Different radionuclides for bone palliation.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{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"}]},book:{item:{type:"book",id:"10351",leadTitle:null,fullTitle:"Enhanced Liposuction - New Perspectives and Techniques",title:"Enhanced Liposuction",subtitle:"New Perspectives and Techniques",reviewType:"peer-reviewed",abstract:"Liposuction began as a simple, minimally invasive method of reducing the amount of localized fat in a region. Today it is a sophisticated and complex process, with many variations in purpose and technique. In this book, a global slate of expert surgeons offers a detailed description of various minimally invasive and non-invasive options for contouring the face, neck, and body. Chapters detail the evolution and utilization of various energy-based devices and combination treatments. They also describe procedure limitations and treatment of complications. Finally, they discuss indications for various approaches with case study descriptions so readers might be assisted with treating patients in their everyday practice.",isbn:"978-1-83968-105-9",printIsbn:"978-1-83962-823-8",pdfIsbn:"978-1-83968-106-6",doi:"10.5772/intechopen.91537",price:139,priceEur:155,priceUsd:179,slug:"enhanced-liposuction-new-perspectives-and-techniques",numberOfPages:410,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f08ed6de16da357614586c5b58ed4dfa",bookSignature:"Diane Irvine Duncan",publishedDate:"April 20th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10351.jpg",numberOfDownloads:3334,numberOfWosCitations:0,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:6,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:8,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 24th 2020",dateEndSecondStepPublish:"December 22nd 2020",dateEndThirdStepPublish:"February 20th 2021",dateEndFourthStepPublish:"May 11th 2021",dateEndFifthStepPublish:"July 10th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"279869",title:"Dr.",name:"Diane Irvine",middleName:null,surname:"Duncan",slug:"diane-irvine-duncan",fullName:"Diane Irvine Duncan",profilePictureURL:"https://mts.intechopen.com/storage/users/279869/images/system/279869.jpg",biography:"Dr. Diane Irvine Duncan is a US-based board-certified plastic surgeon known for research and international education. She has published frequently in peer-reviewed journals, books, and video format. She is on the editorial board of the Aesthetic Surgery Journal, and reviews for LMS and JCD. Dr. Duncan is a coordinator for the Lasers and EBD alert section and a member of the IMCAS faculty. She has recently completed a BBC documentary and has participated in and moderated many educational panels and webinars. Her current area of focus is regenerative modalities for the treatment of skin and soft tissue, including reversal of age-related sarcopenia.",institutionString:"Plastic Surgical Associates in Fort Collins",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Colorado Health",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:"1143",title:"Cosmetic Surgery",slug:"cosmetic-surgery"}],chapters:[{id:"78973",title:"History of Body Contouring",doi:"10.5772/intechopen.99098",slug:"history-of-body-contouring",totalDownloads:143,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The evolution of body contouring follows decades of procedures and technologic advances in body shaping. Beginning many decades ago with extensive surgical resections of skin and subcutaneous fat, the evolution was dramatically changed with the introduction of suction assisted lipectomy (liposuction). Further refinement in the technique of liposuction allowed more precise sculpting of the body and, most recently, has evolved to high definition liposuction. Following the introduction of liposuction in the early 1980s, energy based devices were developed to allow non or minimally invasive procedures to sculpt the body. The energy sources include laser energy, radiofrequency energy, ultrasonic energy, and plasma based energy. This evolution has provide the cosmetic surgeon with a variety of options to obtain optimal body contouring in a variety of clinical presentations. The safety and the efficacy of these procedures are the most important considerations in adopting new technology and techniques.",signatures:"Malcolm D. Paul and Garrett Wirth",downloadPdfUrl:"/chapter/pdf-download/78973",previewPdfUrl:"/chapter/pdf-preview/78973",authors:[{id:"59069",title:"Mr.",name:"Malcom D.",surname:"Paul",slug:"malcom-d.-paul",fullName:"Malcom D. Paul"},{id:"418215",title:"Dr.",name:"Garrett",surname:"Wirth",slug:"garrett-wirth",fullName:"Garrett Wirth"}],corrections:null},{id:"76356",title:"The Safe Evolution of Liposuction into Liposculpture",doi:"10.5772/intechopen.97351",slug:"the-safe-evolution-of-liposuction-into-liposculpture",totalDownloads:176,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Liposuction was described in the 1920s & popularised in 1977 by Illouz. He developed smaller diameter blunt cannulas. To add safety he also developed the wet technique to reduce blood loss. Tumescent anaesthesia described by Klein in 1987 made large volume liposuction safer allowing for more refined body contouring through significantly minimising blood loss. Liposuction journey started as mechanical debulking that evolved over the last 4 decades into a refined high definition body contouring and proportioning surgery, thus making sculpturing a shape of figurine possible. To achieve such high definition body sculpting technology including Laser, and Vaser not only added safety, however, they also achieved outcomes that cannot be matched with the older methods of liposuction, under local anaesthesia. In this chapter we aspire to discuss the journey of how liposuction evolved into body contouring surgery with large volume lipo-aspirates yet more safely.",signatures:"Ali Juma, Jamil Hayek and Simon Davies",downloadPdfUrl:"/chapter/pdf-download/76356",previewPdfUrl:"/chapter/pdf-preview/76356",authors:[{id:"343918",title:"Dr.",name:"Jamil",surname:"Hayek",slug:"jamil-hayek",fullName:"Jamil Hayek"},{id:"344364",title:"Mr.",name:"Simon",surname:"Davies",slug:"simon-davies",fullName:"Simon Davies"},{id:"351015",title:"Dr.",name:"Ali",surname:"Juma",slug:"ali-juma",fullName:"Ali Juma"}],corrections:null},{id:"75578",title:"The Basic Science of Radiofrequency-Based Devices",doi:"10.5772/intechopen.96652",slug:"the-basic-science-of-radiofrequency-based-devices",totalDownloads:401,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"This chapter outlines the basic science and specific principles of operation for radiofrequency (RF) technologies with a focus on minimally-invasive applications enhancing liposuction procedure. Before discussing the parameters, settings and techniques for radiofrequency-assisted lipolysis (RFAL) and fractional RF subdermal treatment, it is important to understand the fundamentals of the basic science of RF technologies and applications. The chapter accurately describes the physics of the processes occurring during RF-based treatment, and the factors affecting its safe and efficacious outcome. The discussion of RF-based devices will use terminology and definitions provided by FDA guidance for electrosurgical devices. Measurements and computer simulations conducted by the authors to illustrate importance of different parameters for the specific treatments of skin and subcutaneous fat are also presented.",signatures:"Michael Kreindel and Stephen Mulholland",downloadPdfUrl:"/chapter/pdf-download/75578",previewPdfUrl:"/chapter/pdf-preview/75578",authors:[{id:"343659",title:"Dr.",name:"Stephen",surname:"Mulholland",slug:"stephen-mulholland",fullName:"Stephen Mulholland"},{id:"347622",title:"Ph.D.",name:"Michael",surname:"Kreindel",slug:"michael-kreindel",fullName:"Michael Kreindel"}],corrections:null},{id:"76785",title:"Contractile Effects of Radiofrequency Energized Helium Plasma on the Fibrous Septal Network",doi:"10.5772/intechopen.97849",slug:"contractile-effects-of-radiofrequency-energized-helium-plasma-on-the-fibrous-septal-network",totalDownloads:158,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Body contouring with liposuction has evolved significantly from the early approach of simply debulking excess fatty tissue, to affecting the mechanical properties of different tissue types and layers. Operative paradigms have been expanded to apply energy-based technologies intraoperatively to provide more uniform aspiration, selective fatty tissue emulsification in soft and fibrous body areas, minimize trauma to nerves and vessels, expose the fibrous septal network, reduce operator fatigue and help deliver smooth shapes with less discomfort and bruising. Advanced refinements with the delivery of monopolar and bipolar radiofrequency energy for soft tissue heating have been shown to reduce the residual soft tissue laxity that often follows voluminous fat removal. The Renuvion® (Apyx™ Medical, Clearwater, FL) radiofrequency powered helium plasma technology introduces an emerging concept in which the delivery of subdermal thermal energy preferentially coagulates the fascia and fibrous septal network through a conductive helium plasma stream seeking the path of least resistance, which in turn results in collagen contraction and tissue shrinkage that permits re-draping of the skin and enhanced definition. The physics and mechanics of Renuvion® subdermal soft tissue coagulation will be presented, along with clinical applications that have provided the authors more contouring finesse and has augmented liposuction outcomes.",signatures:"Vaishali B. Doolabh",downloadPdfUrl:"/chapter/pdf-download/76785",previewPdfUrl:"/chapter/pdf-preview/76785",authors:[{id:"344573",title:"Dr.",name:"Vaishali B.",surname:"Doolabh",slug:"vaishali-b.-doolabh",fullName:"Vaishali B. Doolabh"}],corrections:null},{id:"78630",title:"Use of Technologies to Improve the Liposuction Outcome Including Skin Texture and Form",doi:"10.5772/intechopen.99947",slug:"use-of-technologies-to-improve-the-liposuction-outcome-including-skin-texture-and-form",totalDownloads:135,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Liposuction as the word suggests involves sucking out fat from the subcutaneous layers. In many parts of the world it is used interchangeably with weight loss and non-surgical fat reduction procedures. The gold standard for liposuction for many decades has been the “Suction assisted Liposuction’ also called SAL. Newer technologies have been introduced with varied claims about skin retraction, painless and complete evacuation of fat as well as a faster recovery. This chapter elaborates the personal experience of the Authors with regards to the discussed newer technologies bringing into perspective their indications, mechanism of action as well as clinical outcomes. At the outset the Authors would like to state emphatically that technologies are as good as the surgeon holding them and that somewhat same result can be achieved through a traditional liposuction in most of the cases. A surgeon looking to incorporate these technologies in practice should first achieve a mastery of traditional SAL for the best outcomes.",signatures:"Mohan Thomas, James D’silva and Amal Abraham",downloadPdfUrl:"/chapter/pdf-download/78630",previewPdfUrl:"/chapter/pdf-preview/78630",authors:[{id:"342416",title:"Prof.",name:"Mohan",surname:"Thomas",slug:"mohan-thomas",fullName:"Mohan Thomas"},{id:"342418",title:"Dr.",name:"James",surname:"D’silva",slug:"james-d'silva",fullName:"James D’silva"},{id:"429620",title:"Dr.",name:"Amal",surname:"Abraham",slug:"amal-abraham",fullName:"Amal Abraham"}],corrections:null},{id:"76342",title:"Internal and External Radiofrequency Assisted Lipo-Coagulation (RFAL) in the Control of Soft Tissue Contraction during Liposuction: Part 1 “Inside Out” Thermal Tissue Tightening",doi:"10.5772/intechopen.97378",slug:"internal-and-external-radiofrequency-assisted-lipo-coagulation-rfal-in-the-control-of-soft-ti-1",totalDownloads:157,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Radiofrequency Assisted Lipo-coagulation (RFAL) BodyTite is a contact, impedance, internal and external thermal regulation controlled, internal, minimally invasive, non-excisional procedure providing soft tissue lipo-coagulation and contraction that has been used for over 10 years to optimize skin and soft tissue contraction during liposuction procedures. The device deploys a bipolar applicator inserted into the liposuction zone. The internal, coated, electrode is positively charged and emits a coagulative, ablative injury that results in adipose liquification and Fibroseptal Network (FSN) contraction. The RF flows from the internal electrode after ablation and coagulation up to the external negatively charged return electrode moving on the skin, which heats and tightens the papillary dermis non-ablatively. The body areas that most benefit from this BodyTite technology and procedure include those areas most in need of non-excision contraction include the abdomen, upper arms, inner thighs, bra-line, neck and jaw line. Studies, show, that the combination of BodyTite internal thermal coagulation and external Morpheus8 (see Part 2) at the time of liposuction can result in 40–70% area skin contraction, greatly improving the soft tissue contours and Body shaping outcomes following lipo-contouring procedures.",signatures:"Robert Stephen Mulholland",downloadPdfUrl:"/chapter/pdf-download/76342",previewPdfUrl:"/chapter/pdf-preview/76342",authors:[{id:"343659",title:"Dr.",name:"Stephen",surname:"Mulholland",slug:"stephen-mulholland",fullName:"Stephen Mulholland"}],corrections:null},{id:"75958",title:"Internal and External Radiofrequency Assisted Lipo-Coagulation (RFAL) in the Control of Soft Tissue Contraction during Liposuction: Part 2 “Outside In” RFAL Thermal Tissue Tightening",doi:"10.5772/intechopen.97031",slug:"internal-and-external-radiofrequency-assisted-lipo-coagulation-rfal-in-the-control-of-soft-ti",totalDownloads:283,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The new Morpheus8 is a novel external RFAL device that uses the proven soft tissue contraction of BodyTite in an external, non-invasive procedure. This external RF applicator, which is also powered by BodyTite, inserts up to 40 positively charged, coated electrodes 8 mm into the subcutaneous, soft tissue envelope. A monopolar ablative lesion is generated from the tip of the electrode, stimulating contraction of the FSN and adipose coagulation. The RF then flows up to the distant negative, return electrodes on the surface of the skin, providing a non-ablative thermal stimulation to the papillary dermis. The “burst” feature of the Morpheus8, delivers simultaneous multiple levels of internal coagulation in a single one second pulse, amplifying the adipose ablation and contraction effect. Studies, show, that the combination of BodyTite internal thermal coagulation