Incidence of postoperative hemorrhage in gynecological surgery.*
\\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\\nWe 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
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'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\nThroughout 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\nReleased 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\nWe 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
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"10529",leadTitle:null,fullTitle:"Hearing Loss - From Multidisciplinary Teamwork to Public Health",title:"Hearing Loss",subtitle:"From Multidisciplinary Teamwork to Public Health",reviewType:"peer-reviewed",abstract:"The auditory system is one of the finest structures in the human body. Although its anatomical structure is so small compared to other organs, without it, it would greatly affect a person’s basic life. Hearing loss, also known as hearing impairment, is a partial or total inability to hear. When people communicate with others, listening is always the first step. That is why Helen Keller once said, “Blindness separates people from things; deafness separates people from people.” To avoid the “epidemic” of hearing loss in the near future, it is necessary to promote early screening, change public attitudes toward noise, and wear hearing aids appropriately. Based on the contributions of many authors, whom I sincerely respect, this book incorporates updated developments as well as future perspectives in the ever-expanding field of hearing loss. This book can also serve as a reference for persons who are involved in this field whether they are clinicians, researchers, or patients.",isbn:"978-1-83968-678-8",printIsbn:"978-1-83968-677-1",pdfIsbn:"978-1-83968-679-5",doi:"10.5772/intechopen.92694",price:119,priceEur:129,priceUsd:155,slug:"hearing-loss-from-multidisciplinary-teamwork-to-public-health",numberOfPages:194,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a4b7dbb02ba00e7412422cd5dbffa029",bookSignature:"Tang-Chuan Wang",publishedDate:"July 7th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/10529.jpg",numberOfDownloads:2358,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:0,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 3rd 2020",dateEndSecondStepPublish:"October 1st 2020",dateEndThirdStepPublish:"November 30th 2020",dateEndFourthStepPublish:"February 18th 2021",dateEndFifthStepPublish:"April 19th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"201262",title:"Dr.",name:"Tang-Chuan",middleName:null,surname:"Wang",slug:"tang-chuan-wang",fullName:"Tang-Chuan Wang",profilePictureURL:"https://mts.intechopen.com/storage/users/201262/images/system/201262.gif",biography:"Dr. Tang-Chuan Wang is an excellent otolaryngologist – head and neck surgeon in Taiwan. He is also a research scholar of Harvard Medical School and University of Iowa hospital. During his substantial experience, he ever worked in Stanford University, University of Pennsylvania, Boston Children's Hospital and Massachusetts Eye and Ear. Besides, he is not only working hard on clinical & basic medicine but also launching out into public health in Taiwan. In recent years, he devotes himself to innovation and telemedicine. He always says that “in theoretical or practical aspects, no innovation is a step backward\". Due to his contribution to biodesign, he was invited into executive committee of Advanced Joint R & D Center in Taiwan",institutionString:"China Medical University Hsinchu Hospital",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"3",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1099",title:"Otology",slug:"otology"}],chapters:[{id:"75066",title:"Noise Exposure",doi:"10.5772/intechopen.95997",slug:"noise-exposure",totalDownloads:231,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Noise exposure is a basic concept used to assess the risk of noise induced hearing loss in the workplace. It is very important, since loud noise is omnipresent in almost all human activity, especially in industry, construction, mining and transportation. The question to answer is how to determine the risk of a person performing in an environment where the noise levels, duration and frequency content change with time. The answer is obtained by measuring his noise exposure. Although the measurement itself is not complex or difficult, a proper knowledge of what exactly is the noise exposure and how to deal with the measurement result in fundamental to avoid getting wrong conclusions.",signatures:"Alberto Behar",downloadPdfUrl:"/chapter/pdf-download/75066",previewPdfUrl:"/chapter/pdf-preview/75066",authors:[{id:"318448",title:"Prof.",name:"Alberto",surname:"Behar",slug:"alberto-behar",fullName:"Alberto Behar"}],corrections:null},{id:"75934",title:"Occupational Hearing Loss",doi:"10.5772/intechopen.97109",slug:"occupational-hearing-loss",totalDownloads:296,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Occupational hearing loss received attention after the Industrial Revolution and through World Wars I and II. It currently accounts for the largest portion of occupational diseases, and a third of all hearing loss is due to noise. Occupational hearing losses include noise-induced hearing loss (NIHL), hearing loss caused by ototoxic substances and hearing loss caused by their complex interactions. In the case of NIHL, even when exposed to the same noise, the degree of hearing damage and recovery may vary from person to person, and also be affected by other noise in daily life. Various organic solvents and some heavy metals exposed in workplace are important causes of ototoxic hearing loss, and they are known to have additive or synergistic effects when accompanied by noise. In Korea, NIHL is the most common occupational disease and has been increasing continuously since the 1990s. The number of claims for compensation has also been increasing steadily. However, the developed country including Korea almost never considered the effects of chemicals on the diagnosis and compensation for hearing loss workers. Occupational hearing loss can be prevented through hearing conservation programs. In this chapter, we will introduce the scientific basis of noise induced hearing loss, the impacts of ototoxic substance and co-existence impact on hearing loss.",signatures:"Joong-Keun Kwon and Jiho Lee",downloadPdfUrl:"/chapter/pdf-download/75934",previewPdfUrl:"/chapter/pdf-preview/75934",authors:[{id:"214399",title:"Prof.",name:"Jiho",surname:"Lee",slug:"jiho-lee",fullName:"Jiho Lee"},{id:"342285",title:"Prof.",name:"Joong-Keun",surname:"Kwon",slug:"joong-keun-kwon",fullName:"Joong-Keun Kwon"}],corrections:null},{id:"75383",title:"Noise Induced Hearing Loss: A Case Study from a Speech-Language Pathologist’s Perspective",doi:"10.5772/intechopen.96332",slug:"noise-induced-hearing-loss-a-case-study-from-a-speech-language-pathologist-s-perspective",totalDownloads:267,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Hearing loss is very common in the United States and the most widespread disability in the U.S. Hearing loss is the third most chronic health condition in the U.S. Noise induced hearing loss (NIHL) results from damaging external noise. This injury leads to temporarily or permanently affecting sensitive inner ear structures (e.g., cochlea, organ of Corti, and hair cells). NIHL can result from a single high-level noise exposure or repeated exposures to excessively loud noises [i.e., typically 85 dBA or greater, (A weighted decibel)]. Damage to the inner ear can also result from aging (i.e., presbycusis). This case study documents the hearing loss of an otherwise healthy 21-year-old, male individual and his progressive moderate-to-severe sensorineural hearing loss over a period of 41 years. His history will be reported along with his perspective as a speech-language pathologist and speech scientist. The individual with hearing loss has adapted to wearing hearing aids over the last five years. Issues that have occurred affecting comprehension along with compensatory strategies that assisted listening and comprehension will be discussed.",signatures:"Alejandro Brice",downloadPdfUrl:"/chapter/pdf-download/75383",previewPdfUrl:"/chapter/pdf-preview/75383",authors:[{id:"201179",title:"Prof.",name:"Alejandro",surname:"Brice",slug:"alejandro-brice",fullName:"Alejandro Brice"}],corrections:null},{id:"75996",title:"Neonatal Hearing Screening",doi:"10.5772/intechopen.95942",slug:"neonatal-hearing-screening",totalDownloads:187,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Around the world 10 million people have some type or degree of auditory problem, of them, between 200,000 and 400,000 have total deafness. Estimating that a large population presents this problem from birth (61%), with an incidence of 1 to 3 of every 1000 newborns. For this reason, early implementation through the neonatal auditory sieve allows timely detection to respond early to the hearing impairment of the newborn, as the ideal age to carry out rehabilitation with the help of an auditory auxiliary and initiate Language therapy is at six months of age. Most of the international guides for the integral attention to persons with auditory disability it indicates that all newborns should be screened Auditory before his hospital discharge. The prevalence of auditory disturbances in our environment is 0.3%, a proportion that places us above national and global statistics, so it is very important to screen all newborns including those who do not have Apparent risk factors in order to establish the appropriate diagnosis, the necessary treatment and thus avoid delays in neurodevelopment.",signatures:"Alejandra Itzel Contreras Rivas, Gaston Eduardo Estudillo Jiménez, Edgar Flores Molina and Patricio Guerra Ulloa",downloadPdfUrl:"/chapter/pdf-download/75996",previewPdfUrl:"/chapter/pdf-preview/75996",authors:[{id:"318590",title:"Dr.",name:"Alejandra Itzel",surname:"Contreras Rivas",slug:"alejandra-itzel-contreras-rivas",fullName:"Alejandra Itzel Contreras Rivas"},{id:"318594",title:"Dr.",name:"Gaston Eduardo",surname:"Estudillo Jimenez",slug:"gaston-eduardo-estudillo-jimenez",fullName:"Gaston Eduardo Estudillo Jimenez"}],corrections:null},{id:"75723",title:"Cisplatin Ototoxicity in Children",doi:"10.5772/intechopen.96744",slug:"cisplatin-ototoxicity-in-children",totalDownloads:253,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Cisplatin is a highly effective chemotherapy medicine used in the treatment of many childhood cancers. Like all medications, cisplatin has many side effects and as always the treatment of cancer in children is a balance between the risks of the medications used and their potential benefits. While many side effects of cisplatin chemotherapy are reversible, one major side effect is permanent and irreversible hearing loss (ototoxicity) in both ears which may worsen with time. The severity of cisplatin-related ototoxicity is associated with age and the cumulative dose received: the younger the child and the higher the total dose, the more severe the hearing loss may be. The spectrum of hearing loss varies from mild to moderate high tone hearing loss, to profound loss across the hearing range and permanent deafness. In addition to hearing loss, some children, especially adolescents, also experience tinnitus and vertigo. Cisplatin ototoxicity is one of most important of the many long-term effects experienced by children who are cured of their cancer. The burden of this toxicity may be compounded by other long-term health issues that emerge with time. This chapter will focus on cisplatin-induced hearing loss, its mechanisms, its health impact on the young person and ways to mitigate or reduce the severity of ototoxicity. This chapter has been written by a multi-disciplinary team including paediatric oncologists, audiologists, a psychologist, a health scientist and a parent of a child growing up with high frequency hearing loss.",signatures:"Penelope Brock, Kaukab Rajput, Lindsey Edwards, Annelot Meijer, Philippa Simpkin, Alex Hoetink, Mariana Kruger, Michael Sullivan and Marry van den Heuvel-Eibrink",downloadPdfUrl:"/chapter/pdf-download/75723",previewPdfUrl:"/chapter/pdf-preview/75723",authors:[{id:"47503",title:"Prof.",name:"Mariana",surname:"Kruger",slug:"mariana-kruger",fullName:"Mariana Kruger"},{id:"331740",title:"Dr.",name:"Penelope",surname:"Brock",slug:"penelope-brock",fullName:"Penelope Brock"},{id:"338248",title:"Dr.",name:"Kaukab",surname:"Rajput",slug:"kaukab-rajput",fullName:"Kaukab Rajput"},{id:"338249",title:"Dr.",name:"Lindsey",surname:"Edwards",slug:"lindsey-edwards",fullName:"Lindsey