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Clinically, VTE presents as deep vein thrombosis (DVT) and pulmonary embolism (PE) which account for two-third and one-third of VTE, respectively [2]. The estimated annual rate of incidence of VTE is 80 to 260 per 100000 population [3]. In general, the incidence of VTE increases with age. One epidemiologic study in United States showed that the incidence of VTE was 143 per 100000 in papulation at age 45–49 years and 1134 per 100000 in those at age > 80 years [4]. There is difference of incidence between ethnicities and black and white have higher incidence than other races [2]. Although patients with VTE might be asymptomatic, VTE is a potentially fatal disease. One study reported that the estimated annual VTE-related death was around 300000 in U.S [5] and nearly 30% of VTE patients died within 30 days after diagnosis. Compared to DVT, PE accounts for majority of early-stage mortality of VTE [6, 7]. In addition to VTE-related mortality and cardiovascular sequelae, such as post-thrombotic syndrome, chronic venous insufficiency and chronic thromboembolic pulmonary hypertension, etc., patients with VTE have high risk of other atherosclerotic diseases and acute cardiovascular events, such as acute myocardial infarction and ischemic stroke, in the short-term and long-term follow-up [8, 9, 10]. With a brief review of pathogenesis and risk factors of VTE, the following of this chapter focuses on percutaneous interventions for VTE.
Virchow’s triad composed of stasis, vascular damage and hypercoagulable status describes the essential components contributing to the thrombus formation [11]. In most cases of VTE, stasis plays a major role triggering the formation of venous thrombosis [12]. However, the exact pathogenesis of VTE seems to be more complex and is not fully understood [2, 13]. Only one existing contributing factor is hard to result in the development of clot formation [14]. Nonetheless, the interaction between multiple concurrent contributing factors increases the risk of formation of venous thrombosis which progresses to significant VTE clinically thereafter.
In clinical aspect, many diseases and circumstances regarded as risk factors are identified to predispose to the development of VTE. In general, these risk factors are classified into genetic and acquired risk [15, 16, 17, 18]. Genetic risk factors including protein C and S deficiency, antithrombin deficiency, the factor V Leiden gene mutation, antiphospholipid syndrome, etc. Acquired risk factors are further divided into concurrent diseases (elderly, chronic diseases, active cancer, obesity) and transient states (surgery, trauma, hospitalization, immobility, central venous catheter or device indwelling, oral contraceptives, etc.) [2]. Of note, hospitalization is an important period that multiple risk factors encounter concurrently and increase the risk of VTE greatly [2, 19]. Although predisposing factors are identified in most cases of VTE, there are still almost 20% of case having no obvious etiology. The result suggests the significance of unknown genetic or acquired risk factors to the development of VTE [2, 3].
To date, anticoagulation is still the principal treatment in VTE. In addition to traditional anticoagulation, including heparin, low molecular weight heparin and vitamin K antagonists, as well as direct thrombin inhibitors, non-vitamin K oral anticoagulants (NOACs), known as direct oral-anticoagulant (DOACs) change the strategy in medical treatment of VTE. The update of principles and strategies of medical treatment of VTM will be illustrated in another chapter. On the other hand, endovascular or surgical thrombectomy and embolectomy have role in treatment of VTE. Historically, Läwen conducted the first thrombectomy for venous thrombosis of upper extremity in 1938 [20]. After evolution in nearly 90 years, there are great advances in techniques and modalities in performing thrombectomy and embolectomy. However, thrombectomy or embolectomy is still indicated in limited population in modern treatment of VTE, especially in patients with massive or submassive thrombus burden accompanied by unstable hemodynamic status or critical complications [21, 22, 23]. Theoretically, endovascular or surgical thrombectomy removes majority of thrombus load more completely and recanalization of occluded vessels earlier [24, 25]. Moreover, some previous studies even reported that thrombectomy may have potential benefits comparing to anticoagulation alone in long-term complications and quality of life in certain VTE patients [22, 26]. The aim of this chapter will focus on the advances of modalities of endovascular and surgical thrombectomy.
