\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"3774",leadTitle:null,fullTitle:"Trends in Telecommunications Technologies",title:"Trends in Telecommunications Technologies",subtitle:null,reviewType:"peer-reviewed",abstract:"The main focus of the book is the advances in telecommunications modeling, policy, \r\nand technology. In particular, several chapters of the book deal with low-level \r\nnetwork layers and present issues in optical communication technology and optical \r\nnetworks, including the deployment of optical hardware devices and the design of \r\noptical network architecture. Wireless networking is also covered, with a focus on \r\nWiFi and WiMAX technologies. The book also contains chapters that deal with \r\ntransport issues, and namely protocols and policies for efficient and guaranteed \r\ntransmission characteristics while transferring demanding data applications such as \r\nvideo. Finally, the book includes chapters that focus on the delivery of applications \r\nthrough common telecommunication channels such as the earth atmosphere. \r\nThis book is useful for researchers working in the telecommunications field, in order \r\nto read a compact gathering of some of the latest efforts in related areas. It is also \r\nuseful for educators that wish to get an up-to-date glimpse of telecommunications \r\nresearch and present it in an easily understandable and concise way. It is finally \r\nsuitable for the engineers and other interested people that would benefit from an \r\noverview of ideas, experiments, algorithms and techniques that are presented \r\nthroughout the book.",isbn:null,printIsbn:"978-953-307-072-8",pdfIsbn:"978-953-51-5877-6",doi:"10.5772/180",price:159,priceEur:175,priceUsd:205,slug:"trends-in-telecommunications-technologies",numberOfPages:780,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"f3dbabed739298bd4f93be0b050c5288",bookSignature:"Christos J Bouras",publishedDate:"March 1st 2010",coverURL:"https://cdn.intechopen.com/books/images_new/3774.jpg",numberOfDownloads:155482,numberOfWosCitations:109,numberOfCrossrefCitations:54,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:162,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:325,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"July 1st 2013",dateEndSecondStepPublish:"July 22nd 2013",dateEndThirdStepPublish:"October 26th 2013",dateEndFourthStepPublish:"January 24th 2014",dateEndFifthStepPublish:"February 23rd 2014",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"4780",title:"Prof.",name:"Christos",middleName:"J.",surname:"Bouras",slug:"christos-bouras",fullName:"Christos Bouras",profilePictureURL:"https://mts.intechopen.com/storage/users/4780/images/system/4780.jpg",biography:"Christos Bouras is Professor in the University of Patras, Department of Computer Engineering and Informatics. Also he is a scientific advisor of Research Unit 6 in Computer Technology Institute and Press - Diophantus, Patras, Greece. His research interests include Analysis of Performance of Networking and Computer Systems, Computer Networks and Protocols, Mobile and Wireless Communications, Telematics and New Services, QoS and Pricing for Networks and Services, e-learning, Networked Virtual Environments and WWW Issues. He has extended professional experience in Design and Analysis of Networks, Protocols, Telematics and New Services. He has published more than 450 papers in various well-known refereed books, conferences and journals. He is a co-author of 9 books in Greek and editor of 2 in English. He has been member of editorial board for international journals and PC member and referee in various international journals and conferences. He has participated in R&D projects.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Patras",institutionURL:null,country:{name:"Greece"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"541",title:"Wireless Communication System",slug:"communications-and-security-wireless-communication-system"}],chapters:[{id:"9701",title:"A Novel PFC Circuit for Three-Phase Utilizing Single Switching Device",doi:"10.5772/8484",slug:"a-novel-pfc-circuit-for-three-phase-utilizing-single-switching-device",totalDownloads:4528,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Keiju Matsui and Masaru 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Among the difficulties in twin birth, we highlight: prematurity, non-cephalic presentations, dystocia, funicular prolapse, placental abruption, increased operative incidence, postpartum hemorrhages, perinatal anoxia and tocotraumatism [2].
In this chapter we will review the main aspects related to the time and mode of delivery in multiple pregnancies and issues related to fetal weight assessment.
Multiple pregnancies have high rates of mortality and morbidity when compared to single pregnancies. This is mainly due to prematurity, complications close to delivery, and placental insufficiency [1].
In fact, this risk is related to chorionicity. The monochorionic (MC) pregnancies present a higher incidence of perinatal mortality, higher admission in neonatal intensive care unit and low birth weight [3]. It is possible that the single placental mass shared between pairs originates from an imbalance in placental anastomoses, may be overloaded in the third trimester [4].
A large Dutch cohort with 1407 multiple pregnancies showed that after 32 weeks’ gestation, mortality was 11.6% in MC and 5% in dichorionic (DC) [5]. The risk of uterine death was significantly higher in MC than in DC (hazard ratio 8.8, 95% CI 2.7–28.9), and in most cases no change in fetal status was observed. The authors concluded that fetal vitality control was not sufficient to prevent adverse events and delivery should be planned up to the 37th week for MC.
A study with 94,170 multiple deliveries showed that the risk of fetal death increased significantly between 37 and 38 weeks of gestation in twin pregnancies. This risk was higher between 34 and 37 weeks of gestation in triplet pregnancies. The risk of child death after delivery gradually declined as pregnancies neared full term. This group recommended increased fetal surveillance after 34 weeks of gestation in multiple pregnancies [6].
