Indications of types of sutures and time for stitch removal
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\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:"5703",leadTitle:null,fullTitle:"Electrical Resistivity and Conductivity",title:"Electrical Resistivity and Conductivity",subtitle:null,reviewType:"peer-reviewed",abstract:'Motivated by the importance of electrical resistivity and conductivity, important experts in this field grasp most recent researches in this book. It addresses recent advances in electrical resistivity and conductivity modelling, measurement, estimation and sensing methods and implications. This book introduces innovative case studies for "Electrical Resistivity Sensing Methods and Implications", "Resistivity Model of Frozen Soil and High-Density Resistivity Method for Exploration of Discontinuous Permafrost", "Measurement of Electrical Resistivity for Unconventional Structures", "Estimation of Hydrological Parameters from Geoelectric Measurements" and "Assessment of Cryoprotectant Concentration by Electrical Conductivity Measurement and Its Applications in Cryopreservation". These recent advances are well prepared and presented in six chapters. These chapters are carefully selected to reflect current variable techniques, new concepts and methods related to the book\'s topic from different perspectives.',isbn:"978-953-51-3186-1",printIsbn:"978-953-51-3185-4",pdfIsbn:"978-953-51-4815-9",doi:"10.5772/65130",price:119,priceEur:129,priceUsd:155,slug:"electrical-resistivity-and-conductivity",numberOfPages:124,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"1610778635f74a85054885a032a5554a",bookSignature:"Adel El Shahat",publishedDate:"May 31st 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5703.jpg",numberOfDownloads:9923,numberOfWosCitations:16,numberOfCrossrefCitations:9,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:21,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:46,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 29th 2016",dateEndSecondStepPublish:"September 19th 2016",dateEndThirdStepPublish:"December 16th 2016",dateEndFourthStepPublish:"March 16th 2017",dateEndFifthStepPublish:"May 15th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"193331",title:"Dr.",name:"Adel",middleName:null,surname:"El-Shahat",slug:"adel-el-shahat",fullName:"Adel El-Shahat",profilePictureURL:"https://mts.intechopen.com/storage/users/193331/images/system/193331.jpg",biography:"Dr. Adel El-Shahat received a B.Sc. in Electrical Engineering from Zagazig University, Egypt, in 1999. the M.Sc. in Electrical Engineering (Power and Machines) from Zagazig University, Egypt, in 2004, and the Ph.D. degree (Joint Supervision) from Zagazig University, Egypt, and The Ohio State University (OSU), Columbus, OH, USA, in 2011. He is currently an Assistant Professor - Energy Technology, School of Engineering Technology at Purdue University, USA. He is the Founder and Director of Advanced Power Units and Renewable Distributed Energy Lab (A_PURDUE). His research focuses on Modeling, Design, Multi-Objectives Optimization, Simulation, Analysis, and Control of various aspects such as Smart Nano & Micro- Grids; Electric Mobility & Transportation Electrification, Renewable Energy Systems; Wireless Charging of Electric Vehicles; Electric Vehicles; Special Purposes Electric Machines; Deep Learning Techniques; Distributed Generation Systems; Thermoelectric Generation; Special Power Electronics Converters; Power Systems; Energy Storage & Conservation; and Engineering Education. So far, He has 9 books, 5 chapters in books, 63 journal papers, 73 conference papers, and 106 other publications with his collaborators, and students related to his research interests. He has more than 20 years of working experience in academia and industry. He has experience in funding grant proposals, and He got some awards and recognitions due to his research work. He has good experience directing research for both graduate and undergraduate students for funded projects. He holds full-time academic positions at Purdue University, Georgia Southern University, the University of Illinois at Chicago, Ohio State University, USA, and Suez University, Egypt, along with some full-time and part-time positions in Egyptian companies as an electrical engineer, and consultant as a professional engineer. Additionally, He has distinguished professional training, and He is a Senior Member in the IEEE and IRED institutions along with 21 professional memberships in other societies. Finally, He served as a book editor for 4 books, and a reviewer for 8 books. He is a guest editor and editor-in-chief for three international journals. Also, He is a reviewer for other 35 international journals. Moreover, He served as invited conference sessions chair and reviewer for 31 international conferences along with other community and academic services.",institutionString:"Purdue University West Lafayette",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Purdue University West Lafayette",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"756",title:"Power Electronics",slug:"power-electronics"}],chapters:[{id:"55295",title:"Introductory Chapter: Recent Advances",doi:"10.5772/intechopen.69046",slug:"introductory-chapter-recent-advances",totalDownloads:1310,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Adel El-Shahat",downloadPdfUrl:"/chapter/pdf-download/55295",previewPdfUrl:"/chapter/pdf-preview/55295",authors:[{id:"193331",title:"Dr.",name:"Adel",surname:"El-Shahat",slug:"adel-el-shahat",fullName:"Adel El-Shahat"}],corrections:null},{id:"54410",title:"Electrical Resistivity Sensing Methods and Implications",doi:"10.5772/67748",slug:"electrical-resistivity-sensing-methods-and-implications",totalDownloads:1706,totalCrossrefCites:5,totalDimensionsCites:12,hasAltmetrics:1,abstract:"This chapter discusses and explains the basic operating principles of various measuring methods of resistivity for materials in both liquid and solid phase. It provides explanations for two-, three-, and four-pole as well as toroidal resistivity cells. The van der Pauw technique is explored as a step-by-step procedure to estimate the resistivity of a material with no arbitrary shape. The special case of sheet material resistivity and resistance is explained in more detail, and equation for that special problem is simplified. It further provides information on common experimental errors and a short guideline to improve the reliability and accuracy of the measurements. The implications and challenges faced during resistivity measurements are explored and explained with ways to compensate for errors due to temperature and capacitance changes. In addition, the way to experimentally determine the cell constant of a cell is described and the necessity for calibration is clearly explained. It further provides information to overcome the standard problem of polarisation when the resistivity of solutions with high ionic content is investigated.",signatures:"Marios Sophocleous",downloadPdfUrl:"/chapter/pdf-download/54410",previewPdfUrl:"/chapter/pdf-preview/54410",authors:[{id:"195268",title:"Dr.",name:"Marios",surname:"Sophocleous",slug:"marios-sophocleous",fullName:"Marios Sophocleous"}],corrections:null},{id:"54869",title:"Resistivity Model of Frozen Soil and High‐Density Resistivity Method for Exploration Discontinuous Permafrost",doi:"10.5772/intechopen.68197",slug:"resistivity-model-of-frozen-soil-and-high-density-resistivity-method-for-exploration-discontinuous-p",totalDownloads:1775,totalCrossrefCites:4,totalDimensionsCites:5,hasAltmetrics:0,abstract:"In permafrost‐degraded areas, “islands” of permafrost can be buried in the unfrozen soil. When permafrost is arranged in this discontinuous pattern, it is more difficult to analyze from an engineering or geological perspective. The degree of resistivity of unfrozen soil is determined by the dry density, temperature, moisture content, and pore water resistivity of the soil, as well as by the mineral composition, size, and cementing state of the soil particles. Part of the water in the soil pores experiences a phase change as the soil freezes, so permafrost has different resistivity than unfrozen soil. In this chapter, we explore the conduction characteristics of permafrost. First, we established a theoretical model to analyze the factors affecting the resistivity of permafrost. Next, we used an experimental study to analyze how unfrozen water content, initial moisture content, soil temperature, and dry density influence the resistivity of frozen soil. These experimental study results served to validate the rationality of the model of permafrost resistivity. To analyze differences in conductivity between underground media, we used a high‐density resistivity (HDR) method, which infers the storage of underground geologic bodies with different resistivity based on the distribution of a conduction current under the electric field action. In this chapter, the WGMD‐9 super HDR measurement system produced by the Chongqing Benteng Numerical Control Technique Research Institute was used to obtain the resistivity profile. The study region was the road area from Bei’an Expressway to Heihe Expressway in the permafrost degeneration area in Northeast China. A permafrost profile map was drawn based on data from engineering drilling and an analysis of factors that influence permafrost resistivity. The reliability of the permafrost profile map was verified by an analysis of temperature data taken at measured points at different depths of the soil profile.",signatures:"Wei Shan, Zhaoguang Hu, Ying Guo, Chengcheng Zhang and Yao\nLiu",downloadPdfUrl:"/chapter/pdf-download/54869",previewPdfUrl:"/chapter/pdf-preview/54869",authors:[{id:"139091",title:"Dr.",name:"Wei",surname:"Shan",slug:"wei-shan",fullName:"Wei Shan"},{id:"162871",title:"Dr.",name:"Ying",surname:"Guo",slug:"ying-guo",fullName:"Ying Guo"},{id:"184953",title:"Mr.",name:"Zhaoguang",surname:"Hu",slug:"zhaoguang-hu",fullName:"Zhaoguang Hu"},{id:"204567",title:"Dr.",name:"Chengcheng",surname:"Zhang",slug:"chengcheng-zhang",fullName:"Chengcheng Zhang"},{id:"204568",title:"Dr.",name:"Yao",surname:"Liu",slug:"yao-liu",fullName:"Yao Liu"}],corrections:null},{id:"54627",title:"Measurement of the Electrical Resistivity for Unconventional Structures",doi:"10.5772/67854",slug:"measurement-of-the-electrical-resistivity-for-unconventional-structures",totalDownloads:1693,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This study presents an apparatus for the measurement of the electrical volume resistivity of concrete structures in civil and industrial constructions in 2.5 accuracy class, which operates at 500 Hz, for measuring the in situ resistivity of concrete in the range of 5–100 Ωm that is immune to errors due to the polarization phenomena at the interface probe/concrete sample. Also, a quench protection active system (QPS), which works in tandem with a superconducting coil structures (SCSs), in order to prevent the damaging effects when the coil structures pass from the superconducting state into normal conduction state (quench), is presented. An SCS made of YBCO tape high‐temperature superconductor (HTS) type, with a critical temperature of 92 K, has been experimented. In order to minimize the heat transfer influx by convection, the SCSs are confined to a cryostat, which is vacuumed at about 0.001 mbar. The working temperature of the HTS coil structures is about 77 K, ensured by liquid nitrogen as cryogenic agent. Finally, the measurement of the electrical resistance of the sensing element (SE) as part of the resistive‐type gas sensor is shown. The SE is placed on a Wheatstone bridge. The electrical resistance of the SE is variable by an amount ΔR, on when all the resistances of a Wheatstone bridge are nominally equal.",signatures:"Lucian Pîslaru‐Dănescu and Lipan Laurențiu Constantin",downloadPdfUrl:"/chapter/pdf-download/54627",previewPdfUrl:"/chapter/pdf-preview/54627",authors:[{id:"187612",title:"Dr.",name:"Lucian",surname:"Pîslaru-Dănescu",slug:"lucian-pislaru-danescu",fullName:"Lucian Pîslaru-Dănescu"},{id:"196151",title:"Dr.",name:"Laurentiu Constantin",surname:"Lipan",slug:"laurentiu-constantin-lipan",fullName:"Laurentiu Constantin Lipan"}],corrections:null},{id:"54740",title:"Estimation of Hydrological Parameters from Geoelectrical Measurements",doi:"10.5772/67990",slug:"estimation-of-hydrological-parameters-from-geoelectrical-measurements",totalDownloads:2045,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:1,abstract:"In the coastal aquifer of the lowlands on the right side of the river Sinaloa there is need for fresh water for agricultural development since, around 15% of the water used in agricultural irrigation, is from underground sources. This situation is exacerbated in periods of drought, which promotes drilling with the risk of finding