Percutaneous management, also known as catheter-based therapy (CBT), for VTE can be divided into two mechanisms: thrombolysis-based and mechanical thrombectomy. There are also devices combining these two mechanisms. For certain conditions, percutaneous approaches also include balloon angioplasty and stenting. We describe different types of CBT in the following sections.
Compared to systemic thrombolysis, catheter-based thrombolysis is, by concept, more likely a local therapy. The advantage of this approach is a reduced-dose thrombolysis. Therefore, there is less risk of bleeding [27, 28]. Although with lower dosage needed, absolute contraindications for catheter-directed thrombolysis are the same as for systemic thrombolysis, including history of any intracranial hemorrhage, ischemic stroke within three months, structural intracranial lesion, active bleeding, recent head, eye or spinal surgery, and recent head trauma [29, 30].
This approach is done by placing an infusion catheter with multiple side holes and a tip occluding wire or a dedicated catheter specifically for a certain device, preferentially into the thrombus. It may sometimes require two catheters to be placed in each of the main pulmonary arteries. If there is no specialized catheter, a standard pig-tail or pulmonary artery catheter may also serve to deliver thrombolytic agent locally. When performing intervention for pulmonary embolism (PE), power injection may be necessary to take clear angiography to localizes the emboli. For each main pulmonary artery, perform contrast injection at 15–20 m/s for a total volume of 30 ml [28]. For intervention of deep venous thrombosis (DVT), careful hand injection with low-volume contrast is preferred to avoid disruption of thrombi with progression to PE [30].
Thrombolytic agent is administered via the carefully placed catheter. There is no standard for the agent and dosage used. It varies according to accompanied device, patients’ bleeding tendency, and physicians’ preferences. A commonly used regimen is tissue plasminogen activator (tPA) 0.5–1.0 mg/hr for 6–24 hours, with total dosage usually between 12 and 24 mg. Fibrinogen should be monitored during infusion of fibrinolytic agent. Dose reduction or discontinuation should be considered if level of fibrinogen falls below 150 mg/dL. During t-PA infusion, a low-dose heparin infusion is usually kept, with a partial thromboplastin time (PTT) just around the lower limit of therapeutic range, usually PTT 40–50 seconds [28, 30].
Catheter-directed thrombolysis applies for both DVT and PE. A key factor to success of lytic-based approach is that whether the thrombolytic agent is delivered into the thrombus with good penetration. A resolution to this problem is combining other method to enhance efficacy of drug delivery, such as the EkoSonic system.
EkoSonic™ Endovascular System (EKOS) is a device for ultrasound-assisted catheter-directed thrombolysis. It includes a control unit and a uniquely designed catheter to achieve better penetration of thrombolytics by so-called acoustic pulse thrombolysis. The catheter is composed of an ultrasonic core in central lumen, central coolant lumen, and drug delivery lumen. The ultrasonic core generates an acoustic field to enhance drug delivery into the clot and to unwind the fibrin for better exposure to thrombolytic agents. This system is indicated for both DVT and PE [31].
There were also devices designed for a true localized therapy. Trellis™ Peripheral Infusion System is a specialized device for isolated thrombolysis. It consists of two occlusive balloons to isolate the treatment area, an infusion zone to deliver thrombolytic agents, an oscillation drive unit to better disperse the drug to thrombi, and an aspiration window to remove the dissolved clot. Although with a unique design to ensure localized thrombolysis and thrombi removal, the devices were recalled due to incorrectly labelling of proximal and distal balloons [32].
Of note, catheter-directed thrombolysis alone may not be sufficient to clear all blood clots, although it is true that the goal of catheter-directed thrombolysis for PE is not to remove emboli completely, but to reduce the risk from high to intermediate [29]. Further intervention to remove emboli and thrombi may be needed and there are devices combining local thrombolysis and sequential blood clot removal, which would be described later.
Mechanical thrombectomy is achieved by physical disruption of thrombus via different methods, with various devices designed for this purpose. These devices have different benefits, adverse effects, and special concerns while manipulation. Overall, they are less invasive compared with traditional surgical thrombectomy. Some devices achieve thrombus removal in a single session, sparing the use of thrombolytic agents. The following section describes devices with approval. Devices still under development are not covered.