The American College of Obstetricians and Gynecologists (ACOG) suggests that delivery be performed between 38 + 0 and 38 + 6 weeks in uncomplicated twin dichorionic pregnancies [7]. Depending on complications such as fetal growth restriction, termination of pregnancy is recommended before 38 weeks.
In 2016, a systematic review included 32 studies (29,685 dichorionic, 5486 monochorionic pregnancies) and showed that in dichorionic pregnancies beyond 34 weeks (15 studies, 17,830 pregnancies), the weekly risk of stillbirths due to expectant management and the risk of neonatal death were balanced at the 37th week of gestation. When delivery was delayed for 1 week (up to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies [8].
The same review showed that monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), had a tendency for an increase in stillbirths compared to neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant [8].
Just like DC gestations, there are no high-quality studies to respond with great certainty the right time for terminate monochorionic pregnancies. Most specialists in large reference centers recommend delivery of monochorionic/diamniotic twins between 36 + 0 and 36 + 6 weeks. This may be the point of balance between the already reduced risk of prematurity and the risk of fetal death [9].
There is still a lot of divergence between medical societies for the correct time of delivery. ACOG suggests delivery of monochorionic twins between 34 + 0 to 37 + 6 weeks of gestation [7] and the North American Fetal Therapy Network suggests delivery at 36 + 0 to 37 + 6 weeks of gestation [9]. However, others delegate delivery at 32 weeks of gestation [10]. It is clear that in cases of Twin-Twin Transfusion Syndrome, most of deliveries are performed earlier and this depends on the degree of complication that is present.
On the other hand, in monoamniotic pregnancies, most specialized centers in the world recommend delivery between 32 and 34 weeks. This fact is justified by the high rate of perinatal mortality in the third trimester (30–70%) and has as main motive the umbilical cords entanglement in the same amniotic chamber [4, 11, 12].
The mode of delivery in twin pregnancy depends on multiple factors and is very controversial in the literature. The most important factors to be considered on deciding the delivery mode are the fetus presentation, especially the first twin, fetal weight, weight difference between the fetuses, gestational weight and maternal clinical conditions. Women’s parity is also a condition with high influence in mode of delivery in a twin pregnancy, as nulliparous usually result in less success when attempting a vaginal delivery [13].
The decision on either performing an elective cesarean delivery must consider the best neonatal and maternal outcomes, to reduce neonatal morbidity and mortality, maternal complications and preserving the women’s reproductive future. The biggest risk in a vaginal delivery is for the second twin, as complications can occur after the delivery of the first twin, including placental abruption, cord prolapse and long delivery intervals [14].
It is important to consider that conditions that would indicate a cesarean section in singleton pregnancies should also be applied in multiple pregnancies.
Determining fetal presentation is fundamental in the decision of the mode of delivery. The presentation of twin pairs in a term twin pregnancy is 40% of the times cephalic/cephalic, 35–40% cephalic/non-cephalic and only 20% with the first twin non-cephalic [15]. It is a general consensus that, when both fetuses are in cephalic presentation, a vaginal delivery should be attempted [13, 14, 15]. However, it is important to notice that the second twin change its presentation in about 20% of the time, after the first one is born [15].
When the second twin is in a non-cephalic presentation, vaginal delivery is controversial. Some studies say that neonatal morbidity is higher for the second twin in those cases and an elective cesarean section should be planned [16, 17]. However, both a systematic review and meta-analysis [14] and a recent published prospective cohort study [18] support that cesarean deliveries neither add neonatal morbidity nor mortality. Therefore, a vaginal delivery is a safe option. In those cases, the second twin can either be delivered by breech extraction or an external cephalic version can be attempted [19].
Finally, when the first twin is non-cephalic, the safest delivery mode is the cesarean section. A randomized multicenter trial, The Breech Trial, showed that a planned cesarean delivery decreases significantly perinatal mortality and neonatal serious morbidity, when compared with a planned vaginal delivery in pregnancies with a non-cephalic presenting twin [20].
Twin pregnancies are more likely to show deviations in fetal growth curve. Conditions such as prematurity, intrauterine growth restriction and fetal malformations are common in multiple gestations, raising the risk of mortality and perinatal morbidity to 3–7 times when compared to single pregnancies [21]. Prematurity is present in approximately 55% of twin pregnancies, with adverse consequences even in short and long term [22].
When comparing the weights of fetuses from twin pregnancies to those of single pregnancies, it is observed that fetuses of twin pregnancies have a lower weight than fetuses of single pregnancies, especially from the end of the second trimester. It is known that this variation between the weights starts at around 28 weeks and at 38 weeks the 50th percentile for a twin pregnancy corresponds to the 10th percentile for a single pregnancy [23], but this difference does not seem to increase neonatal mortality. Therefore, it is argued that the lower weight of twin fetuses, when compared to that of single pregnancies, may be physiological of this condition.