brackish water in them; besides, there is the risk of not meeting water demand due to low hydraulic transmissivity (T) of the aquifer, putting at risk the drilling costs that this implies. In this sense, the determination of T and K (hydraulic conductivity) is important for the development and management of groundwater exploitation of the study area. Generally by means of pumping tests in wells, T is obtained, with high costs, so there are few values of T. K is generally obtained by wells and laboratory test. The aim of this chapter is to establish an empirical relationship between T and K with Dar-Zarrouk parameter in porous media, transverse resistance (T\nR\n), in addition to a characterization of the water quality through the electrical resistivity. This parameter is estimated from surface resistivity measurements, which are more economical in relation to the pumping tests; thus, T was characterized in the study area. The coefficient of correlation of the exponential adjustment is 0.79 and the relation is T=137185.7 TR0.020758−156691 and K=367.210.0548−518.813 with coefficient of correlation of 0.678.",signatures:"Héctor José Peinado Guevara, Jaime Herrera Barrientos, Omar\nDelgado Rodríguez, Víctor Manuel Peinado Guevara, Omar Llanes\nCárdenas and María Ladrón De Guevara Torres",downloadPdfUrl:"/chapter/pdf-download/54740",previewPdfUrl:"/chapter/pdf-preview/54740",authors:[{id:"36734",title:"Dr.",name:"Héctor José",surname:"Peinado-Guevara",slug:"hector-jose-peinado-guevara",fullName:"Héctor José Peinado-Guevara"},{id:"196347",title:"Dr.",name:"Jaime",surname:"Herrera Barrientos",slug:"jaime-herrera-barrientos",fullName:"Jaime Herrera Barrientos"},{id:"196348",title:"Dr.",name:"Omar",surname:"Delgado Rodríguez",slug:"omar-delgado-rodriguez",fullName:"Omar Delgado Rodríguez"},{id:"196349",title:"Dr.",name:"Víctor Manuel",surname:"Peinado Guevara",slug:"victor-manuel-peinado-guevara",fullName:"Víctor Manuel Peinado Guevara"},{id:"196350",title:"Ms.",name:"María",surname:"Ladrón De Guevara Torres",slug:"maria-ladron-de-guevara-torres",fullName:"María Ladrón De Guevara Torres"},{id:"205290",title:"Dr.",name:"Omar",surname:"Llanes Cardenas",slug:"omar-llanes-cardenas",fullName:"Omar Llanes Cardenas"}],corrections:null},{id:"54433",title:"Assessment of Cryoprotectant Concentration by Electrical Conductivity Measurement and Its Applications in Cryopreservation",doi:"10.5772/67747",slug:"assessment-of-cryoprotectant-concentration-by-electrical-conductivity-measurement-and-its-applicatio",totalDownloads:1395,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"This chapter presents an important application of the electrical conductivity measurement in cryopreservation. Long-term cryopreservation of cells and tissues is essential in both clinical treatments and fundamental researches. In order to reduce the cryo-injury to the cells during cryopreservation, cryoprotective agents (CPAs) should be added before freezing, but also removed after thawing duo to the cytotoxicity. In these steps, severe osmotic stresses may result in injuries to the cells too. Therefore, monitoring the addition and removal of CPAs to the cell samples is critical in order to prevent the osmotic injury. In this chapter, the electrical conductivity measurement was applied to assess the CPA concentration in cryopreservation. Firstly, the standard correlations between the CPA concentration and the electrical conductivity of the solutions (including CPA-NaCl-water ternary solutions and CPA-albumin-NaCl-water quaternary solutions) were experimentally obtained for a few mostly used CPAs. Then a novel ?dilution-filtration? system with hollow fiber dialyzer was designed and applied to remove the CPA from the solutions effectively. Measurement of electrical conductivity was validated as a safer and easier way to on-line and real-time monitoring of CPA concentration in cell suspensions. This work demonstrated a very important application of electrical conductivity in the biomedical engineering field.",signatures:"Zhiquan Shu, Hsiu-Hung Chen, Xiaoming Zhou and Dayong Gao",downloadPdfUrl:"/chapter/pdf-download/54433",previewPdfUrl:"/chapter/pdf-preview/54433",authors:[{id:"100298",title:"Prof.",name:"Dayong",surname:"Gao",slug:"dayong-gao",fullName:"Dayong Gao"},{id:"173780",title:"Dr.",name:"Zhiquan",surname:"Shu",slug:"zhiquan-shu",fullName:"Zhiquan Shu"},{id:"195682",title:"Dr.",name:"Hsiu-Hung",surname:"Chen",slug:"hsiu-hung-chen",fullName:"Hsiu-Hung Chen"},{id:"195683",title:"Dr.",name:"Xiaoming",surname:"Zhou",slug:"xiaoming-zhou",fullName:"Xiaoming Zhou"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"7211",title:"Electric Machines for Smart Grids Applications",subtitle:"Design, Simulation and 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Minor surgery (MS) is defined as the group of surgical techniques of a short duration that are generally applied to superficial structures. They tend to require the application of local anaesthesia and involve little risk and a minimum degree of complications [1].
During Primary Care consultations, one frequently comes across health problems that require these procedures for treatment and diagnosis. For this reason, MS falls within the fields of knowledge and competences [2] of a Family Physician (FP), being an additional cost-effective tool [3–5] for quality professional practices [6], both during programmed clinical treatments (excision of skin disorders) and in case of emergency (stitching of injuries).
The fundamental component for excellent MS is the technical capability of the FP carrying it out [1, 4, 7]. On the other hand, MS is not exempt from risk, either while it is being carried out or afterwards. It is therefore essential that, in addition to carrying out correct technical surgical procedures [8, 9] as appropriately indicated [10, 11], we also offer the patient a clear and complete information, which will be set out in the informed consent form. Furthermore, it is highly recommended that there should be some form of insurance available with specific cover for such techniques [12].
In this section, our aim is to provide scientific responses as to where? with what? and how? quality MS should be carried out by the FP.
In order to carry out MS, there are some basic requirements with regard to infrastructure and furnishings [1, 13].
The recommended size is in the order of 15–20 m2, with adequate temperature, well ventilated and a good source of artificial light. The ideal situation is to have a room set aside exclusively for MS procedures (Figure 1), although it is sufficient to have a well-prepared treatment room. It is very recommendable that the room should have a wash basin with a single-action tap control and an automatic soap dispenser for washing hands.
Well equipped minor surgery room
This should be located in the centre of the room so that it can be accessed from all sides. It is recommended that it should be height-adjustable so that the operator can work comfortably, whether seated or standing. Clinical examination benches are not acceptable.
An auxillary table is for setting out the materials and instruments used during the surgical procedure. It should have wheels and be height-adjustable and should be placed close to the area of the surgical procedure in order to facilitate the treatment. We should avoid placing any surgical materials on top of the patient.
There should be a stool available for the doctor’s use, which should have wheels and be height-adjustable so that the MS can be carried out comfortably.
This should provide the appropriate amount of light, having an illumination level of at least 45,000 lux. It can be portable with wheels or be attached to a wall or to the ceiling. These lamps can be moved in various directions. The intensity of the luminosity can be modified, and the focal point of the light can be concentrated. It is recommended that there should also be an auxiliary lamp with a magnifying glass, which is useful for extracting foreign bodies or for working with magnification.
Although risks to life are minimal during MS, it is essential that there should be a carriage available with cardiopulmonary resuscitation equipment on it, carrying the materials for vascular access, intubation of the air passages, serums, resuscitation medication and a defibrillator.
The centre in which MS procedures are carried out should have an autoclave for sterilising surgical materials and equipment, or an external circuit should be set up so that the material can be sterilised.
These are useful for the storage of perishable materials and surgical instruments. Likewise, there should be containers available for biocontaminated materials and an elimination system that conforms to the sanitary legislation in force at the time.
In the area of primary care, where teamwork is a key to the realization of all clinical activities, the work of the nurse is also a key for successful accomplishment of minor surgery techniques. In many cases, it is the perfect surgical assistant for preoperative, operative and postoperative and in other cases as lead actor of surgery, suturing wounds or performing cryosurgery techniques. In either case, the good cooperation between doctor and nurse entails highly efficient outcomes for the patients.
Furthermore, carrying out MS involves the risk of transmission of infectious and contagious diseases. Universal precautionary steps should be taken in order to minimise this risk. Among these steps are the use of appropriate clothing and accessories and the correct washing of hands and the sterile donning of surgical gloves [1, 14].
During MS procedures, we consider the wearing of an overall to be essential (disposable overalls are very useful) or at least sterile pyjamas and gloves; highly recommended are the use of a surgical mask and of protective glasses or goggles.
There are different methods; thus, we have
Surgical gloves are sterile, single use and are available in several sizes (numbered [from 6½ to 8½] or alpha-numeric [XS, S, M, L and XL]. There are models with or without latex and with or without a dusted coating.
Surgical gloves are put on in such a way as to avoid them becoming contaminated. The dusted or internal part of the glove can be touched with the hands, whereas the external or non-dusted part should only be touched with the other glove.
The FP should have in-depth knowledge of the surgical instruments and their use. The quality and the type of instrument (and its state of conservation) can affect the result of the surgical technique; that is, why it is important to correctly select the appropriate instrument for each intervention [1, 13]. The most significant characteristics of the instruments recommended for minor surgery are described below.
This enables sharp cuts to be made to the skin and other tissues and precise dissections of tissue to be carried out. It should have a number 3 handle and number 15 and 11 blades. The scalpel blade should be attached to the handle in a single position, making the guide of the blade coincides with that of the handle.
It is handled with the dominant hand, even though it was a pencil (Figure 2), enabling small and precise incisions to be made. The hand should be partially supported by the work surface in order to ensure the precision of the cut. The opposing hand should be used to stretch the skin in a direction that is perpendicular to that of the incision. The scalpel should make a cut that is perpendicular to the skin (not bevelled), except in hairy areas (the scalp or eyebrows) where it should be inclined so that it is parallel to the direction in which the hair comes out, so as not to affect the follicles.
The knife is held with the dominant hand, as if it were a pencil
The needle holders, or “holders”, are designed to safely hold the curved needles without damaging them (the points or grips are appropriate for holding the needles). The needle is held somewhere between the middle and the back third of said needle. It is recommended that there should be standard small- or medium-sized holders (12–15 cm.) with tips capable of handling needles of up to 4/0.
Like other instruments with finger rings, the needle holder is handled by partially introducing the distal phalanges of the thumb and the index finger of the dominant hand, with the index finger pointing towards the tip (Figure 3). When carrying out a stitch, the holder should describe a pronation–supination movement to facilitate the passage of the needle through the tissue. The angle of entry of the needle through the skin should be 90° while the non-dominant hand holds the skin with dissecting forceps, in opposition to the pressure of the needle.
The needle- holders is managed partly by introducing the distal phalanges of the thumb and fourth finger of the dominant hand on the rings, while the index is directed towards the tip.