and external Morpheus8 at the time of liposuction can result in 60–70% area skin contraction, greatly improving the soft tissue contours and Body shaping outcomes following lipo-contouring procedures.",signatures:"Robert Stephen Mulholland",downloadPdfUrl:"/chapter/pdf-download/75958",previewPdfUrl:"/chapter/pdf-preview/75958",authors:[{id:"343659",title:"Dr.",name:"Stephen",surname:"Mulholland",slug:"stephen-mulholland",fullName:"Stephen Mulholland"}],corrections:null},{id:"78675",title:"VASER Liposuction - How to Get Natural Results with Ultrasound Assisted Liposuction?",doi:"10.5772/intechopen.100154",slug:"vaser-liposuction-how-to-get-natural-results-with-ultrasound-assisted-liposuction-",totalDownloads:143,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Ultrasound assisted liposuction technology is a selective technique to emulsify fatty tissue and improve the removal of fat. This technique can be used on many areas of the body such as: chin neck, back, buttocks, abdomen, legs, arms. Fatty areas, as well as, skin and cellulite can be molded in a process known as ultrasound cavitation. Results can produce significant skin contraction and smoothing of areas. Using this method reduces the need for surgical intervention and requires less energy to achieve similar results. This method is also good for treatment of fibrous scar tissue, producing less bruising and blood loss. The advantages of the VASER ultrasound prepared liposuction in comparison to the mechanical liposuction method are better with fat extraction, less blood loss, and smoother results. While the disadvantages of VASER ultrasound method are possible thermal injuries, the need for larger incisions for protective ports, increased incidence of seromas, slightly increased cost and longer preparation and operative times. However further presentation will show the benefits of this newer generation of liposuction method. Also, various probes for better fat extraction and specific treatment areas will be discussed.",signatures:"Dinko Bagatin, Tomica Bagatin, Judith Deutsch, Katarina Sakic, Johann Nemrava, Eduardo Isomura and Martina Sarec Ivelj",downloadPdfUrl:"/chapter/pdf-download/78675",previewPdfUrl:"/chapter/pdf-preview/78675",authors:[{id:"343179",title:"Assistant Prof.",name:"Dinko",surname:"Bagatin",slug:"dinko-bagatin",fullName:"Dinko Bagatin"},{id:"343261",title:"Dr.",name:"Tomica",surname:"Bagatin",slug:"tomica-bagatin",fullName:"Tomica Bagatin"},{id:"343263",title:"Prof.",name:"Katarina",surname:"Sakic",slug:"katarina-sakic",fullName:"Katarina Sakic"},{id:"343264",title:"Dr.",name:"Johann",surname:"Nemrava",slug:"johann-nemrava",fullName:"Johann Nemrava"},{id:"343265",title:"Dr.",name:"Judith",surname:"Deutsch",slug:"judith-deutsch",fullName:"Judith Deutsch"},{id:"343266",title:"Dr.",name:"Martina",surname:"Sarec Ivelj",slug:"martina-sarec-ivelj",fullName:"Martina Sarec Ivelj"},{id:"343267",title:"Dr.",name:"Eduardo",surname:"Isomura",slug:"eduardo-isomura",fullName:"Eduardo Isomura"}],corrections:null},{id:"78078",title:"Laser-Assisted Liposuction in Face and Body Contouring",doi:"10.5772/intechopen.99145",slug:"laser-assisted-liposuction-in-face-and-body-contouring",totalDownloads:124,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Laser liposuction was developed as minimally invasive liposuction technique where energy breaks adipocytes (comparing with traditional liposuction where disruption is manual). After its implementation in the early 1990s, various academic reports were published that showed superiority of the laser assisted liposuction over standard tumescent technique. After tissue damage with photo-optical thermal energy, histological changes result in adipocyte disruption, blood vessel coagulation and neocollagenesis. The clinical manifestation of the latter is significant skin tightening and faster and more comfortable recovery. The diameter of the laser fiber is very small. Therefore, it is possible to reach adipose tissue entrapped in fibrotic areas and also superficially under the skin. The lysis of the given adipose tissue enables the subsequent suction with microcannulas. That explains the widespread use of the laser-assisted liposuction in the face and neck. Due to the significant skin tightening, the procedure can be done solely for rejuvenation purposes and is called endolight lifting. The possibility to reach fat in the fibrotic areas makes laser-assisted lipolysis/liposuction ideal procedure for contouring irregularities from previous body contouring procedures.",signatures:"Zoran Žgaljardić and Ivonne Žgaljardić",downloadPdfUrl:"/chapter/pdf-download/78078",previewPdfUrl:"/chapter/pdf-preview/78078",authors:[{id:"185691",title:"Prof.",name:"Zoran",surname:"Žgaljardić",slug:"zoran-zgaljardic",fullName:"Zoran Žgaljardić"},{id:"193469",title:"Dr.",name:"Ivonne",surname:"Žgaljardić",slug:"ivonne-zgaljardic",fullName:"Ivonne Žgaljardić"}],corrections:null},{id:"80193",title:"Non-invasive Alternatives for Liposuction",doi:"10.5772/intechopen.101396",slug:"non-invasive-alternatives-for-liposuction",totalDownloads:91,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Body dissatisfaction due to an increased amount of subcutaneous fat, muscle laxity and/or skin imperfection poses a great concern for today’s society. Invasive surgical procedures intended for an immediate improvement of body contour such as liposuction were perceived as a means of restoring the optimum body shape. However, the invasive nature of liposuction plus a certain amount of discomfort and downtime leads to increasing popularity in the noninvasive esthetic procedures. This chapter aims to emphasize the use of latest noninvasive technologies as a viable alternative to the liposuction. Three patient cases with different levels of treatment outcomes were reviewed. Patients received treatments either with high-intensity focused electromagnetic field (HIFEM) procedure or a combination of HIFEM and synchronized radiofrequency (RF), optionally followed by the simultaneous therapy by targeted pressure energy (TPE) plus monopolar RF. HIFEM alone resolves muscle laxity, reduces the separation of abdominal muscles and reduces abdominal adipose tissue. When combined with synchronized RF, the effect on muscle and fat tissue is enhanced. Concomitant use of monopolar RF and TPE shows considerable improvements in skin quality, including diminished skin laxity or cellulite. The use of HIFEM, RF and TPE technologies can be a good noninvasive liposuction alternative.",signatures:"Diane Irvine Duncan, Suneel Chilukuri, David Kent, Klaus Hoffmann and Lim Tingsong",downloadPdfUrl:"/chapter/pdf-download/80193",previewPdfUrl:"/chapter/pdf-preview/80193",authors:[{id:"279869",title:"Dr.",name:"Diane Irvine",surname:"Duncan",slug:"diane-irvine-duncan",fullName:"Diane Irvine Duncan"},{id:"442691",title:"Dr.",name:"Suneel",surname:"Chilukuri",slug:"suneel-chilukuri",fullName:"Suneel Chilukuri"},{id:"442692",title:"Dr.",name:"David",surname:"Kent",slug:"david-kent",fullName:"David Kent"},{id:"442693",title:"Dr.",name:"Klaus",surname:"Hoffmann",slug:"klaus-hoffmann",fullName:"Klaus Hoffmann"},{id:"442694",title:"Dr.",name:"Lim",surname:"Tingsong",slug:"lim-tingsong",fullName:"Lim Tingsong"}],corrections:null},{id:"75785",title:"Liposuction for Fat Transfer: The “Island Technique”",doi:"10.5772/intechopen.96869",slug:"liposuction-for-fat-transfer-the-island-technique-",totalDownloads:163,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The material harvested during liposuction is discarded but the fat used for fat grafting must be preserved and not polluted by the products used for tumescent anaesthesia. The “Island technique” used for decades during the FAMI procedure (Fat autografting Muscle Injection), provides samples of fat which had no or little contact with the lidocaine. The first step of the injection is made between the muscle and fat deposit and the second step between the deep skin layers and the same fat deposit. It is one important factor of the successful outcome of our adipose SVF grafting in hundreds of cases of reconstructive and aesthetic surgeries since 1998.",signatures:"Roger E. Amar",downloadPdfUrl:"/chapter/pdf-download/75785",previewPdfUrl:"/chapter/pdf-preview/75785",authors:[{id:"342452",title:"Dr.",name:"Roger E.",surname:"Amar",slug:"roger-e.-amar",fullName:"Roger E. Amar"}],corrections:null},{id:"77470",title:"The Versatility of Autologous Fat Transplantation in Abnormalities of the Craniofacial-Complex and Facial Esthetics",doi:"10.5772/intechopen.97015",slug:"the-versatility-of-autologous-fat-transplantation-in-abnormalities-of-the-craniofacial-complex-and-f",totalDownloads:98,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In the historical pursuit of soft tissue augmentation, fat has seemed a natural choice for plastic surgeons. The use of fat transfer to replace volume or camouflage soft tissues is an increasingly popular method in craniofacial surgery and facial esthetics. Craniofacial malformations undoubtedly have a certain psychosocial effect. Children of early age are particularly vulnerable to comments, teasing, and harassment related to their appearance; therefore, improving the facial image is of great importance. We believe that volumetric lipoinjection represents an excellent alternative to obtain greater facial esthetic harmony, which directly increases patient self-esteem in children and adults.",signatures:"Yanko Castro-Govea, Cynthia M. Gonzalez-Cantu, Gabriel A. Mecott, Everardo Valdes-Flores and Mauricio M. Garcia-Perez",downloadPdfUrl:"/chapter/pdf-download/77470",previewPdfUrl:"/chapter/pdf-preview/77470",authors:[{id:"344434",title:"Ph.D.",name:"Yanko",surname:"Castro-Govea",slug:"yanko-castro-govea",fullName:"Yanko Castro-Govea"},{id:"344435",title:"Dr.",name:"Cynthia M.",surname:"Gonzalez-Cantu",slug:"cynthia-m.-gonzalez-cantu",fullName:"Cynthia M. Gonzalez-Cantu"},{id:"424944",title:"Dr.",name:"Gabriel A.",surname:"Mecott",slug:"gabriel-a.-mecott",fullName:"Gabriel A. Mecott"},{id:"424945",title:"Dr.",name:"Everardo",surname:"Valdez-Flores",slug:"everardo-valdez-flores",fullName:"Everardo Valdez-Flores"},{id:"424946",title:"Dr.",name:"Mauricio M.",surname:"Garcia-Perez",slug:"mauricio-m.-garcia-perez",fullName:"Mauricio M. Garcia-Perez"}],corrections:null},{id:"78981",title:"Applications of Helium Plasma in Rejuvenation of the Face and Neck",doi:"10.5772/intechopen.100162",slug:"applications-of-helium-plasma-in-rejuvenation-of-the-face-and-neck-1",totalDownloads:139,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Energy based devices have been developed for the purposes of tissue contraction and skin tightening. Its application in the face and neck have been explored using lasers, temperature controlled monopolar and bipolar radiofrequency, and ultrasound. The purpose of this chapter is to explore the various applications for the face and neck using Renuvion™, a unique energy driven device based on plasma generated from the combination of helium gas and radiofrequency energy. The advantage of this technology is its ability to offer precise delivery of heat to tissue with minimal thermal spread, in part due to the rapid cooling aided by the helium gas. We will explore the options in which this technology can be incorporated to rejuvenate the face and neck, the patient selection considerations in choosing method of approach, surgical technique, anticipated outcomes, potential concerns and or complications associated with this and expected perioperative care. Applications in the face and neck include: (1) Subdermally in the neck as a stand alone procedure with or without liposuction. (2) Subdermally in a limited incision, non-excisional technique with a concomitant platysmaplasty either with an open approach or percutaneous use of suture suspension for the platysmal muscle. (3) Subdermally in conjunction with an open traditional rhytidectomy involving skin excision. (4) Ablative resurfacing—fractional or pulsed and full continuous modalities (non-FDA cleared at the time of this writing). It is the authors’ experience that with appropriate patient selection this can be a powerful tool that can deliver skin tightening and rhytid reduction not seen by other technologies available.",signatures:"Deirdre Leake and Janet Lee",downloadPdfUrl:"/chapter/pdf-download/78981",previewPdfUrl:"/chapter/pdf-preview/78981",authors:[{id:"346204",title:"Dr.",name:"Deirdre",surname:"Leake",slug:"deirdre-leake",fullName:"Deirdre Leake"},{id:"436774",title:"Dr.",name:"Janet",surname:"Lee",slug:"janet-lee",fullName:"Janet Lee"}],corrections:null},{id:"76392",title:"Correction of the Lower Third of the Face and Submental Area in Various Types of Aging with Laser-Assisted Liposuction",doi:"10.5772/intechopen.95932",slug:"correction-of-the-lower-third-of-the-face-and-submental-area-in-various-types-of-aging-with-laser-as",totalDownloads:194,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Age-related changes in the face - at all times were not a desirable phenomenon in socially active and successful people. In modern society, success is primarily identified with an attractive appearance and a healthy lifestyle. Healthy lifestyle is actively promoted in mass media, this message has many followers all over the world. The most striking manifestations of age-related changes are concentrated in the lower third of the face and submental area, which is manifested in violation of the contours of the jaw line, as well as in the smoothing of the cervical - chin angle. In some genetic features, such as micrognathia, these changes lead to the visual perception of the face less young than it actually is, even without obvious manifestations in other areas of the face. We have developed and put into practice a minimally invasive method for correcting the lower third of the face and the submental area, using laser-assisted liposuction, with various degrees of age-related changes. Which allows you to effectively deal with this problem.",signatures:"Igumnov Vitaliy Aleksandrovich",downloadPdfUrl:"/chapter/pdf-download/76392",previewPdfUrl:"/chapter/pdf-preview/76392",authors:[{id:"343782",title:"M.D.",name:"Igumnov Vitaliy",surname:"Aleksandrovich",slug:"igumnov-vitaliy-aleksandrovich",fullName:"Igumnov Vitaliy Aleksandrovich"}],corrections:null},{id:"77824",title:"Power-Assisted Liposuction Mammaplasty (PALM): A Short Scar Mammaplasty in Gigantomastia",doi:"10.5772/intechopen.98816",slug:"power-assisted-liposuction-mammaplasty-palm-a-short-scar-mammaplasty-in-gigantomastia",totalDownloads:122,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Breast reduction has been widely studied throughout the years, with different types of resection and breast reshaping techniques being described based on one or two pedicles. This chapter introduces the combination of parenchymal resection and liposuction to treat Gigantomastia, leaving a short scar. Liposuction improves