Edwards"},{id:"338250",title:"MSc.",name:"Annelot",surname:"Meijer",slug:"annelot-meijer",fullName:"Annelot Meijer"},{id:"338251",title:"Dr.",name:"Alex",surname:"Hoetink",slug:"alex-hoetink",fullName:"Alex Hoetink"},{id:"338252",title:"Mrs.",name:"Philippa",surname:"Simpkin",slug:"philippa-simpkin",fullName:"Philippa Simpkin"},{id:"339186",title:"Prof.",name:"Marry",surname:"Van Den Heuvel-Eibrink",slug:"marry-van-den-heuvel-eibrink",fullName:"Marry Van Den Heuvel-Eibrink"},{id:"340060",title:"Prof.",name:"Michael",surname:"Sullivan",slug:"michael-sullivan",fullName:"Michael Sullivan"}],corrections:null},{id:"75597",title:"Hearing Loss in Chronic Kidney Disease",doi:"10.5772/intechopen.96572",slug:"hearing-loss-in-chronic-kidney-disease",totalDownloads:309,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Chronic kidney disease (CKD) is assuming public health significance worldwide largely driven by the surge in diabetes mellitus, hypertension and obesity. CKD patients, particularly those from resource restraint regions of the world, face huge challenge in terms of accessibility and affordability to care. Besides these challenges in care, several other co-morbidities often exist among these patients in addition to the primary disease like diabetes and hypertension. Yet, these “subtle” co-morbidities are often overlooked by Caregivers. Hearing loss is one of such co-morbidities CKD patients face but it is often overlooked. The situation is worse among children who often cannot express themselves. The etiology of hearing loss among CKD patients are multifactorial. It is hoped that this neglected aspect of care for patients with chronic kidney disease will receive the needed attention for holistic care of the CKD patient.",signatures:"Sampson Antwi and Mohammed Duah Issahalq",downloadPdfUrl:"/chapter/pdf-download/75597",previewPdfUrl:"/chapter/pdf-preview/75597",authors:[{id:"331855",title:"Prof.",name:"Sampson",surname:"Antwi",slug:"sampson-antwi",fullName:"Sampson Antwi"},{id:"331857",title:"Dr.",name:"Mohammed",surname:"Issahalq",slug:"mohammed-issahalq",fullName:"Mohammed Issahalq"}],corrections:null},{id:"76269",title:"Brainstem Auditory Evoked Potentials in Type 2 Diabetes Mellitus",doi:"10.5772/intechopen.97469",slug:"brainstem-auditory-evoked-potentials-in-type-2-diabetes-mellitus",totalDownloads:225,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetes mellitus is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Diabetes affects many systems and produces complications in the human body, in those complications one is diabetic central neuropathy. The pathological mechanisms involved in the central neuropathy include chronic hyperglycaemia, hypoglycaemic episodes, angiopathy and blood–brain barrier dysfunction. Diabetic central neuropathy is detected by using of brainstem auditory evoked response (BAER), Visual evoked potential (VEP), somatosensory evoked potential (SEP). These abnormalities are present at different levels and may appear before appearance of overt complications. The central nervous system abnormalities are more frequent in patients with peripheral neuropathy but evoked potentials can be abnormal even in patients without neuropathy. The BAER is a physiological recording technique to study the auditory pathway and does not require subject’s attention and generates waves during the first 10 ms after the sound stimulus. Each BAER wave is generated by the activation of a sub-cortical component of the auditory pathway with 90% sensitivity and 70–90% of specificity.",signatures:"Rajesh Paluru and Devendra Singh Negi",downloadPdfUrl:"/chapter/pdf-download/76269",previewPdfUrl:"/chapter/pdf-preview/76269",authors:[{id:"330541",title:"Dr.",name:"Rajesh",surname:"Paluru",slug:"rajesh-paluru",fullName:"Rajesh Paluru"},{id:"346320",title:"Dr.",name:"Devender",surname:"Singh Negi",slug:"devender-singh-negi",fullName:"Devender Singh Negi"}],corrections:null},{id:"76173",title:"Variation of Sensitivity of a MEMS Capacitive Accelerometer Based Microphone with Suspension System Topology",doi:"10.5772/intechopen.97185",slug:"variation-of-sensitivity-of-a-mems-capacitive-accelerometer-based-microphone-with-suspension-system-",totalDownloads:171,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The present research seeks to improve a highly sensitive MEMS capacitive accelerometer as a probable completely implantable hearing aid microphone. The research analyses the effect of different suspension system topologies on accelerometer efficiency. The topology of folded beam suspension is considered to be the most suitable for the proposed system. The design factors such as weight, height and resonant frequency are considered to make the accelerometer an effective biomedical system which can be completely implanted with COMSOL MULTIPHYSICS 4.2 the optimized system is simulated and validated. The accelerometer occupies 1mm2 of sensing area and achieves a nominal capacitance of 5.30 pF and an optimized capacitive sensitivity of 6.89fF.",signatures:"Apoorva Dwivedi, Prateek Asthana, Gargi Khanna and Tarun Chaudhary",downloadPdfUrl:"/chapter/pdf-download/76173",previewPdfUrl:"/chapter/pdf-preview/76173",authors:[{id:"218477",title:"Mr.",name:"Prateek",surname:"Asthana",slug:"prateek-asthana",fullName:"Prateek Asthana"},{id:"301592",title:"Ph.D. Student",name:"Apoorva",surname:"Dwivedi",slug:"apoorva-dwivedi",fullName:"Apoorva Dwivedi"},{id:"343610",title:"Dr.",name:"Gargi",surname:"Khanna",slug:"gargi-khanna",fullName:"Gargi Khanna"},{id:"343615",title:"Dr.",name:"Tarun",surname:"Chaudhary",slug:"tarun-chaudhary",fullName:"Tarun Chaudhary"}],corrections:null},{id:"76825",title:"Cost-Effective Design of Amplifiers for Hearing Aides Using Nullors for Response Matching",doi:"10.5772/intechopen.97842",slug:"cost-effective-design-of-amplifiers-for-hearing-aides-using-nullors-for-response-matching",totalDownloads:203,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter starts reviewing Fixator-Norator Pairs (FNP) as an effective tool used to design analog amplifiers for a prescribed bandwidth and frequency profile. Among number of cases and applications, designing for hearing aides are particularly important, where the hearing frequency profiles, known as audiograms, are changing from person to person, and also for a person by the age. The design is mainly focused on front-end or stand-alone amplifiers. In case of a front-end the response from the amplifier can be digitized, properly controlled and adjusted to fit the digital application. Here is how the design proceed. For a given audiogram, an Audiogram Generator Circuit (AGC) is initially constructed. This AGC, usually a complete passive circuit, produces a frequency response that closely matches with the audiogram, obtained from a hearing impaired patient. The AGC is then embedded in an amplifier circuit where a fixator is placed at its output port, “forcing” the amplifier to generate the desired output frequency response profile. A flat band frequency response, for example, compensates the hearing losses and provides a uniform hearing to the patient in the entire audio bandwidth. The amplifier can be further enhanced to perform other requirements, for example, to cancel undesirable noises in certain frequencies or to magnify the voice in critical frequencies for clarity. Another alternative design methodology is also introduced in this chapter, which uses the negative feedback technique.",signatures:"Reza Hashemian",downloadPdfUrl:"/chapter/pdf-download/76825",previewPdfUrl:"/chapter/pdf-preview/76825",authors:[{id:"334682",title:"Dr.",name:"Reza",surname:"Hashemian",slug:"reza-hashemian",fullName:"Reza Hashemian"}],corrections:null},{id:"76594",title:"Childhood Hearing Loss in Developing Countries: From Multidisciplinary Team Work to Public Health",doi:"10.5772/intechopen.97659",slug:"childhood-hearing-loss-in-developing-countries-from-multidisciplinary-team-work-to-public-health",totalDownloads:217,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter will highlight the common causes of hearing loss in children and emphasize on the fact that most of the hearing loss is due to causes that are preventable. We know that hearing loss in childhood not only impacts on the child’s learning and social interaction with the child’s peers and society, but also has economic implications when the child grows into an adult. Public health awareness is therefore paramount in preventing a large chunk of the hearing gloss and therefore greatly contributes to making sure that the child grows into a productive citizen of the society that the child grows or lives in.",signatures:"Francis Msume Banda and Britt Nakstad",downloadPdfUrl:"/chapter/pdf-download/76594",previewPdfUrl:"/chapter/pdf-preview/76594",authors:[{id:"278443",title:"Dr.",name:"Francis Msume",surname:"Banda",slug:"francis-msume-banda",fullName:"Francis Msume Banda"},{id:"414497",title:"Dr.",name:"Britt",surname:"Nakstad",slug:"britt-nakstad",fullName:"Britt Nakstad"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"7461",title:"Management of Tinnitus",subtitle:"The Enriching Views of Treatment Options",isOpenForSubmission:!1,hash:"9626e5a89247b934de503a3d08752e14",slug:"management-of-tinnitus-the-enriching-views-of-treatment-options",bookSignature:"Tang-Chuan Wang",coverURL:"https://cdn.intechopen.com/books/images_new/7461.jpg",editedByType:"Edited by",editors:[{id:"201262",title:"Dr.",name:"Tang-Chuan",surname:"Wang",slug:"tang-chuan-wang",fullName:"Tang-Chuan Wang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7245",title:"Challenging Issues on Paranasal Sinuses",subtitle:null,isOpenForSubmission:!1,hash:"67a331ebb2dd2b8f73228fa4daa7382f",slug:"challenging-issues-on-paranasal-sinuses",bookSignature:"Tang-Chuan Wang",coverURL:"https://cdn.intechopen.com/books/images_new/7245.jpg",editedByType:"Edited by",editors:[{id:"201262",title:"Dr.",name:"Tang-Chuan",surname:"Wang",slug:"tang-chuan-wang",fullName:"Tang-Chuan Wang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1393",title:"Hearing Loss",subtitle:null,isOpenForSubmission:!1,hash:"2708b72df1b6ff9c1cd1960233e1cdff",slug:"hearing-loss",bookSignature:"Sadaf Naz",coverURL:"https://cdn.intechopen.com/books/images_new/1393.jpg",editedByType:"Edited by",editors:[{id:"88753",title:"Dr.",name:"Sadaf",surname:"Naz",slug:"sadaf-naz",fullName:"Sadaf Naz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4654",title:"Update On Hearing Loss",subtitle:null,isOpenForSubmission:!1,hash:"e873bdf86336e2ebfd21f0d9855fe861",slug:"update-on-hearing-loss",bookSignature:"Fayez Bahmad Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/4654.jpg",editedByType:"Edited by",editors:[{id:"77351",title:"Prof.",name:"Fayez",surname:"Bahmad 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Her laboratory employs morphological, behavioral, and electrophysiological techniques to better understand sensory mechanisms by which larval and adult insects find host plants and detect plant-associated volatiles. Dr. Shields received a BS and Ph.D. from the University of Regina, Regina, Saskatchewan, Canada. A portion of her Ph.D. studies was carried out at the University of Alberta, Edmonton, Alberta, Canada. 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Main research objects of these key issues such as water, polluted air, and mudflow are soft geo-objects. Modeling and 3D visualization of soft geo-objects is emerging research area. In computer graphics, several approaches have been applied for simulation of soft objects, e.g., the particle system approach and the metaball approach [1]. However, the particle system approach and the metaball approach are driven by physical force objects, which are not suitable to simulate geographic process that is driven by more complex geomodeling [2]. Mitasova et al. used densities of particles to sample rainfall excess and sediment transportation of sand and clay. Compared to traditional sampling method, their method showed several advantages [3]. For example, it can be easily extended into arbitrary dimensions, and is fairly straightforward to be implemented in a multiscale framework with data adaptive capabilities. But the method has obvious limitations. Firstly, it cannot accurately represent the dynamic change of sample points’ velocity and direction over space and time because all sample points have the same size. Furthermore, the geographic phenomena of soil separation and fusion during the process of soil erosion have not been represented. Soil erosion is a naturally occurring process in land which refers to wearing away of a field’s top soil by natural forces of water and wind. How the sediment transports, how the soil separates, and how much soil losses, all these are driven by geomodeling.