There should be some toothed Adson forceps, 12 cm in length, for handling the skin, and some untoothed Adson forceps for the removal of stitches. Otherwise, standard small forceps should be used. It is important not to handle the skin with untoothed forceps.
Dissecting forceps are the most important of the auxiliary instruments used with the non-dominant hand; they enable the tissues that are handled, dissected or stitched to be exposed while the other hand uses the main instrument. The forceps are held like a pencil between the first, second and third fingers.
These enable the cutting of both cloth and materials (sutures, bandages and dressings), as well as the dissection of tissues. There should be curved Mayo (cutting) scissors with blunt tips, 14 cm in length, and curved Metzembaum (dissecting) scissors with blunt tips, 11.5 cm in length. The dissecting scissors are not recommended for cutting materials. They are handled by introducing part of the distal phalanges of the thumb and fourth finger into the finger rings, supporting the second finger on the arms of the instrument.
For blunt dissection, the Metzembaum scissors are introduced with the tips closed, and these are then opened separating the tissues through more or less anatomical layers. For cutting dissections, the scissors are introduced with the tips open, and these are then closed cutting the tissue.
There should be two or three sets of curved 12-cm untoothed mosquito forceps. These should be used for creating traction in tissues for haemostasis and in some cases for carrying out blunt dissection when we have no scissors available.
These enable the surgical field to be exposed by separating or retracting the edges of the injury. If the surgery is being carried out with the help of an assistant, it will be he or she who uses the retractors; otherwise, it will be the surgeon who uses them with the non-dominant hand. In MS, it is recommendable to have a Senn-Mueller retractor (with a scoop on one end and curved tynes on the other). Another useful retractor in MS is a hook or distractor.
Additional expendable materials are single-use gauze dressings, sterile dressings and bandages, antiseptics (iodised povidone [polyvinylpyrrolidone]), needles, syringes, local anaesthetics with and without vasoconstrictors (see local anaesthetic guide) and formaldehyde for transfers to anatomic pathology.
To perform the majority of MS techniques, only a
Starter Kit minor surgery. From left to right, curved mosquito forceps without teeth, needle holders medium Asson dissecting forceps, scissors Mayo, Scalpel Handle number 3
Instruments consisting of a handle with an end in the shape of a small spoon or cutting ring enable the scraping of injuries on the surface of the skin. They can be disposable or not and have different diameters. The curette is handled with the dominant hand in accordance with the surgical technique known as “scraping” or enucleating benign superficial skin lesions (protruding or hyperkerastotic) that do not require histological confirmation [15].
Instruments consisting of a handle with an end in the shape of a cutting cylinder (drill bit) enable tissue biopsies to be extracted. They tend to be disposable and can have different diameters (from 2 to 28 mm.) and enable samples to be taken of the full thickness of the useful skin for histological analysis. They are used with the dominant hand carrying out rotating movements of the instrument in order to cut the skin and obtain the sample [16].
These devices apply a cryogen, generally liquid nitrogen, by means of pulverization or swabs to treat skin lesions [17]. The cryogen is stored in tanks or containers in order to avoid its evaporation. There are portable units available which have a mechanism for pulverising the nitrogen over the lesion to be treated; they are equipped with a range of outlets and probes, which enable the intensity of the pulverisation to be modified, thus varying the amount applied depending on the size and location of the lesion to be treated.
Electrical apparatus consists of a central unit that applies an electrical current through a sterile terminal, with the capacity to coagulate and cut; it also consists of an earth to close the electrical circuit [18]. There are different terminals available depending on the type of procedure to be carried out.
With appropriate care, surgical instruments last a long time. The majority of the damage that they suffer is due to incorrect cleaning and handling. On the other hand, MS instruments should always be used in a sterile state. The steps taken care of these details are as follows:
Separate sharp or pointed single-use objects (using gloves) and dispose of them in the biocontaminated materials container.
The instruments should be placed in disinfecting solutions (a glutaraldehyde or clorhexidine solution at 0.05%, etc.) or a soapy solution.
Sterilising. The most appropriate and recommended method is to use an autoclave to control the quality of the sterilisation process.
Packaging and labelling.
There are different types of materials available: threads, staples, adhesive sutures and tissue adhesives. The use of a certain type of suturing material or type of needle can determine differences in the surgical result, so the choice should be based on scientific criteria and be backed up by good practice.
Thread sutures provide a sure close and ensure the greatest support for the wound and the minimum level of dehiscence compared to other types of closure [19, 20]; however, they require anaesthesia, the intervention takes longer, they traumatise the tissue, introduce foreign bodies into the wound and increase the risk of accidental inoculation.
The alternatives to conventional sutures are mechanical sutures and adhesive tapes, which provide less reactivity and a lower degree of incidence of infections [21]. Glues and tissue adhesives have appeared as an option to common procedures [22–25].
These are classified in accordance with: their origin (natural or synthetic), their configuration (multifilament or monofilament), their calibre (the thickness of the thread is measured in zeros [USP system] with the fewer zeros meaning lower calibre and the most commonly used in minor surgery ranging from 3/0 to 4/0 or 5/0, the finer calibres with smaller needles requiring more precise needle holders) (Figure 5).
Information of on of suture: (1) calibre of the thread (system USP and metric), (2) trade name of the suture, (3) composition and physical structure of the thread, (4) length of the thread, (5) color of the thread, (6) model of needle (every manufacturer uses different references), (7) I draw from the needle to scale 1:1, (8) circumference of the needle (expressed in parts of circle), (9) section of the needle, (10) length of the needle, (11) expiry date, (12) indexes of the manufacturer, (13) indicator of sterile packing.
We will use a certain type and thickness of suture thread depending on the anatomical area and the characteristics of the wound and the patient (Table 1).
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t|
\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Scalp | \n\t\t\tstaples 2/0 silk | \n\t\t\tVicryl® or Dexon® 3/0 | \n\t\t\t7–9 | \n\t\t\t6–8 | \n\t\t
Eyelids | \n\t\t\t6/0 monofilament 6/0 silk | \n\t\t\t- | \n\t\t\t3–5 | \n\t\t\t3–5 | \n\t\t
Ears | \n\t\t\t4/0-5/0 monofilament 4/0-5/0 silk | \n\t\t\t- | \n\t\t\t4–5 | \n\t\t\t3–5 | \n\t\t
Nose | \n\t\t\t4/0 monofilament 4/0 silk | \n\t\t\tVicryl® or Dexon® 4/0 | \n\t\t\t4–6 | \n\t\t\t3–5 | \n\t\t
Lips | \n\t\t\t4/0 monofilament 4/0 silk | \n\t\t\tVicryl® or Dexon® 4/0 | \n\t\t\t4–6 | \n\t\t\t4–5 | \n\t\t
Forehead and face Neck | \n\t\t\t4/0–5/0 monofilament 4/0–5/0 silk | \n\t\t\tVicryl® or Dexon® 4/0 | \n\t\t\t4–6 | \n\t\t\t3–5 | \n\t\t
Trunk / abdomen | \n\t\t\t3/0–4/0 monofilament | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t7–12 | \n\t\t\t7–9 | \n\t\t
Back | \n\t\t\t3/0–4/0 monofilament | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t12–14 | \n\t\t\t14 | \n\t\t
Upper limb / hand | \n\t\t\t4/0 monofilament | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t8–10 | \n\t\t\t7–9 | \n\t\t
Pulp of fingers | \n\t\t\t4/0 monofilament | \n\t\t\t- | \n\t\t\t10–12 | \n\t\t\t8–10 | \n\t\t
Lower extremity | \n\t\t\t3/0 monofilamentstaples | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t8–12 | \n\t\t\t7–10 | \n\t\t
Foot | \n\t\t\t4/0 monofilament | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t10–12 | \n\t\t\t8–10 | \n\t\t
Penis | \n\t\t\t4/0 monofilament | \n\t\t\tVicryil® or Dexon® 3/0 | \n\t\t\t7–10 | \n\t\t\t6–8 | \n\t\t
Mouth and tongue | \n\t\t\t3/0 Vicryil® | \n\t\t\t- | \n\t\t\t- | \n\t\t\t- | \n\t\t
Indications of types of sutures and time for stitch removal
These are used for skin sutures that will be removed or for internal structures that need to maintain constant pressure (tendons and ligaments).
Silk: Indicated for skin suturing and generally extractable, however, they do cause significant tissue reaction.
Nylon: Indicated for precise skin suturing, internal structures that need to maintain constant pressure (tendons and nerves). They are more difficult to handle but produce minimum tissue reaction.
Polypropylene: Indicated for continuous intradermal skin sutures. They are very smooth sutures with a long memory, so they require more knotting so that they do not come undone. They cause minimum tissue reaction.
These disappear gradually by biological reabsorption or hydrolysis and provoke localised inflammation. They are used for deep or non-extractable suturing.
Polyglactin 910: Indicated for dermal sutures, subcutaneous cellular tissue, deep suturing and the ligature of small vessels. They have an absorption time of 60 days (conserving tissue support for 28–30 days). There are varieties with a quicker absorption time (Vicryl®rapid) that are absorbed in 10 days and are used for the suturing of children’s skin.
Polyglycolic acid: Indications similar to the above. They have an absorption time of 90 days and the support of 15–20 days.
The time (in days) recommended for the removal of stitches together with the indication of the type of suture thread is shown in Table 1.
In the face, it is important to remove the sutures as soon as possible, although adhesive sutures are put in place for an additional 7 days to protect the wound against small traumatisms. In other anatomical regions where the aesthetic result is not as important and scarring is not as quick as in the face, stitches should be left in for longer. In particular, in periarticular regions and in the lower extremities, which have a slower scarring time, stitches are left in for longer than normal.
The needles are designed to take the suture through the tissue producing minimum damage. The selection of these is determined by the type of tissue to be sutured, its accessibility and the thickness of the thread used. There are
The section of the needle can be triangular, conical or spatula-shaped. The triangular ones have cutting edges that enable them to pass through highly resistant tissue, such as skin and subcutaneous tissue, these being the needle of choice for MS.
The adhesive sutures consist of porous adhesive paper tape (Steri-Strip®, etc.) capable of bringing the edges of a wound or incision together. They are available in sterile presentations with different widths and lengths although they can be cut to the appropriate size as required. Advantage of adhesive sutures is the speed and simplicity of application when compared to conventional sutures because they do not require local anaesthesia and they do not leave “stitch marks”.
Adhesive sutures are left for as long as a conventional suture would be left in the same anatomical region. Unlike other sutures, a wound with adhesive sutures should not be allowed to get wet during the first few days because of the possibility that they will become unstuck.
Staples are available in different widths (W: wide staples, R: normal staples), in disposable staplers preloaded with a varying number of staples (35 in the case of large staplers and 10 for smaller ones). The use of staples as compared to conventional sutures has certain advantages, such as the speed with which the suturing is carried out, their resistance and null tissue reaction (the material is stainless steel).
One of the latest advances in the treatment of wounds has been the development of tissue adhesives or tissue glues (22, 23). These products (cyanoacrylates) act as an adhesive, using an effect of joining the epidermal layer (the stratum corneatum), thus keeping the edges of the wound joined together. The compound forms a bridge over the edges of the wound creating an effective joint during a period of 7–14 days. After this time, the major part of the compound is loosened and detached, together with the
Bring the edges of the wound together precisely using the fingers or dissecting forceps.