breast remodeling, whereas breast glandular resection and repositioning enhances the upper pole fullness. The Power-Assisted Liposuction Mammaplasty (P.A.L.M.) technique is a safe and reliable procedure, insuring an optimal vascularization to the breast through the preservation of the central, superior and lateral pedicle, thus reducing the complication rate. In this chapiter we emphasize the importance of the preoperative markings, considered as essential for optimal results.",signatures:"Nicolas Abboud and Marwan Abboud",downloadPdfUrl:"/chapter/pdf-download/77824",previewPdfUrl:"/chapter/pdf-preview/77824",authors:[{id:"343142",title:"Dr.",name:"Marwan",surname:"Abboud",slug:"marwan-abboud",fullName:"Marwan Abboud"},{id:"344232",title:"Dr.",name:"Nicolas",surname:"Abboud",slug:"nicolas-abboud",fullName:"Nicolas Abboud"}],corrections:null},{id:"77808",title:"Enhanced Lipocontouring of the Arms",doi:"10.5772/intechopen.98807",slug:"enhanced-lipocontouring-of-the-arms",totalDownloads:167,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The visibility of arm contour in both men and women has been a source of discussion throughout time. Arm strength and athleticism is not limited to the male physique only. Iconic women such as Madonna and Michelle Obama have made discussions about arm contour more and more commonplace. Over the years arm contour has been a difficult area to address due to the thinness of the skin which often required surgical excision and unsightly scars. Liposuction of the arm has advanced to not only allow for improved contour but also options of refining muscular definition. With the addition of energy-based technologies such as radiofrequency, we can offer less invasive options to patients who may have previously only been candidates for excisional procedures. Liposuction of the arms can be performed under local anesthesia. This chapter introduces a new algorithm for assessment and treatment of arm contour which incorporates newer energy-based devices along with surgical options.",signatures:"Julie Khanna and Maryam Saheb-Al-Zamani",downloadPdfUrl:"/chapter/pdf-download/77808",previewPdfUrl:"/chapter/pdf-preview/77808",authors:[{id:"345233",title:"Dr.",name:"Julie",surname:"Khanna",slug:"julie-khanna",fullName:"Julie Khanna"},{id:"346161",title:"Dr.",name:"Maryam",surname:"Saheb-Al-Zamani",slug:"maryam-saheb-al-zamani",fullName:"Maryam Saheb-Al-Zamani"}],corrections:null},{id:"76487",title:"Enhanced Liposuction for Arms",doi:"10.5772/intechopen.97572",slug:"enhanced-liposuction-for-arms",totalDownloads:135,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Arm contouring is a desired goal of the arm esthetics. Brachioplasty is a developing and safe surgery to improve the arm silhouette but scar is a one of the most distracting factor for both patients and surgeons. In this chapter conventional liposuction with laser assisted liposuction (LAL) is proposed to yield satisfactory results in selected group of patients. Classification systems are helpful to decide for proper patient selection for this technique. It includes assessment of fat excess, skin excess, and location of the deformity (proximal, entire arm, arm and chest). Patients with minimal to extensive fat deposits plus minimal to moderate skin laxity are the best candidates for this approach. When properly performed, with realistic expectations, liposuction and LAL combination is considerably a procedure of choice for arm contouring in these selected cases. The contraction of arm skin is considerably consistent. Our approach, except in the most extreme cases, is to initially recommend liposuction and possibly even a second liposuction prior to recommending brachioplasty. An esthetically pleasant result can be obtained even in massive arms with good skin tone. Massive arms with poor skin tone, however, may not. Patient selection and preoperative planning are discussed in detail. A thorough description for patient positioning and anesthesia options are studied. The technique of the liposuction is widely described including specific regional contour goals with artistic attention to enhance the contour. Refinement regarding skin tightening and skin surface smoothness are also discussed. Arm contouring is a growing field of body contouring and can be practiced with low complication rates and high patient satisfaction. Available classification systems help to select proper patient group. Laser assisted fat removal combined with conventional liposuction are promising procedures for selected patients.",signatures:"Engin Selamioglu and Ercan Karacaoglu",downloadPdfUrl:"/chapter/pdf-download/76487",previewPdfUrl:"/chapter/pdf-preview/76487",authors:[{id:"73035",title:"Prof.",name:"Ercan",surname:"Karacaoglu",slug:"ercan-karacaoglu",fullName:"Ercan Karacaoglu"},{id:"343312",title:"Dr.",name:"Engin",surname:"Selamioglu",slug:"engin-selamioglu",fullName:"Engin Selamioglu"}],corrections:null},{id:"78147",title:"Enhanced Abdominal Contouring",doi:"10.5772/intechopen.99398",slug:"enhanced-abdominal-contouring",totalDownloads:121,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter will discuss the various energy-based modalities that are available to optimize circumferential trunk liposuction to enhance patient results. We will discuss multimodal liposuction using power assisted liposuction, ultrasonic energy addition, as well as radiofrequency assisted modalities to achieve adipose reduction and concurrent skin and soft tissue contraction. An in-depth look at patient selection and intraoperative technique will be presented. The postoperative management for each modality will be discussed in detail, including expected results from each modality and potential complications and their ensuing management. We will also discuss the application of different modalities alone and in combination to achieve superior results.",signatures:"Shawna R. Kleban, Gaurav Bharti and Bill G. Kortesis",downloadPdfUrl:"/chapter/pdf-download/78147",previewPdfUrl:"/chapter/pdf-preview/78147",authors:[{id:"346485",title:"Dr.",name:"Gaurav",surname:"Bharti",slug:"gaurav-bharti",fullName:"Gaurav Bharti"},{id:"350260",title:"Dr.",name:"Shawna R.",surname:"Kleban",slug:"shawna-r.-kleban",fullName:"Shawna R. Kleban"},{id:"350263",title:"Dr.",name:"Bill G.",surname:"Kortesis",slug:"bill-g.-kortesis",fullName:"Bill G. Kortesis"}],corrections:null},{id:"78952",title:"Posterior Torso and Buttocks Contour Enhancement",doi:"10.5772/intechopen.100529",slug:"posterior-torso-and-buttocks-contour-enhancement",totalDownloads:149,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The harmonious contour and movement of the dorsal human form--male and female, youthful through senescent--has been observed, critiqued, and physically and surgically sculpted throughout human existence with the goal of producing a more functional, balanced and beautiful body. This chapter will explore variations and pendulum swings of desirable/beautiful/athletic posterior contours and how the cosmetic units of the upper back, bra roll, axilla, waist, low back, upper buttocks, vertical and horizontal buttocks folds, lateral hips and banana rolls are both independent and interdependent. The evaluation of the topography of the posterior torso and buttocks, at rest and in movement, will be reviewed, Invasive and non-invasive technologies, utilized alone and bundled together for sculpting and refining optimal outcomes with reduced risks will be discussed. Improving the elasticity and tightness of the tissues and enveloping skin will be considered.",signatures:"Edward M. Zimmerman",downloadPdfUrl:"/chapter/pdf-download/78952",previewPdfUrl:"/chapter/pdf-preview/78952",authors:[{id:"342078",title:"M.D.",name:"Edward M.",surname:"Zimmerman",slug:"edward-m.-zimmerman",fullName:"Edward M. Zimmerman"}],corrections:null},{id:"78639",title:"Applications and Limitations of Suction Assisted Transverse Medial Thigh Lift",doi:"10.5772/intechopen.100120",slug:"applications-and-limitations-of-suction-assisted-transverse-medial-thigh-lift",totalDownloads:126,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Aims and objectives: Skin laxity or excess can be a part of ageing process and weight loss. Skin laxity or excess is commonly experienced following weight loss around arms, thighs, face and neck, breast and abdomen. Various methods and techniques are described to address these excess skin issues. Liposuction assisted abdominoplasty has been described by Saldanha along with Colour Doppler studies of the superior and inferior epigastric arteries. Similarly DJ Hurwitz has described liposuction assisted brachioplasty. The process allows honeycombing of the subcutaneous tissue when suction lipectomy is performed using blunt tipped cannulas. Process allows creation of a safe plane superior to the deep fascial layer with preservation of the important nerves and vessels. Skin excess is removed without the need of sharp dissection or risks to the underlying structures. Postoperative bleeding and bruising is minimal and most of the instances the procedure is performed as a day case without drains. Patient postoperative analgesia requirements are minimal and allows patient to ambulate early with a quick recovery. Methods: Between 2009 and 2018, 153 suction assisted procedure were performed on various parts of the body. Of the 153 procedures 22 patients had thigh lifts as an outpatient. Results: There was no skin loss, DVT, PE or motor nerve damage. All patients retained sensation of the distal limbs.",signatures:"Umar Daraz Khan",downloadPdfUrl:"/chapter/pdf-download/78639",previewPdfUrl:"/chapter/pdf-preview/78639",authors:[{id:"345097",title:"Dr.",name:"Umar Daraz",surname:"Khan",slug:"umar-daraz-khan",fullName:"Umar Daraz Khan"}],corrections:null},{id:"79323",title:"Complications and Solutions for Post-Operative Liposuction Deformities",doi:"10.5772/intechopen.101284",slug:"complications-and-solutions-for-post-operative-liposuction-deformities",totalDownloads:110,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this chapter, the authors will review the complications associated with liposuction and laser liposuction procedures, using published reports as the guide to document these complications and deformities to the readers. In addition, the authors will also report on the use of tumescent anesthesia and the published documentation regarding safety concerns that have been presented via the use of tumescence versus general anesthesia when performing liposuction or laser liposuction. Real-world discussions also will take place in which the authors describe best treatment practices as solutions to those complications described. Liposuction and laser liposuction are wonderful procedures that have been performed for many years. Understanding and being able to identify and treat any untoward complications is extremely important to make everyone a better surgeon and a better physician.",signatures:"Chris W. Robb and Michael H. Gold",downloadPdfUrl:"/chapter/pdf-download/79323",previewPdfUrl:"/chapter/pdf-preview/79323",authors:[{id:"345391",title:null,name:"Michael H.",surname:"Gold",slug:"michael-h.-gold",fullName:"Michael H. Gold"},{id:"345776",title:"Dr.",name:"Chris W.",surname:"Robb",slug:"chris-w.-robb",fullName:"Chris W. Robb"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"330",title:"Advanced Techniques in Liposuction and Fat Transfer",subtitle:null,isOpenForSubmission:!1,hash:"b46d7571b3a7f78d03a83f809c7a637f",slug:"advanced-techniques-in-liposuction-and-fat-transfer",bookSignature:"Nikolay Serdev",coverURL:"https://cdn.intechopen.com/books/images_new/330.jpg",editedByType:"Edited by",editors:[{id:"32585",title:"Dr.",name:"Nikolay",surname:"Serdev",slug:"nikolay-serdev",fullName:"Nikolay Serdev"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"797",title:"Rhinoplasty",subtitle:null,isOpenForSubmission:!1,hash:"81bc805ee420b3b2f35cc0a009b6566c",slug:"rhinoplasty",bookSignature:"Michael J. Brenner",coverURL:"https://cdn.intechopen.com/books/images_new/797.jpg",editedByType:"Edited by",editors:[{id:"63530",title:"Dr.",name:"Michael",surname:"Brenner",slug:"michael-brenner",fullName:"Michael Brenner"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5110",title:"Miniinvasive Techniques in Rhinoplasty",subtitle:null,isOpenForSubmission:!1,hash:"795ab5e7adfc30a3907f52b636c45029",slug:"miniinvasive-techniques-in-rhinoplasty",bookSignature:"Nikolay Serdev",coverURL:"https://cdn.intechopen.com/books/images_new/5110.jpg",editedByType:"Edited by",editors:[{id:"32585",title:"Dr.",name:"Nikolay",surname:"Serdev",slug:"nikolay-serdev",fullName:"Nikolay Serdev"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"3",chapterContentType:"chapter",authoredCaption:"Authored by"}},{type:"book",id:"2989",title:"Miniinvasive Face and Body Lifts",subtitle:"Closed Suture Lifts or Barbed Thread Lifts",isOpenForSubmission:!1,hash:"7e9600ab8fe9125b2c41161d2ee91ff3",slug:"miniinvasive-face-and-body-lifts-closed-suture-lifts-or-barbed-thread-lifts",bookSignature:"Nikolay Serdev",coverURL:"https://cdn.intechopen.com/books/images_new/2989.jpg",editedByType:"Edited by",editors:[{id:"32585",title:"Dr.",name:"Nikolay",surname:"Serdev",slug:"nikolay-serdev",fullName:"Nikolay Serdev"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7836",title:"The Art of Body Contouring",subtitle:null,isOpenForSubmission:!1,hash:"983c155c9b836c8e4947bb3946694bc9",slug:"the-art-of-body-contouring",bookSignature:"Alexandro Aguilera",coverURL:"https://cdn.intechopen.com/books/images_new/7836.jpg",editedByType:"Edited by",editors:[{id:"162339",title:"Dr.",name:"Alexandro",surname:"Aguilera",slug:"alexandro-aguilera",fullName:"Alexandro Aguilera"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10866",title:"Skin Grafts for Successful Wound Closure",subtitle:null,isOpenForSubmission:!1,hash:"7f96063ba4feb9aab82c344a88a8c90c",slug:"skin-grafts-for-successful-wound-closure",bookSignature:"Madhuri Gore",coverURL:"https://cdn.intechopen.com/books/images_new/10866.jpg",editedByType:"Edited by",editors:[{id:"157243",title:"Dr.",name:"Madhuri",surname:"Gore",slug:"madhuri-gore",fullName:"Madhuri Gore"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9122",title:"Cosmetic Surgery",subtitle:null,isOpenForSubmission:!1,hash:"207026ca4a4125e17038e770d00ee152",slug:"cosmetic-surgery",bookSignature:"Yueh-Bih Tang",coverURL:"https://cdn.intechopen.com/books/images_new/9122.jpg",editedByType:"Edited by",editors:[{id:"202122",title:"Prof.",name:"Yueh-Bih",surname:"Tang",slug:"yueh-bih-tang",fullName:"Yueh-Bih Tang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],ofsBooks:[]},correction:{item:{id:"79356",slug:"corrigendum-enhancing-abiotic-stress-tolerance-to-develop-climate-smart-rice-using-holistic-breeding",title:"Corrigendum: Enhancing Abiotic Stress Tolerance to Develop Climate-Smart Rice Using Holistic Breeding Approach",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/79755.pdf",downloadPdfUrl:"/chapter/pdf-download/79755",previewPdfUrl:"/chapter/pdf-preview/79755",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/79755",risUrl:"/chapter/ris/79755",chapter:{id:"76501",slug:"enhancing-abiotic-stress-tolerance-to-develop-climate-smart-rice-using-holistic-breeding-approach",signatures:"M. Akhlasur Rahman, Hasina Khatun, M. Ruhul Amin Sarker, Hosneara Hossain, M. Ruhul Quddus, Khandakar M. Iftekharuddaula and M. Shahjahan Kabir",dateSubmitted:"March 6th 2021",dateReviewed:"March 17th 2021",datePrePublished:"June 10th 2021",datePublished:"December 22nd 2021",book:{id:"11571",title:"Cereal Grains",subtitle:"Volume 2",fullTitle:"Cereal Grains - Volume 2",slug:"cereal-grains-volume-2",publishedDate:"December 22nd 2021",bookSignature:"Aakash Kumar Goyal",coverURL:"https://cdn.intechopen.com/books/images_new/11571.