Accuracy in the estimation of fetal weight is of paramount importance for the proper follow-up of prenatal care and ultrasonography study has been the main tool for this evaluation.
Currently fetal weight estimation by ultrasonography is most commonly performed by the formula of Hadlock et al. [24], which uses two-dimensional measures of cephalic pole, abdominal circumference and femur length. However, studies have shown that formulas using two-dimensional parameters can generate variations of up to 15% in relation to the real weight of the fetus [25].
New methods have been sought to improve the accuracy of fetal weight estimation such as three-dimensional ultrasonography. In the early 2000s, Lee et al. [26] introduced a new sonographic parameter, the fraction limb volume. This parameter is based on evaluation of 50% of bone diaphysis length (arm and thigh).
This method has the advantage of reducing the time spent to perform the test, maintaining a good accuracy for the estimation fetal weight.
In general, the accuracy of estimation weight in twin pregnancies is worse than single pregnancies. Biometric measurement of these fetuses in the third trimester is greatly impaired due to the technical difficulty of examination. When using 33 formulas to assess the accuracy of estimation weight by two-dimensional ultrasonography, 25 of these formulas present a weight variation of less than 10% for single pregnancies, but only 3 of these formulas present the same result for twin pregnancies [27].
An ongoing study that has been developed in multiple pregnancy unit of Federal University of São Paulo has shown that the use of fraction limb volume in twin pregnancies can improve the accuracy of estimation weight in these pregnancies, as well as reduce the time of the examination.
Although evaluation of fetal body volume through the use of magnetic resonance imaging is still considered an expensive method, there is good accuracy in fetal weight estimation, besides being a good predictor in the diagnoses of small fetuses for gestational age when compared to two-dimensional ultrasonography [28].
Estimating weight in twin pregnancies remains a challenge. New research needs to be conducted in search for new methods in order to improve accuracy.
Fetal weight should not be considered when both fetuses are cephalic. In those cases, regardless the fetal weight, a vaginal delivery can be attempted. However, in cephalic/non-cephalic twin pregnancies, the influence of weight on mode of delivery is controversial. Most studies showed worst perinatal outcomes for vaginal deliveries when the second twin was non-cephalic and under 1500 g [29, 30].
Weight difference is related to worst neonatal outcomes, regardless the delivery mode [31], and also to unsuccessful attempt of labor [32]. Furthermore, a weight difference above 40% has been associated with higher neonatal mortality rates in vaginal deliveries, regardless fetal presentation, in a retrospective study in 2005 [33].
A previous cesarean delivery is considered a risk factor for an emergency C-section after attempting a vaginal delivery in twin pregnancies [34]. Regardless, a caution trial of labor can be a safe option in those patients, when the first twin is cephalic [35].
On the other hand, patients with two or more previous cesarean sections should not attempt a vaginal delivery due to higher risk of uterine rupture.
There is limited existing evidence to determine the safest mode of delivery for extremely preterm twins. Therefore, it is important to consider the fetal presentation and weight when deciding the delivery mode, regardless gestational age.
A recently published meta-analysis showed no significant difference in neonatal death and severe brain injury by mode of delivery for cephalic/non-cephalic twins with a gestational age under 28 weeks [36]. This study found higher rates of maternal complications in growth-discordant twins.
Higher rates of maternal morbidities are found in multiple gestations, compared to singletons. There is a higher risk of pre-eclampsia, diabetes and post-partum complications, as uterine atony and postpartum hemorrhage. Regardless, maternal conditions are rarely an indication of a cesarean section. An elective cesarean delivery can be performed after maternal request, after exposing the risks of the procedure, as longer maternal hospital stay, increased risk of the newborn going to the ICU due to respiratory problems and increased risks for subsequent pregnancies, as placenta previa and uterine rupture [37]. In those cases, the surgery should be planned to the appropriate gestational age, considering chorionicity and amnionicity.
Although the data about triplet pregnancies are still limited, and the monoamniotic and diamniotic triplets should be delivered between 32 + 0 and 32 + 6 weeks [38], most studies and guidelines suggest delivery time at no later than 36 weeks, even in uncomplicated triamniotic triplets [6, 39, 40]. The preferred delivery route is the cesarean section because vaginal delivery is associated with an increased risk of adverse outcomes if compared with the cesarean [41, 42].
In conjoined twins, the data available is based in small case report studies and expert opinion, but what is suggested is the delivery time and mode of the viable ones must be near term cesarean section after confirming lung maturity. In selected cases an EXIT procedure can be performed in order to stabilize the fetuses with cardiac union to examine and close the vessel communication safely [43].
Another controversial subject about delivery in twins is the time interval between fetuses in vaginal delivery.
New guidelines such as the American College of Obstetricians and Gynecologists do not recommend an upper limit to the time interval between fetuses, if the fetal heart rate is reassuring, as some studies also suggests [44, 45, 46, 47]. However, there are studies that provide evidence of an association, but not necessarily causality, between longer twin-to-twin time interval and poor second twin outcome, such as lower apgar grades and decreasing pH in umbilical arterial blood gas [48, 49, 50]. This lack of strong evidence leaves space for different approach and expectant management [51].
