Molecular parameters of starch with varying amylose (AM) content.
\\n\\n
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"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:"7572",leadTitle:null,fullTitle:"Trauma in Dentistry",title:"Trauma in Dentistry",subtitle:null,reviewType:"peer-reviewed",abstract:"Identifying and treating traumatic dental injuries is an extremely important part of the dentistry profession. The stomatognathic system is a complex structure that is rich with tactile and motor neuron sensors and therefore trauma to the area should be diagnosed and treated as quickly and effectively as possible. Trauma in Dentistry not only covers the scientific basis of dental trauma and dental trauma-related matters, but it also draws attention to advanced diagnostic and treatment methods for dealing with traumatic dental injuries. This volume includes information for treating both adults and children, with two chapters dedicated to pediatric dental trauma. Other chapters focus on occlusal trauma, dental implants, and biomaterials.",isbn:"978-1-83881-127-3",printIsbn:"978-1-78985-626-2",pdfIsbn:"978-1-83881-128-0",doi:"10.5772/intechopen.77126",price:119,priceEur:129,priceUsd:155,slug:"trauma-in-dentistry",numberOfPages:172,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"7cb94732cfb315f8d1e70ebf500eb8a9",bookSignature:"Serdar Gözler",publishedDate:"July 3rd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",numberOfDownloads:16901,numberOfWosCitations:7,numberOfCrossrefCitations:11,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:14,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:32,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 12th 2018",dateEndSecondStepPublish:"May 3rd 2018",dateEndThirdStepPublish:"July 2nd 2018",dateEndFourthStepPublish:"September 20th 2018",dateEndFifthStepPublish:"November 19th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"174",title:"Dentistry",slug:"dentistry"}],chapters:[{id:"67655",title:"Introductory Chapter: Etiology, Diagnostic, and Treatment Procedure at Traumatic Cases in Dentistry",doi:"10.5772/intechopen.86630",slug:"introductory-chapter-etiology-diagnostic-and-treatment-procedure-at-traumatic-cases-in-dentistry",totalDownloads:1077,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Serdar Gözler",downloadPdfUrl:"/chapter/pdf-download/67655",previewPdfUrl:"/chapter/pdf-preview/67655",authors:[{id:"204606",title:"Dr.",name:"Serdar",surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler"}],corrections:null},{id:"64637",title:"Dental Implants and Trauma",doi:"10.5772/intechopen.81202",slug:"dental-implants-and-trauma",totalDownloads:977,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Implant dentistry treatment target to avoid any kind of edentulous state including tooth loss due to trauma. In the literature there are numerous case reports and few clinical studies documenting treatment options of post-trauma patients by dental implants. Principally there are some limitations of dental implant application related to the age and available bone volume of patients. Implant candidate should complete bone growth as the metallic implants do not follow bony development phases. Most often traumatic dental injuries occur in childhood and implant treatment should postponed. In this aspect the major problem associated with dental implant placement is the lack of adequate bone volumes at the future time of surgery as such cases receives traumatic dental injury in the early years and disuse atrophy occurs during waiting period. Future trends and strategies in dental traumatology in general and with special attention to dental implant applications are based on the education of population in terms of emergency treatments and urgent transport of patients to the clinics.",signatures:"Tosun Tosun and Koray Meltem",downloadPdfUrl:"/chapter/pdf-download/64637",previewPdfUrl:"/chapter/pdf-preview/64637",authors:[{id:"255366",title:"Prof.",name:"Tosun",surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun"},{id:"258195",title:"Associate Prof.",name:"Meltem",surname:"Koray",slug:"meltem-koray",fullName:"Meltem Koray"}],corrections:null},{id:"63684",title:"Biomaterial Used in Trauma Patients",doi:"10.5772/intechopen.81004",slug:"biomaterial-used-in-trauma-patients",totalDownloads:807,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The development of bone tissue engineering and bone regeneration is always of interest to improve methods to reduce costs of trauma patient. Ability to use autogenous bone forming cells attached to bone morphogenetic proteins would be ideal. There are many clinical reasons to develop bone tissue engineering alternatives, for use in the reconstruction of large defects and implants. The traditional methods of bone defect management include autografting and allografting cancellous bone, vascularized grafts, and other bone transport techniques. However, these are the standard treatments. Since bone grafts are avascular and dependent on the size of the defect, the viability can limit their application. In large defects, the grafts can be resorbed by the body before osteogenesis is complete; tissue loss develops in the living organism due to infection, trauma, congenital, and physiological reasons. Placing tissue defects in the dentist and maxillofacial surgery and accelerating wound healing are an important issue. From an old Egypt, material used in treatment of different doctors with various causes. Oral surgery, periodontology, and implantology, which are surgical branches of the dentistry, need to increase bone formation in the treatment of bone defects, congenital defects, and defects around the implant. Many years of work have been done to obtain ideal biomaterials, and many materials have been used. We have prepared detailed information on biomaterials used in dentistry, oral, and maxillofacial surgeries in this book to help dentists and dental students.",signatures:"Mehmet Yaltirik, Meltem Koray, Hümeyra Kocaelli, Duygu Ofluoglu and Cevat Tugrul Turgut",downloadPdfUrl:"/chapter/pdf-download/63684",previewPdfUrl:"/chapter/pdf-preview/63684",authors:[{id:"258195",title:"Associate Prof.",name:"Meltem",surname:"Koray",slug:"meltem-koray",fullName:"Meltem Koray"},{id:"260116",title:"Dr.",name:"Mehmet",surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik"},{id:"265270",title:"Dr.",name:"Humeyra",surname:"Kocaelli",slug:"humeyra-kocaelli",fullName:"Humeyra Kocaelli"},{id:"270191",title:"Dr.",name:"Duygu",surname:"Ofluoglu",slug:"duygu-ofluoglu",fullName:"Duygu Ofluoglu"},{id:"270192",title:"Dr.",name:"Cevat Tugrul",surname:"Turgut",slug:"cevat-tugrul-turgut",fullName:"Cevat Tugrul Turgut"}],corrections:null},{id:"66669",title:"Dental Traumatology in Pediatric Dentistry",doi:"10.5772/intechopen.84150",slug:"dental-traumatology-in-pediatric-dentistry",totalDownloads:2221,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"In this chapter, epidemiology of dental trauma will be discussed in terms of its incidence and prevalence among primary and permanent dentition. Dental trauma causes and its distribution in accordance with age and sex will be highlighted. Classification of dental trauma based on soft and hard tissue injuries will be outlined, and subsequently, clinical examination and diagnosis will be featured. Treatment modalities and variations between permanent and primary dentition will be discussed along with the new treatment era namely regenerative approach and decoronation. Splints, techniques, and follow-up routines will also be discussed. Last but not least, prevention of dental trauma will be discussed.",signatures:"Asli Topaloglu Ak, Didem Oner Ozdas, Sevgi Zorlu and Pinar Kiymet Karataban",downloadPdfUrl:"/chapter/pdf-download/66669",previewPdfUrl:"/chapter/pdf-preview/66669",authors:[{id:"255394",title:"Prof.",name:"Aslı",surname:"Topaloglu-Ak",slug:"asli-topaloglu-ak",fullName:"Aslı Topaloglu-Ak"},{id:"272237",title:"Dr.",name:"Pinar",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban"},{id:"272238",title:"Dr.",name:"Didem",surname:"Oner Ozdas",slug:"didem-oner-ozdas",fullName:"Didem Oner Ozdas"},{id:"290840",title:"Dr.",name:"Sevgi",surname:"Zorlu",slug:"sevgi-zorlu",fullName:"Sevgi Zorlu"}],corrections:null},{id:"65088",title:"Evaluation and Management of Mandibular Fracture",doi:"10.5772/intechopen.83024",slug:"evaluation-and-management-of-mandibular-fracture",totalDownloads:2907,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The mandibular bone is an important component of the facial bone, which has a unique role in digestive system, speech, and facial esthetics. For these important functions of mandibular bone, it is vital that surgeons should not only treat function but also consider the esthetics together. Mandibular fractures are among the most common traumatic injuries of the maxillofacial region. Even though treatment modalities are well established and being practiced for a long time, untreated and postoperative complications still decrease the patient’s quality of life. This chapter aims to describe the cause, clinical presentations, diagnoses, and current treatment methods on the basis of resent literature.",signatures:"Guhan Dergin, Yusuf Emes and Buket Aybar",downloadPdfUrl:"/chapter/pdf-download/65088",previewPdfUrl:"/chapter/pdf-preview/65088",authors:[{id:"178412",title:"Associate Prof.",name:"Guhan",surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin"},{id:"178414",title:"Prof.",name:"Yusuf",surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes"},{id:"202198",title:"Dr.",name:"Buket",surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar"}],corrections:null},{id:"66306",title:"Orthodontic Approach in Facial and Dental Trauma",doi:"10.5772/intechopen.83015",slug:"orthodontic-approach-in-facial-and-dental-trauma",totalDownloads:1130,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this review, the prevalence of dental trauma, prevention and diagnosis of traumatic injuries, the effects of dental trauma in patients in need of orthodontic treatment, orthodontic intervention to dental traumatized teeth, and treatment options for poor anterior teeth due to trauma are discussed. Dental trauma is a condition that is frequently encountered in dentistry. When orthodontic treatment of traumatized teeth is planned, the orthodontist should be considered before orthodontic treatment and during orthodontic treatment. Prognosis is divided into two types as treatment options of bad anterior teeth, retaining the tooth in the mouth or pulling the tooth and restoration of the opening. The multidisciplinary teamwork and the role of the orthodontist in this team are important in order to achieve optimal results in the clinical intervention of these cases. Autotransplantation, orthodontic closure, or opening of the space are discussed when tooth extraction and toothless space restoration are required. It is very important to decide if orthodontic forces should be applied or not, and if orthodontic force is necessary, when should it be applied. Information on orthodontic forces applied to traumatized teeth was given in this chapter.",signatures:"Sanaz Sadry",downloadPdfUrl:"/chapter/pdf-download/66306",previewPdfUrl:"/chapter/pdf-preview/66306",authors:[{id:"256417",title:"Associate Prof.",name:"Sanaz",surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry"}],corrections:null},{id:"63335",title:"Platelet-Rich Plasma in Trauma Patients",doi:"10.5772/intechopen.79966",slug:"platelet-rich-plasma-in-trauma-patients",totalDownloads:1029,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Platelet-rich plasma (PRP) was mixed with thrombin and excess calcium resulting in activated platelets trapped within the fibrin network; within the matrix, platelets secrete bioactive substances that diffuse into the surroundings tissues. PRP is prepared from