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"97604",title:"Dr.",name:"Aakash K.",middleName:null,surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. Goyal"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"338812",title:"Dr.",name:"M. Akhlasur",middleName:null,surname:"Rahman",fullName:"M. Akhlasur Rahman",slug:"m.-akhlasur-rahman",email:"akhlas08@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340364",title:"Dr.",name:"Hasina",middleName:null,surname:"Khatun",fullName:"Hasina Khatun",slug:"hasina-khatun",email:"hasinabrri09@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340367",title:"Dr.",name:"Hosneara",middleName:null,surname:"Hossain",fullName:"Hosneara Hossain",slug:"hosneara-hossain",email:"shimulbrri@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340368",title:"Dr.",name:"M. Ruhul Amin",middleName:null,surname:"Sarker",fullName:"M. Ruhul Amin Sarker",slug:"m.-ruhul-amin-sarker",email:"mrasbrri@yahoo.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340369",title:"Dr.",name:"Khandakar M.",middleName:null,surname:"Iftekharuddaula",fullName:"Khandakar M. Iftekharuddaula",slug:"khandakar-m.-iftekharuddaula",email:"kiftekhar03@yahoo.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"352116",title:"Mr.",name:"M. Ruhul",middleName:null,surname:"Quddus",fullName:"M. Ruhul Quddus",slug:"m.-ruhul-quddus",email:"rquddus265@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"352118",title:"Dr.",name:"M. Shahjahan",middleName:null,surname:"Kabir",fullName:"M. Shahjahan Kabir",slug:"m.-shahjahan-kabir",email:"kabir.stat@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}}]}},chapter:{id:"76501",slug:"enhancing-abiotic-stress-tolerance-to-develop-climate-smart-rice-using-holistic-breeding-approach",signatures:"M. Akhlasur Rahman, Hasina Khatun, M. Ruhul Amin Sarker, Hosneara Hossain, M. Ruhul Quddus, Khandakar M. Iftekharuddaula and M. Shahjahan Kabir",dateSubmitted:"March 6th 2021",dateReviewed:"March 17th 2021",datePrePublished:"June 10th 2021",datePublished:"December 22nd 2021",book:{id:"11571",title:"Cereal Grains",subtitle:"Volume 2",fullTitle:"Cereal Grains - Volume 2",slug:"cereal-grains-volume-2",publishedDate:"December 22nd 2021",bookSignature:"Aakash Kumar Goyal",coverURL:"https://cdn.intechopen.com/books/images_new/11571.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"97604",title:"Dr.",name:"Aakash K.",middleName:null,surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. Goyal"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"338812",title:"Dr.",name:"M. Akhlasur",middleName:null,surname:"Rahman",fullName:"M. Akhlasur Rahman",slug:"m.-akhlasur-rahman",email:"akhlas08@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340364",title:"Dr.",name:"Hasina",middleName:null,surname:"Khatun",fullName:"Hasina Khatun",slug:"hasina-khatun",email:"hasinabrri09@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340367",title:"Dr.",name:"Hosneara",middleName:null,surname:"Hossain",fullName:"Hosneara Hossain",slug:"hosneara-hossain",email:"shimulbrri@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340368",title:"Dr.",name:"M. Ruhul Amin",middleName:null,surname:"Sarker",fullName:"M. Ruhul Amin Sarker",slug:"m.-ruhul-amin-sarker",email:"mrasbrri@yahoo.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"340369",title:"Dr.",name:"Khandakar M.",middleName:null,surname:"Iftekharuddaula",fullName:"Khandakar M. Iftekharuddaula",slug:"khandakar-m.-iftekharuddaula",email:"kiftekhar03@yahoo.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"352116",title:"Mr.",name:"M. Ruhul",middleName:null,surname:"Quddus",fullName:"M. Ruhul Quddus",slug:"m.-ruhul-quddus",email:"rquddus265@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}},{id:"352118",title:"Dr.",name:"M. Shahjahan",middleName:null,surname:"Kabir",fullName:"M. Shahjahan Kabir",slug:"m.-shahjahan-kabir",email:"kabir.stat@gmail.com",position:null,institution:{name:"Bangladesh Rice Research Institute",institutionURL:null,country:{name:"Bangladesh"}}}]},book:{id:"11571",title:"Cereal Grains",subtitle:"Volume 2",fullTitle:"Cereal Grains - Volume 2",slug:"cereal-grains-volume-2",publishedDate:"December 22nd 2021",bookSignature:"Aakash Kumar Goyal",coverURL:"https://cdn.intechopen.com/books/images_new/11571.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"97604",title:"Dr.",name:"Aakash K.",middleName:null,surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. Goyal"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"11587",leadTitle:null,title:"Updates on ADHD - New Approaches to Assessment and Intervention",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tAttention Deficit and Hyperactive Disorder (ADHD) is a common neurobehavioral disorder in childhood with high global prevalence rates ranging from 5.3 to 7.2%, with an average of around 5%. This disorder is characterized by three groups of symptoms: inattention, impulsivity, and hyperactivity. Furthermore, their combination gives rise to three types of presentation of ADHD: inattentive presentation, hyperactive and impulsive presentation, and combined presentation. In this way, depending on the kind of presentation, more accurate recommendations will be made. In this sense, considering the high prevalence rates and their symptomatologic complexity, it is necessary to advance in the evaluation process (from an innovative perspective) as well as in the design of interventions adjusted to the needs of patients. For all these reasons, this book will include works that aim to advance the evaluation and intervention of ADHD to achieve a better prognosis.
",isbn:"978-1-80356-144-8",printIsbn:"978-1-80356-143-1",pdfIsbn:"978-1-80356-145-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"e0718a84e5fda7ed4287095c3ef27dae",bookSignature:"Dr. Celestino Rodríguez Pérez and Mrs. Debora Areces",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11587.jpg",keywords:"Differential Diagnosis, Assessment Tools, Ecological Validity, Assessment Protocols, Intervention Design, Response to Intervention, Intervention Protocols, New Technologies, Models – ADHD, Theories – ADHD, Perspectives on ADHD, Approaches to ADHD",numberOfDownloads:25,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 1st 2022",dateEndSecondStepPublish:"May 5th 2022",dateEndThirdStepPublish:"July 4th 2022",dateEndFourthStepPublish:"September 22nd 2022",dateEndFifthStepPublish:"November 21st 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Celestino Rodríguez has participated in numerous national and international conferences (USA, Switzerland, Holland, Italy, Portugal, etc.) and contributed to the advances in contemporary psychology research trends on many levels focusing on ADHD, learning disabilities, SRL, learning strategies, and gifted children. He has collaborated with researchers from the countries such as England, Germany, the Netherlands, and the United States of America.",coeditorOneBiosketch:"Dr. Débora Areces is the author of several scientific articles and book chapters (Spanish and English). In her research work, she focuses on innovative perspectives and new theoretical models in interpreting ADHD.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"85114",title:"Dr.",name:"Celestino",middleName:null,surname:"Rodríguez Pérez",slug:"celestino-rodriguez-perez",fullName:"Celestino Rodríguez Pérez",profilePictureURL:"https://mts.intechopen.com/storage/users/85114/images/system/85114.jpg",biography:"Celestino Rodríguez, PhD in Psychology and Education (Oviedo, Spain), is an Associate Professor in the Department of Psychology and Vice-dean at Faculty of Teaching Training and Education (University of Oviedo) Spain. His main research areas include learning disabilities and ADHD, learning assessment, academic achievement, learning strategies, gifted children, SRL (Self-regulated learning), ICTs, higher education, CBLEs (Computer Based Learning Environments), metacognition, dynamic hypermedia learning environments and more. He is an author of more than 110 papers in peer-review international journals, around 30 chapters and collaboration in Education, Psychology and Higher Education books and handbooks. Celestino Rodríguez has made several national and international conferences with more than 150 participants in the International Congress (USA, Switzerland, Holland, Italy, Portugal, etc.). Through numerous research, projects, and research stays, he has collaborated with researchers from different countries, such as England, Germany, the Netherlands, and the United States of America. He is also an Editor of various Journals and a member of the International Association of Research in Learning Disabilities (IARLD).",institutionString:"University of Oviedo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Oviedo",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:{id:"206200",title:"Mrs.",name:"Debora",middleName:null,surname:"Areces",slug:"debora-areces",fullName:"Debora Areces",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Dr. Débora Areces is a researcher of the ADIR Group - Learning School, Academic Difficulties and Performance (which belongs to the Department of Psychology from the University of Oviedo). Her main research areas include Learning Disabilities and ADHD. More specifically, her studies mainly focus on the early assessment and intervention of ADHD and Learning Disabilities from an innovative perspective. She is the author and co-author of many articles and book chapters published in Spanish and English and has made several national and international conferences contributions.",institutionString:"University of Oviedo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Oviedo",institutionURL:null,country:{name:"Spain"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:[{id:"81873",title:"ADHD Training for Primary Care Professionals",slug:"adhd-training-for-primary-care-professionals",totalDownloads:25,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"478197",firstName:"Veronika",lastName:"Radosavac",middleName:null,title:"Dr.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"veronika@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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However, progression to androgen-independent status is the main cause of death in these patients [3]. Most deaths related to PC are due to metastatic disease, which results from any combination of blood, lymphatic, or local spread. Targeted radionuclide therapy is an attractive and quickly developing therapy option for many different cancers, such as lymphoma, melanoma, and neuroendocrine tumors [4–7]. Radionuclide therapies should be targeted, because this procedure always involves the administration of unsealed sources of radioactivity.
\nMost therapeutic tracers utilize β-particle emissions due to the ability of these particles to penetrate tissues. The deposition of energy in tissue by β-emitters results in cellular damage. Among the β-emitters, there are several choices regarding the energy of the β-emission. Lower energy β-particles can travel a few cell diameters, or at most in the submillimeter range. Higher energy β-particles, such as those emitted by Yttrium-90 (90Y) or Lutetium-177 (177Lu), have excellent tissue penetration with a range beyond the source of several millimeters [8, 9]. The only routinely used α-emitter for the treatment of metastatic disease is Radium-223 (223Ra), which has been approved for the treatment of bone metastases in patients with prostate cancer and symptomatic disease with no known visceral metastases [10]. The physical half-life of therapeutic radionuclide is an important consideration and an underlying principle for therapy planning [11].
\nProstate-specific membrane antigen (PSMA), also known as folate hydrolase I or glutamate carboxypeptidase II, is a type II transmembrane protein anchored in the cell membrane of prostate epithelial cells [12]. Several biological characteristics make PSMA an outstanding target for drug development. PSMA is highly expressed on prostate epithelial cells and strongly upregulated in PC. PSMA expression levels are directly correlated to androgen independence, metastasis, and PC progression [13]; thus, PSMA is an attractive target for the diagnosis and therapy of metastasized PC. Its target specificity is maintained after radiolabeling with 68Ga [12, 14].
\nA commonly used radionuclide is 68Ga-PSMA-11, which has been successfully used for the imaging of PC with high sensitivity and specificity, even in patients with very low prostate-specific antigen (PSA) levels (<2 ng/ml) [15]. Direct comparison studies support the superiority of 68Ga-PSMA-11 in lymph node assessment over CT 3D volumetric-based lymph node assessments [16] and in overall disease assessment compared to 18F-methylcholine, especially in patients with low PSA levels [17]. These positive results will lead to or have already led to a paradigm shift in the use of imaging in primary staging of PC. In a recent study by Hijazi et al., the diagnostic accuracy of 68Ga-PSMA-11 in the preoperative assessment of nodal metastases was very high for macrometastases and even micrometastases in lymph nodes. Correlating imaging and tissue specimens of 213 removed nodes provided 94% sensitivity, 99% specificity, 89% positive predictive value, and 99.5% negative predictive value [18].
\nAfter rather unsuccessful therapy with the 90Y-CYT-356 monoclonal antibody (mAb) recognizing the intracellular domain of PSMA [19], Phase I and II clinical trials utilizing the PSMA mAb J591, radiolabeled with 177Lu or 90Y, have shown promising results [20–23].
\nJ591 is an anti-PSMA mAb that binds with 1 nM affinity to the extracellular domain of PSMA [24, 25]. Milowsky et al. [26] treated 29 patients in the 90Y-J591 Phase I trial; patients received therapeutic doses of 185, 370, 555, 647.5, and 740 MBq/m2 90Y-J591. Dose-limiting toxicity was seen at 740 MBq/m2, with two patients experiencing thrombocytopenia with nonlife-threatening bleeding episodes requiring platelet transfusions. The 647.5 MBq/m2 dose was determined to be the maximum tolerated dose (MDT).