\nIn GIS existing research studies focus more on rigid objects such as mountains, roads, and buildings, and few methods have been proposed for the modeling and 3D visualization of soft geo-objects. GIS flow elements (FEs) and GIS soft voxels (SVs) were proposed and developed for 3D modeling of soft geo-objects. GIS FEs can realistically represent the dynamics and stochastics of soft geo-objects while GIS SVs can simulate deformation of soft geo-objects.
\nA GIS FE is a basic simulation unit and spatially corresponds to a pixel in remotely sensed imagery. It is characterized by the position (i.e.,
A GIS SV is a basic unit for deformation simulation. Similar to FE, a GIS SV is also based on a pixel from remotely sensed imagery and it also features with position, velocity, and direction, which are controlled by geomodeling. But a GIS SV carries volume information. A SV is covered by an isosurface that can well represent volume shape and surface deformation. A GIS SV has potential to carry more information by adding colors and textures or by modeling its internal structure.
\nHere the basic parameters include direction, velocity, shape, and volume.
\n8-neighborhood tracing algorithm is used to calculate the direction of a FE. Eq. (1) is used to compute the velocity of the FE (
The following section will introduce the application of using GIS FE and GIS SV theories in modeling and 3D simulation of rainfall, overland flow, and soil erosion.
\nThe objective is to simulate raindrops falling from the sky to the ground surface.
\nForce objects on a raindrop include gravity, air buoyancy, air resistance, wind force, and the kinematic equation for a raindrop in vertical direction is [4]:
\nwhere
A schematic view of raindrop dynamic analysis.
In this study raindrop GIS FE representation meets artificial rain experiments criteria [5]:
Raindrop particle size distribution is close to natural rainfall. Natural rainfall raindrop sizes range from near zero to about 7 mm. The median particle size of an erosive rain storm is between 1 and 3 mm. Raindrop diameters normally increase with the increase in rainfall intensity.
Raindrop impact velocity is close to the natural raindrops. Raindrop impact velocity, from droplet velocity near zero to the maximum raindrop velocity of more than 9 m/s. The landing speed of an ordinary raindrop with a diameter of 2 mm is 6–7 m/s.
Rainfall intensity is close to the natural rainfall. Natural rainfall intensity from near zero to a few millimeters per minute. In general, low rainfall intensity is not important to soil erosion, and the frequency of high rainfall intensity is very low, so that the importance is limited. Common rainfall intensity of 0.2–2 mm/min is usually the most important rainfall intensity.
Throughout the study area, raindrop characteristics and strength is fairly uniform.
The rainfall is continuously simulated in the study area.
The impact angle of most raindrops is not too much deviated from the vertical line.
The representation includes geometry representation and dynamic representation.
\nRaindrop is considered to have a shape of a combination of a taper and a semisphere with white color and it is transparent. The initial position,
The development platforms are Visual Studio C++ and OpenGL.
\nCreate raindrops by meeting artificial rain experiment criteria. The raindrop array stores raindrop total number, color, transparency, and coordinates information. 3D coordinates of the start point of rain line are generated with a random function. Coordinates of the end point of the rain line are calculated based on dynamic analysis.
\nCreate raindrops animation by meeting artificial rain experiment criteria as well and the pseudo code is as follows:
\nFor
{
\nTranslate the start and end points of the rain line to a new position along
Add an acceleration increment to the initial velocity of the raindrop
If a rain line touches or penetrates DEM, then
{
The life of the rain line is ended
Reinitialize a new rain line and set the initial velocity
}
}
\nThe objective is to simulate the velocity and direction of overland flow.
\nSaint Venant kinematic equation of unsteady flow of water is used as the governing equation [6]:
\nor it is written as:
\nwhere
A schematic view of flow streamline dynamic analysis.
Overland flow velocity is an equation of discharge per unit width and slope angle [7]:
\nwhere
where
where
Water and sediment discharge computation based on grid DEM is usually determined using single flow path algorithm, i.e., the method of determining the maximum gradient. For a 3 × 3 window, the center cell has eight neighbors. The water and sediment flow direction coding of each cell is based on the digital coding method in Refs. [8, 9]. For example, if the flow direction of water and sediment of a grid unit as the center of the window is due west, i.e., water and sediment in the center of the window flow into the adjacent cell 4, then the flow direction value of the center cell is 4.
\nIn the algorithm, following values are combined for identification of landform structure.
DEM elevation values, stored in the array ALT[i, j].
Flow direction values, stored in the array PTR[i, j].
Flow streamline coordinates, stored in the array FLOWLINE[i, j].
The above arrays have the same size. Each grid unit has a value to identify one of its attributes. In addition, the algorithm uses the following terms:
Outflow point: if water and sediment flows out of a grid unit, then the unit is called an outflow point.
Inflow point: if water and sediment flows into a grid unit, then the unit is called an inflow point.
Flow point: if water and sediment flows from grid cell (i, j) to grid cell (x, y), then (x, y) is a flow point of (i, j).
In fact, in addition to certain points along watershed boundary that only have outflow, other points have both inflow and outflow. Algorithm:
\nIn a 3 × 3 window, gradients from the center cell to its 8-neighborhoods are used to determinate flow directions.
For cells at the edge of DEM or boundary of the study area, the flow direction of each cell is defined as the direction toward the boundary.
For any other grid cell, calculate the cell’s elevation gradients to its eight neighbors. EG0, i = Z0 − Zi (i = 1, 3, 5, or 7) represents the elevation gradient in horizontal or vertical directions, and EG0, i = Z0 − Zi/sqrt(2) (i = 2, 4, 6, or 8) represents the elevation gradient in diagonal directions.
Determinate the neighboring cell which has the maximum elevation gradient.
Identification of isolated depression flow direction. Scan the study area using a 3x3 window, and (i, j) is the center cell of the window. Calculate the eight elevation gradients of (i, j). If the maximum gradient value is less than 0, then identify (i, j) as an isolated depression.
Identification of outflow point flow direction. Scan the study area using a 3×3 window, and (i, j) is the center cell of the window. Calculate the eight elevation gradients of (i, j). If the maximum gradient value is greater than 0, then identify (i, j) as an outflow point.
The representation includes both geometry representation and dynamic representation.
\nFlow is considered to have a fine cylinder shape with Cambridge blue color and it is transparent. The initial position starts from the intersection point between raindrop and collision plane on DEM. Its velocity and direction is determined based on the analysis of dynamics. The lifetime of the flow streamline ends when it runs into a channel.
\nThe objective is to simulate sediment transport and the process of soil erosion by water.
\nDynamic analysis of a sediment particle is shown in Figure 3 [9]. The parameters are W as gravity,
Because spatially varied forces acting on flow streamline and sediment particles are too complicated to be precisely represented, we firstly use an 8-neighborhood tracing algorithm to compute the flow direction on hillslopes, then apply the modeling theory of remote sensing information model combined with experimental results to obtain an equation for flow velocity computation on hillslopes to simulate dynamic sediment laden flow in 3D space.
\nA schematic view of sediment particle dynamic analysis.
We form GIS SVs on a pixel basis and name it erosion voxel to simulate the separation and fusion of soil mass. The erosion voxel combines the attributes not only from geographic pixels, but also from particles and metaballs in computer graphics.
\n(1) The main characteristics of a pixel-based erosion voxel are described as follows:
The appearance of an erosion voxel is designed as a circumscribed ellipsoid of a cuboid. The width and length of the cuboid are equal to cell length, and the height of the cuboid represents the averaged thickness of soil loss per unit duration (which depends on specific time, location, and amount of rainfall);
Represents averaged volume of soil loss per unit duration; therefore, it has statistical meaning;
Represents the highest precision of geographic image data, and includes soil properties, vegetation coverage, slope, elevation (represented by the elevation of center point of top face of its inscribed cuboid) and other information;
Once time reaches the specific step of duration, we separate a specific erosion voxel from a specific pixel, and it will run off with water (i.e., erosion voxel separation);
When the velocity falls to zero, the erosion voxel will subside, and the fusion of erosion voxels will occur;
When the erosion voxel runs into a channel, its lifetime will be ended.