Apply the glue to the external surface of the skin, avoiding it penetrating inside the wound. The application process is repeated at least three or four times.
Keep the edges in contact for 30–60 seconds to achieve an adequate degree of polymerization. The final tension is produced 2 minutes after application.
After application, no dressings are required. The wound should be kept dry for 5 days and subsequently it can be moistened with care, avoiding prolonged contact with water. The glue will disappear after a period of 7–10 days.
They would require 4/0 sutures or finer.
They are not associated with multiple trauma.
The patients do not have any peripheral vascular illness, diabetes mellitus, haemorrhagic diathesis or a history of the formation of keloids.
The cause is not an animal bite, puncturing, decubitus ulcers or injuries arising from crushing, which provokes star-shaped lesions.
There are no visual signs of active local or systematic infection, visible contamination or lifeless tissue.
They are not localised around the pigmented edges of the lips in the mucous areas or in areas covered in dense hair.
The practicing of MS requires a knowledge of the correct handling of surgical instruments (described above) and control of the consecutive steps of each surgical technique: that is to say, capabilities in surgical manoeuvres.
Dissection is a manoeuvre that consists of detaching layers of similar tissue. There are two methods for carrying it out: one is called blunt dissection (non-cutting which is generally carried out with Metzembaun scissors or with mosquito forceps) and the other known as cutting, where a scalpel or scissors are used. In MS, the more frequent degree of dissection should be for the face and neck, which corresponding to the joint between the dermis and the subcutaneous tissue, and for the scalp, the subgalea layer and for the trunk and the extremities, which corresponding to the joint between the superficial and the profound fascias [26).
Dissection manoeuvres must be carried out in a delicate manner and with the field of operation well exposed, never obscured, so as not to damage important structures in an irreversible manner; it is therefore fundamental that one knows the topographic anatomy of the area being operated.
The design of the incisions should be done bearing in mind that the type of lesion that is to be treated so, for excisions, it is necessary to leave an adequate margin (1–2 mm) of healthy skin around the wound and in depth, depending on each wound. On many occasions, it is useful to mark out the planned excision so that reference points are not lost when surgical swabs are put in place.
Likewise, when planning a surgical incision, it is necessary to take into account the anatomy of the area to be operated upon and the lines of minimum tension; in this way, an appropriate scar will result both from an aesthetic and from a functional point of view. It is therefore necessary to direct incisions parallel to the lines of minimum tension (coinciding with the lines of facial expression and the lines of cutaneous relaxation; Figure 6).
Graphs of the lines of minimal tension (the lines of Langers)
These are used to achieve a surgical exposure of the more profound layers (e.g., epidermal cysts, lipomas) or for the draining of ulcers. They can be lineal, angled, or curved depending on the anatomical area to be treated and the type of surgery.
These are used to extract cutaneous lesions with a margin of healthy skin around the wound and in depth [27, 28). As a general rule, the length of the ellipse should be three times its width and the ends should have angles of 30° (Figure 7). They should be directed in accordance with the lines of minimum tension not according to the major axis of the wound.
Characteristics of the fusiform excision.
This is a surgical manoeuvre that enables not only the control of bleeding but also a clarifying of the view of the surgical anatomy. The majority of haemorrhages in MS (where incisions or wounds do not tend to affect important vessels) are controllable with pressure using a gauze. On the other hand, a compress bandage over the wound during the immediate post-operative period reduces the possibility of bruising or seromas forming.
The
Haemostasis by means of
The objective of a suture is to draw tissues with similar characteristics together so that they can scar correctly. To achieve an optimum surgical closure, the principles shown in Table 2 should be taken into account [30, 31].
1. 2. 3. 4. | \n\t\t
For an optimal surgical closure, the following principles should be remembered
Discontinuous sutures are those where each stitch is independent of the following one. They are the most appropriate for MS because it is easier to distribute the tension, favouring the drainage of the wound. Also, the stitches can be removed more easily.
This is the suture of choice for suturing skin and is only used in combination with buried stitches if the wound is deeper.
This is used for drawing together the deeper layers, reducing the tension and for obliterating empty spaces before suturing of the skin; it is not necessary for superficial wounds. Absorbable materials are used, and the suturing is carried out in such a way that the knot is left in the depths of the wound, reducing the possibility that the stitch might be exposed through the incision. The knot is cut right down to reduce the amount of foreign matter inside the wound.
This is a double stitch that increases the resistance of the suture but is more aggressive around the edges of the wound. There are three types [30, 32]:
These make the drainage of the wound more difficult, so they are contraindicated if there is a suspicion of infection or in very contaminated wounds. The stitches are more difficult to remove, and it is not possible to remove them in various sessions [30].
This is a succession of stitches with an initial knot and another at the other end. It is scarcely used in MS.
This type of suture enables the suturing to be carried out without passing through the skin, avoiding scarring from “stitch marks” and providing an optimum aesthetic result. They are carried out by passing the suture through the dermis in a horizontal manner, along the length of the whole wound; at the ends, the suture can appear outside the skin (extractable intradermal suture), in which case it is carried out with non-absorbable monofilament material, or it can be knotted inside the wound (non-extractable intradermal suture), in which case absorbable material is used. Carrying out this suture with multifilament materials, such as silk, should be avoided, as it would be very difficult to remove the suturing material. It is used in wounds where it is necessary to maintain the stitch in place for a long time (more than 15 days). Its use in MS is limited.
The knot that the surgeon should use consists of a double loop followed by various simple loops. The advantage of this knot is the safety that is provided by the first double loop, which avoids the knot untying while the following loops are carried out.
If the knot is tied with a multifilament thread (silk) then three loops are sufficient; if it is monofilament (nylon, polypropylene), it is preferable to carry out a further loop.
It is convenient for the knot to be placed to one side of the wound rather than on top of the incision. This enables a better view of the wound, it interferes less with scarring and facilitates the removal of the stitches.
The indications for MS are carried out on the basis of the diagnosis of the lesion to be treated; an erroneous diagnosis can lead to incorrect treatment and to the loss of clinical information that is relevant to the patient’s prognosis [8]. It is therefore essential that the FP should have extensive knowledge of the lesions that are most frequently susceptible to MS and, should there be any doubts regarding the nature of the lesion, these should always be resolved through consultation with other specialists [10, 11, 33, 34]. Each lesion has a surgical procedure that is considered to be optimum or of choice, whereas other alternatives are merely valid or can be contraindicated [1, 13].
There are certain areas of the body that are considered to be at risk when MS procedures are carried out. This is due to the superficial location of anatomic structures, susceptible to damage during the surgical intervention. To avoid damaging these structures, it is necessary to know their theoretical routing and keep the surgery, wherever possible, on a superficial level (subcutaneous superficial cellular tissue). Furthermore certain areas (face, neck) are also considered at risk by the aesthetic impact of poor technique may result [1].
The areas at risk during MS include the facial and cervical regions, the axillary and supraclavicular regions, the wrists, hands and fingers, the groin area, the popliteal fossa and the feet (Figure 8A and 8B).
A and B. MS risk areas in Family Medicine
Together with the above considerations, we should also consider those anatomical areas with a greater tendency for pathological scarring: the deltoid region, shoulder, area of the sternum and the interscapular region. Also, the skin of black patients and children is especially prone to the appearance of hypertrophic scars and keloids. Therefore, in these cases, it is important to discuss these possibilities with the patients, especially if there are only aesthetic reasons for the surgery.
All lesions extracted during MS should be sent on to a pathological anatomy service so that the correct diagnosis can be carried out. No intervention will finish without such results being available [1).
During MS in Primary Care, different procedures are carried out, which would each, in their own right, be the object of action protocols (the extraction of lipomas, epidermal cysts, ingrown toenails, punched biopsies, curettes, cryosurgery of benign lesions). For this reason, the main and ideal techniques for dealing with the majority of these superficial dermatological lesions through MS are summarised below.
This is an exeresis technique designed in the form of a spindle; this spindle should involve all levels of the skin, including the fatty tissues, so as to extract the lesions with a margin of safety on the surface and in the depths of the lesion. Thus, the technique enables not only a histological diagnosis and simultaneous treatment but also a closing suture that is technically simple with very good aesthetic results [27, 35].
The procedure consists of the following steps:
The incision is made with a clean knife cut along the line painted design, while we traction (or pinching the area) with the fingers of the nondominant hand
During basic minor surgical interventions, it is not in general necessary to carry out a systematic pre-operatory study. However, as we are dealing with our own patients, we will have their medical history available, which we will complement with a series of questions directed towards evaluating the situations where minor surgery might pose a risk or might be contraindicated. Tables 3 and 4 summarise the precautions and contraindications of MS in Primary Care.
• Diabetes mellitus and peripheral vascular disease when planning surgery in the lower extremities • In patients with chronic use of immunosuppressors (corticosteroids) • Do not add vasoconstrictor to local anaesthetic in patients with arrhythmia, severe hypertension, hyperthyroidism, pheochromocytoma, pregnancy and in anaesthesia of the fingers • Anatomic areas of risk (Figure 8 A and 8B) • Research specifies the use of oral anticoagulants and antiplatelet since we must raise the suppression (assess risk-benefit) prior to the surgery. Currently, Holbrook et al [36 ] considered that these patients can be operated without changing its pattern whether taking oral anticoagulants (if your INR is within the therapeutic range) as antiplatelet • • | \n\t\t
Precautions of MS in family medicine
• Unless justified exceptions, never involve, malignant skin lesions in family medicine. Likewise, if the pathological result of lesion excised is malignant, should be performed interconsultation with other specialists. • Allergy to local anaesthetics. • Pregnancy: we must postpone the surgery, and if malignancy is suspected, refer to the appropriate specialist. • Acute intercurrent disease: will be postponed until recovery. • Doubts about the motivations of the patient: surgery is contraindicated in patients whose motivation for it is questionable or if there is excessive preoccupation with the aesthetic result • In patients with severe psychiatric disorders or uncooperative patients is contraindicated performing MS in family medicine. • Refusal to any activity reported minor surgical consent. | \n\t\t
Contraindications of MS in family medicine
In the case of patients who are anxious about the intervention, we can consider pre-operatory sedation and can use diazepam 5–10 mg oral or sublingual or lorazepam 1–5 mg sublingual, administered 30 minutes prior to the intervention.
A vasovagal syncope is the most frequent form of complication and is common in young males. Treatment consists of placing the patient in the Trendelenburg position, administering oxygen and fluid therapy, and if it is deemed necessary, the use of atropine can be considered: 0.5–1 mg SC or IV (maximum 2 mg). In general, the majority of episodes recover spontaneously after a few seconds or a few minutes.
In centres where programmed MS is carried out, it is obligatory to always have CPR cardiopulmonary resuscitation (CPR)materials and medication to hand (as previously indicated).
Table 5 lists the complications that might appear following an MS intervention.