Mechanical thrombectomy without a device has long been described in both treatment for DVT and PE. It is usually done by a pigtail with manual rotation or by balloon angioplasty [28]. An important issue of fragmentation is that it might create distal emboli, causing worse distal obstruction; and fragmentation alone may not be enough to resolve obstruction. It may be followed by systemic thrombolysis, catheter-directed thrombolysis, or thrombi removal by manual aspiration. Due to lack of clinical evidence, there is no recommendation for how to combine other strategy after manual thrombus fragmentation.
Besides manual thrombus aspiration with a regular guide catheter or specialized catheters with greater power of suction, there are devices designed to remove thrombus by suction via negative pressure. The advantages are the ability to remove large thrombi or even chronic thrombi, avoidance of thrombolytic agents, and possible less risk of bleeding.
The AngioVac® system works in an extracorporeal circuit and needs two large venous access sites for AngioVac inflow cannula (22Fr) and reinfusion outflow cannula (16–20 Fr). The third generation uses funnel-shaped and different-angled tip (20 degree or 180 degree) to facilitate navigation. Besides the need of two large-bore accesses, another disadvantage of this device is that perfusionist is required. It is indicated for removal of fresh, soft thrombi or emboli in right atrium, right ventricle, superior vena cava, inferior vena cava, and iliofemoral veins during extracorporeal bypass. It is not indicated in pulmonary vasculature although there are case series [33].
The FlowTriever® system includes an Triever Aspiration Catheter, a FlowTriever catheter, and a retraction aspiration device. Thrombus removal is done by manual aspiration with a syringe via the large-lumen aspiration catheter. There are nitinol mesh disks on the tip of FlowTriever catheter to disrupt and drag residual clots into the aspiration catheter for extraction. This system is indicated for PE [34]. A similar system dedicated for DVT is the ClotTriever® system. It includes a ClotTriever sheath and a ClotTriever catheter. The procedure steps are somewhat different. The ClotTriever catheter is position beyond the thrombus. A mesh collection bag on the tip of ClotTriever catheter retracts thrombi into the ClotTriever sheath with a self-expanding funnel tip, providing embolic protection. Manual aspiration is applied if there are residual thrombi in the sheath. Since treatment is completed in a single session and there is no need for thrombolysis, care in intensive care unit (ICU) after procedure may not be necessary. However, a large-bore vascular access (20 Fr) is needed [35].
Penumbra’s Indigo® Aspiration System operates in a more “automatic” way, with less need of manual control. The main components of the system are a catheter, a Penumbra ENGINE to generate vacuum for aspiration, and a tubing system. When the catheter is in position, the system performs automatic aspiration. With different catheters, there are corresponding Separator wires to remove clot in the lumen of aspiration catheters. Compared to AngioVac® and FlowTriever®, the Indigo® system does not require large-bore vascular access but may therefore unable to remove larger thrombi. It is indicated for removal of fresh, soft thrombi or emboli in both peripheral arterial and venous system and for treatment of PE [36].
Syringed-based thrombectomy offers limited force and aspirated volume, and operators could not further manipulate. Pump systems with specific devices provide increased force and volume but usually with increased complexity of the procedure and increased cost. Control Mechanical Thrombectomy™ system (Aspire) works in a different way. The system includes a thrombectomy catheter and a control mechanical aspirator which is like a handle. Through the handle, the operator can adjust strength of the aspirated force, and switch between continuous and pulsed force. It is indicated for removal of fresh, soft thrombi in peripheral vasculature, but not PE [37].
The concept of rotational thrombectomy is thrombus disruption by a catheter with rotating head. Most devices also have the ability to remove thrombus via active suction.
Aspirex® mechanical thrombectomy device consists of a catheter with a handle and a drive system. At the tip of the catheter, there is aspiration port to suck in thrombi; and inside the catheter, there is rotational coil to break down thrombi. The fragmented thrombi are then aspirated out. The device is indicated for both arterial and venous thrombi. With limited case studies, it is not approved for treatment of PE [38].