A very specific approach can be performed in the case of a dichorionic twin pregnancy with spontaneous preterm delivery <24 weeks and never above 28 weeks, which is called delayed interval delivery when the second twin do not have an indication for labor such as infection among other complications. Several techniques and interventions are described but the evidence is not strong, but the main goal is to provide a better outcome for the second twin, and success rates of these particular cases are good according to a systematic review of 2016 [52].
During the last few years, a lot of studies were performed trying to elucidate the question about the best delivery route for twins, according to the associated risks and benefits of planned cesarean section or planned attempt vaginal delivery.
The twin birth study, showed that planned cesarean section was not superior to planned vaginal delivery regarding maternal risk or neonatal mortality or morbidity [53], and ever since some society guidelines suggest attempt to vaginal delivery to diamniotic twin pregnancies if the first twin is in cephalic presentation [54].
The concern about the risks includes the possibility of combined delivery, which involves an unplanned cesarean after attempt of vaginal delivery and is associated with higher second twin morbidity [14] and may be an increased risk of neonatal and/or maternal infection probably because the exposure to labor and rupture of membranes are higher than in a planned cesarean delivery.
Cesarean delivery can expose mothers to short-term risks such as endometritis, wound complications, surgical injuries, hemorrhage [55], although maternal outcomes past 3 month and long-term risks, including abnormal placentation, are similar both ways cesarean an vaginal planned delivery [56, 57].
Newborns delivered by planned cesarean present a higher risk in developing allergic disorders [58, 59, 60].
The twin birth study did not found statistically significant difference in morbidity and fetal or neonatal mortality between planned cesarean or planned vaginal delivery [14, 53], and a 2-year follow up after delivery found no difference in neurodevelopment and death in both groups [61].
A retrospective study with 1070 twin pregnancies attempted trial of labor between 2003 and 2015 showed that in planned cesarean, the first twin has a lower blood pH and base excess than in vaginal delivery, but the study was unpowered for neonatal outcome assessment [13].
The time of delivery in twin pregnancies is around 38 weeks for dichorionic pairs, 36 weeks for monochorionic and 32 weeks for monoamniotic. When both fetuses are on cephalic presentation at delivery, the vaginal route is preferable regardless of weight. Being the first twin in non-cephalic presentation, cesarean section is the best choice. When the first twin is in cephalic presentation and the second non-cephalic, cesarean section is indicated if the fetus weight is less than 1,500g. However, vaginal delivery is possible if the fetus’ weight is above 1,500g. In those cases, the second twin can either be delivered by breech extraction or an external cephalic version can be attempted.
Inguinal hernia repair is one of the most common procedures in surgical practice. In the surgical repair of groin hernia, prosthetic meshes and their fixation have been subject to debate. In the last decades, synthetic meshes have become crucial in surgical treatment of inguinal hernia. Once positioned, meshes are designed to be integrated in local tissue by a fibrotic reaction that gradually incorporates them. Therefore, a good fixation is essential to secure the mesh in its correct position, while the integration process occurs.
The introduction of synthetic meshes and their proper fixation has reduced recurrence rates to below 5%. As a consequence, the most frequent postoperative morbidities have become mesh migration, chronic pain, infection, and seroma [1, 2]. In surgical practice the main challenge in mesh fixation consists in finding a good balance between the strength of fixation, in order to avoid recurrence and the risk of tissue trauma and nerve entrapment, leading to chronic pain.
At present, various fixation techniques and materials have been developed, but no unanimous consent has been reached on the “best” method of fixation. The choice is still based on surgeon’s preferences and experience, and much still depends on local habits and personal beliefs.
The primary function of a fixation device is to keep the mesh in place until tissue ingrowth is completed. The interaction between mesh and tissue depends on the type of mesh; however, complete integration is usually achieved within 2–3 weeks after surgery. It is important to underline that shear strength is reached for 74% during the first 2 weeks. Until then, therefore, proper fixation is essential. Different types of fixation medium can be used in inguinal hernia surgery, the main ones being tissue glues, staples and tacks, and sutures.
Tissue adhesives have been introduced in medical practice during the 1960s. Since then, they have been used in numerous procedures like skin closure, suture reinforcement, arteriovenous embolization, endoscopic treatment of ulcers and varices, and fixation of meshes in abdominal wall defect repair.
Two types of tissue adhesive for mesh fixation are available in surgical practice:
It is made of four components: human purified fibrinogen, bovine atropine solution, human thrombin, and calcium chloride. Alongside its hemostatic action, the fibrinogen component gives the product tensile strength and adhesive properties. It also promotes fibroblast proliferation [3]. These are mixed at the time of fixation to duplicate the terminal coagulation reaction and generate polymerized fibrin [4]. Once applied to the mesh, 3 min may be required to complete the reaction [5].
These glues are synthetic (n-butyl-cyanoacrylate) or hybrid tissue sealants. They are known for strong and rapid adhesive properties. Cyanoacrylic glues ensure high-degree and strong bonding to biologic tissues when compared with other adhesives. When they get in contact with blood or water contained in the tissue, they form a very tight cover, binding to the surface within 5–6 s [6]. Glubran-2 is the most recently produced tissue adhesive. Its peculiarity is a longer radical chain with a lower temperature of polymerization compared to Histoacryl®, which results in lower toxicity and fewer inflammatory reactions [7].