the patient’s own blood, a variety of manufacturing techniques in vastly different cell counts, and growth factor concentrations. The clinical use of PRP is treatment of soft tissue diseases and injuries, treatment of burns, hard-to-heal wounds, tissue engineering, and implantology in dentistry. An essential criterion for PRP is for it to be autologous, for the donor of the blood, and the recipient of the PRP to the same person. Most of the literatures suggest that PRP does not appreciably impact bone healing or induce bone formation. PRP might augment recruitment of osteoblast progenitors to injection sites or in sites expected to experience delayed healing. In this capacity, PRP might be utilized to initiate repair of an otherwise poorly healing bony lesion. PRP stimulates bone repair in fractures. Early through late healing process is compromised with fractures, including reduced cell proliferation, delayed chondrogenesis, and decreased biomechanical properties. In this chapter, the importance of the PRP in oral and maxillofacial surgery in trauma patients is studied",signatures:"Mehmet Yaltirik, Meltem Koray, Hümeyra Kocaelli and Duygu Ofluoglu",downloadPdfUrl:"/chapter/pdf-download/63335",previewPdfUrl:"/chapter/pdf-preview/63335",authors:[{id:"258195",title:"Associate Prof.",name:"Meltem",surname:"Koray",slug:"meltem-koray",fullName:"Meltem Koray"},{id:"260116",title:"Dr.",name:"Mehmet",surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik"},{id:"265270",title:"Dr.",name:"Humeyra",surname:"Kocaelli",slug:"humeyra-kocaelli",fullName:"Humeyra Kocaelli"}],corrections:null},{id:"65714",title:"Oral Mucosal Trauma and Injuries",doi:"10.5772/intechopen.81201",slug:"oral-mucosal-trauma-and-injuries",totalDownloads:6753,totalCrossrefCites:7,totalDimensionsCites:10,hasAltmetrics:1,abstract:"Trauma-related oral lesions are common in clinical practice of dentistry and they can impair patients’ normal oral function and cause pain in patients’ eating, chewing, and talking. An injury to the oral mucosa can result from physical, chemical, or thermal trauma. Such injuries can result from accidental tooth bite, hard food, sharp edges of the teeth, hot food, or excessive tooth brushing. Some injuries can also be caused by iatrogenic damage during dental treatment or other procedures related to oral cavity. In this chapter, oral mucosal trauma and injuries will be examined in four subclasses: physical and mechanical traumas of oral mucosa; chemical injuries of the oral mucosa; radiation injuries; and electrical, thermal burns.",signatures:"Meltem Koray and Tosun Tosun",downloadPdfUrl:"/chapter/pdf-download/65714",previewPdfUrl:"/chapter/pdf-preview/65714",authors:[{id:"255366",title:"Prof.",name:"Tosun",surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun"},{id:"258195",title:"Associate Prof.",name:"Meltem",surname:"Koray",slug:"meltem-koray",fullName:"Meltem Koray"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:{id:"2",series:{id:"3",title:"Dentistry",issn:"2631-6218",editor:{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Universidad Católica San Antonio de Murcia",institutionURL:null,country:{name:"Spain"}}}}},tags:null},relatedBooks:[{type:"book",id:"8837",title:"Human Teeth",subtitle:"Key Skills and Clinical Illustrations",isOpenForSubmission:!1,hash:"ac055c5801032970123e0a196c2e1d32",slug:"human-teeth-key-skills-and-clinical-illustrations",bookSignature:"Zühre Akarslan and Farid Bourzgui",coverURL:"https://cdn.intechopen.com/books/images_new/8837.jpg",editedByType:"Edited by",editors:[{id:"171887",title:"Prof.",name:"Zühre",surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan"}],equalEditorOne:{id:"52177",title:"Prof.",name:"Farid",middleName:null,surname:"Bourzgui",slug:"farid-bourzgui",fullName:"Farid Bourzgui",profilePictureURL:"https://mts.intechopen.com/storage/users/52177/images/system/52177.png",biography:"Prof. Farid Bourzgui obtained his DMD and his DNSO option in Orthodontics at the School of Dental Medicine, Casablanca Hassan II University, Morocco, in 1995 and 2000, respectively. Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). 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\r\n\tAn RNA virus is a virus that contains ribonucleic acid called RNA, it plays a crucial role in carrying genetic information from one generation to the next. RNA viruses usually have a single-stranded RNA (ssRNA) but also pose a double-stranded RNA (dsRNA). Most the RNA viruses replicate and are assembled in the cytoplasm, but DNA viruses replicate and are assembled in the nucleus of the host cell.
\r\n\r\n\tHuman infections caused by RNA virus include Hepatitis A, C and E, Nipah virus, Ebola, HIV, polio, measles, Rabies, SARS-CoV2, Dengue Fever, West Nile fever, Zika virus, Influenza, Hantavirus, etc.
\r\n\tThis book chapter’s main theme will be focused on transmission dynamics, pathogenesis, mechanisms of host interaction and response, epigenetics and markers, molecular diagnosis, RNA interacting proteins, RNA binding proteins, advanced development of tools for diagnosis, possible development of concepts for vaccines and anti drugs for RNA viruses, immunological mechanisms, treatment, prevention and control.
\r\n\t
Osmotic properties are part of wider group of colligative phenomena and concern the liquid-vapour equilibrium in multi-component systems. This group of colligative properties includes depression of the freezing point (cryoscopy), boiling point elevation (ebullioscopy) and osmotic pressure in general. The osmotic pressure can be associated with water activity of various types of products. The essence of the discussed phenomena is related to the changes of pressure of the saturated vapour (Figure 1), which causes the dissolution of the non-volatile substance.
\nPhase equilibrium for pure water and solution.
If the non-volatile substance is a low-molecular-weight chemical compound, the changes in the vapour pressure can be explained by common phenomena, such as association or solvation, which are a result of interactions between molecules. The difference of the vapour pressure would in this case be directly proportional to the molecular mass of a dissolved substance. The osmotic measurements can therefore be used to determine the molar mass, or for multi-molecular substances with significant polydispersion, to determine the average osmotic molecular mass. The osmosis process takes place between the solution and a clear solvent, or between solutions of different concentrations, provided they are separated by a membrane, which is permeable only to the solvents molecules (Figure 2). The solvent moves through the membrane from the solution with lower concentration of the dissolved substance (or from the area of clear solvent) towards the solution with higher concentration. From the point of view of the molecules present in the solution, it is a phenomenon opposite to diffusion. From the solvents perspective, it is a natural intent to balance the chemical potentials, which results in the dilution of the solution with higher concentration. If the osmotic equilibrium takes place in a solution-clear solvent system, the dilution of the solution becomes so significant that the dissolved substances presence becomes suppressed and as a result, the pressure of solvents vapours over the solution becomes equal to the vapour pressure over the clear solvent. Because of that, the osmotic pressure is considered as one of the colligative processes.
\nOsmosis mechanism.
The measurements of osmotic pressure can be carried out using two types of osmometers: membrane and vapour (Figure 3).
\nTypes of osmometers.
A membrane osmometer consists of two chambers divided by a membrane with specific pore sizes, which allow the solvent to move. One of the chambers is filled with pure solvent, while the other with the studied solution and the difference in the hydrostatic pressure between the two chambers is measured. These devices can be used to determine the pressure up to about 0.1 mmH2O, which in practice means measuring polymer and biopolymer solutions of up to 2000 kDa. The lower measuring range depends on the membrane’s permeability. In the case of these devices, the membrane itself is the source of the main issues. The membrane’s permeability depends on its structure: whether it has a system of pores (inorganic materials) or is a molecular sieve (organic materials). Permeability is usually expressed by the lowest molecular mass of a substance that the membrane allows through (
The test results obtained from the osmotic pressure measurements are analysed based on the virial equation, which is mainly associated with real gases. While it might seem surprising, the validity of this approach is based on the nature of interactions between molecules, which move chaotically and collide with each other. In the real gases, the collisions between molecules are not elastic, and as a consequence, they shape the characteristics of the gas phase, so that they diverge from the Clapeyron’s law. For liquid solutions, a similar interpretation can be applied: the polymer/biopolymer molecules are incomparably larger than the solvent molecules (colloid solutions), and therefore, the solvent becomes the `background’ for the interactions between macromolecules. For a macromolecule-solvent system, the nature of the interactions is more complex. Numerous studies on the structure of macromolecules in solutions indicate to two possible behaviour patterns, dependent on the interactions between the solvent and the polymer/biopolymer chains (Figure 4A). As a result of those interactions, the polymer chain can undergo either expansion or contraction (collapse). The scenario is decided by the affinity to the solvent. The chain’s expansion is related to the absorption of the solvents molecules in between the chain’s segments and can be caused by solvation, electrostatic (Couloumb) interactions, formation of a helical structure or the presence of a spatial hindrance in the case of branched polymers (Figure 4A). A contraction caused by low affinity to the solvent induces a collapse, which is often accompanied by the aggregation of the chains or creation of a rigid branched structure, which leads to phase separation (Figure 4A).
\nSwelling mechanism (A) and quality of solvent (B).
The quality of a solvent is examined in close relation to a specific polymer/biopolymer. A good solvent (Figure 4B) causes the expansion of the chain in the solution, which in the range of concentrations
Swelling as a function of temperature and solvents quality.
All the outlined consequences of the solvent-macromolecule and macromolecule-macromolecule interactions mean that the osmotic state equation should, as extensively as possible, take into account the interactions shaping the properties of a tested solution. Because of that, the applied virial state equation takes the following form:
\nIts form is analogous to the virial equation of real gas. From a mathematical point of view, it can be considered as an expansion of the function into a series, around a solution corresponding to ideal solution behaviour. In that equation,
Starch, which is produced and stored in plants seeds and bulbs, is one of the most important plant polysaccharides. It is composed of two types of biopolymers: amylose (AM) and amylopectin (AP). Amylose is a linear fraction composed of α-D-glucose units, bonded to each other through
Starch | \nAM, % | \ng | \n||||
---|---|---|---|---|---|---|
Amylose* | \n100 | \n150–750 | \n25 | \n– | \n– | \n– | \n
Potato | \n24 | \n51,000 | \n222 | \n8.96 | \n7.9 | \n0.166 | \n
Corn | \n22 | \n88,000 | \n213 | \n3.65 | \n3.1 | \n0.077 | \n
Waxy corn | \n0 | \n76,900 | \n234 | \n4.20 | \n3.1 | \n0.130 | \n
Amylstarch | \n76 | \n16,700 | \n231 | \n3.14 | \n17.0 | \n0.168 | \n
Molecular parameters of starch with varying amylose (AM) content.
