Invasive MSSA infection risk factors, MRSA HAP risk factors.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"11024",leadTitle:null,fullTitle:"Hypothyroidism - New Aspects of an Old Disease",title:"Hypothyroidism",subtitle:"New Aspects of an Old Disease",reviewType:"peer-reviewed",abstract:"Hypothyroidism is an endocrine disorder commonly caused by Hashimoto’s disease. Nowadays, autoimmune diseases appear to be on the rise. As such, there is renewed interest in hypothyroidism. This book presents a comprehensive overview of the disorder with chapters on etiology and pathogenesis, precision medicine tools for detection, diagnosis and treatment, the morphology of the thyroid gland, the effect of hypothyroidism on various organ systems, and much more.",isbn:"978-1-83969-341-0",printIsbn:"978-1-83969-340-3",pdfIsbn:"978-1-83969-342-7",doi:"10.5772/intechopen.95721",price:119,priceEur:129,priceUsd:155,slug:"hypothyroidism-new-aspects-of-an-old-disease",numberOfPages:178,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d2f9f9547a1f3431fa0f421af2a6eef8",bookSignature:"Ifigenia Kostoglou-Athanassiou",publishedDate:"April 6th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11024.jpg",numberOfDownloads:848,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:2,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:2,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2021",dateEndSecondStepPublish:"May 4th 2021",dateEndThirdStepPublish:"July 3rd 2021",dateEndFourthStepPublish:"September 21st 2021",dateEndFifthStepPublish:"November 20th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"307495",title:"Dr.",name:"Ifigenia",middleName:null,surname:"Kostoglou-Athanassiou",slug:"ifigenia-kostoglou-athanassiou",fullName:"Ifigenia Kostoglou-Athanassiou",profilePictureURL:"https://mts.intechopen.com/storage/users/307495/images/system/307495.jpg",biography:"Dr. Ifigenia Kostoglou-Athanassiou was born in Thessaloniki, Greece. She is an endocrinologist who graduated from the Medical School, Aristotle University of Thessaloniki, Greece. She obtained an MD from the University of Athens Medical School, and a Ph.D. from the University of London. Her areas of research include breast cancer, neuroendocrinology, melatonin, thyroid cancer, vitamin D, and autoimmune diseases. She has won several awards for her research. Dr. Kostoglou-Athanassiou has published numerous papers and book chapters. Currently, she works as a consultant endocrinologist and head of the Endocrine Department, Asclepeion Hospital, Voula, Athens, Greece.",institutionString:"Department of Endocrinology, Asclepeion Hospital",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"178",title:"Endocrinology",slug:"medicine-endocrinology"}],chapters:[{id:"80671",title:"Autoimmune Hashimoto’s Thyroiditis and Hypothyroidism: Novel Aspects",doi:"10.5772/intechopen.102785",slug:"autoimmune-hashimoto-s-thyroiditis-and-hypothyroidism-novel-aspects",totalDownloads:70,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Autoimmune Hashimoto’s thyroiditis is an organ specific autoimmune disorder. It affects the thyroid gland and it is characterized by the presence of antibodies to thyroid proteins, namely, thyroid peroxidase, TPOab and thyroglobulin, Tgab and thyroid tissue invasion by lymphocytes. The presence of Hashimoto’s thyroiditis may be associated with normal thyroid function or hypothyroidism. In many cases of Hashimoto’s thyroiditis with normal thyroid function may progress to subclinical hypothyroidism or overt hypothyroidism. Risk factors for the development of Hashimoto’s thyroiditis are genetic and environmental. Genetic factors are HLA-DR4, CD40, CTLA-4 and PTP-N22 and genetic factors related to thyroglobulin gene and TSH receptor gene. Environmental factors include the presence of iodine excess in the environment, infectious agents such as hepatitis C virus and the SARS-CoV-2 virus, smoking, alcohol, selenium deficiency, drugs such as amiodarone, interferon-a, highly active antiretroviral therapy and immune checkpoint inhibitors. Female sex is also a risk factor for Hashimoto’s thyroiditis. The disease runs a variable course. Presently there are experimental efforts to pause or reverse the autoimmune process which leads to Hashimoto’s thyroiditis and may progress to the destruction of the thyroid gland. Hypothyroidism is treated by the administration of thyroxine usually for life.",signatures:"Ifigenia Kostoglou-Athanassiou, Lambros