At present, there is no evidence in medical literature as to which glue may be considered better in mesh fixation during inguinal hernia repair. Nevertheless, it must be remarked that using glue for mesh fixation increases the costs of hernioplasty, if compared with sutures.
Tack fixation has been performed since the introduction of laparoscopic inguinal and ventral hernia repair between the late 1980s and the early 1990s. In current practice, three types of tacks are commonly used, divided into two categories: absorbable and nonabsorbable.
It is a laparoscopic device, which places a helical coil into the fascia and muscle of the anterior abdominal wall. The tack itself has a helical shape, measures 4 mm in length and 3 mm in width, and penetrates approximately 3–4 mm into these tissues. To be placed correctly, tacks must be placed 1–1.5 cm apart, along the periphery of the mesh [8].
These tacks are made of polyacetal, a molded, polymer-based material. It is a permanent hollow tack with an atraumatic tip, 6.7 mm long [9].
These tacks are made of polymers or copolymers (poly(D,L)-lactide or glycolide-co-L-lactide). They measure between 6.4 and 6.7 mm and adsorb in 12–16 months [9].
Overall, tacks provide an excellent fixation strength, and they are also easy to apply. Nevertheless, their use is associated with significant morbidity. The penetration of the abdominal wall, in fact, may cause nerve and vessel entrapment. Also, tacks are themselves foreign bodies introduced in the abdomen, so they may cause inflammatory reactions. As a result, a significant number of patients suffer from pain and develop adhesion in the postoperative period. Moreover, cases of migration of titanium tacks have been described. At present, absorbable tacks are connected to lower inflammation rates, adhesion formation, and migration so the use of titanium tacks is no longer advisable.
Sutures commonly used in hernia repair are divided into two: absorbable and nonabsorbable, each characterized by a different degree of tension generated and a different time of strength loss due to degradation.
Their loss of strength has been classified and varies from a minimum of 1 week (Monocryl®) to a maximum of 4–5 weeks (PDS®).
These sutures are designed to retain most of their strength indefinitely.
International medical literature offers evidence that both absorbable and nonabsorbable sutures seem to provide enough strength and tension to prevent recurrence. International randomized trials do not seem to highlight significant difference between the two types of sutures in terms of postoperative complications. Nevertheless, nonabsorbable suture seems to be connected to a higher incidence of postoperative pain due to entrapment of a nerve by suture or mesh [10].
As mentioned above, several mesh fixation methods exist, including tacks, staples, self-fixing, fibrin sealants, synthetic glues, and sutures. Which method to choose to secure a mesh during surgical hernia repair depends on many factors such as personal beliefs, local habits and “dogmas,” type of the hernia, and size of the defect but, most of all, on surgical technique.
Two approaches to repair inguinal hernia are common practice in surgery: the open approach, usually the Lichtenstein technique, and the laparoscopic approach, meaning both preperitoneal and extraperitoneal repair.
Groin hernioplasty is the most common operation in general surgery. Due to its lower costs, shorter operating times, and reduced complication risks, the open Lichtenstein technique is performed more frequently. Lichtenstein hernia repair, in fact, is simple, safe, and easy to learn, with very good results in terms of morbidity and a very low recurrence rate.
Both sutures (absorbable and nonabsorbable) and glues (fibrin and cyanoacrylic) can be used to seal the mesh to the abdominal wall.
According to standard operating technique, once the mesh is placed and adjusted, the upper edge is kept in place with two or three sutures, one to the rectus sheath and the others to the internal oblique aponeurosis. Also the lower lateral edges of each of the two tails of the mesh are fixed to the inguinal ligament, leaving enough space for the passage of the spermatic cord.
The use of tissue adhesive to secure the mesh has become an internationally accepted practice in the last few decades. In the sutureless technique, the mesh is fixated by using fibrin or cyanoacrylic glue, whose components get mixed during the operation. Once activated, the glue is poured beneath the mesh, covering the whole Hesselbach’s triangle. The mesh is placed above the glue and pressed against the inguinal floor for about 2 min [11].
Suture mesh fixation in inguinal hernia repair represents the main source of complications, possibly leading to inflammation and surgical site infection (SSI), hematoma, nerve entrapment, and chronic pain.
A 2014 systematic review including 12 articles by Sanders et al. [12] found an infection rate between 0 and 3.5%, and no significant difference in terms of SSIs incidence was detected between the groups. Anyway, there is no study specifying the depth of infection, whether it was deep or superficial. This could lead to improper conclusions, being a deep infection more related to the presence of the mesh.
Pain is a very important outcome after surgical repair of groin hernia. Pain is defined as acute, when it occurs in the first week after the operation, and chronic, when it lasts beyond 3 months after surgery. Two RCTs, recently published in medical literature, have demonstrated a significant lower incidence of acute pain after using fibrin sealant (p < 0.001) [13] and cyanoacrylic glue (p < 0.003) [14] compared to suture fixation.