CLEANER™ Rotational Thrombectomy System is a one-piece device. Rotating action of its sinusoidal wire breaks down thrombi. The sinusoidal shape provides atraumatic action on thrombi adhered to vessel wall. The device also enables infusion of thrombolytic agents via a distal side hole. It is indicated for removal of thrombus in peripheral vasculature, but not for PE [39].
Rheolytic thrombectomy is based on Bernoulli effect. A high-velocity saline jet creates a low-pressure, drawing thrombi into the catheter. To eliminate thrombi better, it may be accompanied with thrombolysis or other mechanical method such as aspiration.
Among this category, the mostly studied device is AngioJet™ Rheolytic Thrombectomy System, consisting of a console and a thrombectomy catheter. The system works in both pharmacological and mechanical ways. Operators can deliver thrombolytic agents directly into the clot to facilitate removal of thrombus. The console generates pressurized saline to draw thrombi into the catheter via an inflow window near the tip of the catheter, and then evacuates the thrombi. Notable adverse events include pain, cardiac arrythmia (mainly bradyarrhythmia), hypotension, transient hemolysis, bleeding, and acute kidney injury. Hydration before, during, and after the procedure may be considered. AngioJet™ system is indicated in removal of thrombi in peripheral vasculature. When used in PE, there were severe adverse events, including death; so, there is a “black box” warning for AngioJet™ in treating PE [40].
The concept of combination works in at least two modes. One is to combine multiple mechanisms at the same time, usually by devices, like EKOS or AngioJet™. The other way is to use different methods sequentially. For instance, physicians may perform balloon angioplasty first to disrupt the thrombi; and then leave an infusion catheter for thrombolysis. This concept also works in a reverse way. Physicians may place an infusion catheter for thrombolysis first, usually for 24 hours; and then break the loosen thrombi with balloon angioplasty. Theoretically, combing thrombolysis and mechanical thrombectomy improves efficacy of thrombus removal, but there is no standard for how to combine multiple strategies due to limited studies. This so-called pharmacomechanical approach is therefore, largely based on clinicians’ experience.
Besides thrombolysis and mechanical thrombectomy, some adjuvant procedures may be needed, mainly for DVT. Balloon angioplasty plays a role in chronic thromboembolic pulmonary hypertension, but not for acute PE. For DVT, placement of inferior vena cava filter before procedure may be considered to prevent PE, especially for patients with poor cardiopulmonary function and deemed unable to tolerate PE [30]. The results of studies regarding stenting for DVT were inconsistent, although some showed reduced severity in post-thrombotic syndrome and improved quality of life in some aspects [41, 42, 43]. This approach is therefore largely based on clinicians’ experience.
Stenting is considered if there is residual thrombi or residual venous outflow obstruction. It may also be considered when there is non-thrombotic cause of stenosis, such as in May-Thurner syndrome. Therefore, careful assessment of the lesion is important. It is helpful to combine other image modality such as computed tomography or intravascular ultrasound. Besides anatomical nature, clinicians should put patients’ life expectancy, bleeding risk, and likelihood of symptom improvement into consideration. When a stent is placed, there is always risk of in-stent restenosis or occlusion. Risk factors include poor inflow, external compression, inappropriate stent design, stent misplacement or migration, stent fracture, and bleeding. Patients should be notified about the possibility of reintervention [44].
The purpose of CBT is to relieve obstruction quicker, compared with traditional medical therapy. However, there is no strong evidence that CBT is better than traditional systemic thrombolysis since randomized trial assessing hard outcomes, such as mortality, is lacking. Also, among CBT, there is no trial comparing catheter-directed thrombolysis and mechanical thrombectomy or comparing different devices. It is also important to remember that published studies for CBT with devices are of small patient numbers. There are many trials still going on. Hopefully, these trials will provide evidences for more specific guidance.
For any intervention, there are always complications. Possible complications of CBT include access site bleeding, vascular injury, major bleeding (including intracranial hemorrhage), distal emboli (especially of concern with PE when performing intervention for DVT), cardiac tamponade (intervention for PE), hemodynamic deterioration, and deterioration in renal function. Some studies did not demonstrate the presumed benefit of less major bleedings (including intracranial hemorrhage) in percutaneous methods, compared with systemic thrombolysis [28, 29]. The balance between risk and benefit of these interventions should be personalized.