\n\t\t\t\t \n\t\t\t\t \n\t\t\t\t \n\t\t\t\t | \n\t\t
Postoperative complications in MS
RMP, developed from the Hippocratic doctors of the fourth century to C, and technically and scientifically perfected to this day, with its holistic, non-organicist, and multidisciplinary nature, is a continuation of the process of recovery from multiple human conditions, from traumatic to degenerative, at all ages of life. Its mechanism of action, which is becoming better known, is based on the tendency to spontaneous healing that the organism has (Vis medicatrix naturae of the Hippocrats), today explained by the multiple homeostatic mechanisms available to the human economy, some of them collected in Table 1.
System/phenomenon | Mechanism | Function |
---|---|---|
Neuroendocrine regulation | Hypothalamic-pituitary-adrenal/gonadal axis | Growth menstrual cycle birth. lactation, metabolism stress, etc. |
Immune system | Natural and adaptive | Defends against hostile external and internal agents |
Blood coagulation system | Coagulation cascade (12 factors) | Prevents spontaneous bleeding Wound healing process |
Bone regeneration after fracture | Remodeling | Restitutio ad integrum |
HLA system | T cells: examine peptides and distinguish whether they are self or foreign | Recognizes peptides and presents them on the surface of antigen-presenting cells (macrophages) |
Renin-angiotensin-aldosterone system | Kidney-lung/heart-adrenal | Regulates blood pressure |
Thermoregulation | Hypothalamus | Adaptation to the environment |
Bicarbonate-carbonic acid system | Breathing | Maintains pH |
Kidney function | Nephron | Electrolyte and acid-base balance |
Endocrine pancreas | Insulin-glucagon | Glycemic regulation |
Food digestion | Digestive secretion | Nutrient absorption |
Gut microbiota | Absorption of nutrients, synthesis of vitamins, production of short-chain fatty acids, etc. | Immune, neurotransmitters, etc. |
Neuroplasticity | Establishment of neural connections due to the effect of various stimuli | Recovery after brain injuries, cerebrovascular accidents, etc. |
Some of the homeostatic systems of the organism (taken from Guyton and Hall’s medical physiology, 2016 and completed by A. Ursa) [1].
Rehabilitation medicine, physiotherapy, and the like (speech therapy, occupational therapy, orthopedics, psychology) have been enriched in recent decades by a series of techniques and methods, with implantation determined according to different countries and public or private practice, such as acupuncture, osteopathy (joint manipulations), neural therapy, different manual techniques (Cyriax, etc.), dry needling, etc., as well as concepts such as Bobath’s or methods such as Perfetti’s or Therasuit’s, the aims being an assistance comprehensive customer service and functional recovery.
Although it is true that physiotherapy has been gaining in attributions in recent years, such as the capacity for diagnosis and treatment, the scheme “the rehabilitating doctor diagnoses and prescribes and the physiotherapist executes” is still valid.
A legal obstacle for physiotherapists is the limitation in their therapeutic actions. Although it varies from country to country, these health professionals are generally denied access to the internal environment to introduce substances with pharmacological activity. As in other professional groups (Odonto-stomatology, podiatry, etc.), they have a limitation in the pharmacological prescription, covering a reduced group of drugs.
A good number of physiotherapists, especially those who work on their own in the private sphere, knowing about drug iatrogenesis, have adopted unconventional therapies (UT), such as phytotherapy, acupuncture, osteopathy, etc., or conventional ones such as diet therapy, in order to facilitate the healing processes.
This chapter deals with UTs that can contribute to a better response in the field of RMP, either by shortening the recovery time, reducing pain, or achieving good functionality, enriching their scope of action. Some of these techniques can be used in physiotherapy.
It is one of the techniques used in Traditional Chinese Medicine (TCM). Introduced and disseminated in Europe by Soulié de Morant, French ambassador to China in the nineteenth century [2]. The Canon of this discipline is the Nei King, written in the time of Emperor Huang Ti around the year 2610 BC. This treatise includes the conception of life according to Chinese philosophy, the theory of Yin and Yang (the TAO), etc., which is also applied in therapeutics. In the doctrinal exposition of the Nei King, collected in the treatise called Sou Wen, he talks about the Tch’i (Chi) energy that, circulating through some channels (meridians), would fill all the organs of the body with vital energy. The energy from the breath, the cosmic, and others would be added to this energy. All these approaches lead to the Theory of the Five Elements. At first, they coincided with the four elements of the Hippocratic Tradition (water, fire, earth, and air). Later, during the reign of Emperor Wou (1122–255 BC), a fifth element was added. These five elements would be governed by specific laws forming the Ko cycle [3].
The disease in TCM is an alteration of the energy balance, with physical and/or mental impairment. By means of certain techniques, the therapist must be able to restore the energy balance that results in the restoration of health [3].
Table 2 shows the techniques most used in TCM to restore health, in addition to acupuncture.
Technique | Procedure | Rationale |
---|---|---|
Moxibustion | Combustion of mugwort (plant) on specific points | Provides heat to stimulate or inhibit |
Diet Therapy | Food Yin and Yang | Energy balance |
Chinese Materia Medica | Medicinal plants in capsules, tablets, infusion, etc.: minerals, etc. | Specific effects |
Digitopuncture | Massage in certain points | Symptomatic relief in acute conditions |
Auriculomedicine, manopuncture, etc. | Puncture of the pinna, hand, etc. | Represents the entire organism |
Tui Na massage | Stimulation of meridians | Circulation of Chi |
Suction cups | A vacuum is created (negative pressure) | Decongests in depth |
Chi-kung | Specific movements with a certain speed | Preventive and curative purposes through the mobilization of energy |
Techniques most used in TCM (taken from the complete book of Chinese medicine) [4].
Acupuncture is a physical therapy based on the millenary observation that needle puncture in certain areas of the skin lining can lead to the re-establishment of certain conditions. Several mechanisms of action have been proposed, one of the most investigated being the analgesic effect produced by the release of endogenous opioids, already described in the 70s of the twentieth century [5].
In 1979 the World Health Organization (WHO) made public that acupuncture was effective in 49 conditions. With the standardization of the STRICTA criteria for clinical trials with acupuncture, the indications for chronic painful conditions such as headaches, osteoarthritis, low back pain, etc., were reduced [6].
Acupuncture, as a therapy, has its contraindications and side effects. Because of this, it is recommended that a health professional apply it.
Although Homeopathic Medicine (HM) is in low hours, it has been used from the nineteenth century to the present day.
The law of similarity on which homeopathy is based appears already in the Hippocratic writings. In the Renaissance, Paracelsus made his observations on the minimum doses, but it was necessary to arrive at its implementation with the German physician Samuel Hahnemann (1755–1843). Disappointed by the medicine of the time based on bloodletting and other ineffective and highly iatrogenic procedures, he abandoned the medical practice. To continue caring for his large family, he had 11 children, since he was fluent in several languages, he dedicated himself to translating medical books into other languages. In translating a book by Cullen, he called her attention to a procedure that he tried on himself and on his family with good results. Encouraged by the successes, he developed and perfected the homeopathic method. He compiled his observations in a treatise the organon of the art of healing that saw its first edition in 1810. He made numerous disciples and spread homeopathy to the rest of Europe, America, and other countries [7].
The procedure for obtaining the homeopathic remedy follows a series of steps until the desired dilution is obtained. Its mechanism of action is still unknown. Due to this, in recent years a smear campaign has been orchestrated qualifying homeopathy as pseudoscience.
The truth is that homeopathy is still used throughout the world, its results are acceptable – although the demands have been made in clinical trials – it does not produce iatrogenesis, its cost is affordable, and its environmental impact is acceptable.
Homeopathy should continue to be investigated with its own method since as it does not consist of weight doses such as pharmacology, and is individualized treatment, the scientific method for its validation is not always valid.
Possibly the day will come when science and technology have advanced and the mechanism of action of this therapy can be unraveled. When requiring a clinical diagnosis, the prescription of the homeopathic remedy should be exclusive to the doctor. This is not the case in the vast majority of cases, and this could be the reason for the smear campaign.
The term Osteopathic medicine (OM) of osteo (bone) and ducks (disease) is not a graceful name to name this preventive and therapeutic method, with its own diagnostic techniques. Its main field of application is the joints. OM was developed in the United States (USA), its pioneer being the physician Andrew Taylor Still (1828–1917), who stated its principles [8].
Still claimed that human diseases originate from problems of the musculoskeletal system, and that manual manipulation could solve these problems by taking advantage of the body’s self-healing potential [8]. Like many other empiricists, he developed this method after his wife and daughters died of meningitis. The remedies of the time were not enough to save their lives.
OM can be considered as an integral medicine that cares for the person in all its dimensions, unlike allopathy that fragments the organism into patches. It enhances or favors the body’s self-healing processes (the vis medicatrix naturae of the Hippocrats) in order to restore homeostasis [8].
OM is based on the knowledge of the anatomy and physiology of tissues and organs, biomechanics, as well as the functional/dysfunctional interrelation between the different tissues. In the diagnosis and treatment, it uses conventional processes and others specific to the method [8]. The WHO and the European Union, the latter with the European standard on Osteopathy (UNE-EN 16689) defined the academic, professional, scientific, and ethical parameters years ago [8].
The OM is widely disseminated throughout the world. There are countries with official studies (USA, England, France, Belgium, Portugal, etc.). Regarding the professional figure, there are countries that are taught exclusively to doctors, such as Russia. In Italy, they train doctors and physiotherapists respectively in OM. In Spain and Latin America, there are OM schools where physiotherapists are taught above all [8]. In Australia, the United Kingdom, and New Zealand, non-medical osteopaths are regulated by law. In Canada and Germany, both doctors and non-doctors can practice OM, with the corresponding authorizations. In Spain, the order of the Ministry of Science and Innovation CIN/2135/2008, of July 3, established the requirements for the verification of official university degrees that would qualify for the exercise of the profession of physiotherapist and established osteopathy as a subject of the Degree in Physiotherapy. Several Spanish universities offer postgraduate courses in Osteopathy.
The most prominent OM types are listed in Table 3.
Place of actions | Aims/objectives | |
---|---|---|
Structural | l Focuses on the spine | Restore the musculoskeletal, articular, and postural systems |
Cranial | Nervous system (through the mobility of the cranial sutures) | Action on cerebrospinal fluid and circulation |
Visceral | Organs and viscera | Through improved blood flow, obtain a benefit in the organ/viscera |
Types of O/MO (taken from the book osteopathy based on evidence).
The indications for OM, therefore, are broad and focus on the treatment of spinal pain and diseases, visceral dysfunctions (hiatal hernia, gastroesophageal reflux, intestinal transit disorders, etc.), and cranial dysfunctions (neuralgia, migraines, dizziness, etc.) [8].
Despite the criticism of OM for its scientific evidence, more and more quality publications are being made.
OM meets the appropriate conditions to integrate it into the health systems in the near future since it is decisive in musculoskeletal and joint diseases, often without pharmacological intervention, and may contribute to the reduction of health costs. It does not require large facilities and is environmentally sustainable.
Good training, whether medical or non-medical, would be desirable, as it has indications, contraindications, and the possibility of side effects.
The word comes from the Greek – phytós (plant or vegetable) and therapeia (therapy). It is the part of the therapy that uses products of plant origin (medicinal plants) for the prevention, cure, or relief of certain human conditions.