The results shown for amylose were carried out with chromatography methods.
leads to a conclusion that AP chains exhibit smaller dimensions (
For linear amylose, the interactions between its chains result in a formation of cluster structures (Figure 4A). Because of that, the molecular masses determined with the use of light scattering measurements (SLS) are significantly higher than those determined chromatographically for a single chain. The level of aggregation of AM chains depends on the initial concentration, at the start of dissolution. Dissolution of AM in water requires application of high temperatures of 135°C, as well as pressure. The authors of the Ref. [2] study carried out autoclaving at 10–15 bar. These distinct conformations of AM and AP raise a question about the nature of these chains’ coexistence in water solutions: do amylose and amylopectin form separate structures and therefore are two separate components or whether they form a blend. Tests on solutions and pastes indicate the latter; however, phase separation is observed in those systems (Figure 6).
\nIncompatibility phenomenon in starch paste, AFM image of regular maize starch paste (right, own study, GONOTEC Qscope, USA, non-contact mode).
Starch solutions obtained with the use of DMSO do not exhibit incompatibility with the solvent [8]. This behaviour is a result of the fact that the chains do not exhibit a tendency to aggregate. The values of the average radii of gyration and
Starch | \nAM, % | \n|||
---|---|---|---|---|
Amylose1 | \n100 | \n108–235 | \n24–31 | \n0.87–0.94 | \n
Potato1 | \n24 | \n26,000 | \n127 | \n0.0148 | \n
Waxy potato2 | \n0 | \n4000 | \n15 | \n– | \n
Waxy corn2 | \n0 | \n53,000 | \n242 | \n– | \n
The mixture of DMSO and water can be used as a special solvent. These solutions exhibit a strongly non-ideal behaviour, due to the interactions between molecules. The methyl groups of DMSO may induce cooperative ordering in the system by hydrophobic hydration effects. The oxygen atom of a DMSO molecule can interact with water through H-bonding [10] with the continuum percolation transition in aqueous DMSO solutions with the percolation threshold of 12–15 wt.% of DMSO. A number of studies have been carried out over the years to understand the conformational properties of linear amylose [10–14] (Table 3) and branched amylopectin [14–17], in water and DMSO mixtures. The authors determined that the temperature and time of the dissolution have substantial influence on the weight average molecular mass, radius of gyration and the dispersion of the polysaccharide chains in the solution. With an increasing addition of water, the interactions between amylose and DMSO were reduced, leading to the conformational transition of AM from tight helical via loose helical to disordered coil [11]. The AP’s solubility is limited by the presence of water in the solvent [17]. Increasing water content not only limits the AP’s solubility but also causes an aggregation of its chains in the solution. In the case of starch solutions in binary solvents, the phenomenon of coil overlap occurs.
\n\n | Solution H2O/DMSO | \nReference | \n||||
---|---|---|---|---|---|---|
\n | 100/900 | \n765 | \n37.5 | \n272 | \n2.192 | \n\n |
AM | \n200/800 | \n660 | \n38.8 | \n276 | \n1.952 | \n[16] | \n
\n | 500/500 | \n555 | \n34.0 | \n123 | \n1.304 | \n\n |
\n | 700/300 | \n506 | \n26.3 | \n55.6 | \n1.189 | \n\n |
\n | 100/900 | \n151 | \n84 | \n– | \n\n | [13] | \n
\n | 100/900 | \n15,300 | \n99.8 | \n\n | \n | \n |
\n | 300/700 | \n57,500 | \n182.3 | \n\n | \n | [17] | \n
AP | \n500/500 | \n192,700 | \n182.8 | \n\n | \n | \n |
\n | 100/900 | \n171,000 | \n238 | \n\n | \n | [18] | \n
\n | 100/900 | \n150,000 | \n238 | \n0.055 | \n\n | [13] | \n
Molecular parameters of amylose and amylopectin in binary solvents H2O/DMSO tested with light scattering method SLS at 25°C.
In the case of utilising pure DMSO or DMSO/water mixtures, it is possible to achieve a decidedly higher solubility of starch and its derivatives than for pure water—up to 50% (w/w) starch solutions in pure DMSO [20] and in binary solvents ([21], the below photo from own studies).
\nFor amylose solutions (Figure 7), a change in character of the
Correlation between reduced osmotic pressure
\n | Day | \nAM | \nAP | \nStarch native | \nAc | \nPh | \nE1404 | \n|
---|---|---|---|---|---|---|---|---|
30°C | \n1 | \n2.05∙10−6 | \n1.34∙10−5 | \n−1.09∙10−5 | \n4.17∙10−6 | \n1.06∙10−6 | \n−1.84∙10−6 | \n7.47∙10−7 | \n
2 | \n\n | 4.42∙10−5 | \n4.17∙10−5 | \n\n | \n | \n | \n | |
8 | \n\n | 4.17∙10−5 | \n4.48∙10−5 | \n\n | \n | \n | \n | |
40°C | \n1 | \n\n | 4.25∙10−5 | \n1.87∙10−5 | \n\n | \n | \n | \n |
2 | \n\n | 3.32∙10−5 | \n2.62∙10−5 | \n\n | \n | \n | \n | |
8 | \n\n | 2.68∙10−5 | \n3.07∙10−5 | \n\n | \n | \n | \n |
Value of the second osmotic virial coefficient
Storage of the pastes in room temperature causes changes in the interactions between their components (Figure 8). The results of osmotic pressure measurements at 30°C carried out 24 h after the first measurements (
Correlation between reduced osmotic pressure
No qualitative changes in the course of the
The measurements of
Correlation between the reduced osmotic pressure
Chemical modification of starch causes changes in the interactions between polysaccharide chains and water (Figure 10). For phosphorylated potato starch, the reduced osmotic pressure has negative values. This behaviour is different to the native potato starch, as for the tested range of concentrations (0.050–0.075 g/100 mL), the positive values of osmotic pressure were not observed. Based on that, it is possible to speculate that phosphorylation has caused the change to the overlap concentration, at which values of
Correlation between reduced osmotic pressure
Acetylation of starch, similarly to phosphorylation, causes a change to the concentration at which the values of osmotic pressure are positive. This results in a change of osmotic properties, which is in accordance to the results presented by Żmudziński et al. [22]. The values of reduced osmotic pressure are negative for concentrations in the range from 0.050 to 0.065 g/100 mL and positive from 0.070 to 0.080 g/100 mL. The correlation obtained for the tested systems is ascending for the whole range of concentrations. Positive values indicate an increase of water absorbability of the tested solutions. The second virial coefficient calculated for these systems has a positive value. An increase of the affinity of the solvent molecules to the polymer chains occurs, which means that water is a good solvent for acetylated starch.
\nFor solutions of starch oxidised in a microwave radiation field, the obtained
The values of the reduced osmotic pressure obtained for the oxidised starch (E1404) are the highest of all tested systems; however, the obtained correlation is descending. It is worth noting that the concentration range included higher concentrations than for the other systems. A common concentration for the tested starches is 0.080 g/100 mL, for which the value of
The non-starch polysaccharides group includes gums of various plant origin: locust bean gum, konjac, guar gum and carrageenans or bacterial origin polysaccharide: xanthan and chemical modified cellulose: carboxylmethylcellulose.
\nLocust bean gum (carob gum) is obtained by the milling of endosperm of the seeds from the carob tree pods (
Guar gum is a non-ionic polysaccharide obtained from the endosperm of guar seeds (
Konjac gum is obtained from the tubers of the
Gum arabic is a natural plant sap excretion harvested from acacia trees (
Xanthan gum is an extra-cellular polysaccharide produced by the
Carboxymethylcellulose (CMC) is a half-synthetic anionic polysaccharide obtained by chemical modification of cellulose. During the process, a partial substitution by carboxymethyl group occurs of the second, third and sixth hydroxyl groups in cellulose. The linear chains of CMC are formed of glucose units joined by β-(1,4)glycosidic linkage. Average substitution CMC level is defined as an average number of carboxymethyl groups repeating unit. This parameter is defined in the range 0.4–1.5. This polymer is usually available in the form of sodium salt, and the product soluble in water is characterised by the substitution level above 0.5. Molar mass of this polymer is varied, for example, it can be in the range 2.5∙10−5–7.0∙10−5 g mol−1. CMC is widely used in the food, cosmetic, paper, textile and drilling industries [76, 77].
\nCarrageenans are a group of polysaccharides, in which 15 types can be distinguished, differing between each other based on structure. These polysaccharides are obtained by alkaline extraction of red edible seaweeds. The ι-, κ-, λ-carrageenan are mainly used in practical application. The main native polysaccharide chain of these three fractions is formed by a repeated poly-(1,3)-[4-sulphate-β-D-galactopyranose-(1,4)-3,6-anhydro-2-sulphate-α-D-galactopyranose]. κ-Carrageenan poly-(1,3)-[4-sulphate-β-D-galactopyranose-(1,4)-3,6-anhydro-α-D-galactopyranose]. λ-Carrageenan poly-(1,3)-[2-sulphate-β-D-galactopyranose-(1,4)-2,6-anhydro-α-D-galactopyranose. κ- and ι-Carrageenans, as opposed to the lambda fraction, form thermo-reversible gels. Above the melting temperature, the chains of this polymer occur in the form of coils, and during the lowering of temperature, the coils change the conformation to double helices and form larger aggregates and thus form a spatial gel network structure [78, 79].
\nThe tests on the osmotic properties of the polysaccharides water solutions were carried out using a membrane osmometer at two temperatures: 30 and 40°C. For the solutions of locust bean gum (LbG), the relation of the reduced osmotic pressure (
\n | Reference | \n30°C | \n40°C | \n\n\n | \n||
---|---|---|---|---|---|---|
KG | \n105–106 | \n0.08 | \n[87, 89] | \n−2.52∙10−6 | \n−8.14∙10−7 | \n0.24∙105 | \n
GG | \n9.1∙105 | \n0.13 | \n\n | \n | \n | \n |
\n | 7.3∙105 | \n0.28 | \n\n | −2.43∙10−7 | \n−5.40∙10−7 | \n1.6∙105 | \n
\n | 4.0∙105 | \n0.45 | \n[70] | \n\n | \n | \n |
\n | 2.7∙105 | \n0.45 | \n\n | \n | \n | \n |
LbG | \n0.697∙106–0.94∙106 | \n0.4 | \n[71] | \n−2.02∙10−7 | \n−2.20∙10−7 | \n1.4∙105 | \n
\n | 1.94∙106–2.29∙106 | \n0.33 | \n[72] | \n\n | \n | \n |
XG | \n\n | 0.03 | \n[72, 84] | \n−1.36∙10−4 | \n−8.02∙10−5 | \n\n |
CMC | \n3.5∙104–1.7∙106 | \n– | \n[68] | \n−9.84∙10−5 | \n−1.58∙10−4 | \n2.57∙106 | \n
AG | \n5∙105–6.5∙105 | \n– | \n[74] | \n2.80∙10−7 | \n\n | 1.07∙106 | \n
CA | \n6.6∙103–1.2∙106 | \n– | \n[75] | \n−8.41∙10−6 | \n\n | 0.08∙105 | \n
Average molecular masses, values of the first overlap concentration and values of the second osmotic virial coefficient
Correlation of reduced osmotic pressure
In the case of guar gum solutions (GG), the measurements were done in the same range of concentrations as for LbG, both <
Structure changes of xanthan gum chains in water solutions, AFM images (own study, GONOTEC Qscope, USA, non-contact mode).