Generally speaking, CBT may be considered in patients with iliofemoral DVT who have severe symptoms and a low risk of bleeding [45]. For PE, CBT is an alternative to systemic thrombolysis and surgical embolectomy, considered when these approaches are contraindicated or fail [46]. For now, the choice of CBT largely remains on physicians’ experience and local availability.
Surgical intervention is an old skill compared with percutaneous intervention. Surgical embolectomy of PE requires cardiopulmonary bypass. After thoracotomy, emboli are removed manually with forceps. Balloon catheter and suction may be used for residual emboli. Although surgical embolectomy is a class I indication for massive pulmonary embolism, it is usually reserved as a salvage therapy when other therapies fail or are contraindicated, due to its invasive nature. If there is thrombus in right heart or thrombus across patent foramen ovale, surgical embolectomy would be considered the first-line therapy [27].
On the other hand, surgical thrombectomy for DVT is usually done with a special balloon catheter to pull out thrombi in the direction of venous flow, called Fogarty maneuvers [47]. Unlike for PE, surgical thrombectomy for DVT is not recommended by clinical guidelines. Although there are studies showing good patency rates after surgery, it is usually considered only in certain conditions when rapid reduction of venous obstruction is needed, such as in patients with phlegmasia cerulea dolens [48].
Although rapid evolution of modalities and relatively high successful rate in experienced center, routine use of endovascular or surgical thrombectomy and thrombolysis in patient with VTE is not recommended. To date, large-scale clinical trial assessing the efficacy and safety of invasive thrombolysis or thrombectomy is still lack. The application of endovascular or surgical strategies should be considered in selective VTE patients with unstable hemodynamic status or critical VTE-associated complications or having contraindications or high risk of bleeding while receiving systemic thrombolysis. In addition, future studies focusing on cost-effectiveness are needed to integrate these invasive procedures with medical strategies in the protocol of VTE treatment.
IntechOpen - where academia and industry create content with global impact
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\n\nBut, one thing we have in common is -- we are all scientists at heart!
\n\nSara Uhac, COO
\n\nSara Uhac was appointed Managing Director of IntechOpen at the beginning of 2014. She directs and controls the company’s operations. Sara joined IntechOpen in 2010 as Head of Journal Publishing, a new strategically underdeveloped department at that time. After obtaining a Master's degree in Media Management, she completed her Ph.D. at the University of Lugano, Switzerland. She holds a BA in Financial Market Management from the Bocconi University in Milan, Italy, where she started her career in the American publishing house Condé Nast and further collaborated with the UK-based publishing company Time Out. Sara was awarded a professional degree in Publishing from Yale University (2012). She is a member of the professional branch association of "Publishers, Designers and Graphic Artists" at the Croatian Chamber of Commerce.
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\n\nAlex Lazinica is co-founder and Board member of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his Ph.D. in Robotics at the Vienna University of Technology. There, he worked as a robotics researcher with the university's Intelligent Manufacturing Systems Group, as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and, most importantly, co-founded and built the International Journal of Advanced Robotic Systems, the world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career since it proved to be the pathway to the foundation of IntechOpen with its focus on addressing academic researchers’ needs. Alex personifies many of IntechOpen´s key values, including the commitment to developing mutual trust, openness, and a spirit of entrepreneurialism. Today, his focus is on defining the growth and development strategy for the company.