Athanassiou and Panagiotis Athanassiou",downloadPdfUrl:"/chapter/pdf-download/80671",previewPdfUrl:"/chapter/pdf-preview/80671",authors:[{id:"307495",title:"Dr.",name:"Ifigenia",surname:"Kostoglou-Athanassiou",slug:"ifigenia-kostoglou-athanassiou",fullName:"Ifigenia Kostoglou-Athanassiou"},{id:"311714",title:"Dr.",name:"Panagiotis",surname:"Athanassiou",slug:"panagiotis-athanassiou",fullName:"Panagiotis Athanassiou"},{id:"311715",title:"Dr.",name:"Lambros",surname:"Athanassiou",slug:"lambros-athanassiou",fullName:"Lambros Athanassiou"}],corrections:null},{id:"79378",title:"Application of Data Science Approaches to Investigate Autoimmune Thyroid Disease in Precision Medicine",doi:"10.5772/intechopen.101220",slug:"application-of-data-science-approaches-to-investigate-autoimmune-thyroid-disease-in-precision-medici",totalDownloads:95,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In recent times, the application of artificial intelligence in facilitating, capturing, and restructuring Big data has transformed the accuracy of diagnosis and treatment of diseases, a field known as precision medicine. Big data has been established in various domains of medicine for example, artificial intelligence has found its way into immunology termed as immunoinformatics. There is evidence that precision medicine tools have made an effort to accurately detect, profile, and suggest treatment regimens for thyroid dysfunction using Big data such as imaging and genetic sequences. In addition, the accumulation of data on polymorphisms, autoimmune thyroid disease, and genetic data related to environmental factors has occurred over time resulting in drastic development of clinical autoimmune thyroid disease study. This review emphasized how genetic data plays a vital role in diagnosing and treating diseases related to autoimmune thyroid disease like Graves’ disease, subtle subclinical thyroid dysfunctions, Hashimoto’s thyroiditis, and hypothyroid autoimmune thyroiditis. Furthermore, connotation between environmental and endocrine risk factors in the etiology of the disease in genetically susceptible individuals were discussed. Thus, endocrinologists’ potential hurdles in cancer and thyroid nodules field include unreliable biomarkers, lack of distinct therapeutic alternatives due to genetic difference. Precision medicine data may improve their diagnostic and therapeutic capabilities using artificial intelligence.",signatures:"Ayodeji Folorunsho Ajayi, Emmanuel Tayo Adebayo, Iyanuoluwa Oluwadunsi Adebayo, Olubunmi Simeon Oyekunle, Victor Oluwaseyi Amos, Segun Emmanuel Bamidele and Goodness Olusayo Olatinwo",downloadPdfUrl:"/chapter/pdf-download/79378",previewPdfUrl:"/chapter/pdf-preview/79378",authors:[{id:"297006",title:"Dr.",name:"Ayodeji Folorunsh",surname:"Ajayi",slug:"ayodeji-folorunsh-ajayi",fullName:"Ayodeji Folorunsh Ajayi"},{id:"336826",title:"Mr.",name:"Emmanuel",surname:"Tayo Adebayo",slug:"emmanuel-tayo-adebayo",fullName:"Emmanuel Tayo Adebayo"},{id:"435117",title:"MSc.",name:"Iyanuoluwa",surname:"Oluwadunsi Adebayo",slug:"iyanuoluwa-oluwadunsi-adebayo",fullName:"Iyanuoluwa Oluwadunsi Adebayo"},{id:"435118",title:"Dr.",name:"Olubunmi",surname:"Simeon Oyekunle",slug:"olubunmi-simeon-oyekunle",fullName:"Olubunmi Simeon Oyekunle"},{id:"435119",title:"MSc.",name:"Victor",surname:"Oluwaseyi Amos",slug:"victor-oluwaseyi-amos",fullName:"Victor Oluwaseyi Amos"},{id:"435120",title:"MSc.",name:"Segun",surname:"Emmanuel Bamidele",slug:"segun-emmanuel-bamidele",fullName:"Segun Emmanuel Bamidele"},{id:"435121",title:"MSc.",name:"Goodness",surname:"Olusayo Olatinwo",slug:"goodness-olusayo-olatinwo",fullName:"Goodness Olusayo Olatinwo"}],corrections:null},{id:"79538",title:"Morphology Aspects of Hypothyroidism",doi:"10.5772/intechopen.101123",slug:"morphology-aspects-of-hypothyroidism",totalDownloads:187,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Hypothyroidism is a common endocrine disorder resulting of low levels of thyroid circulating hormones. The prevalence in the general population varies between 0.3% and 3.7%. Presents as clinical or subclinical disease based on presence of symptoms and levels of serum TSH and free thyroxine and T4, respectively. Hypothyroidism has numerous etiologies, some of them are originated on the thyroid itself and some others are of extrathyroid origin, with variable manifestations. Classified as primary, secondary, tertiary and peripheral. Thyroid autoimmune disease is the