Xanthan gum solutions (XG) were tested in the range of concentrations below
Correlation of the reduced osmotic pressure
The correlation of
In the case of carboxymethylcellulose (CMC) (Table 5) significantly different behaviours are observed, than in the above-mentioned examples, as the obtained correlation is ascending in the whole range of concentrations (0.005–0.02 g/100 mL) and temperatures (Figure 14). Slow increase of the reduced osmotic pressure is a result of high viscosity of the solution, which hinders the migration of the solvent in the solution. High values of
Correlation of the reduced osmotic pressure
For gum arabic, the relation of
The
Correlation of the reduced osmotic pressure
Since 1956 Gibbon’s first ASD closure using a heart-lung machine, cardiac surgery has made great strides. However, bleeding is still the fearful dream of surgeons. According to the World Bank, in upper-middle-income countries as in Turkey, certain restrictions are compulsorily brought to health-care costs. In this case, about 2000 US dollars is paid for open heart surgery in the social security system in Turkey. However, in today’s conditions, the costs have exceeded the fee paid by the social security institution, and in this case, public hospitals continue to provide health-care services despite the loss. On the other hand, the society is aging, and compulsorily, the riskier patients are being operated, but the prolonged length of intensive care and the hospital stay of these patients increase the costs. In this case, the solution is to provide services with serious sacrifices on the basis of health care providers and institutions, especially surgeons. The main principle here should be to evaluate the patient well before the operation and to gain the patient during the operation and to pass through the intensive care period without any problem. This can only be the result of achieving good cardiac functions and hemostasis with a successful operation.
Cardiac surgery is associated with an invasive procedure, serious anticoagulation requirement and perioperative blood loss due to cardiopulmonary bypass and accordingly high-probability allogenic blood transfusion. Risk factors:
Hemodilution (prime of cardiopulmonary bypass, cardioplegia, and perioperative fluids)
Coagulation and fibrinolysis activation
A consumptive coagulopathy
Anticoagulation with unfractionated heparin
Other physiological disorders such as hypothermia, hypocalcemia, academia [1].
In cardiac surgery, patient blood management (PBM) contributes to the maintenance of perioperative hemostasis, which reduces the requirement for blood transfusion [2]. Both the use of high amounts of blood products and the requirement for reoperation are linked to undesirable clinical outcomes [3, 4]. The use of one or two units of packed red blood cells (PRBCs) in coronary artery bypass grafting (CABG) patients is associated with increased cost as well as dramatic mortality and morbidity [5]. However, it is unclear whether these complications are independent predictors of outcome or a sign of the complexity and complications of surgery [2]. In any case, re-exploration due to bleeding and tamponade is a strong predictor of early postoperative mortality and morbidity. It should be kept in mind that not performing re-exploration when it is required brings about more serious consequences. There is, however, no general consensus on when exploration for postoperative bleeding is indicated, and surgical practice varies considerably in this regard [6]. There may be limited resources to achieve hemostasis, as well as to detect cardiac tamponade or when the patient will be re-explored for bleeding. The cardiac surgeon should be skeptical about this and use all arguments in his or her hand. Hemodynamic deterioration, decrease in urine output, decreasing Hb levels while increasing base gap and lactate levels in blood gas analysis, deterioration in general condition of the patient and chest pain, and most importantly enlarged mediastinum on chest radiogram, hematoma accumulation in lung fields are the most important manifestations of cardiac tamponade and bleeding. The patient should be re-explored without hesitation. It should not be compromised on surgical site cleaning and antisepsis in postoperative cardiac tamponade patients, who are usually opened urgently with impaired hemodynamics. After the urgent removal of hematomas, anastomoses and cardiotomies should be checked first. After bleeding control, the patency of drainage tubes should be checked and they should be replaced, if necessary.
Numerous factors such as advanced age, preoperative dual antiplatelet therapy (DAPT), platelet dysfunction, preoperative anemia, small body surface area, female gender, non-elective surgery, non-isolated surgery, non-CABG surgery, and redo surgery are associated with increased bleeding [7, 8, 9].
A group of hemostatic agents including topical hemostats, sealants and adhesives are available to stop these bleedings. Despite these, hemostasis cannot be achieved due to the inappropriate use of hemostatic agents in 40% of surgical patients, as in the surgery of traumatic injuries [10].
Failure to adequately optimize the patient prior to surgery increases the risk of bleeding and anemia during the operation [2]. The use of routine preoperative screenings has been highly discussed in terms of its ability to identify high-risk patients for postoperative bleeding and transfusion requirements. Preoperatively determined prothrombin time or the activated partial thromboplastin time (aPTT) could not be associated with perioperative blood loss or transfusion requirements [11, 12, 13]. The most commonly identified risk factor for postoperative bleeding is a low fibrinogen level [11, 12, 14, 15, 16]. However, despite its association with bleeding, the positive predictive value of a low-fibrinogen level remains poor (positive predictive value <20%) [15]. A low platelet count (<10,010–9/L) has been associated with increased risk of transfusion, and patients with the highest postoperative blood loss volumes show the lowest platelet counts [12]. It has been shown that patients with the highest postoperative blood loss volumes show the lowest thrombin generation rates, but this test is mainly used for research purposes and is not routinely used in everyday practice [12, 17].
In preoperative Hb evaluations of 1388 female and 3265 male patients undergoing elective cardiac surgery, it was found that borderline anemia (defined as the hemoglobin concentration of 120–129 g L−1) was more common in the female group and about one-third of the patients were in this range. These women had increased morbidity, reflected by increased red cell transfusion and prolonged hospital stay compared with non-anemic women (Hb >130 g L−1). It was also found that these women received more erythrocyte transfusion than male patients [18].
Acetylsalicylic acid (ASA) is one of the cornerstones for the treatment of acute and chronic cardiovascular disease. Primary and secondary prevention with ASA has been shown to reduce mortality, myocardial infarction (MI) and stroke but to increase the risk of bleeding complications [19]. All patients requiring emergency or elective CABG are treated with ASA. A meta-analysis showed that ASA reduced the risk of perioperative MI [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33–0.96] but not the risk of death (OR 1.16, 95% CI 0.42–3.22). Twelve-hour blood loss, PRBC transfusions and surgical re-exploration increased with ASA [20]. A large RCT compared the administration of ASA (100 mg) on the day of surgery versus placebo in patients having CABG [49]. The study showed no effect of treatment with ASA on 24-h bleeding (mean blood loss: 780 vs. 740 mL;
Given all these results, the continuation of ASA treatment in patients undergoing CABG may be reason of increasing postoperative blood loss while reducing ischemic event [2]. In patients with high probability of re-exploration such as those who refuse the blood transfusion, who will undergo non-CABG surgery, complex cases, redo operations, and those who have severe renal failure, hematologic and inherited platelet function disorders, ASA should be discontinued 5 days before surgery. Prevention of thrombotic events outweighs the risk of bleeding in other patients. Current information suggests that ASA-inhibited platelet aggregation can be reversed by platelet transfusion, which supports the continuation of ASA treatment until operation [23, 24]. Mortality rates significantly decrease in patients who are initiated on ASA in the first 48 h after CABG compared to patients who are not initiated on ASA (1.3 vs. 4%
The administration of DAPT, a P2Y12—receptor antagonist (clopidogrel, ticagrelor and prasugrel), in combination with ASA significantly reduces the risk of thrombotic complications in acute coronary syndromes compared to ASA alone [26]. Compared to clopidogrel, the risk of thrombotic complications is significantly reduced by ticagrelor and prasugrel, the second generation P2Y12 antagonists, while the risk of both spontaneous and surgical bleeding increases significantly [27]. Recently, cangrelor, a new reversible intravenous P2Y12 inhibitor with an ultrashort half-life to offset the effect after discontinuation, was introduced [28].
Today, glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors (eptifibatide, tirofiban and abciximab) are almost exclusively used in conjunction with percutaneous coronary interventions, but may also be used for bridging high-risk patients on oral P2Y12 inhibitors to surgery [29, 30]. The discontinuation times of these drugs before surgery are based on pharmacokinetic assumptions. The recovery of platelet functions is obtained within 24–48 h for abciximab and 4–8 h for eptifibatide and tirofiban [31]. In a small retrospective study, tirofiban-treated patients having CABG showed more bleeding than patients who were not treated with tirofiban, but there was no difference between different discontinuation times [32]. Discontinuation of GPIIb/IIIa inhibitor at least 4 h before surgery should be considered to minimize the risk of postoperative bleeding.
As enoxaparin and fondaparinux, LMWH mainly functions by inhibiting factor Xa and reaches plasma peak levels 3–4 h after the administration. In patients with normal renal function, their half-life is 5 h. Their anticoagulant effects can be monitored by measuring plasma anti-FXa activities. LMWH-induced bleeding may be treated with protamine, but this therapy does not completely reverse the anticoagulant effect of LMWH [2].
Vitamin K antagonists (VKAs) are commonly used to prevent and treat thromboembolism in cases of atrial fibrillation, venous thromboembolic disease and mechanical heart valve. They are monitored by the international normalized ratio (INR) and prothrombin time. They should be stopped 3–5 days before surgery to obtain an INR <1.5. For emergency surgeries, their effects are completely reversed by prothrombin complex concentrate. Bridging non-cardiac surgery patients who are taking VKA with a full therapeutic dose of LMWH after surgery are associated with increased risk of bleeding but not with a significant reduction in thrombotic events [33]. Elective cardiac surgery is not recommended unless the INR value falls below 1.5. In cases where surgery cannot be postponed, coagulation factors should be used to antagonize the effects [2].
Direct oral anticoagulants (DOACs) is a group of drugs consisting of dabigatran, a direct thrombin inhibitor, and rivaroxaban, apixaban and edoxaban, oral FXa inhibitors, and novel formulations under development. They are increasingly used as an alternative anticoagulation strategy for VKAs [2]. Since emergency surgery in patients under dabigatran treatment has been associated with severe or even fatal bleeding, it is recommended that these drugs be discontinued 48 h before cardiac surgery [34, 35, 36]. The half-life of DOACs may be prolonged in the case of impaired renal function. For emergency reversal of dabigatran, the newly released antidote (idarucizumab) can be used in the pre- and post-operative settings. Treatment of postoperative FXa-related bleeding includes PCC, activated PCC (FEIBAV R, Shire US Inc., Lexington, MA, USA) and recombinant activated factor VII (rFVIIa), since no specific antidote is approved at the moment [2].