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Müller",authors:[{id:"46289",title:"Dr.",name:"Thomas",middleName:"Ernst",surname:"Müller",slug:"thomas-muller",fullName:"Thomas Müller"},{id:"95358",title:"Dr.",name:"Alexander",middleName:null,surname:"Kraynov",slug:"alexander-kraynov",fullName:"Alexander Kraynov"}]},{id:"13936",doi:"10.5772/14340",title:"Quaternary Ammonium and Phosphonium Ionic Liquids in Chemical and Environmental Engineering",slug:"quaternary-ammonium-and-phosphonium-ionic-liquids-in-chemical-and-environmental-engineering",totalDownloads:13311,totalCrossrefCites:18,totalDimensionsCites:44,abstract:null,book:{id:"72",slug:"ionic-liquids-theory-properties-new-approaches",title:"Ionic Liquids",fullTitle:"Ionic Liquids: Theory, Properties, New Approaches"},signatures:"Anja Stojanovic, Cornelia Morgenbesser, Daniel Kogelnig, Regina Krachler and Bernhard K. Keppler",authors:[{id:"17516",title:"Dr.",name:"Daniel",middleName:null,surname:"Kogelnig",slug:"daniel-kogelnig",fullName:"Daniel Kogelnig"},{id:"20872",title:"Dr.",name:"Anja",middleName:null,surname:"Stojanovic",slug:"anja-stojanovic",fullName:"Anja Stojanovic"},{id:"20873",title:"Dr.",name:"Regina",middleName:null,surname:"Krachler",slug:"regina-krachler",fullName:"Regina Krachler"},{id:"20874",title:"Dr.",name:"Bernhard K.",middleName:null,surname:"Keppler",slug:"bernhard-k.-keppler",fullName:"Bernhard K. 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Thöming",authors:[{id:"14871",title:"Prof.",name:"Jorg",middleName:null,surname:"Thöming",slug:"jorg-thoming",fullName:"Jorg Thöming"},{id:"20897",title:"Dr.",name:"Ewa Maria",middleName:null,surname:"Siedlecka",slug:"ewa-maria-siedlecka",fullName:"Ewa Maria Siedlecka"},{id:"21083",title:"Dr.",name:"Malgorzata",middleName:null,surname:"Czerwicka",slug:"malgorzata-czerwicka",fullName:"Malgorzata Czerwicka"},{id:"21084",title:"Prof.",name:"Piotr",middleName:null,surname:"Stepnowski",slug:"piotr-stepnowski",fullName:"Piotr Stepnowski"},{id:"24146",title:"Dr.",name:"Jennifer",middleName:null,surname:"Neumann",slug:"jennifer-neumann",fullName:"Jennifer Neumann"}]},{id:"20542",doi:"10.5772/23267",title:"Ionic Liquids Recycling for Reuse",slug:"ionic-liquids-recycling-for-reuse",totalDownloads:6877,totalCrossrefCites:7,totalDimensionsCites:33,abstract:null,book:{id:"327",slug:"ionic-liquids-classes-and-properties",title:"Ionic Liquids",fullTitle:"Ionic Liquids - Classes and Properties"},signatures:"Samir I. Abu-Eishah",authors:[{id:"51333",title:"Prof.",name:"Samir",middleName:"Ibrahim",surname:"I. Abu-Eishah",slug:"samir-i.-abu-eishah",fullName:"Samir I. Abu-Eishah"}]},{id:"13747",doi:"10.5772/14702",title:"Application of Room Temperature Ionic Liquids in Electrochemical Sensors and Biosensors",slug:"application-of-room-temperature-ionic-liquids-in-electrochemical-sensors-and-biosensors",totalDownloads:9814,totalCrossrefCites:14,totalDimensionsCites:32,abstract:null,book:{id:"1373",slug:"ionic-liquids-applications-and-perspectives",title:"Ionic Liquids",fullTitle:"Ionic Liquids: Applications and Perspectives"},signatures:"Farnoush Faridbod, Mohammad Reza Ganjali, Parviz Norouzi, Siavash Riahi, and Hamid Rashedi",authors:[{id:"18565",title:"Prof.",name:"Mohammad Reza",middleName:null,surname:"Ganjali",slug:"mohammad-reza-ganjali",fullName:"Mohammad Reza Ganjali"},{id:"20605",title:"Dr.",name:"Parviz",middleName:null,surname:"Norouzi",slug:"parviz-norouzi",fullName:"Parviz Norouzi"},{id:"20606",title:"Dr.",name:"Farnoush",middleName:null,surname:"Faridbod",slug:"farnoush-faridbod",fullName:"Farnoush Faridbod"},{id:"20607",title:"Dr.",name:"Siavash",middleName:null,surname:"Riahi",slug:"siavash-riahi",fullName:"Siavash Riahi"}]}],mostDownloadedChaptersLast30Days:[{id:"20532",title:"1,2,3-Triazolium Salts as a Versatile New Class of Ionic Liquids",slug:"1-2-3-triazolium-salts-as-a-versatile-new-class-of-ionic-liquids",totalDownloads:6048,totalCrossrefCites:6,totalDimensionsCites:12,abstract:null,book:{id:"327",slug:"ionic-liquids-classes-and-properties",title:"Ionic Liquids",fullTitle:"Ionic Liquids - Classes and Properties"},signatures:"Zekarias Yacob and Jürgen