principal cause. A new class of drugs against cancer, like the anti-CTLA-4 and anti-PD-L1/PD1 therapies have been associated with primary or secondary hypothyroidism. Endocrine disorders can be difficult to diagnose based only on morphological features because endocrine manifestations are caused primarily by a hormonal imbalance. Hypothyroidism may have a higher risk of morbidity and mortality. Finally, myxedematous coma is the main complication of terminal stages hypothyroidism.",signatures:"Fernando Candanedo-Gonzalez, Javier Rios-Valencia, Dafne Noemi Pacheco-Garcilazo, Wilfredo Valenzuela-Gonzalez and Armando Gamboa-Dominguez",downloadPdfUrl:"/chapter/pdf-download/79538",previewPdfUrl:"/chapter/pdf-preview/79538",authors:[{id:"414748",title:"Ph.D.",name:"Fernando",surname:"Candanedo-Gonzalez",slug:"fernando-candanedo-gonzalez",fullName:"Fernando Candanedo-Gonzalez"},{id:"435366",title:"Dr.",name:"Dafne Noemi",surname:"Pacheco-Garcilazo",slug:"dafne-noemi-pacheco-garcilazo",fullName:"Dafne Noemi Pacheco-Garcilazo"},{id:"435367",title:"Dr.",name:"Javier",surname:"Rios-Valencia",slug:"javier-rios-valencia",fullName:"Javier Rios-Valencia"},{id:"435368",title:"Dr.",name:"Armando",surname:"Gamboa-Dominguez",slug:"armando-gamboa-dominguez",fullName:"Armando Gamboa-Dominguez"},{id:"436133",title:"Dr.",name:"Wilfredo",surname:"Valenzuela-Gonzalez",slug:"wilfredo-valenzuela-gonzalez",fullName:"Wilfredo Valenzuela-Gonzalez"}],corrections:null},{id:"78562",title:"The Role of Ultrasound in Hypothyroidism, Technique, Differential Diagnosis and Follow-Up",doi:"10.5772/intechopen.99989",slug:"the-role-of-ultrasound-in-hypothyroidism-technique-differential-diagnosis-and-follow-up",totalDownloads:118,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In hypothyroidism, which is as old as humanity, ultrasound has been the first and most important imaging examination in recent decades. This disease is involved in almost all steps in the spectrum from inflammatory diseases to cancer of the thyroid gland. Thyroid ultrasound is a critical tool in the differential diagnosis of hypothyroidism. If thyroid antibodies are negative. It is helpful to determine whether the thyroid is present and to visualize the parenchyma. In a hypothyroid patient, the US may lead to cost savings. If a typical autoimmune pattern is present on US, as a cost-reducing move, further investigations may not be required for the diagnosis of Hashimoto’s thyroiditis. Moreover, the ultrasound image may contribute to the decision process whether to treat patients with positive antithyroid antibodies who are euthyroid or have only a mild subclinical hypothyroidism.",signatures:"Hakan Baş",downloadPdfUrl:"/chapter/pdf-download/78562",previewPdfUrl:"/chapter/pdf-preview/78562",authors:[{id:"346376",title:"M.D.",name:"Hakan",surname:"Baş",slug:"hakan-bas",fullName:"Hakan Baş"}],corrections:null},{id:"79036",title:"Melatonin Modulates Hypophyseal-Thyroid Function through Differential Activation of MT1 and MT2 Receptors in Hypothyroid Mice",doi:"10.5772/intechopen.100524",slug:"melatonin-modulates-hypophyseal-thyroid-function-through-differential-activation-of-mt1-and-mt2-rece",totalDownloads:87,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Hypothyroidism is characterized by the low level of thyroid hormones in circulation, which affects the normal metabolic activities of organisms. Propylthiouracil (PTU) induced hypothyroid condition impairs the antioxidant defense system and therefore normal physiology alters. Melatonin influences most physiological activities and is also known for its antioxidative properties. Melatonin modulates physiological activities through receptor-mediated as well as non-receptor-mediated pathways. In this study, we evaluated the involvement of melatonin MT1 and MT2 receptors in the modulation of hypophyseal-thyroid function in PTU-induced hypothyroid mice. We have noted the decreased level of T3 and T4 and increased level of TSH hormone in PTU-treated mice. Melatonin treatment counteracted the PTU-caused changes in circulatory T3, T4, and TSH hormones. PTU treatment caused increased MT1 receptor protein expression in the thyroid as well as the pituitary gland while increased MT2 receptor protein in the pituitary gland. Melatonin treatment caused increased TSH receptor protein in the thyroid gland. Melatonin induced MT2 receptor protein expression in both the thyroid and pituitary glands whereas MT1 receptor proteins in