(2) Quantitative expression of an erosion voxel
\nAn erosion voxel is represented by a circumscribed ellipsoid:
\nwhere
where
(3) Elevation
\nReal surface elevation is represented by the elevation of the center point of the upper surface of the inscribed cuboid of the erosion voxel.
\n(4) Transport routes
\nConsidering that an erosion voxel only has statistical meaning, we treat its transport routes the same as sediment laden flow [2].
\n(5) Structure parameters of an erosion voxel
\nInclude center-point coordinates, strength, color, transparency, timer, etc. Other attribute parameters such as soil type, vegetation coverage, and slope angle can be added as needed.
\n(6) Separation and fusion
\nUse the basic methods for rendering GIS SVs [11]. Considering that an erosion voxel only has statistical meaning, force analysis to contact surface and volume control are not performed.
\nThe profile of a GIS SV.
Based on the aforementioned technology, including software module design, algorithm design, and pseudo code description, for the implementation of the new methodology, we develop a Modeling and 3D Simulation System for Water Erosion on Hillslopes (M3DSSWEH). The system includes three modules: module of DB management, module of model computation and verification, and module of 3D simulation. The system has been designed and developed based on the platform of Oracle, Visual C++, and OpenGL. It has a user-friendly interface based on human-machine interactive techniques and the advanced module design makes it flexible and easy for function extension.\n User interface of M3DSSWEH.Figure 5.
User interface (UI)
The system UI consists of menus, toolbars, floating panels, and viewports (Figure 5).\n
GIS simulation module
The module simulates rainfall, overland flow, and soil erosion process:
\nRainfall simulation in this study references standard artificial rain experiments. Set raindrop intensity and raindrop diameter based on rainfall intensity and pixel size to enhance scientific simulation and further facilitate the simulation of raindrops splash effect.
\nOverland flow simulation is based on GIS FE, which is represented by a fine cylinder. The height of the cylinder is in direct proportion to the velocity of overland flow; the inclination of the cylinder represents the direction of the movement; the diameter of the cylinder is in direct proportion to the depth of overland flow; and the depth of cylinder color is related to sediment concentration. The deeper the cylinder color is, the greater sediment concentration it represents.
\nSediment simulation is also based on GIS FE, which is represented by a sphere. The radius of the sphere is in direct proportion to sediment size, and the color of the sphere is related to soil type.
\nThe GIS simulation module of M3DSSWEH.
Soil erosion simulation is based on GIS SV and the rendering of the SVs are using the aforementioned template rendering algorithm (Figure 6).\n
Data source
As an implementation, the data source is from a research area located between 39°43’37”–39°46’28”N, and 111°7’7”–111°9’14”E, with an area of 3.85 km2. It is Wufendigou watershed in Inner Mongolia, belonging to China Loess Plateau region. The watershed is characterized by severe water and soil loss and this research will be applicable to improving the understanding of soil erosion in the China Loess Plateau region.
\nTheory and methodology of GIS FE and GIS SV will be further extended to better serve geoscience in the future.
\nGIS simulation of terrain, light, shadow, rainfall, and overland flow.
GIS simulation of soil erosion.
The system shows rainfall, overland flow, and soil erosion simulation using GIS FEs and GIS SVs, and the results are satisfactory. Compared to traditional GIS models such as TIN, grid, tetrahedral, and octree, it is more convenient, vivid, and efficient to use GIS FE and GIS SV to simulate dynamic soft geo-objects. Combining GIS FE and GIS SV with the traditional GIS models, any geo-object in solid, liquid, or gas phase can be well represented.\n
System prospects
This paper discusses the implementation and computer programming of GIS FE and GIS SV. Based on a case study in the China Loess Plateau region, we used GIS FE and GIS SV to simulate rainfall, overland flow, and soil erosion, respectively. Implementations show that the spatiotemporal changes of sediment-laden flow can be more intuitively and realistically simulated after GIS flow elements and GIS soft voxels technology are integrated into the system.
\nBoth GIS FE and GIS SV are proposed based on a pixel from remotely sensed imagery that facilitates the data acquisition particularly with the significant use of remote sensing technique in geosciences and its integration with GIS. On the other hand, the pixel level data can be directly used in the calculation without further spatial operation so as to ensure the data accuracy. Moreover, both the GIS FE and GIS SV are driven by reliable geoscientific models. Therefore, GIS FE and GIS SV together can be used as basic units for simulating soft geo-objects and have the potential for practical use in other research areas such as flood modeling and simulation.
\nSpecial thanks to Professor Ainai Ma and Professor Shanjun Mao from Peking University, and Professor Hui Lin from the Chinese University of Hong Kong for their help and advice.
\nConsidered the second most commonly performed operation after cesarean section worldwide, hysterectomy may be classified as abdominal (laparotomy, laparoscopy, or robotic assistance) and vaginal (via an incision through the superior part of the vagina).
The most common indications for hysterectomy are benign conditions such as uterine fibroids, endometriosis, genital prolapse, pelvic pain, heavy menstrual bleeding, but the technique is also used for gynecological malignancy (usually ovarian, uterine, or cervical) and risk-reducing surgery (in cases of BRCA 1 or 2 mutations or Lynch syndrome) [1, 2, 3, 4].
Actually, there are three types of hysterectomy—total hysterectomy (the uterus and cervix are removed), subtotal or partial hysterectomy (the uterus is removed, but the cervix is left in place), and total hysterectomy with bilateral salpingo-oophorectomy (uterus, fallopian tubes, ovaries, and cervix are removed) [1, 2, 3, 4]. The term radical hysterectomy (removal of the uterus, cervix, parametrium, vaginal cuff, and fallopian tubes) is used to describe a wide range of procedures universally applicable to cervical cancer. However, the degree of radicality clearly depends on preoperative estimation of tumor location, surgical margins and the risk of occult lymphatic spread. Moreover, the ovaries may or may not be removed according to the patient age [1, 2, 3, 4]. In addition, supracervical hysterectomy is sometimes preferred to diminish the intraoperative complications and surgical times, as well as to limit the possibility of lower urinary tract issues and maintain normal sexual function [1, 2, 3, 4].
The best route for hysterectomy is multifactorial, depending not only on the surgeon’s skills and patient safety (minimally invasive procedures as vaginal, laparoscopic, laparoscopic-assisted, and robotic-assisted hysterectomies) but also on economic reasons [1, 2, 3, 4].
Hemorrhage after hysterectomy is recognized as an occasional life-threatening complication in modern gynecological surgery, assuming appropriate medical and surgical management [2, 3, 4, 5, 6, 7, 8, 9].
Classified as “reactionary” (postoperative bleeding within the first 24 hours following surgery) and secondary (bleeding occurring in the interval 3–22 days after surgery), unexpected hemorrhage may arise regardless of the route or subtype of hysterectomy [5, 6, 9]. Early recognition and prompt intervention (reoperation or arterial embolization) to arrest bleeding are essential strategies for the suitable outcome of the patient [2, 3, 4, 5, 6, 7, 8, 9, 10].
While the role of risk factors for “reactionary” hemorrhage is emerging and critical for a correct assessment of the patient, operative laparoscopy is still ideal to treat hemorrhage after vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and laparotomy being necessary only in selected cases [2, 3, 4, 6, 9].
Secondary hemorrhage presents with varying degrees of severity and tends to be more common after laparoscopic hysterectomy, especially total laparoscopic hysterectomy than after the other hysterectomy approaches [5, 9]. Factors potentially responsible are vaginal vault infection, vault hematoma, a poor surgical technique including excessive thermal injury by electrocoagulation, and early resumption of physical activity, large uterus size, excessive use of an energy source for the uterine artery, and culdotomy [2, 3, 4, 5, 7, 9, 10].
Ultimately, the management of secondary hemorrhage is challenging and involves diverse approaches based on the exact cause of bleeding, comprising vaginal packing with or without vault suturing, laparoscopic coagulation of the uterine artery if the source of bleeding could not be identified vaginally or arterial embolization [6, 9, 10].
Because of elective gynecologic surgery, we encourage selective patients to donate their own blood before surgery [6, 11]. Several definitions are actually used:
autologous blood transfusion, when is done with the patient’s own blood; blood is stored and can be transfused during surgery;
homologous transfusion or transfusion from another woman;
parachute pack or umbrella pack is a useful tool for pelvic bleeding after pelvic exenteration;
peanut dissector; this tool is indicated for blunt pressure dissection of small places;
total blood volume; estimated blood volume of total body weight is 8% or 4.5–5.0 liters in the average women. When intraoperative blood loss exceeds 15% of the blood volume, blood transfusion must be taken into consideration in combating hypovolemic shock. About 15% of an adult blood volume can be calculated by amplification a patient’s weight in kg 10 times. The usual method of performing abdominal hysterectomy involved the use of clamps or forceps on vessels.
The present chapter will give an overview on different aspects of bleeding after hysterectomy such as incidence rate, risk factors, mechanisms, and management techniques aiming to expand our knowledge and skills in recognizing and treating this unexpected potentially serious complication. Furthermore, we intend to offer a guide toward standardizing treatment practice across bleeding issues following hysterectomy considering clear recommendations and algorithms.
Postoperative hemorrhage represents a significant potential complication of contemporary gynecological surgery. Despite normal hemostasis, appropriate/suitable surgical technique and close monitoring, postoperative bleeding may occur, leading to the different clinical and operative scenarios and challenging even the most experienced operative team [2, 3, 4, 9, 11, 12].
Based on their timing to surgery, two main subtypes of postoperative hemorrhage are actually recognized [5, 6, 7, 8, 9]:
Although the incidence of postoperative hemorrhage basically varies according to surgery, the difference between abdominal, laparoscopic, and vaginal hysterectomy remains statistically insignificant [5, 6, 7]. Indeed, some authors postulate that postoperative bleeding occurs more frequently after abdominal and laparoscopic than after vaginal hysterectomy, but overall, the incidence of hemorrhagic events after a hysterectomy varies from 0.2 to 3.1%, irrespective of surgical route [5, 6, 7, 8, 10, 13, 14].