Liebscher",authors:[{id:"52686",title:"Prof.",name:"Jürgen",middleName:null,surname:"Liebscher",slug:"jurgen-liebscher",fullName:"Jürgen Liebscher"},{id:"56807",title:"Prof.",name:"Zekarias Yacob",middleName:null,surname:"Fundusa",slug:"zekarias-yacob-fundusa",fullName:"Zekarias Yacob Fundusa"}]},{id:"72530",title:"Application of Vortex Control Principle at Pump Intake",slug:"application-of-vortex-control-principle-at-pump-intake",totalDownloads:1030,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Vortex flow in a pump intake could affect a pump operation significantly if not treated appropriately. Many researches have been conducted to determine the best control method for vortex flow in pump sumps so that the pump lifespan can be maximized. In this study, a vortex control principle designed to minimize the impact of submerged vortex flow in pump sump on major pump components is presented. This principle employs a device called the plate type floor splitter which serves the function of eliminating vortices formed on the sump floor and reduces the intensity of swirling motion in the intake flow. A pump sump model was built to carry out the study by installing a floor splitter plate sample under the pump suction inlet and the corresponding parameters used to quantify the swirl intensity known as the swirl angle was measured. Procedures for the measurement were conducted based on ANSI/HI 9.8-2018 standard. A numerical simulation was performed to study the flow in a full-scale pump sump. The results showed that the installation of floor splitter plate can eliminate vortices efficiently and reduce swirl angle significantly. However, optimization of floor splitter design is needed to achieve a reduction effect that can reduce swirl angles to an acceptable value of lower than 5° according to ANSI/HI 9.8-2018 standard.",book:{id:"10080",slug:"vortex-dynamics-theories-and-applications",title:"Vortex Dynamics Theories and Applications",fullTitle:"Vortex Dynamics Theories and Applications"},signatures:"Zambri Harun, Tajul Ariffin Norizan and Wan Hanna Melini Wan Mohtar",authors:[{id:"243152",title:"Dr.",name:"Zambri",middleName:null,surname:"Harun",slug:"zambri-harun",fullName:"Zambri Harun"},{id:"313310",title:"Mr.",name:"Tajul Ariffin",middleName:null,surname:"Norizan",slug:"tajul-ariffin-norizan",fullName:"Tajul Ariffin Norizan"},{id:"317421",title:"Dr.",name:"Wan Hanna Melini",middleName:null,surname:"Wan Mohtar",slug:"wan-hanna-melini-wan-mohtar",fullName:"Wan Hanna Melini Wan Mohtar"}]},{id:"20216",title:"Ionic Liquids in Separation Techniques",slug:"ionic-liquids-in-separation-techniques",totalDownloads:8542,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"1300",slug:"applications-of-ionic-liquids-in-science-and-technology",title:"Applications of Ionic Liquids in Science and Technology",fullTitle:"Applications of Ionic Liquids in Science and Technology"},signatures:"Jolanta Flieger and Anna Czajkowska-Żelazko",authors:[{id:"20797",title:"Dr.",name:"Jolanta",middleName:null,surname:"Flieger",slug:"jolanta-flieger",fullName:"Jolanta Flieger"},{id:"136020",title:"Prof.",name:"Czajkowska",middleName:null,surname:"Żelazko",slug:"czajkowska-zelazko",fullName:"Czajkowska Żelazko"}]},{id:"71403",title:"Supercritical-Fluids Thermophysical Properties and Heat Transfer in Power-Engineering Applications",slug:"supercritical-fluids-thermophysical-properties-and-heat-transfer-in-power-engineering-applications",totalDownloads:1188,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Researches on specifics of thermophysical properties and heat transfer at supercritical pressures (SCPs) started as early as the 1930s with the study on free-convection heat transfer to fluids at a near-critical point. In the 1950s, the concept of using SC “steam” to increase thermal efficiency of coal-fired thermal power plants became an attractive option. Germany, USA, the former USSR, and some other countries extensively studied heat transfer to SC fluids (SCFs) during the 1950s till the 1980s. This research was primarily focused on bare circular tubes cooled with SC water (SCW). However, some studies were performed with modeling fluids