According to the EACTS/EACTA recommendations, ASA should be continued in the preoperative period in patients scheduled for CABG (Class IIa, Level C). ASA should be discontinued 5 days in advance (Class IIa, Level C) in patients with a high risk of bleeding, refusing the blood transfusion, or undergoing cardiac surgery other than CABG. If there is no severe bleeding in the first 24 h postoperatively, ASA should be initiated in isolated CABG patients (Class I, level B). If CABG is not urgent, ticagrelor should be discontinued 3 days, clopidogrel 7 days and prasugrel should be discontinued 5 days before surgery in patients taking DAPT (Class IIa, Level B). GPIIb/IIIa inhibitors should be discontinued 4 h before surgery (Class IIa, Level B). GP IIb/IIIa inhibitors should be discontinued 4 h before surgery (Class I, Level C). In order to reduce the risk of bleeding, oral anticoagulants should be discontinued only in patients with a high risk of thrombosis and it should be continued with UFH/LMWH (Class I, Level B). LMWHs should be discontinued 12 h before and fondaparinux before should be discontinued 24 h before (Class I, Level B). In the use of VKAs, surgery should be performed after the INR value reduces below 1.5 (Class IIa, Level C). DOACs should be discontinued 48 h before cardiac surgery (Class IIa, Level C).
Bleeding is the most important complication of surgery, which increases mortality and morbidity rates [37, 38, 39]. Uncontrolled bleeding results in adverse clinical outcomes including anemia, hemodynamic instability, hypothermia, hypovolemia, reduced oxygen delivery to tissues, impaired visualization of the surgical site, and prolonged operative time. Surgical bleeding requires expensive blood transfusion and re-operation, in which a large amount of clinical and personnel resources is used [39]. Major bleeding is also associated with an increased risk of postoperative mortality reaching 20% in vascular surgery and 30–40% in trauma surgery [39].
Blood transfusion itself involves many risks. Transfusion-related acute lung injury, which occurs one in every 1000–5000 plasma and erythrocyte transfusions, is the leading cause of mortality and morbidity [40]. Bacterial contamination, which occurs one in every 2000–3000 platelet transfusions, is another complication of transfusion [40]. The authors have reported that the length of hospital stay is longer in patients with bleeding-related complications or more blood transfusion requirements than those without bleeding complications (10.4 vs. 4.4 days, respectively) [41].
Uncontrolled bleeding and transfusion requirement are associated with bleeding complications, resulting in a considerable amount of cost [42]. Stokes et al. also compared the total hospitalization costs for patients with bleeding-related complications or blood transfusions with those for patients without any complication and, again, noted a significant increase in costs among those with complications [41]. There are, of course, the costs of bleeding and blood and blood transfusion for all countries. In the country where I work, these costs are not as high as in the US.
It should be kept in mind that although blood transfusion is an indispensable treatment, whether clinical or economic, it is the most dangerous drug we have ever used [43].
The surgical nurse plays an important role in optimizing hemostatic applications throughout the operation. To meet the requirements for hemostasis by questioning the surgeon before and during surgery. To know the material available to meet the requirements for surgical intervention. To adjust the time required for the preparation of the necessary material during the operation and be in constant communication with the surgeon [42]. Working with a nurse experienced in cardiovascular surgery is always a significant advantage for the surgeon. In general, I trained my surgical nurses myself in private hospitals where I worked in my surgical life. Private hospitals try to minimize the number of staff in order to limit input cost due to their commercial concerns. They also prefer less educated staff. At this point, the responsibility of the surgeon increases, s/he has to perform a successful operation while continuing the training activities of the nurse. In this respect, cardiovascular surgery centers in many private, public and universities in my country train their own surgical nurses. Personally, I have also trained many nurses and even made them gain the qualifications to perform proximal anastomosis and connect prolene sutures. After a while, the surgical nurse could follow the operation, know what to be asked in advance and quickly prepare the required instrument and material. In my opinion, the most serious disadvantage of this is that you are on your own in decision making since there is no experienced assistant surgeon assisting you (Figures 1 and 2).
Saphenous vein graft anastomosis to coronary artery. Small bites from epicardial tissue with appropriate size prolene suture.
Saphenous vein graft anastomosis to coronary artery. Small clips for the small branches of the saphenous graft.
Selection of the most appropriate method for achieving hemostasis is based on correctly defining the nature and severity of the patient’s bleeding. If the patient presents with or develops uncontrolled bleeding in the operating room, first and to the extent permitted by time, a group of coagulation laboratory values (prothrombin time/international normalized ratio, activated partial thromboplastin time, complete blood count with differential and platelets, activated clotting time, fibrinogen, d-dimer and thromboelastography) should be examined [42]. In cases of unexpected or complex coagulopathy, it is necessary to get professional help from a subspecialist such as a hematologist and blood bank specialist. (While such aids actually work in intensive care follow-ups, it seems difficult for the specialist to comprehend the situation in the operation room and offer solutions in the complexity of the surgery. Therefore, the responsible surgeon must be able to master these issues and produce urgent solutions.) (Figure 3).
Here is a left mammarian artery graft anastomosis to left anterior descending artery. A small retractor used for easy visualization of the arteriotomy. Again usage of small clips. When you are performing the repair sutures to bleeding side of the anastomoses, you have to be careful and you do not need to pass the whole layers of coronary artery.
Mechanical approaches usually provide hemostasis without the need for any hemostatic product. The most basic practice is to apply compression with finger or fingers to the bleeding site. Especially in bleedings of the tissues with high pressure such as the ascending aorta, compression should absolutely be applied with finger to save time for strategies to create solutions. In fact, it is the most basic approach to be performed in the case of unexpected bleedings during a routine operation. While the surgeon is using the fingers of his/her non-dominant hand to restrict bleeding, s/he should give the surgical nurse order for repair. Here, a few simple maneuvers can be life-saving. The venous return should be reduced for lowering the pressure in the ascending aorta. Tilting the patient’s head up by operating table is simple and effective. If you fail for lowering the arterial pressure, transient inferior caval clamping before neutralization of heparin may be very helpful, especially when pulling out the aortic cannula. Another technique in old textbooks is total inflow occlusion. In this technique, it has been described that repairs are carried out in a few minutes with cross-clamps placed on both cavas. However, when removing the caval cross clamp, it should be absolutely ensured that the clamp is fully opened. Moreover, a simple approach in aortic cannulation is using teflon pledgets for outer purse-string suture.
The most basic hemostasis approach is to create a mechanical barrier. The use of a needle and suture in an appropriate size and supporting it with teflon pledgets is the most effective, simple and accurate approach. The suture material to be selected is usually prolene. In order to reduce tissue injury, the needle should be as small as possible along with fine needles, but of sufficient thickness to withstand the tension in the tissue and appropriate thickness to be securely attached. (The most important issue to be considered here is that the other hand knot should be tied tightly enough to stop bleeding and ensure tissue integrity not to allow non-dominant hand suture to loosen when making a suture. Excessively tight and hard knots may cause more severe tissue injuries and bleedings.) For sutures that will both stop bleeding and provide anastomosis, it is necessary to use stronger fibrous tissues of the patient such as the adventitia and epicardial layer (Figure 4).
Two anastomoses to LAD. There is no bleeding from anastomotic sides.
Sponges are the most commonly used inexpensive materials to stop bleeding in the operation field. They are very effective with mechanical compression, especially in oozing-type bleedings. Sponges should be intensely applied to the mediastinum after the clamps are removed and it should be waited until the end of protamine neutralization. As a result of reapplication of a clean sponge, especially after ending the heparin effect, locally contaminated sponges may give information about the site of bleeding other than providing hemostasis (Figure 5).
No bleeding from proximal anastomotic sides of sapheneous vein grafts. Also adventitial tissue bites performed. Sponges under the retractor compress the cavernous tissue of sternum.
Hemoclips are an effective and fast method especially for harvesting arterial grafts and ligating small vessels. However, it is necessary to pay particular attention to the selection of hemoclips. Especially, large hemoclips may damage a small vessel and increase bleeding as a result of tissue injury. It is important to remember that these hemoclips may drop when applying sponge to the operation site or performing bleeding control. Therefore, ligation or suturing may be more effective in appropriate cases.
Other mechanical solutions include electrosurgery, laser, radio-frequency energy, argon beam coagulation, ultrasonic scalpel or ultrasonic surgical aspirator use. When using electrocautery, it is beneficial to use it at the lowest energy and appropriate program that can do our work. It should be kept in mind that especially high energy will increase tissue injury.
Pharmacological strategies for blood preservation are also an important tool in the arsenal of the surgical team since these agents alleviate the activation of the hemostatic system without the clinical and economic consequences associated with transfusion [44]. Pharmacological agents may be of some benefit in diffuse surgical bleedings or in those with a hemostatic defect. These agents may be used in combination with surgical hemostatic agents. These agents are recombinant factor VIIa, desamino-d-arginine vasopressin, and antifibrinolytics (e.g., epsilon aminocaproic acid (EACA), tranexamic acid (TXA)) [44, 45]. The recombinant factor VIIa activates platelets to increase thrombin production. It is used in trauma and surgical refractory bleeding. It acts quickly and is quite expensive. Although it is not a preferred product in our country, we prefer fresh frozen plasma (FFP) in such cases. Desmopressin acetate (vasopressin) factor VIII is a selective V2 agonist that causes the release of von Willebrand factor and tissue plasminogen activator. It is used in platelet dysfunction. It acts in a short time, tachyphylaxis and repeated doses increase the risk of bleeding. The parenteral form is not available in Turkey, the nasal spray form is not very effective.
Antifibrinolytic therapy reduces bleeding, the use of blood and blood products and reoperations due to bleeding [2]. This group includes tranexamic acid (TXA), aprotinin and EACA. The sale of aprotinin has stopped in some countries, especially because it increases mortality rates.
The Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) randomized controlled trial compared TXA with placebo in patients undergoing CABG surgery and demonstrated a reduction in the risk for reoperation due to major hemorrhage (RR 0.36, 95% CI 0.21–0.62;
Tranexamic acid is also an antifibrinolytic agent that we use frequently. It inhibits plasmin and plasminogen proteases and reduces surgical bleeding. It may cause thrombosis and hypotension.
These blood products include FFP, platelets, prothrombin complex concentrate, cryoprecipitate, and whole blood. Thrombocytes in plasma are indicated when platelet levels are less than 50 × 109/L. It contains cryoprecipitate factor VIII, von Willebrand factor, fibrinogen and fibronectin, and is indicated when the patient’s fibrinogen is less than 100 mg/mL or when the patient has von Willebrand factor deficiency [49]. FFP contains coagulation factors and fibrinogen in variable amounts, while prothrombin complex concentrate contains factors II, VII, IX, and X and prothrombin, as well as proteins in variable amounts. Both FFP and prothrombin complex concentrate are indicated when a surgical patient who is bleeding has an international normalized ratio greater than 1.5 [49].