On the other hand, the true frequency of delayed bleeding complications is still unknown, although the consequences can be particularly significant in women undergoing outpatient surgery [5, 6, 7, 8, 10, 13, 14]. Paul et al. reported an overall cumulative incidence of secondary hemorrhage after a total laparoscopic hysterectomy of 1.3% [5]. Although secondary hemorrhage is rare, it is more often reported after total laparoscopic hysterectomy than after other hysterectomy approaches [5, 6, 7, 8, 10, 13, 14].
Table 1 summarizes data on the incidence of postoperative hemorrhage reported by several authors.
Authors | Type of study, no of cases | Incidence postoperative hemorrhage |
---|---|---|
Makinen et al. [15] |
|
|
Wilke et al. [13] |
|
|
Holub and Jabor [7] |
|
|
Erian et al. [6] | 719 patients between November 1990 and March 2007: 476 VH, 243 LH |
|
Paul et al. [5] |
|
|
Incidence of postoperative hemorrhage in gynecological surgery.*
AH, abdominal hysterectomy; LH, laparoscopic hysterectomy; VH, vaginal hysterectomy; L-AVH, laparoscopic-assisted vaginal hysterectomy.
Hemorrhage is responsible for about half of the postoperative complications following gynecological surgery, ranging from persistent venous oozing to massive blood loss from injury to retroperitoneal vessels [5, 6, 7, 12, 13].
Main bleeding sites comprise the anterior abdominal wall (both the suprapubic and the umbilical incision), the vaginal cuff (after laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy), and intraabdominal bleeding. Abdominal wall vessel injury occurs with increasing frequency, as the practice of laparoscopic surgery becomes wider and trocars become sharper [2, 3, 4, 7, 9].
The source of bleeding in secondary hemorrhage can be the uterine vessels or descending cervical/vaginal vessels; occasionally, uterine artery pseudoaneurysm can cause delayed heavy vaginal bleeding after laparoscopic hysterectomy [2, 3, 4, 7, 9]; additionally, the technique of vaginal vault closure may also contribute to the occurrence of secondary hemorrhage [5, 9].
Postoperative hemorrhage can result from failure to control vascular injury during surgery. Accurate clamp placement, gentle handling of tissues, and the accuracy of dissection are all important and contribute to maximum efficiency with minimum blood loss and minimum tissue damage when abdominal hysterectomy is performed [9].
The electrosurgical instrument can be used for a precise incision of the abdominal wall with minimal tissue injury. By holding the electrode close to the tissue or touching the metal clamp and pressing the coagulation button, superficial coagulation can be achieved [2, 3, 4, 9].
Intra- and post-operative bleeding generally develops in younger women or those with a more vascular pelvis who underwent a hysterectomy, especially laparoscopic hysterectomy in the presence of fibroids [6, 16].
Possible rationales for secondary hemorrhage comprise a bleeding vessel missed at the end of the procedure, effects of pneumoperitoneum, Trendelenburg position, low intraoperative pressure, wearing off the effect of vasopressin, subacute infection, postoperative analgesia, as well as bleeding disorders [2, 3, 4, 5, 7, 9].
Other potential factors accounting for delayed postsurgical bleeding are vaginal vault infection, vault hematoma, poor surgical technique with excessive thermal injury by electrocoagulation, and early resumption of physical activity [5, 7, 9]. A large-sized uterus, high vascularity, large-sized vessels, excessive use of an energy source for the uterine artery, and culdotomy also play a role in this hemorrhagic event [5, 7, 9].
Most of the complications during or after hysterectomy are preventable or treatable. Other complications may exist as medical conditions before hysterectomy but are worsened during surgery, especially if not managed as part of holistic woman’s care.
Complications after surgery include [2, 3, 4, 9, 12]:
In Romania, the mortality rate following a hysterectomy is very low.
Contemporary management of surgical interventions includes postoperative bleeding and the possibility of blood transfusion with risks of HIV transmission (in 1.9 million cases), the transmission of hepatitis B (one in every 180.000 cases), or a febrile reaction to transfusion (1% cases) [2]. Most experts recommend acute normovolemic hemodilution and cell salvage in women undergoing hysterectomy section who will not accept blood products.
Hypovolemic shock can occur after major bleeding as a direct result of uncontrolled hemorrhage. Depending on the total blood volume lost, hypovolemic shock may be divided into four classes: I (< 75 mL or 15%), II (750–1500 mL, or 15–30%), III (1500–2000 mL or 30–40%) and IV (>2000 mL or > 40%) [6].
The clinical manifestations of class I hypovolemia are not measurable and compensatory mechanisms restore plasma volume within a day. In class II hypovolemia, tachycardia is the most frequent clinical finding as a result of inadequate circulatory volume. The distinction between class I and II hypovolemic shock is made by recording blood pressure and pulse in the standing, sitting, or reclining position. Postural hypotension is observed as result of cardiac failure. Compensatory mechanisms begin to fail with the class III hypovolemic shock. This results in an increase in the arterial and venous oxygen difference with classic signs including worked tachycardia, tachypnea, oliguria, and cold skin. With the class IV hypovolemic shock, a patient’s survival depends on rapid transfusion of blood and immediate surgical intervention before cardiovascular collapse and death or organ system failure.
After initial resuscitative measures are instituted, it is highly recommended for patients to be carried out in a critical care unit. Use of sympathomimetic agents after sufficient hydration and vasodilator is normally preferred in the management of patients with hemorrhagic shock who have arterial pressure higher than 70 mm Hg.
Once restoration of the intravascular volume has been completed, it is important to reassess the patient’s response to blood transfusion when managing women with severe blood loss, especially in those patients who have pulmonary edema, myocardial infarction, or congestive heart failure [12].
Transfusion for patients with hemoglobin of 8–10 mg/dL is no longer recommended.
When major surgery is anticipated and transfusion is massive, platelets in addition to packed cell transfusion are required. It is recommended that cryoprecipitate be reserved for patients with deficiencies in von Willebrand factor, factor VIII, and fibrinogen factor XIII.
Recognized as an uncommon complication of hysterectomy, postoperative hemorrhage represents a true challenge in routine practice [8]; irrespective of the procedure, a close follow-up of the patient in a high-dependency unit is indicated in order to exclude recurrence of bleeding [6, 7].
The key to successful management is timely intervention meaning prompt diagnosis, urgent resuscitation if necessary and rapid decision for either arterial embolization or reoperation according to the severity of bleeding and the hemodynamic stability of the patient. Both techniques are highly effective to control bleeding; nevertheless, if the patient is hemodynamically unstable or of the interval since surgery is under 24 hours suggesting rapid hemorrhage, the emergency return to the operating theater to arrest the bleeding is preferred [6, 7, 9].
Current options for managing hemorrhage include [6, 7, 9]:
every patient should be carefully monitored postoperatively for signs of bleeding (hypotension, tachycardia, tachypnea, abdominal distension);
ultrasound can confirm intraperitoneal bleeding; more ways to determine intraabdominal hemorrhage include abdominal and pelvic CT scan; a routine coagulation profile should be done immediately for the patient with a rapid pulse, low blood pressure, and/or low urine output. The surgeon must take charge of the problem and execute the technical steps necessary to treat hemorrhagic shock in the operating room. Intraperitoneal bleeding can be hidden by incisional pain and analgesic medications. Despite adequate dissection, a small vessel may bleed or the suture may cut through tissue. Skeletonized vessels and small sutures should be used for significantly reducing the incidence of postoperative hemorrhage. Venous bleeding can be more life-threatening than arterial hemorrhage which can be clearly seen and controlled with fast small sutures or clamps.
the presence of unexpected drop in hematocrit or hemoglobin postoperatively.
A simplified algorithm to describe steps after gynecological surgery and potential post-surgery bleeding is provided in Figure 1.
A simplified algorithm of post-surgery bleeding approach.
A closer look at the holistic management of postoperative blood should also underpin the following [9]:
to assess blood value and coagulation mechanisms;
to identify changes in the coagulation components, and to initiate replacement therapy in order to achieve adequate hemostasis. In assessing the patient’s coagulation status, it is very important to avoid such a situation known as the trauma triad of death consisting of—hypothermia, metabolic acidosis, and coagulopathy. In some patients with benign disease, blood transfusion is rarely indicated. Experience has shown that blood transfusion may be significant in women with malignant disease;
to establish the therapeutic strategy by measuring the level of prothrombin time < 14 sec, activated partial thromboplastin time (aptt) < 40 sec, fibrinogen >100 mg/dL, platelets >80 × 103 mL.
In hemodynamically unstable women (rapid pulse, falling blood pressure, with or without renal impairment) or if the bleeding occurs shortly in post-surgery (the so-called reactionary hemorrhage), it is desirable to return to the operating room [5, 6, 7, 8, 9].
A preoperative abdominal and pelvic ultrasound or CT scan is routinely required to visualize the source of bleeding as being intra- or retro-peritoneal, as well as adequate local examination without or under anesthesia. Moreover, the operative procedure should be mentally revised to identify any potential bleeding issue [9].
Surgical revision for postoperative bleeding may be performed transvaginally, laparoscopically, or both [5, 6, 7, 8, 9, 13, 14].
Postoperative hemorrhage from the vaginal vault recurrently originates from the vaginal artery in the lateral vaginal fornix or from one of its branches, since the lateral vaginal angle which includes the vaginal artery may not be accurately protected or turn into disligated [9, 13, 14]. Excessive vaginal bleeding needs to be objectively measured; since the vagina is a distensible organ, clots obstructing the vaginal introitus may lead to a large amount of blood accumulating and distending the vagina, subsequently covering the true significance of hemorrhage [9, 13, 14]. Vaginal bleeding can be controlled by clamping and ligating the bleeding point as well as by delayed-absorbable transfixion suturing of the vaginal mucosa and paravaginal tissue [9, 13, 14]. If such techniques are not enough or bleeding vessels have retracted, other tactics should be intended [8].
When no noticeable vaginal source, bleeding after abdominal or vaginal hysterectomy is traditionally treated by laparotomy or laparoscopy [7, 9]. While laparotomy is recommended in cases of intraperitoneal bleeding or unsuccessful conservative transvaginal treatment, operative laparoscopy is clearly indicated if the source of bleeding cannot be identified by the means of vaginal examination and/or if an intraabdominal bleeding source is suspected [7, 9, 13].