\nBander et al. [21] treated 35 patients with progressing androgen-independent PC with 177Lu-J591, and 16 of these patients received up to three doses. Myelosuppression was dose-limiting at 2775 MBq/m2, and the 2590 MBq/m2 dose was determined to be the single-dose MTD. Repeat dosing at 1665–2220 MBq/m2 was associated with dose-limiting myelosuppression [21]. The authors reported good targeting of all known sites of bone and soft tissue metastases in all patients. They found no clear relationship between a history of prior chemotherapy treatment and the degree of toxicity. Biological activity was seen with four patients experiencing ≥50% declines in PSA levels lasting from 3 to 8 months. An additional 16 patients (46%) experienced PSA stabilization for a median of 60 days [21]. Tagawa et al. presented the results of a Phase II study of radionuclide therapy with the 177Lu-PSMA mAb J591 [20], which was based on two published Phase I studies investigating this agent [21, 26]. In this study [20], 47 hormone-refractory patients (55.3% also had received chemotherapy) were treated with 177Lu-J591. They compared two different doses (2405 vs. 2590 MBq/m2). About 11% of patients experienced a ≥50% decline in PSA, 36.2% experienced a ≥30% decline in PSA, and 59.6% experienced any PSA decline following a single therapy. All experienced reversible hematological toxicity, with Grade 4 thrombocytopenia occurring in 46.8% without significant hemorrhage. Grade 4 neutropenia happened in a total of 25.5% of patients, with one episode of febrile neutropenia. The 2590 MBq/m2 dose resulted in not only 30% more of PSA decline (46.9 vs. 13.3%,
The synthesis and design of a series of small-molecule inhibitors of PSMA have been described by Maresca et al. [28]. On the basis of the work of this group, Hillier et al. [29] performed a preclinical evaluation of two radiopharmaceuticals, 123I-MIP-1072 and 123I-MIP-1095, which were designed to target PSMA in PC cells and tissue. In a recent published study from the Heidelberg group, Zechmann et al. showed the utility of 131I-MIP-1095 PSMA [27]. Therapy with 131I-MIP-1095 PSMA was performed in 25 patients. The patients received a single therapeutic dose of 131I-MIP-1095 (mean activity 4.8 GBq, range 2.0–7.2 GBq). Erythrocyte counts fell below the normal range at the nadir in 21 patients, with 17 patients having lower values prior to therapy. In 14 patients, white blood cell counts fell below the normal range after therapy (one with Grade 3 toxicity). However, five of these 14 patients had levels below normal, prior to therapy (four Grade 1, one Grade 2); 11 patients had a reduction in platelet count below normal after therapy (two Grade 3), and one had a value below normal (Grade 2), prior to therapy. The changes in hematological parameters were not related to the activity administered. The onset of the myelosuppression occurred within 6 weeks after treatment with a quite variable time to recovery, in some cases requiring up to 3–6 months for recovery. White blood cells typically recovered within several weeks, whereas platelets required several months to recover [12, 27]. In contrast to mAb, the low-molecular-weight compounds, with higher permeability into solid tumors, offered a significant advantage in achieving higher uptake per gram of tumor tissue and a higher percentage of specific binding. Moreover, small molecules displayed more rapid tissue distribution and faster blood clearance compared with intact immunoglobulins. These properties often lead to a higher target to nontarget tissue ratio, which is important for successful application of therapeutic absorbed doses [27].
\n131I has a long half-life of 8.02 days and has a β-particle range in soft tissue of just 0.8 mm. Due to its γ-emitting properties and long half-life, 131I is less attractive from a radiation safety point of view. 90Y has a half-life of 64 h, but only undergoes high-energy β-emission, resulting in a long mean β-particle range of 3.6 mm and a maximum range of 10 mm in soft tissue. Due to its long β-particle range, collateral damage to surrounding tissues is quite high [30].
\nRecently, a novel theranostic drug, 177Lu-PSMA 617, which is a DOTA-derivative of the Glu–urea–Lys motif, has been developed for the treatment of patients with metastatic PC [29, 31]. 177Lu has a half-life of 6.7 days and undergoes low-energy β-particle emission with a mean range of 1 mm and a maximum range of 2–4 mm in soft tissue. So, the practical issues surrounding radiation safety with 131I and the limited collateral damage to surrounding tissues compared to 90Y make 177Lu-labeled radionuclide treatment the most attractive option from a physics point of view. Ahmadzadehfar et al. [32] reported on the first 10 consecutive patients who were treated with 177Lu-PSMA-617 in their department (University Hospital Bonn and Muenster, Germany). They showed that 8 weeks after the therapy in these 10 patients, seven patients showed a PSA decline, of whom six experienced a more than 30% and five a more than 50% decline. Three patients showed progressive disease according to the PSA increase. No patients experienced any side effects immediately after injection of 177Lu-PSMA 617 [32]. Relevant hematotoxicity (Grade 3 or 4) occurred 7 weeks after the administration in just one patient. These encouraging results showed again the efficacy of radionuclide therapy in patients who have no other approved therapeutic option. A later study by the group from Bonn showed the efficacy and safety of 177Lu-PSMA 617 therapy in patients who had undergone two cycles of therapy [8]. In this study, 46 cycles of 177Lu-PSMA 617 were performed in 24 consecutive hormone and/or chemorefractory patients. Twenty-two patients received two cycles of therapy. Twenty-two patients had a history of or were on therapy with enzalutamide and/or abiraterone. Twelve patients had received 223Ra (1–6 cycles; median 5 cycles). All patients had multiple bone metastases, and the majority of them also had lymph node metastases. The mean and median PSA levels prior to therapy were 628.3 and 522 ng/ml, respectively (range: 17.1–2360 ng/ml). It was found that 8 weeks after the first cycle of 177Lu-PSMA therapy, 19/24 patients (79.1%) experienced a PSA decline, out of whom 13 experienced a decline of more than 30% and 10 more than 50% (41.6%). Five patients showed progressive disease according to an increase in PSA. Two months after the second cycle in 22 patients who underwent two cycles of 177Lu-PSMA therapy, 15/22 patients (68.2%) experienced a PSA decline in comparison to the baseline PSA value, of whom 15 experienced a decline of more than 30%, and 13 (60%) of more than 50%. Seven patients showed progressive disease according to an increase in PSA or disease progression. Again, in this study, the patients received radioligand therapy as the last therapeutic option [8]. Interestingly, although a majority of prostate cancer patients at such an advanced stage of disease with massive bone marrow infiltration suffer from anemia, relevant hematotoxicity (Grade 3) occurred during the observation period (within 2 months after the last cycle) in just two patients. Apart from some Grade 1 or 2 hematotoxicity, the majority of patients did not show any hematotoxicity during the observation period. Some patients who needed blood transfusions prior to the first cycle needed fewer transfusions after radioligand therapy with 177Lu-PSMA 617 because of the regression of bone marrow involvement [33]. The Nordrhein–Westfalen study group recently published the results of single-dose administration of 177Lu-PSMA 617 in 74 patients. They showed a PSA decline in 47 patients (64%); of these, 23 (31%) had a PSA decline >50%; 35 (47%) had stable disease with a PSA decline from <50% to an increase of <25%; and 17 (23%) showed progressive disease with a PSA increase >25%. Response and tolerability of a single dose of 177Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer: a multicenter retrospective analysis.
\nRahbar K, Schmidt M, Heinzel A, Eppard E, Bode A, Yordanova A, Claesener M, Ahmadzadehfar H. J Nucl Med. 2016 Apr 7. pii: jnumed.116.173757. [Epub ahead of print]
\nFurther research into the efficacy of this therapy is needed. Rahbar et al. showed for the first time the overall survival benefit of RLT in comparison to a historical collective. They showed that the estimated median survival was 29.4 weeks, significantly longer than the survival in the historical control group at 19.7 weeks [hazard ratio: 0.44 (95% confidence interval: 0.20–0.95);
(
Bone metastases, a major cause of morbidity and mortality in patients with castration-resistant prostate cancer, are associated with pain, pathological fractures, spinal cord compression, and decreased survival [35]. The major mechanism of pain from small metastases appears to be the stimulation of nerve endings in the endosteum by a variety of chemical mediators. Larger bone metastases produce stretching of the periosteum, which leads to pain [36]. The incidence of bone metastases in patients with prostate cancer, according to autopsy studies, is 65–85% [37].
\nBone pain palliation with radionuclides has a very long history of using different β-emitters such as phosphorus-32 (32P) [38], strontium-89 (89Sr) [38], rhenium-186-hydroxyethylidene diphosphonate (186Re-HEDP) [39], 188Re-HEDP, samarium-153-EDTMP (153Sm-EDTMP) [39], and recently, lutetium-177-EDTMP (177Lu-EDTMP) [40] and 177Lu-BPAMD [41]. The only approved α-emitter is radium-223 (223Ra) [42].
\nStrontium-89 | \nPhosphorus-32 | \n
Radium-223 | \nSamarium-153-EDTMP | \n
\n | Rhenium-186-HEDP | \n
\n | Rhenium-188-HEDP | \n
\n | Lutetium-177-EDTMP | \n
\n | Lutetium-177-BPAMD | \n
Different radionuclides for bone palliation.
Bone-seeking radionuclides are classified into two groups: calcium analogues and radionuclides attached to phosphate (Table 1). Different radionuclides have different physical characteristics, which are shown in Table 2.
\n\n | ||||
---|---|---|---|---|
Summary of the main physical properties of different radionuclides in clinical use for pain palliation.
All, but Radium-223, are β-emitters.
32P decays by 1.7 MeV (
444 MBq (fractionated) | \n14 days | \n10 weeks | \n<3 months | \n|
150–200 MBq | \n14–28 days | \n12–26 weeks | \n<3 months | \n|
37 MBq/kg | \n2–7 days | \n8 weeks | \n<2 months | \n|
1.3 GBq | \n2–7 days | \n8–10 weeks | \n<2 months | \n|
1.3–4.4 GBq | \n2–7 days | \n8 weeks | \n2 months | \n
89SrCl2 is an element that behaves like calcium and localizes in bone, primarily in areas of osteoblastic activity. It decays by 1.4 MeV (
The biological half-life in normal bone is around 14 days, compared with more than 50 days in osteoblastic metastases. The first studies using 89Sr demonstrated efficacy for pain reduction as high as 80%. Complete response rates vary widely among studies and have been reported in 8–77% of cases. The overall response rate varied from 33 to 82% [49–54]. It was the first radiopharmaceutical to be approved for systemic radionuclide therapy in the palliation of painful bone metastases. The standard recommended dose of 89Sr is 150–200 MBq (Table 3). It was shown to be as effective as both local field and hemibody external-beam radiotherapy in relieving existing bone pain, but delayed the development of new pain at preexisting, clinically silent sites [45, 55].
\nToxicity is limited with the common development of thrombocytopenia, with the nadir between the 4th and 6th weeks. Recovery is typically slow over the next 6 weeks, dictated by skeletal tumor extent and bone marrow reserve [45].
\nThe largest study was published by Robinson et al. In this study, 622 patients were included (466 with prostate cancer). About 15% of patients showed complete pain relief, and a partial response was documented in 81% [56–58]. Tu et al. [59] reported improved survival using six weekly administrations of 89SrCl2 combined with doxorubicin after induction chemotherapy, compared with six weekly administrations of doxorubicin alone; however, the follow-up Phase II trial of the same study group did not confirm the positive effect of this combination therapy on overall survival [60].
\nA nonrandomized study using 12 weekly administrations of estramustine phosphate, vinblastine, and 89SrCl2 recorded effective, durable symptom palliation, more than a 50% reduction in PSA in 48% of treated patients, and reduced demand for subsequent palliative radiotherapy [61]. Several patient characteristics could predict a favorable response to 89Sr. A normal serum hemoglobin level prior to treatment is associated with a higher pain response rate [62]. Other predictors of a poor pain response were low performance status, higher serum PSA, more extensive osseous metastases, and a poor PSA response [63–66].
\n186Re is a medium-energy β-emitter with a physical half-life of 89 h.186Re-1,1-hydroxyethylidene diphosphonate (186Re-HEDP) is a surface bone-seeking radiopharmaceutical used for internal radiotherapy. The maximum tolerated activity is 2960 MBq, but for routine use the recommended activity is 1285 MBq. Peak skeletal uptake occurs 3 h after intravenous administration [67, 68]. An early study by Maxon et al. [69] using 1285 MBq of 186Re-HEDP documented overall pain relief in 80% of patients, with a mean duration of 7 weeks in hormone refractory PC patients (Table 3) [70]. Eighty to ninety percent of patients reported improved symptoms after a single 186Re-HEDP administration. The response was typically rapid, occurring within 24–48 h of activity administration. Placebo-controlled, randomized studies have confirmed the efficacy of 186Re-HEDP [70, 71].186Re-HEDP undergoes rapid urinary excretion and rapid blood clearance (plasma half-life of 41 h) [70]. For the standard applied activity of 1285 MBq, 186Re-HEDP provided a median radiation-absorbed dose of 26 Gy to bone metastases and 1.73 Gy to the red bone marrow [70]. The tumor to marrow dose ratios had a high therapeutic index, with a mean value of 34:1 [69]. Toxicity was limited to temporary myelosuppression, with platelet and neutrophil nadirs at 4 weeks after therapy. Recovery occurred within 8 weeks and was usually complete [72].
\n188Re has a short physical half-life of 16.8 h and a maximum β-particle energy of 2.1 MeV with a 15% γ-component of 155 keV. The maximum β-range in tissue is approximately 10 mm [73]. Blood clearance is rapid after injection, with 41% renal clearance within 8 h of administration. Absorbed doses for bone metastases are in the range of 3.83 ± 2 mGy/MBq, in comparison with 0.61 ± 0.2 mGy/MBq for bone marrow and 0.07 ± 0.02 mGy/MBq for the whole body. The mean effective whole-body half-life is 11.6 ± 2.1 h compared with 15.9 ± 3.5 h in bone metastases [45].188 Re is of special interest in clinical applications because of its excellent availability and cost-effectiveness, as it is the product of a 188W (188W/188Re) generator [74].
\nThe short physical half-life and high dose rate are predicted to lead to a rapid symptom response. Fractionated therapy has been shown to prolong response duration and progression-free survival (PFS). Palmedo et al. [73] randomly assigned 64 patients to two different groups for radionuclide therapy with 188Re-HEDP; patients in group A received a single injection, while patients in group B received two injections with an 8-week interval. In both groups, toxicity was low, with moderate thrombopenia and leukopenia. Repeated 188Re-HEDP therapies (group B) were more effective for pain palliation compared to group A, with a response rate and time of response of 92% and 5.66 months, respectively (
Liepe et al. [75] reported moderate transient bone marrow toxicity with a decrease in the number of platelets from a baseline value of 286 ± 75 × 109/l to a maximum of 218 ± 83 × 109/l with the nadir at 3 weeks. This study group found no evidence of either local or systemic intolerance to treatment with 188Re-HEDP, while a flare reaction with an increase in pain within 14 days after therapy was noted in 16% of patients [75].
\nBiersack et al. [76] also showed the positive effect of repeated therapy on overall survival. They retrospectively analyzed 60 hormone-refractory patients classified into three different groups according to the number of therapies. Group A comprised patients who had received only one therapy (19 patients), group B included patients who had received two therapies (19 patients), and group C included patients who had received three or more therapies (22 patients). All patients had bone pain and presented with more than five lesions documented by a bone scan. Mean survival after the initial therapy improved from 4.5 months in group A to 9.98 months in group B and 15.7 months in group C [76].