The WHO defines phytotherapy as the science in charge of studying plant products for their subsequent use in the therapy of pathological states [9]. It refers, above all, to the empirical use of medicinal plants (MP), with a long tradition in all cultures. Phytomedicine, however, involves a transformation of MP into drugs or phytopharmaceuticals, after clinical trials in order to guarantee the quality, safety, and efficacy [10].
The medicinal use of plants dates back to the mists of time. Used in all great civilizations to restore health, the contributions of Ancient Egypt, Greece, and Classical Rome stand out. There were no great advances in the Middle Ages until the Renaissance, where Paracelsus discovered that the properties of MP lie in the active principles [11].
WHO recommends to health authorities that each country include medicinal plants in health systems and especially in primary health care [9].
In some countries of the European Union, phytotherapy is applied mainly by doctors, although its use is very extensive, and the legislation does not hinder anyone who wants to use it. In the United States, only licensed physicians are allowed. In general, training on phytotherapy is provided in all countries, although their degree of officiality varies: some have specialties for doctors or postgraduate programs at the university, as in Germany, Italy, or Spain. In other countries, training is carried out by non-university entities such as Sweden or Canada [11].
WHO recognizes the importance of medicinal plants in the treatment and prevention of multiple diseases [9].
In general, health professionals qualified as primary and specialized care physicians have little knowledge on this subject and, at times, it is a reason for discord with patients, since many MPs cause interactions with commonly prescribed drugs. Phytotherapy is a resource to consider for multiple reasons: MP is found in nature, it is easy to prepare, etc. If we want to obtain better results, we have to go to Phytomedicine which, with standardized preparations, backed by clinical studies, guarantees quality, safety, and efficacy.
The brothers Ferdinand and Walter Huneke, German doctors, in 1928 made known to the world of medicine the existence of “unknown distant effects of local anesthetics.” Surprising results had been achieved since 1923 by applying procaine to certain areas (scars, etc.). Ferdinand Huneke observed in 1940 the so-called phenomenon in seconds. By applying a procaine injection in the area of periostitis in the context of chronic osteomyelitis in a lower limb, he managed to cure in a few seconds a persistent and painful disease in the shoulders that had been treated without success with the so-called segment therapy. With this fact, he deduced that the states of nervous irritation, called interference fields (IF), located outside the metamere can cause and maintain different diseases. By applying procaine, these IFs and pathologies that are reluctant to conventional therapies can be eliminated [12].
The purpose of Neural Therapy (NT) is to facilitate the self-healing mechanisms of the diseased organism through stimuli in specific points/areas that act on the autonomic or vegetative nervous system (VNS) [12].
The scientific bases of NT have their beginnings in the investigations of Pavlov and Speransky. Later the contributions of Ricker, Pischinger, and Virchow [12] were decisive.
To understand the neural therapeutic effect, it is necessary to take into account the concept of the basic system (BS), described by Pischinger, which is the carrier of non-specific defense functions. Its regulatory system is located in the extracellular space and behaves as a functional unit. The whole organism is connected through this BS and this also connects with the cells of the parenchyma. In chronic diseases, there is a dysfunction of the BS.
BS consists of undifferentiated soft connective tissue cells (reticulocytes or fibroblasts), extracellular tissue fluid, capillaries, and nerve terminal vegetative fiber plexuses [12].
The levels of integration of VNS, with feedback systems, explain many of the effects of NT. Table 4 lists these levels of integration.
Level | Location | Action/effects |
---|---|---|
Autonomous periphery | Basic system (Pischinger) | Nonspecific defense |
Peripheral-spinal | Reflex segment | Physical (muscle) and psychic (emotions, etc.) levels |
Rhombus-mesencephalic | Medulla, protuberance, reticular formation, tectum, etc. | Cardiocirculatory, alertness, muscle tone, etc. |
Diencephalic | Thalamus and hypothalamus | Neuro-endocrine coordination |
Cortical | Limbic system | Psychic phenomena in somatic pathology |
Integration levels of VNS (taken from the book by L. Fischer, neural therapy according to Huneke, 2012).
Although in NT chemical substances such as procaine or lidocaine are used, in very low concentrations, I wanted to introduce this therapy in this chapter since there are many advantages it offers to restore health as long as it is applied by an experienced therapist.
The “irritations” in the nervous system can be produced by infections, surgical interventions, scars, fractures, dental problems, mental trauma, eating disorders, etc. These events can generate the conditions for the appearance of certain conditions that can manifest locally or remotely, depending on the predispositions of each person. The goal of NT is to neutralize these irritations that affect VNS and cause health problems. To neutralize these irritations, a local anesthetic is used, one of the most common being procaine hydrochloride at a concentration of 0.5 to 1%. This substance is used since it has a high electrical potential. Procaine repolarizes and stabilizes the cell membrane potential (previously altered) thus allowing the recovery and stabilization of VNS. Furthermore, VNS can be acted upon through the cuti-visceral sympathetic reflex. Although there are other neural therapies, procaine offers more advantages due to its vasodilator effect, short half-life, and low toxicity [12].
The improvement achieved with NT can be immediate (phenomenon in seconds), although the most common is the repetition of several sessions until recovery is achieved. Although NT can be used in any condition, the fields in which it is most used are in the musculoskeletal system and in chronic pain. NT has its indications, contraindications, and side effects, so it is advisable to practice it by a health professional (medicine, nursing, odonto-stomatology) with experience in the technique. It can be used in all ages and for any disease. Physiotherapists cannot use NT but it is important for them to know the technique for good coordination within a multidisciplinary team. NT is therapy with good results, safe and economically and environmentally sustainable. It would be desirable to include it in the national health system of the different countries in order to obtain rapid results, reduce iatrogenesis and health costs.
According to the International Academy of Homotoxicology (IAH) Antihomotoxic Medicine (AM) is a regulatory therapy devised by the German physician Hans-Heinrich Reckeweg (1905–1985). In 1952, he published the theory of Homotoxicology based on homeopathic medicine. The foundation of this therapy is the fight against homotoxins since they would be the cause of diseases. Reckeweg’s goal was to establish a comprehensive perspective of medical science at the time and to establish a bridge between conventional and unconventional medicine [13].
According to Reckeweg, all the processes, syndromes, and manifestations that we know as diseases are the expression of the body’s fight against toxins and its intention to neutralize and excrete them. To achieve this end he uses homeopathic products, medicinal plants, organic, and pharmacological products, etc., in various homeopathic dilutions to apply them in the phase in which the disease is found according to the table of six phases [13].
The “biological cut” is the separation between the cell and the extracellular environment [13].
Homotoxicosis would be a pathophysiological state that would originate after the action of a homotoxin on cells and tissues. It would manifest itself in a humoral or cellular way (see table of the six phases) and can be accompanied by morphological changes in the tissues. This state induces defense measures of the organism in order to eliminate homotoxins and restore health. To do this, it acts on the extracellular matrix (basic system) described by Pischinger (as in Neural Therapy according to Huneke). The body, depending on various factors, can achieve this balance by itself. If this is not possible, there are several possibilities for action. If we use the principle of opposites (anti-inflammatory, etc.) there is the possibility of a progressive vicariation (it would evolve to a disease of greater caliber), on the other hand, if we use AM, the advancement of the disease would not occur but the regression (vicariation regressive) [13].
The different components of the antihomotoxic preparations stimulate the body’s defense system, through the immune assistance reaction (IAR), this being its main mechanism of action. IAR is based on low-dose antigen reactions (D1 to D14). When administering antihomotoxic products orally, parenterally, sublingually, etc., the nonspecific defense (monocytes/macrophages) acts in interaction with the specific one. In areas of dysregulation, especially where there is inflammation, Th3 cells that secrete cytokines such as the transforming tissue growth factor-beta with broad anti-inflammatory effect are attracted [14].
Antihomotoxic preparations must be prescribed in the phase in which the patient is, so an appropriate anamnesis and examination will be necessary. Sometimes techniques such as autohemotherapy, isotherapeutic (nosodes), etc., are used to achieve the objectives. The combined technique of TA with neural therapy achieves better results and in less time [13].
AM, well applied, has shown its effectiveness in most pathological processes, especially in the area of inflammation. In specialties such as sports medicine, it accelerates the healing of injuries and does not produce doping.
The concept “trace element (trace element)” was first used in 1885 by Gabriel Bertrand, who later deduced that trace elements were vital to all cells in minute quantities. The use of trace elements for therapeutic purposes (oligo therapy) began in France with the research of Bertrand (nineteenth century) and Jacques Ménétrier in the middle of the twentieth century [15].
Jacques Ménétrier (1908–1986) is considered the founder of functional medicine, of Catalytic Oligotherapy (CO), and one of the main representatives of field medicine, pioneered by the French scientist Claude Bernard [16]. CO activates a trace element present in the body in order to regulate a specific metabolic pathway [17].
Ménétrier classified groups of diseases according to the inherited terrain, their receptivity or resistance to certain diseases according to their physical and mental behaviors, and defined a series of “terrains” that he called “diathesis.” With his practice, he demonstrated the relationship of a specific diathesis with one or more trace elements that, in case of disease, its administration achieved improvement/recovery, acting on the metabolic pathways of said terrain. Table 5 shows the Ménétrier diathesis, behavior, symptoms, and regulatory trace elements [17].
Number | Diathesis | Behavior | Clinical | Therapeutic |
---|---|---|---|---|
I | Arthritic/allergic | Morning asthenia. Memory impairment. Optimistic | Migraines. Allergy. Heart disease | Mn I/S |
II | Hypostenic | Fatigue. Pessimistic | Respiratory, digestive, and skin fragility | Mn-Cu |
III | Dystonic | Morning asthenia Difficult to focus. Anxiety | Neuro-vegetative dystonia. Circulatory disorders | Mn-Co |
IV | Anergic | Asthenia. Memory disorders Depression | Acute infections Rheumatism | Cu-Au-Ag |
Maladjustment syndrome | Periodic asthenia. Depression | Endocrine dysfunction | Zn-Cu/Zn-Ni-Co |
Diathesis according to Ménétrier (taken from Colonques [17]).
According to Ménétrier, functional diseases present very different and vague clinical pictures, with imprecise signs, compared to classic diseases. They do not present lesions in radiology, nor alterations in clinical analysis. He affirmed that “most diseases do not belong to the sector of true and proper pathology, but they do belong to functional diseases, which are simple dysfunctions of the organism and that, if they are not corrected at this stage, lead to specific diseases [18].
CO, as it can be used for preventive or curative purposes. The highly diluted and ionized preparations are administered. Among the different routes of administration, the sublingual is one of the most widely used. The dosage is the same for all ages. It can be associated with drugs with very few incompatibilities and with most complementary therapies (acupuncture, Phytotherapy, etc.). The European Medicines Agency, in a review a few years ago, left some diathesics treatments for CO out of hand by removing some trace elements for being supposedly “toxic”.