A recent meta-analyses, including 13 RCTs comparing glue versus suture mesh fixation in Lichtenstein inguinal hernia repair [15, 16], showed a lower incidence of early acute pain (p = 0.03) and hematoma in the glue fixation group. On the other hand, chronic pain is one of the main issues after hernioplasty, and sutureless techniques were introduced in surgery in an attempt to reduce its incidence, without affecting recurrence rates. According to the international guidelines for groin hernia management, the incidence of chronic pain ranges from 0 to 36.3% [17]. In particular, 14.7% is for sutures, 7.6% for cyanoacrylic glues, and 3.7% for fibrin glues. Three international RCTs suggest that the use of fibrin or cyanoacrylic glue can reduce pain if compared to suture [10, 12]. In particular, the TIMELI international trial demonstrated that fibrin glue was connected to the reduction of chronic symptoms like numbness and discomfort after 1 year.
Among the possible complications, recurrence is possibly the one that concerns surgeons the most. According to Sanders et al.’s review, recurrence rate is 1.3%. There was no significant difference between fixation methods in any of the RCTs, although long-term recurrence rates have not been determined and large hernias often have been excluded.
Concluding, in open inguinal hernia repair, no differences in recurrence or surgical site infection between different mesh fixation methods have been reported in literature, while sutureless fixation may reduce the onset of acute and chronic pain. Therefore, according to HerniaSurge Group consensus, glue fixation in the Lichtenstein technique can be performed in direct or indirect hernias less than 3 cm large (MII or LII types, EHS classification).
At present, the two most common laparoscopic techniques for hernia repair are the transabdominal preperitoneal repair (TAPP) and the total extraperitoneal repair (TEP). Both techniques involve the placement of a mesh in the preperitoneal space that must cover all potential hernia sites. The mesh in the preperitoneal space is subject to intra-abdominal forces and may be easily displaced before fibrosis seals it to the inguinal canal. In particular, the medial edge of the mesh is most susceptible to displacement, leading to inevitable recurrence if the medial part of the inguinal canal gets exposed. This underlines the importance of fixation [18]. Tacks, glues, and sutures can all be used to fixate the mesh.
Arguably, the most popular technique among surgeons is the use of tacks. However, it is known that using tacks and staples to secure the mesh can lead to complications, such as chronic pain. During the mesh fixation, in fact, it is really important not to place any tack or staple below the iliopubic tract, avoiding the triangle of pain. Lateral fixation should also be avoided, to prevent inadvertent damage to the nerves. Also misplaced tacks are described in literature to be responsible for nerve irritation and injury. The alternatives of the use of tacks are tissue glues and sutures.
Sutures usually require expertise and longer operating times. Both absorbable and nonabsorbable sutures may be used to fixate mesh to the abdominal wall. Sutures are usually applied transfascially after reduction of intraperitoneal pressure. Suture type, quantity, and placement vary among surgeons and no “gold standard” technique has been established [19].
Tissue glues have been introduced in laparoscopic hernia repair to reduce morbidity, such as pain and hematoma, thanks to their atraumatic application and their hemostatic properties [20].
Several studies, including meta-analyses and RCTs, comparing complication rates after different fixation methods, have been produced.
Complications after TEP repair, using tacks against glue, have been analyzed in a recent review by Kaul et al. [21]. The authors included in the study four RCTs for a total of 664 procedures. According to their results, no significant difference in terms of SSIs rates could be registered.
Acute pain after TEP was analyzed in a randomized prospective trial by Lau in [22]. The study concluded that, even if glue group consumed significantly less analgesics compared to staple group (p = 0.034), no significant difference has been registered in the postoperative pain score in the first week after surgery. On the other hand, Kaul et al.’s review reported a significant difference in terms of chronic pain incidence between the two groups (OR 3.25; 95% CI 1.62–6.49).
As already said, recurrence is a very important outcome when it comes to inguinal hernia repair. According to the two meta-analyses present in literature, there is no evidence of a significant difference in terms of recurrence, after using tissue sealants or tacks to fix the mesh [21, 23].
Similar results can be found in literature about TAPP technique. In a recent meta-analyses by Shah et al. [24], including five randomized controlled trials and five non-RCTs, no significant differences were found in terms of acute pain, SSIs, or recurrence. Nevertheless, patients who underwent TAPP hernia repair, using tissue sealant for mesh fixation, experienced significant less chronic pain (p = 0.005). Several RCTs published in the last decade have confirmed these findings [25, 26, 27].
Concluding, international RCTs and several meta-analyses have proven tissue glue to be as safe as tacks in terms of recurrence and SSI. In addition, chronic pain was significantly less represented when tissue adhesives were used for the fixation of the mesh. Therefore, according to international guidelines, to minimize the risk of acute postoperative pain, atraumatic fixation techniques (fibrin glue, cyanoacrylate) should be considered.
When it comes to mesh fixation, no unanimous consent about technique has ever been reached. Several types of fixation methods exist such as tacks, staples, self-fixing, fibrin sealants, glues, and sutures. The choice of which method to use strongly depends on the type of surgery and the type of defect but also (and often decisively) on surgeons’ personal beliefs and local habits. In open technique both sutures and tissue adhesives have been proven equally safe in terms of recurrence and wound infection, but glues are connected to less chronic pain onset. Therefore, glue fixation in the Lichtenstein technique can be performed in MII or LII types (EHS classification) hernias.