\n153Sm-EDTMP has a lower β-emission energy [0.81 MeV (20%), 0.71 MeV (49%), and 0.64 MeV (30%)], a 28% abundance of γ-emission at 103 keV (28%) and a physical half-life of 46.3 h. 153Sm forms a stable complex with ethylenediamine tetramethylene phosphonate (EDTMP). Clearance is bi-exponential after administration, comprising rapid bone uptake (half-life of 5.5 min) and plasma renal clearance (half-life of 65 min) [77].
\nA dose escalation study with 10–36 MBq/kg of 153Sm-EDTMP reported a pain relief rate of 65%, with a duration range from 4 to 35 weeks [78]. A further dose escalation study in 52 patients using administered activities from 37 to 111 MBq/kg had a response rate of 74% with a median duration of 10 weeks [79]. Larger studies with more than 100 patients showed a median therapeutic efficacy of 80%. In a randomized, double-blind, placebo trial (
Dickie et al. compared 89Sr with 153Sm in 57 prostate cancer patients. They found no difference in the pain response rate and toxicity [83]. van der Poel et al. compared 186Re with 89Sr and reported no differences in the response rate or toxicity [54]. A nonrandomized comparison of 188Re-HEDP and 153Sm-EDTMP in patients with painful metastases from prostate and breast cancer by Liepe et al. [84] showed a comparable response and toxicity with both agents. Liepe et al. also performed a comparative study of 188Re-HEDP, 186Re-HEDP, 153Sm-EDTMP, and 89SrCl2 in the treatment of painful bone metastases. They reported that all radiopharmaceuticals were effective in pain palliation, without the induction of severe side effects or significant differences in therapeutic efficacy or toxicity [39].
\n223Ra, an α-emitter, has a half-life of 11.4 days, with a total emitted energy of about 28 MeV. It is the only FDA-approved radiopharmaceutical for the treatment of bone metastases of PC with positive impact on overall survival according to a prospective randomized study [10]. It is a bone stromal-targeted radiopharmaceutical that undergoes α-emission. The α-particle is considerably more destructive to tumor cells than the β-particle. 223Ra has a very high linear energy transfer, and only one to five hits per cell can be fatal. Double-strand breaks are induced even in quiescent cells and at low oxygen levels [85].
\nThe penetration range of α-particles (<100 μm) in tissue is much smaller than that of previously described β-emitters in this chapter; so, despite the high energy, because of the short penetration range, bone marrow damage is minimal [86]. Nonhematological toxicities are more commonly observed, and are mild to moderate in intensity. The most common side effects are diarrhea, fatigue, nausea, vomiting, and bone pain, some of which are dose-related [87–89]. These side effects are easily manageable with symptomatic and supportive treatments [90].
\nParker et al. [89] performed a randomized, double-blind, dose-finding, Phase II study that included 122 PC patients who were randomized to be treated with three injections of 223Ra at 6-week intervals, at doses of 25 kBq/kg (
The ALSYMPCA trial (ALpharadin in SYMptomatic Prostate CAncer) is the first randomized Phase III study demonstrating improved survival with a bone-seeking radioisotope [42]. The number of PC patients recruited was 921. All patients were required to have progressed with symptomatic bone metastases, with at least two or more metastases on bone scintigraphy with no known visceral metastases. Randomization was 2:1 in a double-blind fashion to receive six cycles of intravenous 223Ra every 4 weeks with best standard of care or six infusions of placebo with best standard of care. This study demonstrated a significant prolongation of survival (14.9 vs. 11.3 months, respectively;
Etchebehere et al. retrospectively reviewed 110 patients with metastatic PC treated with 223Ra. The end points of this study were overall survival, bone event-free survival, progression-free survival (PFS), and bone marrow failure. They evaluated the following parameters prior to the first therapy cycle: hemoglobin (Hb), PSA, alkaline phosphatase (ALP), ECOG status, pain score, prior chemotherapy, and external beam radiation therapy (EBRT). Furthermore during/after 223Ra, the PSA doubling time (PSADT), the total number of radium cycles (RaTot), and the use of chemotherapy, EBRT, enzalutamide, and abiraterone were evaluated. A significant reduction of alkaline phosphatase and pain score occurred throughout the 223Ra cycles. The risk of progression was associated with declining ECOG status and decrease in PSADT. RaTot, initial ECOG(Eastern Cooperative Oncology Group) status, ALP, initial pain score, and the use of abiraterone were associated with OS (
Recently, Pacilio et al. [90] performed a dosimetry study and showed that the lesion uptake of 223Ra was significantly correlated with that of 99mTc-MDP. The DRBE (RBE, relative biological effectiveness; DRBE, RBE-weighted absorbed dose) to lesions per unit administered activity was much higher than that of other bone-seeking radiopharmaceuticals, but considering a standard administration of 21 MBq (six injections of 50 kBq/kg to a 70-kg patient), the mean cumulative value of DRBE was about 19 Gy, and was therefore in a similar range as other radiopharmaceuticals.
\nNilsson et al. [92] reported the quality-of-life results of the ALSYMPCA study. It was found that improved survival with 223Ra was accompanied by significant quality-of-life benefits, including a higher percentage of patients with meaningful quality-of-life improvements and a slower decline in quality-of-life over time.
\nA pain response is seen in approximately one-half of patients treated with radionuclides for painful osseous metastases of prostate cancer. The ALSYMPCA study showed an OS benefit with 223Ra treatment. However, it should be mentioned that this study was supported by the company, Bayer. The other radiopharmaceuticals which are mentioned in this chapter were not tested in prospective multicenter trials with a large number of patients. This means that β-emitters could also have an OS benefit, which was shown in only a few studies. A combination of hormone therapy with bone-targeted therapy may be more effective than a single therapy approach. Different combinations of therapies are being studied at the moment. PSMA-targeted therapy has so far shown very promising results. According to the published studies, 177Lu-PSMA therapy after 223Ra is feasible and safe.
\nIn times of crisis and adverse events, a certain type of leadership is required which is often called resilient leadership [1, 2, 3, 4, 5, 6, 7, 8]. The literature on resilient leadership delivers rich knowledge about the characteristics of resilient leadership [2], the leadership styles of resilient leaders [1, 9], their actions and activities during crisis to foster collective and organizational resilience [4, 9] and ways to enhance resilient leadership [8, 10]. In contrast to this, comparably little is known about the role of leadership in building and maintaining the social foundation of organizational resilience. Some scholars have gone in this direction explaining how leaders could cultivate and activate social and cultural resources which foster organizational resilience [11, 12, 13]. The aim of this paper is to continue this work by more closely examining the social preconditions for and dynamics of organizational resilience and the role and starting point of leadership in shaping these phenomena. For this purpose, the chapter focuses first on the concept of organizational resilience, second on the social foundation of organizational resilience and third on the phenomenon of resilience spirals. The role of leadership in building and maintaining this social core of resilience and managing resilience spirals and the starting points to do so are emphasized.
This chapter presents two perspectives on the nature of organizational resilience and stresses the importance of examining the preconditions of organizational resilience.
The individualistic perspective on organizational resilience regards the individual resilience of the members of an organization as the main basis for organizational resilience [14, 15, 16]. Individual resilience could be defined as “the ability to bounce back from adversity, frustration, and misfortune” [17]. From the individualistic perspective, organizational resilience is the result of the aggregation of the individual resilience of all members. The factors that foster the resilience of individuals are a mixture of pessimism and optimism [14, 16], a proactive orientation [14, 18, 19, 20], sense-making abilities [14, 21], autonomy and self-determination [22], risk awareness [16], the ability to connect to others’ knowledge [23, 24], the ability to use available resources [24], individual readiness to change [25, 26] and tolerance for ambiguity [27, 28].
The systemic perspective conceptualizes organizational resilience as an attribute of the organization. The literature describes at least four different systemic conceptions of resilience. The ecological resilience concept characterizes resilience as a system’s ability to absorb external energy without structural change. This means that “the measurement of resilience is the magnitude of disturbance that can be absorbed before the system changes its structure by changing the variables and processes that control behavior” [29]. The second systemic concept describes resilience as the ability to bounce back to the previous equilibrium. This type of resilience “concentrates on stability near an equilibrium steady state, where resistance to disturbance and speed of return to the equilibrium are used to measure the property” [30]. The third conception of resilience defines resilience as the ability to achieve a new equilibrium, thus attaining a renewal state [16, 31]. The most dynamic systemic conception describes resilience as the ability of a system to switch between different equilibria [32, 33, 34] without changing the stable core of the system [33]. This core consists of the “keystone structuring processes which enables systems to adapt across a number of scales, sources of renewal and reformation” [33]. One aim of this chapter is to propose the hypothesis that in the case of social systems, the social infrastructure of collective systems is an important part of this core.
There are specific and nonspecific preconditions that contribute to organizational resilience. Scholars have identified specific conditions that promote resilience. According to Hollnagel [35], resilient organizations are characterized by four abilities, namely (1) the ability to anticipate, (2) the ability to monitor possibly dangerous developments, (3) the ability to respond quickly and appropriately and (4) the ability to learn from past events and crises [36]. These abilities can be fostered by different measures [37], such as focused Human Resource (HR) strategic management [19, 22, 31], collective risk awareness tools, critical incident reporting systems [38, 39, 40], preparedness strategy [16], uncertainty strategies [19] and analysis tools such as the resilience analysis grid [35, 41].
Nonspecific preconditions for organizational resilience are factors that are necessary but not sufficient for resilience. They are useful not only for coping with crises but also for managing routine, everyday demands. Nonspecific preconditions lay the foundation for resilience but are unable to produce resilience on their own. Research into organizational resilience has identified many attributes in organizations that could contribute to resilience in a nonspecific way [37]. Identified nonspecific preconditions for organizational resilience include ritualized ingenuity [14, 42], flexibility [42], elasticity [28], adaptive capacity [16], organizational readiness to change [26, 43], proactiveness [19, 44], robustness [16], redundancy [16], resourcefulness [16], rapidity [16] and the regeneration capacity of an organization [45]. Other nonspecific preconditions are financial resources [46, 47], technical resources [28, 47] and informational resources [28]. With regard to the social foundations of organizational resilience, it is worthwhile to more closely examine the social resources which have been identified as relevant for organizational resilience. These are communication (to exchange information and knowledge relevant in times of crisis) [16], commitment and emotional attachment to the organization [16, 24, 26], common values [21, 48], trust and open communication [26, 28, 48, 49, 50] as well as social capital, sense of belonging and relational reserves [16, 26, 28, 46, 51].
One purpose of this paper is show, that the stable core, which Gunderson [33] describes as a property of higher order resilient systems, is—in the case of social systems—equivalent to the social infrastructure of these systems. This social infrastructure guarantees that fast collective decisions and action could be made and that the collective systems experiences collective agency during normal times and during crisis. This social infrastructure consists of at least four infrastructural components: adaptive structures, goal-attaining structures, integrative structures and pattern maintenance structures. According to the infrastructural model of organizational resilience (see Figure 1), these structures together heighten the agency capacity of an organization, which is its basis for collective action and collective agency. Collective agency itself is a general precondition for all management activities in an organization as long as these activities are based on collective action. This is also true for resilience management, which if properly done leads to a higher amount of organizational resilience. Additionally, organizational resilience is not only dependent on resilience management alone but also on infrastructure, agency capacity and collective agency in a direct way. The amount of organizational resilience in turn influences the amount and quality of the social infrastructure of collective agency (Figure 1).
The social infrastructure model of organizational resilience.
According to the structural-functional theory, I distinguish functions from structures. The underlying hypothesis is that certain structures may have certain functions [52, 53, 54]. The structure is then a solution to a systemic problem. Talcott Parsons’ structural-functional theory further states that a social system has to fulfill four functions to act and survive: adaption (A), goal attainment (G), integration (I) and latent pattern maintenance (L; AGIL functions). The hypothesis here is that if all four functions are fulfilled, the collective possesses systemic agency capacity (see Figure 2) and by this, the ability to be an autopoietic social system. This autopoietic system is “self-producing or self-constructing” [55]. In this case, all four functions work together, forming the systemic agency capacity (Figure 2) and making a collective system able to act and react, to regulate itself according to its own value-based standards and to rebuild and reconstruct itself in times of crisis. Thus, if the metafunction systemic agency capacity exists within an organized collective, the emergence of an autopoietic social system from this collective is highly probable.
Systemic agency capacity as a higher-order function of the AGIL functions.
I now more closely examine the structures necessary to fulfill these four functions. They form the social infrastructure for collective agency and action. Adaptive structures enable a collective to produce (common) goods and deliver services and thus obtain resources from the environment in exchange, which can be used as general resources to adapt to new situations [53]. Goal-attaining structures enable a collective to make consensual decisions, set goals, control the goal-attaining process, analyze the gains and losses in a reflective way and redirect activities that have not been helpful to achieve a goal [56]. Integrative structures are necessary to prevent disintegration, subgroup conflicts and noncohesiveness and to build social capital. Integrative structures include reciprocity-based and trustful social networks [51, 57, 58]. Latent pattern maintenance structures [59], such as a system of values, knowledge, beliefs and symbols are necessary to guide and evaluate action with regard to the systems´ own value standards. Institutionalization and socialization agents and processes are part of this structure because they have the task of transferring the values, knowledge, beliefs and symbols into the collective system and to the next generation of individual members (see Table 1).
Adaptive structures | Goal attainment structures |
Integrative structures | Latent pattern maintenance structures |
The social infrastructure of collective agency.
Organizational resilience requires (a) fast and consensual collective decision-making to react to new events in a timely fashion; (b) common collective actions of the leaders and followers to execute resilience management in an impactful way; and (c) a robust organization with a stable core, absorptive capacity and the property of general agency, which enables organizational fitness. The first point should not be taken for granted within organized collectives, especially within management boards [60] and top management teams [61], where leadership in singular is replaced by leadership in plural. Leadership in plural is the new normal [62]. In sum, resilient organizations need collective agency and the general capacity to execute this agency as the foundation for fast, united and impactful collective action with regard to adverse events.
Collective action could be defined as “joint activities by a wide group of actors on the basis of mutual interests” [63]. Because people often do not have mutual interests, collective inaction is commonly observed [63, 64]. To overcome the default tendency of collective inaction and enter the state of collective action, collectives have to transform themselves into a collective agent [63] and in the long run into an autopoietic social system [65, 66].