Post-surgery bleeding requires laparotomy in two situations.
Firstly, if the surgical hemostasis cannot be achieved transvaginally, laparotomy may be necessary [9].
Secondly, if the patient underwent an abdominal hysterectomy, the incision should be reopened, succeeding the following steps (i) clots and blood evacuation from the abdomen and pelvic area; (ii) searching of the potential bleeding sites, commencing with the most expected places; (iii) ligating, suturing, or clipping of the identified bleeding sites; (iv) verifying the ureteral integrity as high risk of ureteral damage during reoperation; and (v) closing second time after a completely dry abdomen and pelvis [9].
The laparoscopic approach to postoperative bleeding following laparoscopic hysterectomy, vaginal hysterectomy, or laparoscopic-assisted vaginal hysterectomy is an attractive alternative to the abdominal surgical approach in the majority of patients [6, 7, 9, 13]. The procedure can be used to adequately evaluate the pelvis and the abdominal wall, which is occasionally the source of hemorrhage after laparoscopic hysterectomy. Moreover, whether the bleeding is from the abdominal wall, the surgical pedicles, or the vaginal cuff, it can be managed laparoscopically [8, 9]. Evidently, hemostasis can be more easily obtained in laparoscopic surgery because of magnification, close inspection, routine use of suction irrigation, and bipolar coagulation [7, 9]. Besides, bipolar coagulation, a Foley catheter introduced in the port-site bleeding, or a collagen-fibrin agent can be used to achieve local hemostasis during laparoscopy [7, 9].
Following laparoscopic irrigation/suction using Ringer’s solution to clear the operative field, a combination of laparoscopic suturing using absorbable suture material and laparoscopic bipolar coagulation is commonly recommended [6, 8, 9]. Also, electrosurgery is effective in controlling bleeding during laparoscopic surgery. Furthermore, different forms of fibrin adhesive are tested in gynecologic open surgery in order to stop oozing hemorrhages after primary hemostatic treatment with a high efficacy rate (98%) [6]. Holub and Kliment reported successful treatment of hemorrhage from damaged tissue near important pelvic structures using the laparoscope to apply collagen fleece combined with fibrin glue [7, 17].
To avoid further risk of injury to the abdominal wall and to improve the recovery time from surgery,
Conversely, if the patient is reasonably stable and there is not abrupt early bleeding (based on the volume of blood in the abdomen or retroperitoneal space as estimated by ultrasound and the time from surgery), it seems realistic to try to identify the bleeding artery and embolize it by transcatheter interventional radiological techniques [2, 3, 4, 9, 10].
Arterial embolization remains an important minimally invasive option for the management of delayed postoperative hemorrhage [2, 3, 4, 8, 9, 18]. Transcatheter arterial embolization has been shown to be an effective tool for the management of postoperative hemorrhage after gynecologic laparoscopy, but also after abdominal and vaginal hysterectomy [8, 9]. Selective angiographic arterial embolization is a quite simple and safe procedure with a clinical success rate up to 90% in routine practice and usually a low complication rate less than 10%, including a mild postembolization syndrome with pain, fever, high leucocyte count related to vascular thrombosis and tissue necrosis [8, 9]. Bladder necrosis, vesicovaginal fistula, neuropathies as well as renal toxicity are uncommon, isolated side effects [9].
Arterial embolization technique comprises the following main steps—(i) identification of the site of bleeding by angiofluoroscopy if more than 2–3 mL/min bleeding rate; (ii) percutaneous catheterization of the femoral artery or, uncommonly, brachial artery under local anesthesia with retrograde direct access to the hypogastric artery; (iii) canulation of the hypogastric artery or specific collateral vessel if appropriate; (iv) injection of the embolization material under angiographic observation (metal coins, autologous clot, small pieces of gelfoam, small silastic spheres, subcutaneous tissue, or other hemostatic materials; (v) repeat angiography to demonstrate the occlusion of the bleeding vessel; (vi) remove of the catheter followed by careful monitoring for further bleeding [8, 9, 10].
Although second surgery is often the initial choice for postoperative hemorrhage, for a patient who is hemodynamically stable but is experiencing postoperative hemorrhage, transcatheter arterial embolization is a welcome alternative to a second surgery [8, 9]. However, if rapid access to interventional radiology is not available or if transcatheter arterial embolization is unsuccessful, laparoscopy can still be considered [8, 9]. Besides, a potential advantage of surgical management of postoperative hemorrhage over transcatheter arterial embolization is the ability to evacuate the hemoperitoneum, which may decrease postoperative pain, the risk of infection, and the risk of ileus [8, 9].
It is typical to expect some bleeding after hysterectomy in the 6–8 weeks following the procedure; the discharge may be red, brown, or pink. Bleeding should steadily decrease in the days and weeks following the surgery and should never be excessive at any point of recovery [18]. The exception is menstruation in women who have undergone a subtotal hysterectomy [18, 19]. In case of bleeding after hysterectomy, it is more likely to be of some pathologic cause instead of menstruation which needs to be ruled out [19].
However, a sudden and significant increase in bleeding during recovery should be considered abnormal. Points of concern comprise but are not limited to—bright red vaginal bleeding (indicating active bleed), temperature over 100.4°F, severe nausea or vomiting, increasing pelvic pain, a local complication such as redness, swelling, or drainage at the incision site as well as difficulty in urinating or pain with urination suggesting either an infection or a neurogenic bladder [18].
Delayed vaginal hemorrhage after laparoscopic supracervical hysterectomy usually requires emergent reoperation. Several studies have described continued cyclical bleeding from the cervical stump after supracervical hysterectomy in 0–25% of cases [20].
Effective interventions addressing hemorrhage after hysterectomy are needed to reduce women’s mortality worldwide.
Prior to hysterectomy, these women should be offered specific counseling and have a prospective plan for the management of their disease, developed by gynecologists of how their condition and hysterectomy interact. Prehysterectomy counseling services starting for all women planning this surgical intervention are a key part of hospital services and should be an integral part of the local health services network. They could be provided by general practitioners or specialist clinicians or surgeons, all of whom should be suitably trained or may require different management or specialized services before hysterectomy. There are special circumstances as congenital or acquired coagulation disorders that should be considered to evaluate by a thorough history and lab tests.
Professional interpretation services for women who do not speak English.
It is not clear how much the specific medical terminology is conveyed to the patient. Healthcare providers have to invest in technology, security, specialists, and translators to ensure healthcare becomes world-class. Medical tourism is growing each year. Romania provides the highest quality healthcare at the lowest price. Also, the cost of hysterectomy in Romania is lower than the same treatment in UK or UE. In developed countries as the USA, UE countries or Canada patients have to wait a long time for major surgeries. The cost involved in treating a patient depends upon factors like—type of hysterectomy needed, hospital and physician selected for it, and duration of staying.
Communication and referrals among professionals.
Good communication among professionals is essential. Referral between specialties involved should be rapid. They can use a variety of communication methods including—mobile phone, email, fax, Whatsapp, Instagram, Tik Tok, Facebook, etc. In many cases, junior trainees in the front line did not have proper support and need to have clear guidelines about when to seek senior help.
Women with serious medical conditions
They require immediate and appropriate multidisciplinary specialist care; women will require referral to tertiary or specialist medical centers for their preexisting medical or mental conditions before hysterectomy. Conditions that require prehysterectomy counseling and advice include—epilepsy, diabetes, asthma, congenital or known acquired cardiac disease, autoimmune disorders, renal and liver disease, obesity (BMI > 30), severe mental illness, or psychiatric conditions that require a change of medication, HIV infection. Women with potential serious underlying preexisting medical on mental health conditions should be immediately referred to appropriate specialist centers of expertise as soon as their symptoms develop.
Clinical training
All clinical staff must undertake regular training for the identification and management of serious disease conditions or potential emergencies or signs and symptoms of potentially life-threatening conditions, circulatory failure, severe hypertension or major hemorrhage, pyrexia >38°C, tachycardia >100 bpm, breathlessness. The local clinicians may be excellent at the management of severely ill women but must also accept written, documented, and audited courses. There should be a well-trained team of doctors for recording and charting investigations performed, obtaining quick results, ensuring that abnormal results are followed up promptly and have resulted in a better outcome.
Identifying and managing very sick women with critical illness before, during or after hysterectomy
In very acute situations, a team approach can be very healthful. The management of patients with an acute severe illness with circulatory failure, arterial hypertension, and major hemorrhage requires a team approach and help from the anesthetic and critical care services. There are some healthcare professionals who failed to manage crisis situations outside their immediate area of expertise; therefore, it is crucial to recognize their limitations and to know when and whom to call for another opinion once the patient was admitted to the hospital.
Coagulation factors, hematocrit, serum calcium, glucose, and electrolytes could be assessed every 120 minutes or after 10 U of transfusion; these lab tests are very helpful for the diagnosis of postoperative bleeding.
RCOG guidelines of the responsibilities of the consultant on call should be followed.
Bilateral hypogastric artery ligation can reduce blood loss to a minimum during hysterectomy [9].
Hypotensive anesthesia is also a safe and effective technique in reducing the circulation to the operative field [9].
Serious incident and women death reporting
Health professionals, senior or junior, must recognize an act on the signs and symptoms of potentially life-threatening conditions.
The evaluation of such a report must include clinicians from relevant disciplines (including anesthetics) who were not involved with the deaths. This report is recommended to be a requirement in the future.
The identification and act on women’s death should be reviewed as a serious incident and disseminated to all health professionals, junior or senior. Women’s deaths are generally underreported because of incorrect classification of cause.
Fatal hemorrhage can result from laceration of the external iliac vein or the hypogastric vein where they join together which are at risk of injury when the surgeon dissects between the distal common iliac artery, the psoas muscle, and the area of lumbosacral nerve trunks [9]. These vessels cannot be clamped and ligated with clips or sutures [9].
Dissection around the aorta and vena cava done with inadequate exposure performed in order to remove lymph nodes around them can result in serious hemorrhage. Bleeding usually can be avoided by placing a finger over the laceration and a vascular needle is used to close the laceration from side to side. The same technique may be used for common and external iliac veins [9].
Also, bleeding can occur by dissecting pararectal space and presacral space as well as obturator fossa [9].
Pathology
Patient death autopsy must be improved and require more expertise.