Similarly, in the laparoscopic approach, tacks or glues can be used to secure the mesh showing similar recurrence rates. Again, adhesive fixation is connected to less morbidity in terms of chronic pain.
In conclusion, international RCTs and recent meta-analyses have confirmed tissue adhesives to be a valid alternative to traditional sutures and tacks. When it comes to the choice of which fixation procedure to perform in inguinal hernia repair, many authors advise the use of tissue sealants to minimize the risks of chronic pain, justifying the higher costs due to the use of expensive glues.
Morena Burati MD: project conception; acquisition; analysis; and interpretation of data and drafting of the work. Marco Chiarelli MD: project design; acquisition; interpretation of data; and revising of the work.
Alberto Scaini MD: project design; acquisition; and interpretation of data.
Luca Andrea Fumagalli MD: project design; acquisition; and interpretation of data.
Francesco Gabrielli PhD: project design; acquisition; interpretation of data; and revising of the work.
The authors do not have any conflict of interest.
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The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"28882",title:"Infectious Disease and Personal Protection Techniques for Infection Control in Dentistry",slug:"infectious-disease-and-personal-protection-techniques-for-infection-control-in-dentistry",totalDownloads:4832,totalCrossrefCites:0,totalDimensionsCites:1,abstract:null,book:{id:"1820",slug:"infection-control-updates",title:"Infection Control",fullTitle:"Infection Control - Updates"},signatures:"Bahadır Kan and Mehmet Ali Altay",authors:[{id:"99656",title:"Dr.",name:"Bahadir",middleName:null,surname:"Kan",slug:"bahadir-kan",fullName:"Bahadir Kan"},{id:"131781",title:"Dr.",name:"Mehmet Ali",middleName:null,surname:"Altay",slug:"mehmet-ali-altay",fullName:"Mehmet Ali Altay"}]},{id:"76011",title:"The Role of the Radiation Safety Officer in Patient Safety",slug:"the-role-of-the-radiation-safety-officer-in-patient-safety",totalDownloads:451,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The role of the Radiation Safety Officer (RSO) is to prevent unnecessary exposure to ionizing radiation and maintain necessary exposures as low as reasonably achievable (ALARA). The RSO is delegated broad authority throughout the organization by senior management. This authority includes permission to stop unsafe practices and identifying radiation protection problems, initiating, recommending, or providing corrective actions and verifying implementation of these actions. For the most part, these efforts are focused on maintaining radiation doses to employees and the public ALARA. Regulations do not address a role for the RSO in reducing radiation exposure to patients, except when unnecessary exposure is suspected due to equipment malfunction or human error. There is increasing concern about the risks of cancer and other effects from the use of medical imaging procedures. This chapter will discuss the tools and resources available to the RSO to educate members of the medical community and senior management on the need to manage radiation doses to patients so that the physician is able to obtain information necessary to properly diagnose and treat patients while avoiding unnecessary exposure.",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Thomas L. Morgan and Sandy Konerth",authors:[{id:"343320",title:"Dr.",name:"Thomas L.",middleName:"Logan",surname:"Morgan",slug:"thomas-l.-morgan",fullName:"Thomas L. 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Vice-versa, the HF with preserved ejection fraction (diastolic HF or HFpEF phenotype) is a much more complex syndrome, in which co-morbidities (such as COPD, depression, anemia, and diabetes, CAD) play a significant role in the decompensation episodes.",book:{id:"4650",slug:"primary-care-in-practice-integration-is-needed",title:"Primary Care in Practice",fullTitle:"Primary Care in Practice - Integration is Needed"},signatures:"Monica Lorenzini, Caterina Ricci, Silvia Riccomi, Federica Abate,\nBarbara Casalgrandi, Benedetta Quattrini, Gianbattista Spagnoli,\nLetizia Reggianini and Oreste Capelli",authors:[{id:"110047",title:"Dr.",name:"Oreste",middleName:null,surname:"Capelli",slug:"oreste-capelli",fullName:"Oreste Capelli"},{id:"111587",title:"Dr.",name:"Silvia",middleName:null,surname:"Riccomi",slug:"silvia-riccomi",fullName:"Silvia Riccomi"},{id:"174922",title:"Dr.",name:"Monica",middleName:null,surname:"Lorenzini",slug:"monica-lorenzini",fullName:"Monica Lorenzini"},{id:"176492",title:"Dr.",name:"Caterina",middleName:null,surname:"Ricci",slug:"caterina-ricci",fullName:"Caterina Ricci"},{id:"176493",title:"Dr.",name:"Letizia",middleName:null,surname:"Reggianini",slug:"letizia-reggianini",fullName:"Letizia Reggianini"},{id:"186451",title:"BSc.",name:"Federica",middleName:null,surname:"Abate",slug:"federica-abate",fullName:"Federica Abate"},{id:"186452",title:"BSc.",name:"Barbara",middleName:null,surname:"Casalgrandi",slug:"barbara-casalgrandi",fullName:"Barbara Casalgrandi"},{id:"190027",title:"Dr.",name:"Gianbattista",middleName:null,surname:"Spagnoli",slug:"gianbattista-spagnoli",fullName:"Gianbattista Spagnoli"},{id:"190029",title:"MSc.",name:"Benedetta",middleName:null,surname:"Quattrini",slug:"benedetta-quattrini",fullName:"Benedetta