A collective agent “is a collective (…) that can (…) be the subject of attitudes and can perform actions as a collective” [67]. An important property of a collective agent is collective agency. According to the social cognitive theory perspective, “people’s shared beliefs in their collective power to produce desired results are a key ingredient of collective agency” [68]. This includes not only “shared knowledge and skills of its different members, but also (…) the interactive, coordinative, and synergistic dynamics of their transactions” [68]. According to Bandura, “perceived collective efficacy is not simply the sum of the efficacy beliefs of individual members (…) it is an emergent group level property” [68].
Systemic agency is a special type of collective agency. It is produced if the collective transforms itself into an autopoietic social system [69] by incorporating additional structural features. The social ontology perspective within collective research [67] delivers some hints about these necessary features. According to this approach, the collective agency of an autonomous collective agent consists of at least three components. First, a collective which possesses collective agency should be a “social entity that consists of an unspecified number of individuals who share some properties that allow for their identification as a collective” [67] and which “exhibit a certain degree of persistence regarding their own identity in the case the identity of their constituents is changed” [67]. Examples of this are common values or even a common worldview of the members of the collective. Second, a collective agent which possesses collective agency should be clearly distinguishable from its environment and able to actively shape this environment and evaluate its own behavior with regard to normative standards and values, which are generated by the collective itself [67]. Third, the collective agency should be a significant property of the collective agent as a whole [67]. Out of this perspective, collective agency is a potential: “possessing agency (…) does not imply that the collective actually performs any particular action or holds a specific attitude at any instance”, but it implies “that it would be possible for it to do so” [67]. To distinguish this form of collective agency from the term used by Bandura [68], I propose to call the social-ontological-based term “systemic collective agency” or “systemic agency”.
The amount of collective and systemic agency depends on functional preconditions. As in the case of humans where personal agency requires that the human body is able to fulfill basic functions like body coordination [70], collective agency requires that the collective system is able to fulfill basic functions necessary for acting and surviving as a social unit. The agency capacity is the most important of these basic functions. The amount and quality of the agency capacity of a collective corresponds with the development stage of the collective (Table 2).
Stages of collective development | Basic function | Social infrastructure | Type of capacity | Type of collective (perspective of action theory) | Type of social systems (perspective of system theory) |
---|---|---|---|---|---|
Stage 1 | — | — | None | Mere collective | Absence of a social system |
Stage 2 | I | Integrative structures | Action-shaping capacity | Cohesive collective | Social system capable of shaping action |
Stage 3 | GI | Integrative & goal-attaining structures | Collective agency capacity | Collective agent | Social system capable of acting |
Stage 4 | AGIL | Integrative, goal-attaining, adaptive & maintenance structures | Systemic agency capacity | Corporate actor | Autopoietic social system |
Stages of collective development, AGIL functions and capacity type.
Legend: I = Integration; G = Goal attainment; A = adaptation; L = Latent pattern maintenance.
A mere collective (stage 1 collective) is transformed into a cohesive collective (stage 2 collective) by adding social cohesion to the disorganized mere collective. In this case, the group fulfills the function of integration (I-function). The social group is therefore able to shape the actions and behavior of its members, producing conformity, group think and behavior change [51, 71, 72, 73]. This enables cooperation between individuals, including those with divergent interests [57, 74]. In cohesive collectives, social cohesion bundles otherwise chaotic individual energies and transforms these into social energy [56]. This kind of collective system can be called an action-shaping social system or social system capable of shaping action [75], and the type of capacity this collective possesses can be called action-shaping capacity.
If a cohesive collective is also able to set goals and attain them and if the members of this collective develop a sense of purpose [76], the goal attainment function (G-function) is fulfilled. Stage 3 collectives fulfill the G-function plus the I-function. This leads to the “GI factor” [56, 77]. This factor “produces collective energy within a group and gives this energy a direction, producing goal-oriented collective action” [56]. The result is a collective with “a sense of purpose and unity”, speaking with one voice [56, 77] and possessing shared beliefs of collective efficacy [68]. This kind of collective system could be called a collective agent or, from the social system perspective, a social system capable of acting [75]. These types of collectives possess “collective agency capacity”.
Social systems capable of acting (collective agent) could further transform themselves into an autopoietic system by fulfilling two functions, namely the adaptive function (A-function) and the latent pattern maintenance function (L-function).
The A-function is achieved if the collective produces goods and services for the environment to receive needed resources in exchange in order to accumulate needed resources as well as slack resources like social, human, economic and cultural capital [60, 78, 79]. The A-function is also fulfilled if the collective internally produces slack resources and flexible structures to be able to adapt to new situations in turbulent times [79, 80].
The L-function is fulfilled if the collective has incorporated value systems, knowledge systems, belief systems and symbolic systems (a) which serve as guiding standards and values against which the collective system’s behavior is evaluated by itself and (b) which could be transferred to the next generation of members via socialization and internalization [54, 81]. Additionally, the L-function is fulfilled if these cultural elements are institutionalized into the collective system by roles, positions and norms [54, 64, 81]. This leads to an organization-culture fit [82]. By these three means—socialization, internalization and institutionalization of cultural structures—social systems, which are capable of acting, are additionally able to maintain the latent pattern of these systems over time. This and the ability of the social system to evaluate its own behavior by the cultural values which the system has generated itself ensure self-organization and autopoiesis independent of the strategies and personalities of the individuals who are temporarily members of this system.
If a social system fulfills all four AGIL functions, systemic agency capacity is produced (see Figure 2). This is a necessary condition for sustainable agency and the emergent birth of an autopoietic social system. From Coleman’s action theory perspective, this type of system can be called a corporate actor [57]. From the sociological systems theory perspective, such a collective can be called an autopoietic social system [65, 66, 83, 84, 85].
Resilience management comprises different dimensions [86, 87, 88]. As already outlined, resilience management rests on four abilities: the ability to anticipate, the ability to monitor possibly dangerous developments, the ability to respond quickly and appropriately and the ability to learn from past events and crises [35]. The basis for these abilities is the capacity to perform collective action in a self-organized way. Without a minimum amount of this agency capacity, resilience management would be less impactful.
Resilience management could be defined as the process of collective coping with an adverse event and its consequences with the aim to prevent and reappraise adverse events and to buffer their impact or compensate for losses or damages. The concept of resilience management presented here consists of four types of collective resilience management, namely (1) appraisal-focused, (2) problem-focused, (3) impact-focused and (4) spiral-focused resilience management.
With regard to appraisal-focused resilience management, leaders can shape and influence the collective perception and appraisal of a given or expected situation with regard to its threat and loss potential. Leaders are also able to shape and influence the collective appraisal of the coping resources available to handle the situation properly. Additionally, they can support the collective reappraisal of a given situation [89]. In a positive scenario, a perceived threat could with the help of the leader be reappraised collectively as less threatening or as no longer threatening [90]. Charismatic leaders in particular are good at this [90].
Problem-focused resilience management aims to prevent adverse events in the future by altering the dangerous environment in the midterm and long term and/or decreasing the burden of the existing adverse event. Measures that fall into this category of resilience management include altering by political, regulatory or technological means the natural, technical, biological and psychosocial environment with the goal to minimize the probability and severity of adverse events in the future [91]. Other measures within this category include monitoring of possible threats, learning from crises (e.g., [92]), critical incident reporting [38, 39], preparedness strategy [16] and uncertainty management [19].
Impact-focused resilience management aims to manage the consequences of the adverse event. The aim of the measures in this category is not to solve the primary problem but to prevent the occurrence of follow-up problems caused by the primary adverse event and to mitigate the impact of the adverse event and the follow-up problems on the organization and their members. Measures within this category include using financial reserves, staff overhang, organizational slack, storage capacity, social capital and other impact-absorbing structures and resources (e.g., [47, 92, 93]). Other measures are to compensate for losses or impairment and to ameliorate the collective pain caused by the adverse event by organizing, for example, positive events to replace negative emotions with positive emotions. Another form of impact-focused resilience management is to accept the negative structural consequences of the adverse event and to adapt the organization to the new situation by restructuring it and attaining a new, often lower equilibrium. The fourth form of resilience management—the management of resilience spirals—is explained later in detail.
Organizational resilience occurs if an organized collective is able to prevent, appraise, absorb and cope with adverse events and their consequences in such a way that the organized collective can either (a) maintain the previous equilibrium; (b) bounce back to the previous equilibrium; (c) find a new, satisfying equilibrium; or (d) find new equilibria by maintaining a stable core within the system [33, 37, 94]. An optimal form of organizational resilience is obtained when an external adverse event can be managed by the organized collective without loss of collective performance.
The concept of functional performance levels outlined here proposes a hierarchical model of optimal organizational resilience. This model consists of five main levels of equilibria and five levels of a functional performance (see Table 3). The levels of equilibria are the (1) nonautonomous, (2) autonomous, (3) routine, (4) innovation and (5) resilience equilibria levels. These levels are separated by five functional thresholds: (a) survival, (b) autonomy, (c) routine, (d) innovation and (e) resilience. If an organized collective system falls below a threshold, it immediately moves to a lower functional performance level.
Level 5 | The autonomous organized collective system is able to manage routine work, to be innovative and to cope with disruptions and troubles (resilience level) |
T 5 | Threshold of coping with disruptive events |
Level 4 | The organized collective system is able to act and to manage the professional routine work as well as tasks to innovate and change (innovation & exploration level) |
T 4 | Threshold of coping with the innovation and change tasks |
Level 3 | The organized collective system is autonomous and able to manage professional routine work (routine & exploitation level) |
T 3 | Threshold of coping with routine demands |
Level 2 | The organized collective system is able to act without help from outside (autonomous level) |
T 2 | Threshold of acting autonomously |
Level 1 | The organized collective system is able to act but depends on help from outside (nonautonomous level) |
T 1 | Threshold of surviving |
Level 0 | The organized collective system is not surviving |
The concept of functional performance levels of organizations.
An organized collective system which is located on the functional performance level 5 fulfills all the requirements for good organizational resilience while still accomplishing innovation work as well as routine work in a parallel way. An organized collective system at functional performance level 4 (see Table 3) is able to innovate and do routine work but is unable to manage disruptive events without damaging innovation management and routine processes. This functional status is close to the status known in the management literature as ambidexterity. Ambidexterity is defined as an organization’s ability to simultaneously exploit the present (by routine work) and explore the future (by innovation management) [95, 96]. Ambidexterity is regarded as a prerequisite for organizational survival [97], and there are empirical results that support this hypothesis [98]. Ambidexterity could be regarded as a prerequisite for resilience [99, 100] because “ambidextrous firms are better than others at responding to disruptive new business models and emerging technologies” [101]. Factors that promote ambidexterity include a collaborative community [102], support [103] and trust [103]. These factors are important parts of the social infrastructure of collective action as previously shown in this article.
If organized collective systems are unable to perform at level 3, they fall below the routine threshold, which means that they act autonomously but cannot manage routine tasks in the necessary quantity, quality, efficiency or timeliness.
If organizations also fall below the autonomy threshold, they reach functional performance level 2. This means that they need external support to act and survive. This external support could stem from the government or investors. An example of this are the bailouts of airlines during the COVID-19 pandemic [104] or bankruptcy. Some scholars argue that bankruptcy leads to a relief of financial burdens, but it does not change the structures and processes that led to bankruptcy. Therefore, without changing structures and processes and achieving a new equilibrium, long-term survival is doubtful in these cases [105].
If organizations also fall below the survival threshold, the organization will no longer survive.
Organizations differ with regard to the levels of their functional abilities and can be located according to these abilities on the functional performance ladder already shown in Table 3. Organizations that are close to bankruptcy are at the bottom of this ladder, and organizations that are flourishing are at the top. The important point is that first, organized collective systems are able to move up or down this functional performance ladder and that second, this move takes on the form of a spiral: an upward spiral in the case of organizational success and a downward spiral in that of organizational failure.
The reciprocal nature of the relationship between organizational success and organizational resources nurtures the organizational spiral. During upward spirals, the availability of resources leads to organizational success, this success leads to additional resource gains and so on. Some of the resources gained through success include financial or human resources (e.g., attracting young talent). This resource gain provides fertile ground for even more success in the future. In short, success breeds success. This effect is also known as the Matthew effect [106], which is the central pillar for upward spirals. Organizations on an upward spiral experience an accumulation of institutional advantages over time. Contrary to this, in downward spirals, a depletion of resources could provoke organizational failure, and this organizational failure reduces the probability of gaining additional resources in the near future. The causal path “resource depletion > failure > resource depletion > failure” produces a downward spiral. Organizations on a downward spiral experience an accumulation of institutional disadvantages over time [107].
Resilience spirals are a subtype of organizational spirals. The basic causal path is illustrated in Figure 3. The social infrastructure promotes organizations’ agency capacity. This agency capacity enables collective agency, which is necessary to execute resilience management. Additionally, this collective agency leads to strong organized collective systems, which due to their stable “social infrastructure” core can withstand even strong disruptive events by their mere stability and absorptive structures. If an organization is resilient by its mere presence and stability, it is able to gain resources even during times of trouble. This gain in resources could further foster the infrastructure of the social system, which leads to a causal chain of “infrastructural resources → organizational resilience → gain in infrastructural resources → gain in organizational resilience”. This pattern could be called an upward resilience spiral.
The resilience spiral: downward spirals (-), upward spirals (+) and steady state (=).
In the case of a downward resilience spiral, the causal chain is “weak organizational resilience → loss of infrastructural resources → weaker organizational resilience → additional loss of infrastructural resources”. For example, the collective learning process after a disaster could lead to the conclusion that the organization needs to strive for a new equilibrium. A move from the previous equilibrium to the new one could be associated with a gain or loss of resources (see also [108]). If the new equilibrium is on a higher functional level, the move is associated with a resource gain, while if the new equilibrium is on a lower functional level, there is a loss of resources. In this last scenario, the organization is stabilized on a weaker resource level than before. This loss of resources leads to lower collective agency, which could weaken organizational resilience and heightens the possibility of further loss of resources. In this case, there will be a downward resilience spiral. Upward resilience spirals are based in part on the Matthew effect [106]. Downward spirals are characterized by an accumulation of systemic disadvantages. This can be described as a negative Matthew effect.