such as SC carbon dioxide and refrigerants instead of SCW. Currently, the use of SC “steam” in coal-fired thermal power plants is the largest industrial application of fluids at SCPs. Near the end of the 1950s and at the beginning of the 1960s, several studies were conducted to investigate a possibility of using SCW as a coolant in nuclear reactors with the objective to increase thermal efficiency of nuclear power plants (NPPs) equipped with water-cooled reactors. However, these research activities were abandoned for some time and regained momentum in the 1990s. In support of the development of SCW-cooled nuclear-power reactor (SCWR) concepts, first experiments have been started in annular and various bundle flow geometries. At the same time, more numerical and CFD studies have been performed in support of our limited knowledge on specifics of heat transfer at SCPs in various flow geometries. As the first step in this process, heat transfer to SCW in vertical bare tubes can be investigated as a conservative approach (in general, heat transfer in fuel bundles will be enhanced with various types of appendages, that is, grids, end plates, spacers, bearing pads, fins, ribs, etc.). New experiments in the 1990–2000s were triggered by several reasons: (1) thermophysical properties of SCW and other SCFs have been updated from the 1950s–1970s, for example, a peak in thermal conductivity in the critical/pseudocritical points was “officially” introduced in 1990s; (2) experimental techniques have been improved; (3) in SCWRs, various bundle flow geometries will be used instead of bare-tube geometry; (4) in SC “steam” generators of thermal power plants, larger diameter tubes/pipes (20–40 mm) are used, however in SCWRs hydraulic-equivalent diameters of proposed bundles will be within 5–12 mm; (5) with Research and Development (R&D) of next-generation or Generation-IV nuclear-power-reactor concepts, new areas of application for SCFs have appeared—for example, SCP helium was proposed to be used as a reactor coolant, SCP Brayton and Rankine cycles with SC carbon dioxide as a working fluid are being developed, etc. A comparison of thermophysical properties of SCFs with those of subcritical-pressure fluids showed that SCFs as single-phase fluids have unique properties, which are close to “liquid-like” behavior below critical or pseudocritical points and are quite similar to the behavior of “gas-like” substances above these points. A comparison of selected SCW heat transfer correlations has shown that their results may differ from one to another by more than 200%. Based on these comparisons, it became evident that there is a need for reliable, accurate, and wide-range SCW heat transfer correlation(s) to be developed and verified. Therefore, the objective of this chapter is to summarize in concise form specifics of supercritical-fluids thermophysical properties and heat transfer in power-engineering applications.",book:{id:"9201",slug:"advanced-supercritical-fluids-technologies",title:"Advanced Supercritical Fluids Technologies",fullTitle:"Advanced Supercritical Fluids Technologies"},signatures:"Igor L. Pioro",authors:[{id:"15933",title:"Prof.",name:"Igor",middleName:"Leonardovich",surname:"Pioro",slug:"igor-pioro",fullName:"Igor Pioro"}]},{id:"41932",title:"The Structure of Supported Ionic Liquids at the Interface",slug:"the-structure-of-supported-ionic-liquids-at-the-interface",totalDownloads:3597,totalCrossrefCites:0,totalDimensionsCites:5,abstract:null,book:{id:"3178",slug:"ionic-liquids-new-aspects-for-the-future",title:"Ionic Liquids",fullTitle:"Ionic Liquids - New Aspects for the Future"},signatures:"Fatemeh Moosavi",authors:[{id:"23490",title:"Ph.D.",name:"Fatemeh",middleName:null,surname:"Moosavi",slug:"fatemeh-moosavi",fullName:"Fatemeh Moosavi"}]}],onlineFirstChaptersFilter:{topicId:"935",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},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:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"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. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. 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