A task little known by users of health systems but insisted ad nauseam by IRP professionals is the preventive aspect. Users, in general, go to IRP services in case of injury and most are unaware of the preventive aspect of IRP in both athletes and non-athletes. On the other hand, the WHO has issued a document in 2017 (Rehabilitation 2030) in which it warns of the need for IRP in the world and that due to the lack of these professionals, the inhabitants of less developed countries will be left unprotected. This will lead, posteriori, to higher healthcare costs since illnesses and/or injuries have not been detected, assessed, and treated which, if they had done so, would have contributed to reducing morbidity and mortality. In developed countries, the services offered by IRP are not sufficiently valued for various reasons. It is not uncommon for a stroke to be included in an IRP program late, due to service saturation or other reasons, obtaining worse functional recovery.
According to the WHO, greater access to rehabilitation services is required to “ensure healthy lives and promote well-being for all at all ages”. This coincides with point 3 of the Sustainable Development Goals (SDG) and specifically SDG 3.8: “Achieve universal health coverage, including protection from financial risks, access to quality basic medical services and access to safe, effective, quality and affordable basic medicines and vaccines…” [19].
The role of rehabilitation is essential for the effective implementation of the Global Strategy and Plan of Action on Aging and Health (2016–2020) [20], the Plan of Action on Mental Health (2013–2020) [21], and the Framework on people-centered integrated health services, and as a contribution to the WHO [22].
There are approximately one billion people with disabilities on the planet, most of whom lack access to medical care and RMP services. Because of this, these people have more problems achieving and maintaining an adequate level of autonomy and health. The deficit of RMP services hinders inclusion and participation in all aspects of life, leading to misery and poverty.
The processes and procedures employed in RMP are intended to allow people with disabilities to achieve and maintain an optimal level of physical, sensory, intellectual, psychological, social, and spiritual performance. RMP encompasses a wide range of therapeutic possibilities, some with scientific evidence and others with less scientific evidence, but widely used by the world population and with wide acceptance. The WHO has been recommending for decades that all available therapeutic resources should be used and that research is continued for their validation [23].
Persons with disabilities should have access to general medical care and adequate RMP services.
The Convention on the Rights of Persons with Disabilities states that countries must ensure that persons with disabilities have access to appropriate health services, including general health care and RF services, and do not suffer discrimination in the provision of health services. WHO actively supports the application of the Convention, having ratified it in successive meetings with representatives of member countries.
There is no conflict of interest.
RMP | Rehabilitation medicine and physiotherapy |
UT | Unconventional Therapies |
TCM | Traditional Chinese Medicine |
USA | United States of America |
WHO | World Health Organization |
MP | Medicinal plants |
OM | Osteopathic Medicine |
AM | Antihomotoxic medicine |
IAH | International Academy for Homotoxicology |
IAR | Immune assist reaction |
NT | Neural Therapy |
IF | Interference field |
BS | Basic system (Pischinger) |
VNS | Vegetative nervous system |
CO | Catalytic Oligotherapy |
IRP | Integrative Rehabilitation and Physiotherapy |
SDG | Sustainable Development Goals |
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In this section, recent studies have been compiled which aim to extraction of plant material in high yield and quality and determine optimum conditions for this extraction process.",book:{id:"5856",slug:"statistical-approaches-with-emphasis-on-design-of-experiments-applied-to-chemical-processes",title:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes",fullTitle:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes"},signatures:"Alev Yüksel Aydar",authors:[{id:"218870",title:"Dr.",name:"Alev Yüksel",middleName:null,surname:"Aydar",slug:"alev-yuksel-aydar",fullName:"Alev Yüksel Aydar"}]},{id:"56460",doi:"10.5772/intechopen.69501",title:"Application of Taguchi-Based Design of Experiments for Industrial Chemical Processes",slug:"application-of-taguchi-based-design-of-experiments-for-industrial-chemical-processes",totalDownloads:3194,totalCrossrefCites:25,totalDimensionsCites:48,abstract:"Design of experiment is the method, which is used at a very large scale to study the experimentations of industrial processes. It is a statically approach where we develop the mathematical models through experimental trial runs to predict the possible output on the basis of the given input data or parameters. The aim of this chapter is to stimulate the engineering community to apply Taguchi technique to experimentation, the design of experiments, and to tackle quality problems in industrial chemical processes that they deal with. Based on years of research and applications, Dr. G. Taguchi has standardized the methods for each of these DOE application steps. Thus, DOE using Taguchi approach has become a much more attractive tool to practicing engineers and scientists. And since the last four decades, there were limitations when conventional experimental design techniques were applied to industrial experimentation. And Taguchi, also known as orthogonal array design, adds a new dimension to conventional experimental design. Taguchi method is a broadly accepted method of DOE, which has proven in producing high-quality products at subsequently low cost.",book:{id:"5856",slug:"statistical-approaches-with-emphasis-on-design-of-experiments-applied-to-chemical-processes",title:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes",fullTitle:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes"},signatures:"Rahul Davis and Pretesh John",authors:[{id:"199438",title:"Mr.",name:"Rahul",middleName:null,surname:"Davis",slug:"rahul-davis",fullName:"Rahul Davis"}]},{id:"14634",doi:"10.5772/15998",title:"The Application of FT-IR Spectroscopy in Waste Management",slug:"the-application-of-ft-ir-spectroscopy-in-waste-management",totalDownloads:6635,totalCrossrefCites:18,totalDimensionsCites:34,abstract:null,book:{id:"1574",slug:"fourier-transforms-new-analytical-approaches-and-ftir-strategies",title:"Fourier Transforms",fullTitle:"Fourier Transforms - New Analytical Approaches and FTIR Strategies"},signatures:"Ena Smidt, Katharina Böhm and Manfred Schwanninger",authors:[{id:"20376",title:"Dr.",name:"Katharina",middleName:null,surname:"Böhm",slug:"katharina-bohm",fullName:"Katharina Böhm"},{id:"22840",title:"Dr.",name:"Ena",middleName:null,surname:"Smidt",slug:"ena-smidt",fullName:"Ena Smidt"},{id:"22915",title:"Dr.",name:"Manfred",middleName:null,surname:"Schwanninger",slug:"manfred-schwanninger",fullName:"Manfred Schwanninger"}]},{id:"15157",doi:"10.5772/15959",title:"Fourier Transform Mass Spectrometry for the Molecular Level Characterization of Natural Organic Matter: Instrument Capabilities, Applications, and Limitations",slug:"fourier-transform-mass-spectrometry-for-the-molecular-level-characterization-of-natural-organic-matt",totalDownloads:4331,totalCrossrefCites:6,totalDimensionsCites:33,abstract:null,book:{id:"122",slug:"fourier-transforms-approach-to-scientific-principles",title:"Fourier Transforms",fullTitle:"Fourier Transforms - Approach to Scientific Principles"},signatures:"Rachel L. Sleighter and Patrick G. Hatcher",authors:[{id:"22676",title:"Dr.",name:"Rachel L.",middleName:null,surname:"Sleighter",slug:"rachel-l.-sleighter",fullName:"Rachel L. Sleighter"},{id:"23168",title:"Dr.",name:"Patrick G.",middleName:null,surname:"Hatcher",slug:"patrick-g.-hatcher",fullName:"Patrick G. Hatcher"}]},{id:"60097",doi:"10.5772/intechopen.75381",title:"Robust Optimization: Concepts and Applications",slug:"robust-optimization-concepts-and-applications",totalDownloads:2535,totalCrossrefCites:23,totalDimensionsCites:30,abstract:"Robust optimization is an emerging area in research that allows addressing different optimization problems and specifically industrial optimization problems where there is a degree of uncertainty in some of the variables involved. There are several ways to apply robust optimization and the choice of form is typical of the problem that is being solved. In this paper, the basic concepts of robust optimization are developed, the different types of robustness are defined in detail, the main areas in which it has been applied are described and finally, the future lines of research that appear in this area are included.",book:{id:"6587",slug:"nature-inspired-methods-for-stochastic-robust-and-dynamic-optimization",title:"Nature-inspired Methods for Stochastic, Robust and Dynamic Optimization",fullTitle:"Nature-inspired Methods for Stochastic, Robust and Dynamic Optimization"},signatures:"José García and Alvaro Peña",authors:[{id:"227809",title:"Ph.D.",name:"Jose",middleName:null,surname:"Garcia",slug:"jose-garcia",fullName:"Jose Garcia"},{id:"240407",title:"Dr.",name:"Alvaro",middleName:null,surname:"Peña",slug:"alvaro-pena",fullName:"Alvaro Peña"}]}],mostDownloadedChaptersLast30Days:[{id:"59209",title:"Utilization of Response Surface Methodology in Optimization of Extraction of Plant Materials",slug:"utilization-of-response-surface-methodology-in-optimization-of-extraction-of-plant-materials",totalDownloads:5398,totalCrossrefCites:57,totalDimensionsCites:87,abstract:"Experimental design plays an important role in several areas of science and industry. Experimentation is an application of treatments applied to experimental units and is then part of a scientific method based on the measurement of one or more responses. It is necessary to observe the process and the operation of the system well. For this reason, in order to obtain a final result, an experimenter must plan and design experiments and analyzes the results. One of the most commonly used experimental designs for optimization is the response surface methodology (RSM). Because it allows evaluating the effects of multiple factors and their interactions on one or more response variables it is a useful method. In this section, recent studies have been compiled which aim to extraction of plant material in high yield and quality and determine optimum conditions for this extraction process.",book:{id:"5856",slug:"statistical-approaches-with-emphasis-on-design-of-experiments-applied-to-chemical-processes",title:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes",fullTitle:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical Processes"},signatures:"Alev Yüksel Aydar",authors:[{id:"218870",title:"Dr.",name:"Alev Yüksel",middleName:null,surname:"Aydar",slug:"alev-yuksel-aydar",fullName:"Alev Yüksel Aydar"}]},{id:"74096",title:"Time Frequency Analysis of Wavelet and Fourier Transform",slug:"time-frequency-analysis-of-wavelet-and-fourier-transform",totalDownloads:1219,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"Signal processing has long been dominated by the Fourier transform. However, there is an alternate transform that has gained popularity recently and that is the wavelet transform. The wavelet transform has a long history starting in 1910 when Alfred Haar created it as an alternative to the Fourier transform. In 1940 Norman Ricker created the first continuous wavelet and proposed the term wavelet. Work in the field has proceeded in fits and starts across many different disciplines, until the 1990’s when the discrete wavelet transform was developed by Ingrid Daubechies. While the Fourier transform creates a representation of the signal in the frequency domain, the wavelet transform creates a representation of the signal in both the time and frequency domain, thereby allowing efficient access of localized information about the signal.",book:{id:"10065",slug:"wavelet-theory",title:"Wavelet Theory",fullTitle:"Wavelet Theory"},signatures:"Karlton Wirsing",authors:[{id:"325178",title:"Dr.",name:"Karlton",middleName:null,surname:"Wirsing",slug:"karlton-wirsing",fullName:"Karlton Wirsing"}]},{id:"60864",title:"Statistical Methodology for Evaluating Business Cycles with the Conditions of Their Synchronization and Harmonization",slug:"statistical-methodology-for-evaluating-business-cycles-with-the-conditions-of-their-synchronization-",totalDownloads:1328,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The importance of the topic of business cycle research and their interaction is due to the fact that the cyclical nature of development is a universal feature of the market economy (regardless of the level of development of the country’s economy and the principles of its organization). In all cases, cyclical ups and downs depend not only on internal system cyclical processes and their factors in countries but also on the consequences of intercountry interaction. The ability to measure and predict business cycles, taking into account their mutual influence, is a prerequisite for the development of an adequate business policy of countries and their associations.",book:{id:"6703",slug:"statistics-growing-data-sets-and-growing-demand-for-statistics",title:"Statistics",fullTitle:"Statistics - Growing Data Sets and Growing Demand for Statistics"},signatures:"Elena Zarova",authors:null},{id:"54366",title:"Solution of Differential Equations with Applications to Engineering Problems",slug:"solution-of-differential-equations-with-applications-to-engineering-problems",totalDownloads:6815,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"Over the last hundred years, many techniques have been developed for the solution of ordinary differential equations and partial differential equations. While quite a major portion of the techniques is only useful for academic purposes, there are some which are important in the solution of real problems arising from science and engineering. In this chapter, only very limited techniques for solving ordinary differential and partial differential equations are discussed, as it is impossible to cover all the available techniques even in a book form. The readers are then suggested to pursue further studies on this issue if necessary. After that, the readers are introduced to two major numerical methods commonly used by the engineers for the solution of real engineering problems.",book:{id:"5513",slug:"dynamical-systems-analytical-and-computational-techniques",title:"Dynamical Systems",fullTitle:"Dynamical Systems - Analytical and Computational Techniques"},signatures:"Cheng Yung Ming",authors:[{id:"191017",title:"Dr.",name:"Cheng",middleName:null,surname:"Y.M.",slug:"cheng-y.m.",fullName:"Cheng Y.M."