Upward and downward resilience spirals are processes where old equilibria are abandoned and new equilibria achieved: lower ones in the case of downward spirals and higher ones in the case of upward spirals. In all these cases, the core of the system—the social infrastructure and the resulting agency capacity—should be protected to ensure stability during change and to make change possible. If this protection is no longer possible, the downward spiral has reached a critical phase. This critical phase occurs when further resource loss leads to a situation where the social infrastructure and the corresponding agency capacity function is impaired in such a way that the functioning of the collective system, meaning its ability to act and to do this in effective way, is endangered.
Resilient leadership exists if leaders care about organizational resilience in at least three ways. One way is to lay the groundwork for long-term organizational resilience by building the social infrastructure for collective action. Another way is more specific, namely to develop resilience management, run it and activate it fully in times of trouble. In addition to these two leadership strategies, there is a third one, namely the strategy of managing organizational spirals in general and resilience spirals in particular. Therefore, we distinguish three starting point for resilient leadership: (1) the social infrastructure of collective action and agency, (2) resilience management and (3) resilience spirals. Because we already discussed resilience management, we now focus on how leaders could foster the social foundation and then on how they are able to manage resilience spirals.
A central leadership task is building and maintaining the social infrastructure for collective action by accumulating and conserving the adaptive, political, integrative and cultural structures. These structures are necessary to fulfill all four basic AGIL functions and their higher-order function systemic agency capacity. Leaders who manage social systems, which possess systemic agency capacity, are more successful in reaching their goals. This is greatly independent from the content of the goals and measures as long as they are compatible with the value system of the organized collective. Organizational resilience is an example of such a goal.
In times of rapid change, leaders have to build up structures which enable adaptation. This fosters the A-function and the capacity to adapt to new situations [109]. The primary way to do this is to promote adaptive leadership [110]. This is the ability of leaders “to become more fit with the environment in which they operate, including but not limited to modifying existing procedures, adjusting to new circumstances, and updating knowledge and skills to meet new situational demands”, [110] and it includes the “need to continually learn, change and keep a flexible mindset” [110].
The second task of leaders with regard to social infrastructure is to establish and optimize collective decision-making structures as well as the process of strategic goal-setting, −controlling and -attaining. There is broad knowledge about how to conduct and organize managerial decision-making [111] even in complex environments [112] and how to conduct and measure strategic goal-setting and -attaining [51, 113, 114, 115].
The third task of leaders is to strengthen the social integration and cooperation within the collective they lead. Leaders are responsible for building and maintaining solidarity and cohesiveness within the organized collective. This strengthens the social capital and the integrative structures of the collective they lead. Leaders can contribute to this by (1) a “consideration” leadership style which stresses the orientation toward good social relationships [116, 117]; (2) a transformational leadership style which combines having vision with creating a “we-feeling” among the followers [118] in such a way that they are willing to transfer the vision into practice; (3) cohesive leadership [119], which promotes social cohesion within the followers; or (4) collaborative leadership [120, 121, 122, 123, 124], which “recognizes the need for appropriate balance—between power sharing and control, between process and results, between continuity and change, and between interpersonal trust and formalized procedures” [123] and which is most appropriate in professional organizations, knowledge work organizations and partnership networks [123, 125, 126]. Therefore, enhancing the social capital and cooperation within organizations is central for fulfilling the I-function and is one of the top tasks of leaders within organizations [76, 127].
The fourth task of leaders with regard to the infrastructure for collective agency is to build up the cultural structures within the collective they lead [128, 129]. Cultural structures comprise the value system, knowledge system, belief system and symbolic system. Leaders can shape the culture of an organization in many ways [59, 130, 131, 132, 133, 134, 135]. They shape the culture of the collective by being a role model with regard to the common values of the collective [134, 136]. Additionally, they should be aware that their decisions send cultural signals to their followers with regard to the values the organized collective prefers [76, 133]. This is the case, for example, with job promotion (e.g., which person with which attitudes and values is the preferred one?) [76]. Additionally, leaders should organize the transfer of values, knowledge, beliefs and worldviews to their followers and the next generation. Organized collectives often try to establish a person-culture fit to reproduce their culture by employing individuals who fit into the organizational culture [82, 137]. However, if leaders want to change the culture of organized collectives, they should change the personnel selection team and the selection criteria in order to not reproduce the old culture by recruiting the same way the same sort of people as always.
The fifth function of leaders with regard to social infrastructure is to organize and manage the maintenance and modernization of these four structural elements: the maintenance and modernization of organizational culture [134, 138, 139, 140]; the maintenance, reproduction and modernization of the social structures which produce solidarity and integration [76, 141]; the maintenance and modernization of the adaptive structures like machines and technologies; [142] and the maintenance and modernization of the goal-attaining and decision-making structures [143, 144]. This guarantees the sustainability and adaptability of the collective system and its long-term survival.
Leadership plays a central role in the management of organizational spirals in general and resilience spirals in particular. The main task of resilience-oriented leaders is to manage the collective system they lead in such a way that the reciprocal mechanism (see Figure 3) stabilizes the system in a steady state where resource gains equal resource losses. In this scenario, there is a strong probability that organizational resilience can be maintained on a given level (either a low or a high level) [145]. If the level is low, one of the critical tasks of leaders and managers is to move the organization or organizational unit up the functional performance levels. They are able to accomplish this by using the causal pathway (see Figure 3) to higher resilience via fostering the social infrastructure of collective action by establishing adaptive structures, by investing in the social capital of the organization (integrative resources), by creating efficient decision-making structures and processes (political resources) and by working on common values, visions and knowledge (cultural resources). The second way is to manage the activities of the members in a goal-oriented and motivating way. The third way is by building up systematic resilience management through the implementation of specific resilience measures, such as resilience engineering, resilience analysis and threat monitoring (e.g., [92, 94, 146]). Another important point of resilient leadership is to heighten the capacity of the collective system to be ambidextrous. This enables an organization to do routine as well as innovation work in an efficient and robust way with enough room and energy to also cope with adverse events. Another important task of leaders is to build up an early warning system which signals to them that a downward resilience spiral is just beginning and which delivers evidence-based suggestions [147] about how to stop the downward spiral in a fast and efficient way.
The main limitation of this article is its nonempirical foundation. The article presents theoretical thinking about the social foundations and social dynamics of organizational resilience. The hypotheses presented are not supported by empirical evidence. Thus, as long as these concepts and hypotheses have not been empirically tested and proven, it is necessary to be cautious with practical conclusions. However, it has to be stressed that the concept of the social infrastructure rests on the theoretically proven AGIL concept of Talcott Parsons [53] which has been used or discussed by several social theorists like Habermas [138, 141], Luhmann [148], Münch [149, 150] and Gerhardt [52, 151] and which has been tested empirically in part in some studies [56, 152].
With this limitation in mind, it is possible to draw some tentative practical conclusions from the concepts outlined. The first conclusion is that leaders should take care of followers by enhancing the integrating forces among them [76, 127]. The second conclusion is that leaders should be aware of the importance of effective and efficient decision-making structures and processes and goal-attaining structures (e.g., the controlling system) within the organizational unit they lead in order to enhance the unit’s agency capacity. Third, leaders should foster the adaptive structures of their unit by building processes and structures to produce goods and services efficiently and by accumulating resources to obtain organizational slack which can be used in times of crisis. The fourth conclusion is that leaders should install knowledge and value management to stabilize and enhance the organization’s cultural capital. The fifth practical conclusion is that leaders are better off if they install systematic resilience management which protects the organizational units in times of crisis [153, 154]. The sixth conclusion is that leaders should build up early warning systems to detect the beginning of downward spirals [155].
The aim of this paper was to describe the social foundations and dynamics of organizational resilience and the role of leadership in building and steering these social phenomena. The two main hypotheses were that organizational resilience depends on collective resilience management and the agency capacity of the organization. This capacity was conceptualized as a higher-order function combining the four AGIL functions. These functions are fulfilled if four AGIL-promoting structures are present, namely adaptive, goal-attaining, integrative and latent pattern structures. The reciprocal relationship between the social infrastructure of collective action and organizational resilience could lead to a resilience spiral going either upward or downward. In sum, the task of resilient leadership is to build and maintain the social infrastructure of collective action, foster the agency capacity of their own organization, execute resilience management and prevent downward spirals.
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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Resistance to antibiotics, mediated by genetic factors or, phenotypical, due to biofilm formation, called also tolerance, is the most important cause of therapy failure of biofilm-associated infections, including periodontitis; the mechanisms of tolerance are different, the metabolic low rate and cell’s dormancy being the major ones. 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Subtle changes that occur over time in periodontal tissues that are below the detection limit of visual examination or periodontal probing can be found and tracked accurately over time using 3D imaging, fluorescence spectroscopy, and optical coherence tomography. During debridement of teeth and dental implants, the effective removal of subgingival microbial biofilms and dental calculus deposits can be enhanced using magnifying loupes and operating microscopes and by novel methods based on the interactions of light with bacterial deposits, such as differential reflectometry and light-induced fluorescence. While such techniques can also be used using initial case assessment, their primary purpose is for checking debridement procedures, since the point when bacterial deposits are no longer present represents an endpoint for treatment. The concept of real-time feedback has been developed, using fluorescence readings to control the removal of deposits. 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The purpose of this chapter is to show the current panorama of the immunological mechanisms involved in the pathogenesis of periodontal disease.",book:{id:"8202",slug:"periodontal-disease-diagnostic-and-adjunctive-non-surgical-considerations",title:"Periodontal Disease",fullTitle:"Periodontal Disease - Diagnostic and Adjunctive Non-surgical Considerations"},signatures:"José Luis Muñoz-Carrillo, Viridiana Elizabeth Hernández-Reyes, Oscar Eduardo García-Huerta, Francisca Chávez-Ruvalcaba, María Isabel Chávez-Ruvalcaba, Karla Mariana Chávez-Ruvalcaba and Lizbeth Díaz-Alfaro",authors:null},{id:"65145",title:"Treatment of Gingival Enlargement",slug:"treatment-of-gingival-enlargement",totalDownloads:2065,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Gingival enlargement or overgrowth is a common disease of gingiva. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. They commonly present as bulbous interdental gingival, diffuse swelling of gingival. Due to the unaesthetic appearance of the overgrown gingiva, treatment becomes inevitable. This results in excision of overgrowth known as gingivectomy. The first gingivectomy procedure was explained by Robicsek in 1884 and later by Zentler (1918). Grant (1979) defined gingivectomy as excision of soft tissue wall of pathologic periodontal pocket. Gingivectomy procedures can be done by means of scalpel, laser, electrosurgery and chemosurgery. The ultimate result remains the same indifferent of the method used. However the amount of remaining keratinized gingival and esthetic appearance is of supreme importance.",book:{id:"7060",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",title:"Gingival Disease",fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention"},signatures:"Shruti Bhatnagar",authors:[{id:"270317",title:"Dr.",name:"Shruti",middleName:null,surname:"Bhatnagar",slug:"shruti-bhatnagar",fullName:"Shruti Bhatnagar"}]},{id:"61980",title:"Periodontal Diseases in Patients with Special Health Care Needs",slug:"periodontal-diseases-in-patients-with-special-health-care-needs",totalDownloads:1309,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"A wide variation of people with an impairment or disability requires a “special care dentistry” once their general manifestations directly act in the oral cavity. This target public is inserted into the following categories: neuromotor disability, sensory disability, mental disorder, infecto-contagious diseases, chronic systemic diseases, and systemic conditions. Among the several oral illnesses found in these groups, periodontal diseases have been the most frequent, becoming a major challenge for the dental practitioners. Thus, we described the microbiological, histopathological, and clinical features of periodontal diseases in each “special health care needs” group. Advances in “Omic” technologies have suggested the application of molecular biology methods to assess the genomics (genes), proteomics (proteins), transcriptomics (mRNA), and metabolomics (metabolites) aspects of periodontal diseases. These researches aim to promote a better understanding of the mechanisms involved in the pathogenesis and in the identification of new biomarkers of periodontal diseases that help in diagnosis of periodontal diseases and in tissue responses after treatments of gingivitis and periodontitis. As an alternative therapy, some bioactive materials and photobiomodulation may be indicated once they strongly stimulate the periodontal tissue regeneration, attenuate the inflammatory processes, and/or promote the reconstruction of the microstructure of the periodontium.",book:{id:"7244",slug:"periodontology-and-dental-implantology",title:"Periodontology and Dental Implantology",fullTitle:"Periodontology and Dental Implantology"},signatures:"Mônica Fernandes Gomes, Andrea Carvalho De Marco, Lilian Chrystiane Giannasi and Miguel Angel Castillo Salgado",authors:[{id:"205710",title:"Associate Prof.",name:"Mônica",middleName:"Fernandes",surname:"Gomes",slug:"monica-gomes",fullName:"Mônica Gomes"},{id:"243846",title:"Dr.",name:"Andrea",middleName:null,surname:"Carvalho De Marco",slug:"andrea-carvalho-de-marco",fullName:"Andrea Carvalho De Marco"},{id:"243847",title:"Dr.",name:"Miguel Angel",middleName:null,surname:"Castillo Salgado",slug:"miguel-angel-castillo-salgado",fullName:"Miguel Angel Castillo Salgado"},{id:"243848",title:"Dr.",name:"Lilian Chrystiane",middleName:null,surname:"Giannasi",slug:"lilian-chrystiane-giannasi",fullName:"Lilian Chrystiane Giannasi"}]},{id:"20291",title:"Gingival Indices: State of Art",slug:"gingival-indices-state-of-art",totalDownloads:41999,totalCrossrefCites:10,totalDimensionsCites:24,abstract:null,book:{id:"352",slug:"gingival-diseases-their-aetiology-prevention-and-treatment",title:"Gingival Diseases",fullTitle:"Gingival Diseases - Their Aetiology, Prevention and Treatment"},signatures:"Maria Augusta Bessa Rebelo and Adriana Corrêa de Queiroz",authors:[{id:"65936",title:"Prof.",name:"Maria Augusta",middleName:"Bessa",surname:"Rebelo",slug:"maria-augusta-rebelo",fullName:"Maria Augusta Rebelo"},{id:"76211",title:"Prof.",name:"Adriana",middleName:"Corrêa De",surname:"Queiroz",slug:"adriana-queiroz",fullName:"Adriana Queiroz"}]}],onlineFirstChaptersFilter:{topicId:"1000",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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