodiversity",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive species, Destruction of habitats, Overexploitation of natural resources, Pollution, Global warming, Conservation of natural spaces, Bioremediation",scope:"
\r\n\tIn general, the harsher the environmental conditions in an ecosystem, the lower the biodiversity. Changes in the environment caused by human activity accelerate the impoverishment of biodiversity.
\r\n
\r\n\tBiodiversity refers to “the variability of living organisms from any source, including terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; it includes diversity within each species, between species, and that of ecosystems”.
\r\n
\r\n\tBiodiversity provides food security and constitutes a gene pool for biotechnology, especially in the field of agriculture and medicine, and promotes the development of ecotourism.
\r\n
\r\n\tCurrently, biologists admit that we are witnessing the first phases of the seventh mass extinction caused by human intervention. It is estimated that the current rate of extinction is between a hundred and a thousand times faster than it was when man first appeared. The disappearance of species is caused not only by an accelerated rate of extinction, but also by a decrease in the rate of emergence of new species as human activities degrade the natural environment. The conservation of biological diversity is "a common concern of humanity" and an integral part of the development process. Its objectives are “the conservation of biological diversity, the sustainable use of its components, and the fair and equitable sharing of the benefits resulting from the use of genetic resources”.
\r\n
\r\n\tThe following are the main causes of biodiversity loss:
\r\n
\r\n\t• The destruction of natural habitats to expand urban and agricultural areas and to obtain timber, minerals and other natural resources.
\r\n
\r\n\t• The introduction of alien species into a habitat, whether intentionally or unintentionally which has an impact on the fauna and flora of the area, and as a result, they are reduced or become extinct.
\r\n
\r\n\t• Pollution from industrial and agricultural products, which devastate the fauna and flora, especially those in fresh water.
\r\n
\r\n\t• Global warming, which is seen as a threat to biological diversity, and will become increasingly important in the future.
",annualVolume:11968,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/40.jpg",editor:{id:"209149",title:"Prof.",name:"Salustiano",middleName:null,surname:"Mato",fullName:"Salustiano Mato",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRLREQA4/Profile_Picture_2022-03-31T10:23:50.png",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorTwo:{id:"60498",title:"Prof.",name:"Josefina",middleName:null,surname:"Garrido",fullName:"Josefina Garrido",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRj1VQAS/Profile_Picture_2022-03-31T10:06:51.jpg",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorThree:{id:"464288",title:"Dr.",name:"Francisco",middleName:null,surname:"Ramil",fullName:"Francisco Ramil",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003RI7lHQAT/Profile_Picture_2022-03-31T10:15:35.png",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorialBoard:[{id:"220987",title:"Dr.",name:"António",middleName:"Onofre",surname:"Soares",fullName:"António Soares",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNtzQAG/Profile_Picture_1644499672340",institutionString:null,institution:{name:"University of the Azores",institutionURL:null,country:{name:"Portugal"}}}]},{id:"41",title:"Water Science",keywords:"Water, Water resources, Freshwater, Hydrological processes, Utilization, Protection",scope:"
\r\n\tWater is not only a crucial substance needed for biological life on Earth, but it is also a basic requirement for the existence and development of the human society. Owing to the importance of water to life on Earth, early researchers conducted numerous studies and analyses on the liquid form of water from the perspectives of chemistry, physics, earth science, and biology, and concluded that Earth is a "water polo". Water covers approximately 71% of Earth's surface. However, 97.2% of this water is seawater, 21.5% is icebergs and glaciers, and only 0.65% is freshwater that can be used directly by humans. As a result, the amount of water reserves available for human consumption is limited. The development, utilization, and protection of freshwater resources has become the focus of water science research for the continued improvement of human livelihoods and society.
\r\n
\r\n\tWater exists as solid, liquid, and gas within Earth’s atmosphere, lithosphere, and biosphere. Liquid water is used for a variety of purposes besides drinking, including power generation, ecology, landscaping, and shipping. Because water is involved in various environmental hydrological processes as well as numerous aspects of the economy and human society, the study of various phenomena in the hydrosphere, the laws governing their occurrence and development, the relationship between the hydrosphere and other spheres of Earth, and the relationship between water and social development, are all part of water science. Knowledge systems for water science are improving continuously. Water science has become a specialized field concerned with the identification of its physical, chemical, and biological properties. In addition, it reveals the laws of water distribution, movement, and circulation, and proposes methods and tools for water development, utilization, planning, management, and protection. Currently, the field of water science covers research related to topics such as hydrology, water resources and water environment. It also includes research on water related issues such as safety, engineering, economy, law, culture, information, and education.
",annualVolume:11969,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/41.jpg",editor:{id:"349630",title:"Dr.",name:"Yizi",middleName:null,surname:"Shang",fullName:"Yizi Shang",profilePictureURL:"https://mts.intechopen.com/storage/users/349630/images/system/349630.jpg",institutionString:"China Institute of Water Resources and Hydropower Research",institution:{name:"China Institute of Water Resources and Hydropower Research",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"216491",title:"Dr.",name:"Charalampos",middleName:null,surname:"Skoulikaris",fullName:"Charalampos Skoulikaris",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRMsbQAG/Profile_Picture_2022-04-21T09:31:55.jpg",institutionString:null,institution:{name:"Aristotle University of Thessaloniki",institutionURL:null,country:{name:"Greece"}}},{id:"300124",title:"Prof.",name:"Thomas",middleName:null,surname:"Shahady",fullName:"Thomas Shahady",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002kuIgmQAE/Profile_Picture_2022-03-18T07:32:10.jpg",institutionString:null,institution:{name:"Lynchburg College",institutionURL:null,country:{name:"United States of America"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/116797",hash:"",query:{},params:{id:"116797"},fullPath:"/profiles/116797",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()