FFP is obtained from the plasma of volunteer blood donors containing coagulation factors and other proteins. An increasing number of countries use pooled plasma. Pooled plasma contains plasma from multiple donors and is inactivated for viruses with a lower risk of transfusion-induced lung injury [2]. The largest body of evidence is gathered on the prophylactic administration of FFP to patients without a diagnosed coagulopathy and is summarized in a Cochrane review and three other systematic reviews [50, 51, 52, 53]. In patients undergoing cardiac surgery, there was no difference in blood loss and allogeneic blood transfusion requirement when patients intraoperatively receiving FFP were compared with the control group. The RCTs included were limited by small sample sizes and divergent doses of FFP [51, 52, 53]. It has also been shown that FFP is not effective in 24-h blood loss in patients with diagnosed coagulopathy or in the reversal of oral anticoagulation when it is used at a therapeutic dose [51, 53]. In summary, FFP might be used to reverse the action of oral anticoagulation or in the case of persistent perioperative bleeding, but there is no evidence that prophylactic or therapeutic FFP transfusions reduce blood loss after cardiac surgery [2].
Topical hemostatic agents consisting of mechanical, active, flowable, and fibrin sealants provide hemostasis by forming blood clots [54, 55, 56]. Agents in this class vary greatly with respect to safety, efficacy, usability, and cost. An appropriate agent should be selected for each clinical situation.
It consists of combining hemostatic agent and sponge, foam or pad absorbable material. They create a surface against blood flow where blood clots can form [56]. Common mechanical hemostatic agents include porcine gelatin products (e.g., Gelfoam®, Gelfoam Plus®, Surgifoam®), cellulose products (e.g., Surgicel®, Surgicel Fibrillar™, Surgicel Nu-Knit®), bovine collagen products (e.g., Avitene™ sheets, Avitene Ultrafoam™ collagen sponges), and polysaccharide spheres (e.g., Arísta®, Hemostase MPH®, Vitasure™) [54, 55, 56]. They are effective in minimal bleedings and when the coagulation cascade is normal. They are easy to use since they are ready-to-use packaged products, do not require special preparation, are easy to store and act by direct application to the bleeding site [56]. It is important to slightly irrigate before removal not to take clotting beneath them. These products are relatively inexpensive and well-tolerated, while swelling and increased risk of infection are possible side effects [44]. They are usually used as the initial response to bleeding [56]. Cellulose-containing products such as Surgicel are commonly used since they are cheap and easily accessible. Because these products are absorbable, they are easily applied to the bleeding site. They should be used carefully and practically, as they easily disintegrate by swelling when they get wet or come into contact with blood. Although they can be used directly, we use it by mixing with a small amount of cyanoacrylate in a tablespoon for bleedings of difficult to reach points such as the posterior of the aortic root during the operation. In this application, the most important point to consider is to pay attention to the amount of cyanoacrylate used, as it may cause tissue injury. It quickly hardens in a short time when mixed with the polymerized cyanoacrylate cellulose. Therefore, it should be applied quickly and practically. However, it is not effective in severe bleeding since it does not adhere to the tissue. It can be applied hypotensively or by applying compressed medical air to the point of bleeding while the blood is removed. Cyanoacrylate products prepared for medical purpose can also be used, which should be preferred. In emergency situations, products prepared as adhesive can be used as well.
The tablespoon is a simple but effective tool when necessary that should be included in the open heart surgery set. It can be very helpful ascending aorta bleedings especially in proximal anastomosis after weaning from CPB, it gives repair chance to surgeon by keeping it like a shed 4–5 cm distance above. Also helpful for delivering hemostatic powders to bleeding site. It can be herbal powders sold for this purpose, as well as crystallized vancomycin powder, which we usually use. It can also be helpful in the excision of brittle tissues such as fluid or myxoma.
As a cardiac surgeon, I think the most important side effect of such products is that they offer the surgeon extra confidence. The surgeon must provide the patient with hemostasis during the operation, otherwise the drainage ongoing in the intensive care process brings about serious consequences. For this, the surgeon should repeatedly check anastomoses, cardiotomies, surround tissues, especially the sternotomy and stop bleeding with appropriate sutures and ligations.
By converting fibrinogen to fibrin, active hemostats—namely the three topical thrombin products: bovine thrombin (Thrombin-JMI®), pooled human plasma thrombin (Evithrom®), and recombinant thrombin(Recothrom®)—facilitate clot formation at the bleeding site [55, 56, 57]. Active hemostatic agents are the most commonly used adjunctive hemostatic therapies in the surgical setting and conservative estimates show that more than one million patients are treated with topical thrombin administration annually in the United States [58].
While all three preparations are applied to the locally bleeding area or larger areas in diffuse bleedings in the form of spray, they also require certain preparations before application. For example, bovine and recombinant thrombin are stored in powder form at room temperature and prepared with certain special liquids before use. Pooled human thrombin is available in a liquid form and can be stored in a refrigerator for as long as 1 month [56]. In such cases, it should be used together with active hemostatic agents such as absorbable gelatin sponge or powder, since thrombin administered in the presence of active bleeding can be rapidly irrigated. IV should not be used since it may cause a major anaphylactic reaction [59, 60, 61].
As the results showed similar efficacy in all three products, health care providers canalized their next assessment to select the most appropriate agent for the clinical situation. For example, although there are clinical studies showing similar safe use of all these products, bovine thrombin administration has been associated with antibody formation that can lead to immune-mediated coagulopathy and death, which is why this product carries a black box warning [59, 62]. These preparations are not available in Turkey. Even if they are, social security providers do not cover them since they are very expensive.
These products (e.g., Surgiflo®, Floseal®) contain thrombin along with a mechanical gelatin agent. They work together to obstruct blood flow and convert fibrinogen to fibrin [55, 56]. Although the mechanism of action is similar, Surgiflo is porcine gelatin available for use with bovine, human pooled plasma, or recombinant thrombin, whereas Floseal includes absorbable bovine gelatin particles combined with pooled human thrombin [55, 56]. All these agents are most effective in local bleedings and with the help of a syringe, they are applied downward into the wound, on the wound edges, providing an ultimate mechanical barrier and forming an active clot [55, 56]. The surgeon can spray these agents not only on the upper parts of the wound, but also on large irregular surfaces. The product forms a thick structure in the bleeding site approximately 3 min after administration. At the same time, the surgeon can apply pressure with a sponge soaked with saline [56].
While many fibrin sealants are available as topical hemostat, sealant and adhesive, Tisseel has received FDA approval for use only [56, 63]. This product is also available in our country and is used especially in aortic surgery. Since they contain high concentrations of fibrinogen and thrombin, which are naturally found in the blood, they cause blood clot formation [56]. Fibrin sealants—namely Tisseel™, Evicel®, and Vitagel™—are effective for both local and diffuse bleeding and can be applied using either a syringe for local bleeding or spray with a gas-driven device for diffuse-bleeding areas [55, 56]. These agents act better when applied to a relatively dry surface and can be used with absorbable gelatin sponge as the surgeon can press with the finger [56]. In aortic root surgeries such as Bentall procedure, after the placement of valved conduit in the aortic root and left coronary button anastomosis, Tisseel can be applied to this region providing sealing since this area cannot be re-visualized again.
Bovine albumin and glutaraldehyde (BioGlue®) is a cross-linkage between bovine serum albumin and 10% glutaraldehyde [56]. It has been approved by the FDA for adhering intimal and adventitial layers to each other in aortic dissection. This sealant agent is also available, and we especially use it in aortic surgery dissections. In particular, it is applied between the layers of the media at the distal of the primary intimal tear so the layers are adhered to each other.
Octyl cyanoacrylate (e.g., Dermabond™) and butyl cyanoacrylate (e.g., Indermil®, Histoacryl®, Histoacryl® Blue) are for topical use only. While these agents hold the edges of the skin together, they also form a barrier against bacteria [55, 56]. Cyanoacrylates are quick and easy to use, are stored at room temperature, and are relatively inexpensive. However, they have an exothermic reaction when applied to the skin and thus can cause some discomfort in patients. Safety concerns include potential eye injury, and its use on infected, wet, or poorly healing wounds should be avoided [55, 56]. N-butyl cyanoacrylate is currently used for endovenous ablation of varicose saphenous veins. It is a rapidly polymerizing agent in contact with blood. In special cases, it can be applied directly on the tissue and adhered to topical hemostatic agents with cellulose content. It is a simple but effective application.
What are the limited resources in health care delivery? In underdeveloped and developing countries, both the social insurance provider and the delivery of healthcare services substantially belong to the state. This has advantages as well as disadvantages. These limited resources inevitably create limitations in the delivery of healthcare services. If you cannot produce your technology and buy it from outside, these products cost too much, and even if they are used, serious limitations are required. In this case, the surgical team creates solutions to the current situation; the basic rule of being a surgeon is to make the right decision at the right time. At this point, from patient admission to surgical planning, the right assessment, the right strategy and the right indication should be established for the patient. The surgeon should be skeptical, question and investigate. Beginning a cardiac surgery is an irreversible process. Detection and solution of the problems in the preoperative approach will absolutely increase the surgical success in the preoperative and postoperative periods.
Right indication and correct surgical planning are absolutely necessary. Your nick names have to be patience during surgery. The surgeon’s overconfidence, hastiness and misapplication may lead to serious problems. The surgeon and his/her team should determine all materials required for hemostasis in their hands in the preoperative planning and make their preparations accordingly. The blood bank is an essential concept in cardiac surgery. It is essential to use blood products by determining the patient’s need. Hemostasis should be provided during the operation and this should not be left to the intensive care process. Creating a solution is the basic principle of the surgeon and surgery (Figures 6 and 7).
Me and my colleague performing a mitral valve operation with classical sternotomy.
To be a team can figure the problems out in cardiac surgery.