In Romania, the number of women death after hysterectomy (death rate) is very small and many of the autopsies reviewed were considered adequate. When an autopsy is needed, the body can be taken to another area for more expert examination. Despite evaluation by many examiners in the different specialties, the final diagnosis could not be resolved because of inadequate clinical data, poor autopsy quality, or the unmanageable nature of some death.
The lack of routine observation in the postoperative period or a failure to appreciate blood loss or recognition of abnormal vital signs such as oxygen saturation and respiratory rate can lead to death after hysterectomy. The patient should be evaluated before hysterectomy for risk factors and the medical conditions of the women should be diagnosed by a careful history and lab tests in order to decrease the possibility of hemorrhage.
The risks of blood transfusion, the transmission of HIV or hepatitis B should be discussed before surgical procedure.
The peace of surgical intervention should be governed by good exposure of the tissue, accuracy of dissection, and clamping or suturing the vessels in a precise manner. The skills and experiences of the surgeon without wasting time with unnecessary hesitation or indecision will reduce the risk of uncontrolled hemorrhage after a hysterectomy.
The surgeon should control the life-threatening hemorrhage by judgment, knowledge, and technical skills. The patient’s medical history for vital signs, blood loss volume, and levels of coagulation factors will determine how quickly blood transfusion is initiated. Careful postoperative clinical evaluation of the patient by the surgeon and surgical team with abdominal or pelvic ultrasound or CT scanning will help to prevent or minimize significant blood loss after hysterectomy and localize the site of bleeding.
No funding was received for this chapter.
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\r\n\r\nFor a quote or assistance please contact us directly at orders@intechopen.com The quote will be sent to you within 1-2 business days.
\r\n\r\nOur entire portfolio of over 5,500 books is also available through Amazon.
',metaTitle:"Order and delivery",metaDescription:"Our books are published online and are accessible for free. However, if you are interested in ordering your hardcover copy, you can do so by contacting our Print Sales Department at orders@intechopen.com. All IntechOpen books are printed on demand in full-colour and delivered in signature packaging through free DHL Express delivery. A selection of our books in soft cover is also available through Amazon.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
\\n\\nIntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\\n\\nIntechOpen books retail price range is:
\\n\\n100 - 159 GBP ex. VAT (available in USD and EUR)
\\n\\nDiscounts available:
\\n\\nBulk discounts are granted for orders of 10 copies and more.
\\n\\nThere is no minimum or maximum threshold on the quantity of book orders.
\\n\\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\\n\\nWe currently accept the following payment options:
\\n\\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\\n\\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\\n\\nIn accordance with the best security practice, we do not accept card orders via email.
\\n\\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\\n\\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\\n\\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\\n\\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\\n\\nP.O. Boxes cannot be used as a Ship-To Address.
\\n\\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\\n\\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\\n\\nRestricted Ship-to Countries:
\\n\\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\\n\\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\\n\\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\\n\\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\\n\\nBooks International
\\n\\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
\\n\\nChina Publishers Services Ltd - CPS
\\n\\nRepresentative for: China, Taiwan, Hong Kong
\\n\\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\\n\\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\\n\\nLSR Libros Servicios y Representaciones S.A. de C.V
\\n\\nRepresentative for Mexico, Chile and Colombia
\\n\\nMissing Link Versandbuchhandlung eG
\\n\\nRepresentative for: Germany, Austria, Switzerland
\\n\\nKuba Libri, s.r.o.
\\n\\nRepresentative for: Czech Republic
\\n\\nFor partnership opportunities, please contact orders@intechopen.com.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
\n\nIntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\n\nIntechOpen books retail price range is:
\n\n100 - 159 GBP ex. VAT (available in USD and EUR)
\n\nDiscounts available:
\n\nBulk discounts are granted for orders of 10 copies and more.
\n\nThere is no minimum or maximum threshold on the quantity of book orders.
\n\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\n\nWe currently accept the following payment options:
\n\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\n\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\n\nIn accordance with the best security practice, we do not accept card orders via email.
\n\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\n\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\n\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\n\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\n\nP.O. Boxes cannot be used as a Ship-To Address.
\n\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\n\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\n\nRestricted Ship-to Countries:
\n\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\n\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\n\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\n\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\n\nBooks International
\n\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
\n\nChina Publishers Services Ltd - CPS
\n\nRepresentative for: China, Taiwan, Hong Kong
\n\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\n\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\n\nLSR Libros Servicios y Representaciones S.A. de C.V
\n\nRepresentative for Mexico, Chile and Colombia
\n\nMissing Link Versandbuchhandlung eG
\n\nRepresentative for: Germany, Austria, Switzerland
\n\nKuba Libri, s.r.o.
\n\nRepresentative for: Czech Republic
\n\nFor partnership opportunities, please contact orders@intechopen.com.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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However, the goal of reaching so-called “breakeven” energy conditions, whereby the energy produced from a fusion reaction is greater than the energy put in, is yet to be demonstrated. It is the role of ITER, an international collaborative experimental reactor, to achieve breakeven conditions and to demonstrate technologies that will allow fusion to be realized as a viable energy source. However, with significant delays and cost overruns to ITER, there has been increased interest in the development of other fusion reactor concepts, particularly by private-sector start-ups, all of which are exploring the possibility of an accelerated route to fusion. This chapter gives a comprehensive overview of nuclear fusion science, and provides an account of current approaches and their progress towards the realization of future fusion energy power plants. The range of technical issues, associated technology development challenges and future commercial opportunities are explored, with a focus on magnetic confinement approaches.",book:{id:"6838",slug:"power-plants-in-the-industry",title:"Power Plants in the Industry",fullTitle:"Power Plants in the Industry"},signatures:"Shutaro Takeda and Richard Pearson",authors:[{id:"251254",title:"Prof.",name:"Shutaro",middleName:null,surname:"Takeda",slug:"shutaro-takeda",fullName:"Shutaro Takeda"},{id:"262366",title:"Mr.",name:"Richard",middleName:null,surname:"Pearson",slug:"richard-pearson",fullName:"Richard Pearson"}]},{id:"71264",doi:"10.5772/intechopen.90939",title:"Fast-Spectrum Fluoride Molten Salt Reactor (FFMSR) with Ultimately Reduced Radiotoxicity of Nuclear Wastes",slug:"fast-spectrum-fluoride-molten-salt-reactor-ffmsr-with-ultimately-reduced-radiotoxicity-of-nuclear-wa",totalDownloads:939,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"A mixture of NaF-KF-UF4 eutectic and NaF-KF-TRUF3 eutectic containing heavy elements as much as 2.8 g/cc makes a fast-spectrum molten salt reactor based upon the U-Pu cycle available without a blanket. It does not object breeding but a stable operation without fissile makeup under practical contingencies. It is highly integrated with online dry chemical processes based on “selective oxide precipitation” to create a U-Pu cycle to provide as low as 0.01% leakage of TRU and nominated as the FFMSR. This certifies that the radiotoxicity of HLW for 1500 effective full power days (EFPD) operation can be equivalent to 405 tons of depleted uranium after 500 years cooling without Partition and Transmutation (P&T). A certain amount of U-TRU mixture recovered from LWR spent fuel is loaded after the initial criticality until U-Pu equilibrium but the fixed amount of 238U only thereafter. The TRU inventory in an FFMSR stays at an equilibrium perpetually. Accumulation of spent fuel of an LWR for 55 years should afford to start up the identical thermal capacity of FFMSR and to keep operation hypothetically until running out of 238U. Full deployment of the FFMSR should make the entire fuel cycle infrastructures needless except the HLW disposal site.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Yasuo Hirose",authors:[{id:"315264",title:"Dr.",name:"Yasuo",middleName:null,surname:"Hirose",slug:"yasuo-hirose",fullName:"Yasuo Hirose"}]},{id:"72177",doi:"10.5772/intechopen.92547",title:"Nuclear Power Plant or Solar Power Plant",slug:"nuclear-power-plant-or-solar-power-plant",totalDownloads:670,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Both solar energy and nuclear energy face significant economic challenges. Sustainable energy costs have traditionally been greater than any of those associated with the growth of fossil fuel power generation, although the costs of renewable energy technologies (especially photovoltaic) have dropped. Furthermore, capital costs remain a big challenge in the nuclear generation. In many nations, the cost of building small nuclear power plants is quite large due to time, technology, and environmental and safety challenges for consumers. Such problems might not be as big for state-owned corporations or controlled industries for which utilities have quick access to cheap resources, and this partially explains why the interest for nuclear reactors in Asia is far greater than in the United States or Europe. Learning could help decrease costs for both types of technologies, but the track record for learning-by-doing in the nuclear sector is not good.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Mostafa Esmaeili Shayan and Farzaneh Ghasemzadeh",authors:[{id:"317852",title:"Ph.D.",name:"Mostafa",middleName:null,surname:"Esmaeili Shayan",slug:"mostafa-esmaeili-shayan",fullName:"Mostafa Esmaeili Shayan"},{id:"319145",title:"Prof.",name:"Farzaneh",middleName:null,surname:"Ghasemzadeh",slug:"farzaneh-ghasemzadeh",fullName:"Farzaneh Ghasemzadeh"}]},{id:"54655",doi:"10.5772/67858",title:"Key Technical Performance Indicators for Power Plants",slug:"key-technical-performance-indicators-for-power-plants",totalDownloads:3322,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"In this chapter, we will underline the importance of the key performance indicators (KPIs) computation for power plants’ management. The main scope of the KPIs is to continuously monitor and improve the business and technological processes. Such indicators show the efficiency of a process or a system in relation with norms, targets or plans. They usually provide investors and stakeholders a better image regarding location, equipment technology, layout and design, solar and wind exposure in case of renewable energy sources and maintenance strategies. We will present the most important KPIs such as energy performance index, compensated performance ratio, power performance index, yield, and performance, and we will compare these KPIs in terms of relevance and propose a set of new KPIs relevant for maintenance activities. We will also present a case study of a business intelligence (BI) dashboard developed for renewable power plant operation in order to analyze the KPIs. The BI solution contains a data level for data management, an analytical model with KPI framework and forecasting methods based on artificial neural networks (ANN) for estimating the generated energy from renewable energy sources and an interactive dashboard for advanced analytics and decision support.