Quattrini"}]},{id:"60411",title:"Defining Adverse Events and Determinants of Medical Errors in Healthcare",slug:"defining-adverse-events-and-determinants-of-medical-errors-in-healthcare",totalDownloads:1552,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The concept of error typically regards an action, not its outcome, and its meaning becomes clear when separated into categories (medical error, nurse perceptions of (medication) error, diagnostic error). One wrong action may or may not lead to an adverse event either because the abovementioned action did not cause any serious damage to patients’ health condition or because it was promptly detected and corrected. The concept of error, on the contrary, which is used alternatively in the study, refers to the adverse outcome of an action. The responsibility for the emergence of errors in healthcare systems is shared among the nature of the healthcare system that is governed by organizational and functional complexity, the multifaceted and uncertain nature of medical science, and the imperfections of human nature. Medical errors should be examined as errors of the healthcare system, in order to identify their root causes and develop preventive measures. The main aims of this chapter are the following: (1) to understand medical errors and adverse events and define the terms that describe them; and (2) the most excellent way to comprehend how medical errors and adverse events occur and how to prevent them. 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He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. 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His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:4,paginationItems:[{id:"81821",title:"Pneumococcal Carriage in Jordanian Children and the Importance of Vaccination",doi:"10.5772/intechopen.104999",signatures:"Adnan Al-Lahham",slug:"pneumococcal-carriage-in-jordanian-children-and-the-importance-of-vaccination",totalDownloads:0,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Streptococcal Infections",coverURL:"https://cdn.intechopen.com/books/images_new/10828.jpg",subseries:{id:"3",title:"Bacterial Infectious Diseases"}}},{id:"81813",title:"Schistosomiasis: Discovery of New Molecules for Disease Treatment and Vaccine Development",doi:"10.5772/intechopen.104738",signatures:"Andressa Barban do Patrocinio",slug:"schistosomiasis-discovery-of-new-molecules-for-disease-treatment-and-vaccine-development",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"New Horizons for Schistosomiasis Research",coverURL:"https://cdn.intechopen.com/books/images_new/10829.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"81644",title:"Perspective Chapter: Ethics of Using Placebo Controlled Trials for Covid-19 Vaccine Development in Vulnerable Populations",doi:"10.5772/intechopen.104776",signatures:"Lesley Burgess, Jurie Jordaan and Matthew Wilson",slug:"perspective-chapter-ethics-of-using-placebo-controlled-trials-for-covid-19-vaccine-development-in-vu",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"SARS-CoV-2 Variants - Two Years After",coverURL:"https://cdn.intechopen.com/books/images_new/11573.jpg",subseries:{id:"6",title:"Viral Infectious Diseases"}}},{id:"80546",title:"Streptococcal Skin and Skin-Structure Infections",doi:"10.5772/intechopen.102894",signatures:"Alwyn Rapose",slug:"streptococcal-skin-and-skin-structure-infections",totalDownloads:48,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Streptococcal Infections",coverURL:"https://cdn.intechopen.com/books/images_new/10828.jpg",subseries:{id:"3",title:"Bacterial Infectious Diseases"}}}]},overviewPagePublishedBooks:{paginationCount:13,paginationItems:[{type:"book",id:"6667",title:"Influenza",subtitle:"Therapeutics and Challenges",coverURL:"https://cdn.intechopen.com/books/images_new/6667.jpg",slug:"influenza-therapeutics-and-challenges",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Shailendra K. 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Biosensors, Biomaterials and Tissue Engineering",value:9,count:1},{group:"subseries",caption:"Bioinspired Technology and Biomechanics",value:8,count:2},{group:"subseries",caption:"Bioinformatics and Medical Informatics",value:7,count:9}],publicationYearFilters:[{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2019",value:2019,count:5},{group:"publicationYear",caption:"2018",value:2018,count:3}],authors:{paginationCount:302,paginationItems:[{id:"198499",title:"Dr.",name:"Daniel",middleName:null,surname:"Glossman-Mitnik",slug:"daniel-glossman-mitnik",fullName:"Daniel Glossman-Mitnik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/198499/images/system/198499.jpeg",biography:"Dr. Daniel Glossman-Mitnik is currently a Titular Researcher at the Centro de Investigación en Materiales Avanzados (CIMAV), Chihuahua, Mexico, as well as a National Researcher of Level III at the Consejo Nacional de Ciencia y Tecnología, Mexico. His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 255 peer-reviewed papers, 32 book chapters, and 2 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:"Centro de Investigación en Materiales Avanzados",institution:{name:"Centro de Investigación en Materiales Avanzados",country:{name:"Mexico"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. 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