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Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients",subtitle:null,isOpenForSubmission:!1,hash:"be0025c7b271840b95d54511f2783fc5",slug:"pathophysiology-and-clinical-aspects-of-venous-thromboembolism-in-neonates-renal-disease-and-cancer-patients",bookSignature:"Mohamed A. Abdelaal",coverURL:"https://cdn.intechopen.com/books/images_new/832.jpg",editedByType:"Edited by",editors:[{id:"106431",title:"Dr.",name:"Mohamed A.",middleName:null,surname:"Abdelaal",slug:"mohamed-a.-abdelaal",fullName:"Mohamed A. Abdelaal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1830",title:"Hematology",subtitle:"Science and Practice",isOpenForSubmission:!1,hash:"5bcd8875467e51b02e0ea4aec429ad51",slug:"hematology-science-and-practice",bookSignature:"Charles H. Lawrie",coverURL:"https://cdn.intechopen.com/books/images_new/1830.jpg",editedByType:"Edited by",editors:[{id:"103158",title:"Dr.",name:"Charles",middleName:null,surname:"Lawrie",slug:"charles-lawrie",fullName:"Charles Lawrie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:9,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"31178",doi:"10.5772/38961",title:"Physiological Factors in the Interpretation of Equine Hematological Profile",slug:"haematological-profile-of-the-horse-phisiological-factors-influencing-equine-haematology",totalDownloads:10779,totalCrossrefCites:15,totalDimensionsCites:35,abstract:null,book:{id:"1830",slug:"hematology-science-and-practice",title:"Hematology",fullTitle:"Hematology - Science and Practice"},signatures:"K. Satué, A. Hernández and A. Muñoz",authors:[{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo"}]},{id:"37047",doi:"10.5772/32080",title:"Microparticles: Role in Haemostasis and Venous Thromboembolism",slug:"microparticles-role-in-haemostasis-and-venous-thromboembolism",totalDownloads:2455,totalCrossrefCites:0,totalDimensionsCites:4,abstract:null,book:{id:"832",slug:"pathophysiology-and-clinical-aspects-of-venous-thromboembolism-in-neonates-renal-disease-and-cancer-patients",title:"Pathophysiology and Clinical Aspects of Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients",fullTitle:"Pathophysiology and Clinical Aspects of Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients"},signatures:"Anoop K. Enjeti and Michael Seldon",authors:[{id:"90071",title:"Dr.",name:"Anoop",middleName:null,surname:"Enjeti",slug:"anoop-enjeti",fullName:"Anoop Enjeti"},{id:"151786",title:"Dr.",name:"Michael",middleName:null,surname:"Seldon",slug:"michael-seldon",fullName:"Michael Seldon"}]},{id:"59051",doi:"10.5772/intechopen.70937",title:"Acute Myeloid Leukemia in Pediatric Patients: A Review About Current Diagnostic and Treatment Approaches",slug:"acute-myeloid-leukemia-in-pediatric-patients-a-review-about-current-diagnostic-and-treatment-approac",totalDownloads:1565,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Acute leukemia is the most common childhood malignancy, accounting for almost 35% of all childhood cancers. Acute myeloid leukemia (AML) represents 15–20% of pediatric acute leukemia. Majority of AML cases appear de novo, however a minority of cases can present as a secondary malignancy. AML is a highly heterogeneous disease and its diagnosis involves a combination of diagnostic analyses including morphology, immunophenotyping, cytochemistry, and leukemic blasts derived from peripheral blood or bone marrow demonstrating cytogenic and molecular characteristics. Through the identification of recurrent genetic mutations, it has been made possible to refine individual prognosis and guide therapeutic management. The current survival rate of children with AML is approximately 70%. The standard therapeutic regimen is a combination of cytarabine- and anthracycline-based regimens with allogenic stem cell transplantation in appropriate patients. Relapse in pediatric patients suffering from AML occurs in approximately 30% of cases, whereas death occurs in 5–10% of patients as a result of disease complications or chemotherapeutic side effects. In understanding the genetic basis of AML, targeted therapies will have the ability to reduce treatment-related morbidity and mortality. Here, we provide a comprehensive review of AML, its biology, diagnosis and therapeutic management in pediatric patients.",book:{id:"6261",slug:"myeloid-leukemia",title:"Myeloid Leukemia",fullTitle:"Myeloid Leukemia"},signatures:"Katarzyna Derwich, Dorothy Mitkowski and Jolanta Skalska-\nSadowska",authors:[{id:"205540",title:"Dr.",name:"Katarzyna",middleName:null,surname:"Derwich",slug:"katarzyna-derwich",fullName:"Katarzyna Derwich"},{id:"214057",title:"Dr.",name:"Dorothy",middleName:null,surname:"Mitkowski",slug:"dorothy-mitkowski",fullName:"Dorothy Mitkowski"},{id:"214058",title:"Dr.",name:"Jolanta",middleName:null,surname:"Skalska-Sadowska",slug:"jolanta-skalska-sadowska",fullName:"Jolanta Skalska-Sadowska"}]},{id:"61695",doi:"10.5772/intechopen.76931",title:"Angiogenesis and Antiangiogenesis in Multiple Myeloma",slug:"angiogenesis-and-antiangiogenesis-in-multiple-myeloma",totalDownloads:1183,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Multiple myeloma progression is characterized by a dense interaction between cancer cells and bone marrow microenvironment. The interactions of myeloma cells with various stromal cells and extracellular matrix components are the main regulator of the biological processes that underlie the progression of the disease and of the classic symptomatology correlated. The bone marrow of myeloma patients has recognized autocrine and paracrine loops that regulate multiple signaling pathways and the malignant phenotype of plasma cells. One of the pivotal biological processes which are responsible for myeloma progression is the formation of new vessels from existing ones, known as angiogenesis. It represents a constant hallmark of disease progression and a characteristic feature of the active phase of the disease. Near angiogenesis, other two ancestral processes were active in the bone marrow: vasculogenesis and vasculogenic mimicry. These processes are mediated by the angiogenic cytokines, interleukins, and inflammatory cytokines directly secreted by plasma cells and stromal cells. Neovascularization is also mediated by direct interaction between plasma cells and the various components of bone marrow microenvironment. The observation of the increased bone marrow angiogenesis in multiple myeloma and its correlation with disease activity and overall survival led to consider angiogenesis as a new target in the treatment of multiple myeloma.",book:{id:"6710",slug:"update-on-multiple-myeloma",title:"Update on Multiple Myeloma",fullTitle:"Update on Multiple Myeloma"},signatures:"Roberto Ria, Antonio Solimando, Assunta Melaccio, Azzurra\nSportelli and Angelo Vacca",authors:null},{id:"31163",doi:"10.5772/35840",title:"Intravascular Leukocyte Chemotaxis: The Rules of Attraction",slug:"intravascular-leukocyte-chemotaxis-the-rules-of-attraction",totalDownloads:2342,totalCrossrefCites:1,totalDimensionsCites:4,abstract:null,book:{id:"1830",slug:"hematology-science-and-practice",title:"Hematology",fullTitle:"Hematology - Science and Practice"},signatures:"Sara Massena and Mia Phillipson",authors:[{id:"106058",title:"Dr.",name:"Mia",middleName:null,surname:"Phillipson",slug:"mia-phillipson",fullName:"Mia Phillipson"},{id:"106366",title:"Dr.",name:"Sara",middleName:null,surname:"Massena",slug:"sara-massena",fullName:"Sara Massena"}]}],mostDownloadedChaptersLast30Days:[{id:"64871",title:"Diagnosis and Classification of Myelodysplastic Syndrome",slug:"diagnosis-and-classification-of-myelodysplastic-syndrome",totalDownloads:3255,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by morphological dysplastic changes in one or more of the major hematopoietic cell lines. MDS can present with varying degrees of single or multiple cytopenias including neutropenia, anemia and thrombocytopenia. Presentation of MDS can range from asymptomatic to life threatening. MDS diagnosis and classification present important challenges, particularly in the distinction from benign conditions. French-American-British (FAB) classification proposed a classification based on easily obtainable laboratory information and was recommended in early and as modified by guidelines of new classification of World Health Organization (WHO). The strategy of diagnostic laboratory in MDS depends on morphological changes and is based on existence of dysplastic changes in the peripheral blood and bone marrow including peripheral blood smear, bone marrow aspirate smear and bone marrow trephine biopsy. The correct morphological interpretation and the use of cytogenetics, immunophenotyping, immunohistochemistry and molecular analysis will give valuable information on diagnosis and prognosis.",book:{id:"7138",slug:"recent-developments-in-myelodysplastic-syndromes",title:"Recent Developments in Myelodysplastic Syndromes",fullTitle:"Recent Developments in Myelodysplastic Syndromes"},signatures:"Gamal Abdul Hamid, Abdul Wahab Al-Nehmi and Safa Shukry",authors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"},{id:"273724",title:"Dr.",name:"Safa",middleName:null,surname:"Shukry",slug:"safa-shukry",fullName:"Safa Shukry"},{id:"277511",title:"Dr.",name:"Abdulwahab",middleName:null,surname:"Al-Nehmi",slug:"abdulwahab-al-nehmi",fullName:"Abdulwahab Al-Nehmi"}]},{id:"60442",title:"Invasive and Noninvasive Approaches in Prenatal Diagnosis of Thalassemias",slug:"invasive-and-noninvasive-approaches-in-prenatal-diagnosis-of-thalassemias",totalDownloads:1778,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Thalassemia is a significant health problem worldwide. There are two main classifications, α- and β-thalassemias, which are usually caused by the defective synthesis of the α-globin, and which are commonly caused by different mutations of the β-globin chain. Different hemoglobin mutations have been identified to date. Thalassemias can result in profound anemia from early life and, if not treated with regular blood transfusions, can lead to death in the first year. Prenatal diagnosis of thalassemia is the essential part of preventive medicine and is currently dependent on the use of invasive diagnostic tests within the first 2 months of pregnancy. These diagnostic techniques carry a small but significant risk of fetal loss up to 1%. Molecular diagnostic methods have been developed for genotyping thalassemias based on PCR techniques and high-throughput technologies. Noninvasive tests using cell-free DNA (cfDNA) from a maternal blood sample is also an alternative method, thus eliminating the risk of miscarriage. This chapter summarizes the current invasive approaches and the noninvasive methods using cell-free fetal DNA as new molecular diagnostic methods for genotypic diagnosis of thalassemia in clinical practice. Prevention strategies that encompass carrier screening, genetic counseling, and prenatal diagnosis are discussed.",book:{id:"6210",slug:"thalassemia-and-other-hemolytic-anemias",title:"Thalassemia and Other Hemolytic Anemias",fullTitle:"Thalassemia and Other Hemolytic Anemias"},signatures:"Abdullah Tuli and Ebru Dündar Yenilmez",authors:[{id:"183998",title:"Ph.D.",name:"Ebru",middleName:null,surname:"Dündar Yenilmez",slug:"ebru-dundar-yenilmez",fullName:"Ebru Dündar Yenilmez"},{id:"215677",title:"Prof.",name:"Abdullah",middleName:null,surname:"Tuli",slug:"abdullah-tuli",fullName:"Abdullah Tuli"}]},{id:"62044",title:"Sickle Cell Disease: A Genetic Disorder of Beta-Globin",slug:"sickle-cell-disease-a-genetic-disorder-of-beta-globin",totalDownloads:1816,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Sickle cell disease (SCD) is a structural and monogenetic genetic disorder due to a mutation that occurs in the globin β-chain, resulting in the formation of hemoglobin S (Hb S), a protein composed of two normal, and two β-type mutant chains. Estimates indicate that the prevalence among live births is 4.4% in the world. The difficulty in circulating the sickle cell, its interaction with endothelial cells, leukocytes, platelets, endothelial dysfunction, and the abnormal expression of