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Simona Vasilica Oprea and Adela Bâra",authors:[{id:"139804",title:"Prof.",name:"Adela",middleName:null,surname:"Bara",slug:"adela-bara",fullName:"Adela Bara"},{id:"188586",title:"Dr.",name:"Simona Vasilica",middleName:null,surname:"Oprea",slug:"simona-vasilica-oprea",fullName:"Simona Vasilica Oprea"}]},{id:"55841",doi:"10.5772/intechopen.68772",title:"Risk Assessment of NPP Safety in Case of Emergency Situations on Technology",slug:"risk-assessment-of-npp-safety-in-case-of-emergency-situations-on-technology",totalDownloads:1339,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"The last accidents of the nuclear power plant (NPP) in Chernobyl and Fukushima give us the new inspiration to verify the safety level of the NPP structures. This paper presents the new requirements to test the safety and reliability of the NPP structures due to the recent accidents in the world. The IAEA in Vienna required in the document ‘Stress tests’ the verification of the safety of the NPP structures under impact of the extreme loads as the earthquakes, the extreme climatic actions and the technology accidents. The new recommendations to load combinations and design criteria were defined. The risk assessment to verify the safety and reliability of the NPP structures based on probabilistic and nonlinear analysis is presented. The uncertainties of material model (behaviour of the reinforcement and liner, concrete cracking and crushing), degradation effects, the loads level (dead and live loads, extreme climatic and accidental temperature and overpressure) as well as other effects following from the inaccuracy of the calculated model and numerical methods were taken into account in the response surface method (RSM) method. The results of the deterministic and probabilistic analysis of the NPP structures are presented.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Juraj Králik",authors:[{id:"139600",title:"Prof.",name:"Juraj",middleName:null,surname:"Králik",slug:"juraj-kralik",fullName:"Juraj Králik"}]}],mostDownloadedChaptersLast30Days:[{id:"54655",title:"Key Technical Performance Indicators for Power Plants",slug:"key-technical-performance-indicators-for-power-plants",totalDownloads:3324,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"In this chapter, we will underline the importance of the key performance indicators (KPIs) computation for power plants’ management. The main scope of the KPIs is to continuously monitor and improve the business and technological processes. Such indicators show the efficiency of a process or a system in relation with norms, targets or plans. They usually provide investors and stakeholders a better image regarding location, equipment technology, layout and design, solar and wind exposure in case of renewable energy sources and maintenance strategies. We will present the most important KPIs such as energy performance index, compensated performance ratio, power performance index, yield, and performance, and we will compare these KPIs in terms of relevance and propose a set of new KPIs relevant for maintenance activities. We will also present a case study of a business intelligence (BI) dashboard developed for renewable power plant operation in order to analyze the KPIs. The BI solution contains a data level for data management, an analytical model with KPI framework and forecasting methods based on artificial neural networks (ANN) for estimating the generated energy from renewable energy sources and an interactive dashboard for advanced analytics and decision support.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Simona Vasilica Oprea and Adela Bâra",authors:[{id:"139804",title:"Prof.",name:"Adela",middleName:null,surname:"Bara",slug:"adela-bara",fullName:"Adela Bara"},{id:"188586",title:"Dr.",name:"Simona Vasilica",middleName:null,surname:"Oprea",slug:"simona-vasilica-oprea",fullName:"Simona Vasilica Oprea"}]},{id:"55019",title:"Spatial Aspects of Environmental Impact of Power Plants",slug:"spatial-aspects-of-environmental-impact-of-power-plants",totalDownloads:1313,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Strategic Environmental Assessment (SEA) is one of the key instruments for implementing sustainable development strategies in planning in general, namely for analysing and assessing the spatial development concepts, in this case in the field of energy and planning of power plants. The SEA in energy sector planning has become a tool for considering the benefits and consequences of the proposed changes in space, also taking into account the capacity of space to sustain the implementation of the planned activities. This chapter examines the multi-criteria evaluation (MCE) method for carrying out an SEA for the power plants in Energy Sector Development Strategy of the Republic of Serbia (case study). The MCE method has found its use in the analysis and assessment of the energy sector spatial impacts on the environment and elements of sustainable development and, in this context, also considering the importance of impacts, spatial dispersion of impacts, their probability and frequency of occurrence, along with the elaboration of the obtained results in a specific, simple and unambiguous way. The chapter focuses on the consideration of aspects of environmental impact of all kinds of power plants, without taking into account the details regarding other aspects of energy sector development that are dealt with in the case study.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Boško Josimović and Saša Milijić",authors:[{id:"125578",title:"Dr.",name:"Bosko",middleName:null,surname:"Josimovic",slug:"bosko-josimovic",fullName:"Bosko Josimovic"},{id:"200736",title:"Dr.",name:"Sasa",middleName:null,surname:"Milijic",slug:"sasa-milijic",fullName:"Sasa Milijic"}]},{id:"64317",title:"Hybrid Power Plants: A Case Study",slug:"hybrid-power-plants-a-case-study",totalDownloads:1142,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Energy can be treated as an essential element for the development of society. Therefore, aspects like process’ efficiency and environmental impacts must be considered when choosing the supply source. In Brazil, an event showed the fragility of a system that relies on in only one source to attend their necessities; a truckers strike made the whole country stop. The energy sector has a similar situation; more than 60% of Brazilian energetic matrix is represented by one source, hydroelectric power plants. The availability of solar radiation and wind in Brazil makes it possible to diversify its energetic matrix. Thus, the aim of this study is investigating the potential of hybrid solar-wind power plants in two basins of Minas Gerais—Brazil, São Francisco Basin and Jequitinhonha Basin, as well as compare their viabilities in order to address social issues. By analyzing INMET database and economic factors, the study has shown that it is feasible to implement renewable power plants in the basins of the study area, whether individually (solar or wind energy) or hybrid system. It shows in addition that hybrid system should be prioritized, since it presents lower cost, when compared to solar power plant, and more reliability due to seasonality of both sources.",book:{id:"6838",slug:"power-plants-in-the-industry",title:"Power Plants in the Industry",fullTitle:"Power Plants in the Industry"},signatures:"Eduarda Moreira Nascimento, Júnio de Souza Damasceno and\nSabrinne Kelly Souza",authors:[{id:"252477",title:"Dr.",name:"Junio",middleName:null,surname:"Damasceno",slug:"junio-damasceno",fullName:"Junio Damasceno"},{id:"262354",title:"Ms.",name:"Sabrinne",middleName:"Kelly",surname:"Souza",slug:"sabrinne-souza",fullName:"Sabrinne Souza"},{id:"262363",title:"BSc.",name:"Eduarda",middleName:null,surname:"Nascimento",slug:"eduarda-nascimento",fullName:"Eduarda Nascimento"}]},{id:"58753",title:"Detection of Malfunctions and Abnormal Working Conditions of a Coal Mill",slug:"detection-of-malfunctions-and-abnormal-working-conditions-of-a-coal-mill",totalDownloads:1140,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Coal mill malfunctions are some of the most common causes of failing to keep the power plant crucial operating parameters or even unplanned power plant shutdowns. Therefore, an algorithm has been developed that enable online detection of abnormal conditions and malfunctions of an operating mill. Based on calculated diagnostic signals and defined thresholds, this algorithm informs about abnormal operating conditions. Diagnostic signals represent the difference between the measured and the modeled values of two selected mill operating parameters. Models of mill motor current and outlet temperature of pulverized fuel were developed based on the linear regression theory. Various data analysis and feature selection procedures have been performed to obtain the best possible model. The model based on linear regression has been compared with two alternative models. The algorithm validation was carried out based on historical data containing values of operating parameters from 10 months of mill operation. Historical data were downloaded from distributed control system (DCS) of a 200-MW coal-fired power plant. Tests carried out on historical data show that this algorithm can be successfully used to detect certain abnormal conditions and malfunctions of the operating mill, such as feeder blockage, lack of coal and mill overload.",book:{id:"6332",slug:"thermal-power-plants-new-trends-and-recent-developments",title:"Thermal Power Plants",fullTitle:"Thermal Power Plants - New Trends and Recent Developments"},signatures:"Teresa Kurek, Konrad Wojdan, Daniel Nabagło and Konrad Świrski",authors:[{id:"179942",title:"MSc.",name:"Daniel",middleName:null,surname:"Nabagło",slug:"daniel-nabaglo",fullName:"Daniel Nabagło"},{id:"212957",title:"Dr.",name:"Teresa",middleName:null,surname:"Kurek",slug:"teresa-kurek",fullName:"Teresa Kurek"},{id:"212961",title:"Dr.",name:"Konrad",middleName:null,surname:"Wojdan",slug:"konrad-wojdan",fullName:"Konrad Wojdan"},{id:"212962",title:"Prof.",name:"Konrad",middleName:null,surname:"Świrski",slug:"konrad-swirski",fullName:"Konrad Świrski"},{id:"212963",title:"MSc.",name:"Łukasz",middleName:null,surname:"Śladewski",slug:"lukasz-sladewski",fullName:"Łukasz Śladewski"}]},{id:"72177",title:"Nuclear Power Plant or Solar Power Plant",slug:"nuclear-power-plant-or-solar-power-plant",totalDownloads:671,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Both solar energy and nuclear energy face significant economic challenges. Sustainable energy costs have traditionally been greater than any of those associated with the growth of fossil fuel power generation, although the costs of renewable energy technologies (especially photovoltaic) have dropped. Furthermore, capital costs remain a big challenge in the nuclear generation. In many nations, the cost of building small nuclear power plants is quite large due to time, technology, and environmental and safety challenges for consumers. Such problems might not be as big for state-owned corporations or controlled industries for which utilities have quick access to cheap resources, and this partially explains why the interest for nuclear reactors in Asia is far greater than in the United States or Europe. Learning could help decrease costs for both types of technologies, but the track record for learning-by-doing in the nuclear sector is not good.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Mostafa Esmaeili Shayan and Farzaneh Ghasemzadeh",authors:[{id:"317852",title:"Ph.D.",name:"Mostafa",middleName:null,surname:"Esmaeili Shayan",slug:"mostafa-esmaeili-shayan",fullName:"Mostafa Esmaeili Shayan"},{id:"319145",title:"Prof.",name:"Farzaneh",middleName:null,surname:"Ghasemzadeh",slug:"farzaneh-ghasemzadeh",fullName:"Farzaneh Ghasemzadeh"}]}],onlineFirstChaptersFilter:{topicId:"803",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,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:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. 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. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 29th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:32,editor:{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. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. 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,annualVolume:11410,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,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,annualVolume:11413,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,annualVolume:11414,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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