}]},{id:"56538",title:"Stochastic Resonance and Related Topics",slug:"stochastic-resonance-and-related-topics",totalDownloads:1695,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The stochastic resonance (SR) is the phenomenon which can emerge in nonlinear dynamic systems. In general, it is related with a bistable nonlinear system of Duffing type under additive excitation combining deterministic periodic force and Gaussian white noise. It manifests as a stable quasiperiodic interwell hopping between both stable states with a small random perturbation. Classical definition and basic features of SR are regarded. The most important methods of investigation outlined are: analytical, semi-analytical, and numerical procedures of governing physical systems or relevant Fokker-Planck equation. Stochastic simulation is mentioned and experimental way of results verification is recommended. Some areas in Engineering Dynamics related with SR are presented together with a particular demonstration observed in the aeroelastic stability. Interaction of stationary and quasiperiodic parts of the response is discussed. Some nonconventional definitions are outlined concerning alternative operators and driving processes are highlighted. The chapter shows a large potential of specific basic, applied and industrial research in SR. This strategy enables to formulate new ideas for both development of nonconventional measures for vibration damping and employment of SR in branches, where it represents an operating mode of the system itself. Weaknesses and empty areas where the research effort of SR should be oriented are indicated.",book:{id:"6128",slug:"resonance",title:"Resonance",fullTitle:"Resonance"},signatures:"Jiří Náprstek and Cyril Fischer",authors:[{id:"207472",title:"Dr.",name:"Jiri",middleName:null,surname:"Naprstek",slug:"jiri-naprstek",fullName:"Jiri Naprstek"},{id:"213311",title:"Dr.",name:"Cyril",middleName:null,surname:"Fischer",slug:"cyril-fischer",fullName:"Cyril Fischer"}]}],onlineFirstChaptersFilter:{topicId:"15",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82378",title:"Covers and Properties of Families of Real Functions",slug:"covers-and-properties-of-families-of-real-functions",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.100555",abstract:"We present results on the relationships of the covering property GΦΨ for Φ,Ψ∈OΛΩΓ and G∈S1SfinUfin of a topological space and the selection property GΦ0Ψ0 of the corresponding family of real functions. The result already published are presented without a proof, however with a citation of the corresponding paper. We present a general Theorem that covers almost all the result of this kind. Some results about hereditary properties are enclosed. We also present Scheepers Diagram of considered covering properties for uncountable covers.",book:{id:"10677",title:"Advanced Topics of Topology",coverURL:"https://cdn.intechopen.com/books/images_new/10677.jpg"},signatures:"Lev Bukovský"},{id:"82356",title:"Geometric Properties of Classical Yang-Mills Theory on Differentiable Manifolds",slug:"geometric-properties-of-classical-yang-mills-theory-on-differentiable-manifolds",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105399",abstract:"Gauge theories make up a class of physical theories that attempt to describe the physics of particles at a fundamental level. The purpose here is to study Yang-Mills theory at the classical level in terms of the geometry of fiber bundles and differentiable manifolds. It is shown how fundamental particles of bosonic and fermionic nature can be described mathematically. The Lagrangian for the basic interactions is presented and then put together in a unified form. Finally, some basic theorems are proved for a Yang-Mills on compact four-dimensional manifolds.",book:{id:"11502",title:"Manifolds - Recent Developments and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11502.jpg"},signatures:"Paul Bracken"},{id:"82335",title:"Straight Rectangular Waveguide for Circular Dielectric Material in the Cross Section and for Complementary Shape of the Cross Section",slug:"straight-rectangular-waveguide-for-circular-dielectric-material-in-the-cross-section-and-for-complem",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.104815",abstract:"This chapter presents wave propagation along a straight rectangular waveguide for practical applications where there are two complementary shapes of the dielectric profile in the cross section. In the first case, the cross section consists of circular dielectric material in the center of the cross section. In the second case, the cross section consists of a circular hollow core in the center of the cross section. These examples show two discontinuous cross sections and complementary shapes that cannot be solved by analytical methods. We will explain in detail the special technique for calculating the dielectric profile for all cases. The method is based on Laplace and Fourier transforms and inverse Laplace and Fourier transform. In order to solve any inhomogeneous problem in the cross section, more than one technique can be proposed for the same mode-model method. We will explain in detail how and where the technique can be integrated into the proposed mode-model. The image method and periodic replication are needed for fulfilling the boundary condition of the metallic waveguide. The applications are useful for straight rectangular waveguides in millimeter regimes, where the circular dielectric material is located in the center of the cross section, and also for hollow waveguides, where the circular hollow core is located in the center of the cross section.",book:{id:"11150",title:"Recent Advances of Wavelet Transform and Their Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11150.jpg"},signatures:"Zion Menachem"},{id:"82204",title:"Some Solvability Problems of Differential Equations in Non-standard Sobolev Spaces",slug:"some-solvability-problems-of-differential-equations-in-non-standard-sobolev-spaces",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.104918",abstract:"In this chapter an m-th order elliptic equation is considered in Sobolev spaces generated by the norm of a grand Lebesgue space. Subspaces are determined in which the shift operator is continuous, and local solvability (in the strong sense) is established in these subspaces. It is established an interior and up-to boundary Schauder-type estimates with respect to these Sobolev spaces for m-th order elliptic operators, the trace of functions and trace operator are determined, the boundedness of trace operator and the extension theorem are proved, the properties of the Riesz potential are studied regarding these Sobolev spaces, etc. It is considered a second-order elliptic equation, and we study the Fredholmness of the Dirichlet problem in the Sobolev space generated by a separable subspace of the grand Lebesgue space. It is also considered one spectral problem for a discontinuous second-order differential operator and proved the theorem on the basicity of eigenfunctions of this operator in subspace of Morrey space, in which the infinitely differentiable functions with compact support are dense.",book:{id:"11149",title:"Differential Equations",coverURL:"https://cdn.intechopen.com/books/images_new/11149.jpg"},signatures:"Bilal Bilalov, Sabina Sadigova and Zaur Kasumov"},{id:"82011",title:"Spatial Statistics in Vector-Borne Diseases",slug:"spatial-statistics-in-vector-borne-diseases",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104953",abstract:"Vector-borne diseases are those caused by the bite of an infected arthropod, such as the Aedes aegypti mosquito, which can infect humans with dengue or Zika. Spatial statistics is an interesting tool that is currently implemented to predict and analyze the behavior of biological systems or natural phenomena. In this chapter, fundamental characteristics of spatial statistics are presented and its application in epidemiology is exemplified by presenting a study on the prediction of the dispersion of dengue disease in Chiapas, Mexico. A total of 573 confirmed dengue cases (CDCs) were studied over the period of January–August 2019. As part of the spatial modeling, the existence of spatial correlation in CDCs was verified with the Moran index (MI) and subsequently the spatial correlation structure was identified with the mean squarer normalized error (MSNE) criterion. A Generalized Linear Spatial Model (GLSM) was used to model the CDCs. CDCs were found to be spatially correlated, and this can be explained by a Matérn covariance function. Finally, the explanatory variables were maximum environmental temperature, altitude, average monthly rainfall, and patient age. The prediction model shows the importance of considering these variables for the prevention of future CDCs in vulnerable areas of Chiapas.",book:{id:"10678",title:"Biostatistics",coverURL:"https://cdn.intechopen.com/books/images_new/10678.jpg"},signatures:"Manuel Solís-Navarro, Susana G. Guzmán-Aquino, María Guzmán-Martínez and Jazmín García-Machorro"},{id:"81944",title:"The Basics of Structural Equations in Medicine and Health Sciences",slug:"the-basics-of-structural-equations-in-medicine-and-health-sciences",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.104957",abstract:"Structural Equation Models (SEM) are very useful and, with a wide range of practical applications in many fields of science, in medicine and health sciences, have increased interest in their usefulness. This chapter is divided into three sections. The first includes concepts, notation, and theoretical aspects of SEM, such as path diagrams, measurement model, confirmatory factor analysis, structural regression, and identification model. In addition, it includes some simple examples applied to health sciences. The second section deals with the estimation and evaluation of the model. On the first topic, the methods of Maximum Likelihood (ML), Generalized Least Squares, Unweighted Least Squares, and ML with robust standard errors are addressed, as well as alternative methods to the problem of violations of the multivariate normality assumption. On the second topic, some goodness of fit statistics of the estimated model are defined, such as the chi-square statistic, Root Mean Square Error of Approximation, Tucker-Lewis Index, Comparative Fit Index, Standardized Root Mean Square Residual, and Goodness of Fit Index. The last section deals with SEM example and its implementation using the lavaan library of R software.",book:{id:"10678",title:"Biostatistics",coverURL:"https://cdn.intechopen.com/books/images_new/10678.jpg"},signatures:"Ramón Reyes-Carreto, Flaviano Godinez-Jaimes and María Guzmán-Martínez"}],onlineFirstChaptersTotal:42},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:31,numberOfPublishedChapters:314,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:11,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:105,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:18,numberOfOpenTopics:2,numberOfUpcomingTopics:1,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:14,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:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"June 11th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"19",title:"Animal Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/19.jpg",isOpenForSubmission:!0,editor:{id:"259298",title:"Dr.",name:"Edward",middleName:null,surname:"Narayan",slug:"edward-narayan",fullName:"Edward Narayan",profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",biography:"Dr. Edward Narayan graduated with Ph.D. degree in Biology from the University of the South Pacific and pioneered non-invasive reproductive and stress endocrinology tools for amphibians - the novel development and validation of non-invasive enzyme immunoassays for the evaluation of reproductive hormonal cycle and stress hormone responses to environmental stressors. \nDr. Narayan leads the Stress Lab (Comparative Physiology and Endocrinology) at the University of Queensland. A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. 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She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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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. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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