adhesion molecules permeate the beginning of the blood vessel occlusion process as well as pathophysiological aspects of SCD. Among the secondary complications are the stroke, pulmonary hypertension, leg ulcer, renal disorders, and all complications associated with vascular dysfunction. Clinical and biochemical markers of disease severity can be used to predict risk, prevent complications, and increase the expectation and quality of life of the SCD population. The entire scenario generated by Hb S has implications for the health and social inclusion of patients, so the treatment of the person with SCD needs an approach focused on the prevention of these complications in an individualized way.",book:{id:"6210",slug:"thalassemia-and-other-hemolytic-anemias",title:"Thalassemia and Other Hemolytic Anemias",fullTitle:"Thalassemia and Other Hemolytic Anemias"},signatures:"Karen Cordovil",authors:[{id:"228575",title:"M.D.",name:"Karen",middleName:null,surname:"Cordovil",slug:"karen-cordovil",fullName:"Karen Cordovil"}]},{id:"66394",title:"Diffuse Large B-Cell Lymphoma",slug:"diffuse-large-b-cell-lymphoma",totalDownloads:2482,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Diffuse large B-cell lymphoma (DLBCL) is a heterogenous class of aggressive lymphoma and is considered as the most common subtype of non-Hodgkin lymphomas (NHL). Several genetic anomalies such as point mutations, numerical alterations, and, more rarely, translocations and gene amplifications play a role in the pathogenesis of this class of B-cell lymphoma and have been related to specific histological and immunophenotypic subtypes. On the other hand, the treatment protocol in DLBCL did not witness significant changes during the last two decades. The widespread adoption of rituximab as an important adjuvant to standard chemotherapy protocol in CD20+ cases was a notable exception, which provided significant improvement in disease-free survival and overall survival, with limited toxicity. However, no less than 20% of patients diagnosed with DLBCL exhibit relapse after the initial response to R-CHOP regimen, while more than 15% of the patients exhibit primary refractory disease. This is the reason why a review of all the morphological, clinical, and therapeutic particularities of DLBCL is required.",book:{id:"8316",slug:"normal-and-malignant-b-cell",title:"Normal and Malignant B-Cell",fullTitle:"Normal and Malignant B-Cell"},signatures:"Patrascu Ana Maria, Ionela Rotaru, Valeriu Surlin and Stefan Patrascu",authors:[{id:"158096",title:"Associate Prof.",name:"Valeriu",middleName:null,surname:"Surlin",slug:"valeriu-surlin",fullName:"Valeriu Surlin"},{id:"194539",title:"Dr.",name:"Stefan",middleName:null,surname:"Patrascu",slug:"stefan-patrascu",fullName:"Stefan Patrascu"},{id:"290810",title:"Dr.",name:"Ana Maria",middleName:null,surname:"Patrascu",slug:"ana-maria-patrascu",fullName:"Ana Maria Patrascu"},{id:"292959",title:"Dr.",name:"Ionela",middleName:null,surname:"Rotaru",slug:"ionela-rotaru",fullName:"Ionela Rotaru"}]},{id:"61929",title:"Idiosyncratic Drug-Induced Severe Neutropenia and Agranulocytosis: State of the Art",slug:"idiosyncratic-drug-induced-severe-neutropenia-and-agranulocytosis-state-of-the-art",totalDownloads:1621,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"In this chapter, we report and discuss the diagnosis and management of idiosyncratic drug-induced, or drug-associated, severe neutropenia, and agranulocytosis (neutrophil count of <0.5 × 109/L). In this setting, neutropenia remains a potentially serious adverse event due to the frequency of severe sepsis, with severe deep tissue infections (e.g., pneumonia), life-threatening infections, septicemia, and septic shock in two-thirds of all hospitalized patients. Recently, several poor prognostic factors, impacting the hematological recovery, the duration of hospitalization, and the outcome have been identified that may be helpful when identifying “frailty” patients. These factors include: old age, poor performance status, septicemia or shock, comorbidities such as renal failure, and a neutrophil count below 0.1 × 109/L. recovery. In this situation, modern management, with broad-spectrum antibiotics in case of any sepsis sign and hematopoietic growth factors (HGF) (particularly G-CSF), is likely to improve the prognosis, with a current mortality rate around 5%.",book:{id:"6439",slug:"hematology-latest-research-and-clinical-advances",title:"Hematology",fullTitle:"Hematology - Latest Research and Clinical Advances"},signatures:"Emmanuel Andrès and Rachel Mourot-Cottet",authors:[{id:"143493",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Andrès",slug:"emmanuel-andres",fullName:"Emmanuel Andrès"}]}],onlineFirstChaptersFilter:{topicId:"1026",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters: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:140,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:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). 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He is an academic staff member of the Department of Reproduction and Artificial Insemination, Selçuk University, Turkey. He manages several studies on sperms and embryos and is an editorial board member for several international journals. His studies include sperm cryobiology, in vitro fertilization, and embryo production in animals.",institutionString:"Selçuk University, Faculty of Veterinary Medicine",institution:null},{id:"90846",title:"Prof.",name:"Yusuf",middleName:null,surname:"Bozkurt",slug:"yusuf-bozkurt",fullName:"Yusuf Bozkurt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/90846/images/system/90846.jpg",biography:"Yusuf Bozkurt has a BSc, MSc, and Ph.D. from Ankara University, Turkey. He is currently a Professor of Biotechnology of Reproduction in the field of Aquaculture, İskenderun Technical University, Turkey. His research interests include reproductive biology and biotechnology with an emphasis on cryo-conservation. He is on the editorial board of several international peer-reviewed journals and has published many papers. Additionally, he has participated in many international and national congresses, seminars, and workshops with oral and poster presentations. He is an active member of many local and international organizations.",institutionString:"İskenderun Technical University",institution:{name:"İskenderun Technical University",country:{name:"Turkey"}}},{id:"61139",title:"Dr.",name:"Sergey",middleName:null,surname:"Tkachev",slug:"sergey-tkachev",fullName:"Sergey Tkachev",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61139/images/system/61139.png",biography:"Dr. Sergey Tkachev is a senior research scientist at the Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia, and at the Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia. He received his Ph.D. in Molecular Biology with his thesis “Genetic variability of the tick-borne encephalitis virus in natural foci of Novosibirsk city and its suburbs.” His primary field is molecular virology with research emphasis on vector-borne viruses, especially tick-borne encephalitis virus, Kemerovo virus and Omsk hemorrhagic fever virus, rabies virus, molecular genetics, biology, and epidemiology of virus pathogens.",institutionString:"Russian Academy of Sciences",institution:{name:"Russian Academy of Sciences",country:{name:"Russia"}}},{id:"310962",title:"Dr.",name:"Amlan",middleName:"Kumar",surname:"Patra",slug:"amlan-patra",fullName:"Amlan Patra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/310962/images/system/310962.jpg",biography:"Amlan K. Patra, FRSB, obtained a Ph.D. in Animal Nutrition from Indian Veterinary Research Institute, India, in 2002. He is currently an associate professor at West Bengal University of Animal and Fishery Sciences. He has more than twenty years of research and teaching experience. He held previous positions at the American Institute for Goat Research, The Ohio State University, Columbus, USA, and Free University of Berlin, Germany. His research focuses on animal nutrition, particularly ruminants and poultry nutrition, gastrointestinal electrophysiology, meta-analysis and modeling in nutrition, and livestock–environment interaction. He has authored around 175 articles in journals, book chapters, and proceedings. Dr. Patra serves on the editorial boards of several reputed journals.",institutionString:null,institution:{name:"West Bengal University of Animal and Fishery Sciences",country:{name:"India"}}},{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.png",biography:"László Babinszky is Professor Emeritus, Department of Animal Nutrition Physiology, University of Debrecen, Hungary. He has also worked in the Department of Animal Nutrition, University of Wageningen, Netherlands; the Institute for Livestock Feeding and Nutrition (IVVO), Lelystad, Netherlands; the Agricultural University of Vienna (BOKU); the Institute for Animal Breeding and Nutrition, Austria; and the Oscar Kellner Research Institute for Animal Nutrition, Rostock, Germany. In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain.Dr. Satué is accredited as a Private University Doctor Professor, Doctor Assistant, and Contracted Doctor by AVAP (Agència Valenciana d'Avaluació i Prospectiva) and currently, as a full professor by ANECA (since January 2022). To date, Katy has taught 22 years in the Department of Animal Medicine and Surgery at the CEU-Cardenal Herrera University in undergraduate courses in Veterinary Medicine (General Pathology, integrated into the Applied Basis of Veterinary Medicine module of the 2nd year, Clinical Equine I of 3rd year, and Equine Clinic II of 4th year). Dr. Satué research activity is in the field of Endocrinology, Hematology, Biochemistry, and Immunology in the Spanish Purebred mare. She has directed 5 Doctoral Theses and 5 Diplomas of Advanced Studies, and participated in 11 research projects as a collaborating researcher. She has written 2 books and 14 book chapters in international publishers related to the area, and 68 scientific publications in international journals. Dr. Satué has attended 63 congresses, participating with 132 communications in international congresses and 19 in national congresses related to the area. Dr. Satué is a scientific reviewer for various prestigious international journals such as Animals, American Journal of Obstetrics and Gynecology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology, among others. Since 2014 she has been responsible for the Clinical Analysis Laboratory of the CEU-Cardenal Herrera University Veterinary Clinical Hospital.",institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"439435",title:"Dr.",name:"Feda S.",middleName:null,surname:"Aljaser",slug:"feda-s.-aljaser",fullName:"Feda S. Aljaser",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"423023",title:"Dr.",name:"Yosra",middleName:null,surname:"Soltan",slug:"yosra-soltan",fullName:"Yosra Soltan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"349788",title:"Dr.",name:"Florencia Nery",middleName:null,surname:"Sompie",slug:"florencia-nery-sompie",fullName:"Florencia Nery Sompie",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sam Ratulangi University",country:{name:"Indonesia"}}},{id:"428600",title:"MSc.",name:"Adriana",middleName:null,surname:"García-Alarcón",slug:"adriana-garcia-alarcon",fullName:"Adriana García-Alarcón",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428599",title:"MSc.",name:"Gabino",middleName:null,surname:"De La Rosa-Cruz",slug:"gabino-de-la-rosa-cruz",fullName:"Gabino De La Rosa-Cruz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428601",title:"MSc.",name:"Juan Carlos",middleName:null,surname:"Campuzano-Caballero",slug:"juan-carlos-campuzano-caballero",fullName:"Juan Carlos Campuzano-Caballero",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}}]}},subseries:{item:{id:"95",type:"subseries",title:"Urban Planning and Environmental Management",keywords:"Circular Economy, Contingency Planning and Response to Disasters, Ecosystem Services, Integrated Urban Water Management, Nature-based Solutions, Sustainable Urban Development, Urban Green Spaces",scope:"