the pituitary gland. This study may suggest that melatonin regulates hypophyseal-thyroid function through differential sensitization of MT1 and MT2 receptors on the pituitary and thyroid glands in hypothyroid mice.",signatures:"Shiv Shankar Singh, Prashanjit Laskar, Anindita Deb and Sangita Sutradhar",downloadPdfUrl:"/chapter/pdf-download/79036",previewPdfUrl:"/chapter/pdf-preview/79036",authors:[{id:"298761",title:"Ms.",name:"Anindita",surname:"Deb",slug:"anindita-deb",fullName:"Anindita Deb"},{id:"298762",title:"Ms.",name:"Sangita",surname:"Sutradhar",slug:"sangita-sutradhar",fullName:"Sangita Sutradhar"},{id:"299563",title:"Dr.",name:"Prashanjit",surname:"Laskar",slug:"prashanjit-laskar",fullName:"Prashanjit Laskar"},{id:"418940",title:"Dr.",name:"Shiv",surname:"Shankar Singh",slug:"shiv-shankar-singh",fullName:"Shiv Shankar Singh"}],corrections:null},{id:"78814",title:"Hypothyroidism Therapy",doi:"10.5772/intechopen.99978",slug:"hypothyroidism-therapy",totalDownloads:77,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Hypothyroidism refers to the common pathological disorder of thyroid hormone deficiency. The successful therapy for hypothyroidism is levothyroxine (LT4) administration, which is the same as thyroxine but produced synthetically. Serum thyrotropin (TSH) normalization with LT4 replacement therapy in hypothyroidism is generally needed to restore a euthyroid state. The daily dose of thyroxine therapy depends on various factors, such as body weight, age, and severity. It also differs from hypothyroidism during pregnancy to congenital hypothyroidism. The presence of various comorbidities may exist such as myxoedema coma, coronary artery disease, obesity, anemia and COVID-19 which necessitate individualized treatment. LT4 intolerance manifested with sympathetic hyperactivity may appear during the first hours after the LT4 administration. It requires starting with very low doses of LT4 that should be increased gradually, and reaching normal TSH may take several months. The sympathetic hyperactivity may be attributable to the presence of uncorrected iron-deficiency anemia that worsens by the use of thyroid hormone.",signatures:"Wissal Abassi, Nejmeddine Ouerghi and Anissa Bouassida",downloadPdfUrl:"/chapter/pdf-download/78814",previewPdfUrl:"/chapter/pdf-preview/78814",authors:[{id:"415466",title:"Dr.",name:"Wissal",surname:"Abassi",slug:"wissal-abassi",fullName:"Wissal Abassi"},{id:"425402",title:"Dr.",name:"Nejmeddine",surname:"Ouerghi",slug:"nejmeddine-ouerghi",fullName:"Nejmeddine Ouerghi"},{id:"425403",title:"Dr.",name:"Anissa",surname:"Bouassida",slug:"anissa-bouassida",fullName:"Anissa Bouassida"}],corrections:null},{id:"80476",title:"Cytokine Storm in Hypothyroidism in Infertile Women",doi:"10.5772/intechopen.102044",slug:"cytokine-storm-in-hypothyroidism-in-infertile-women",totalDownloads:65,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Thyroid dysfunction interferes with several aspects of reproduction along with pregnancy. Hypothyroidism in females leads to an elevated level of hormone prolactin which decreases levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and finally causes infertility. Obesity acts upon the reproductive cycle by decreasing oestrogen metabolism stimulating menstrual disturbance along with an ovulation. But till date, one of the most underestimated obstacles in fertility is inflammation. Hypothyroidism leads to inflammation in secondary epithelial cells of thyroid gland. This affects immune, nervous system and endocrinal functions of body. Inflammation contributes to oestrogen dominance, a hormonal state that consists of having too little progesterone in the body compared to oestrogen. This leads to progesterone resistance, prevention of progesterone hormone receptors from working properly. This condition also leads to infertility in hypothyroid females. Therefore, not only hormonal profile is sufficient to check up for reproductive problems in the female, but also inflammatory markers like IL-6 and CRP should be added to this profile.",signatures:"Neha Sharma, Sanghapriya Mukherjee and Aparajita Kushwaha",downloadPdfUrl:"/chapter/pdf-download/80476",previewPdfUrl:"/chapter/pdf-preview/80476",authors:[{id:"415812",title:"Associate Prof.",name:"Neha",surname:"Sharma",slug:"neha-sharma",fullName:"Neha Sharma"},{id:"438276",title:"Ms.",name:"Sanghapriya",surname:"Mukherjee",slug:"sanghapriya-mukherjee",fullName:"Sanghapriya Mukherjee"},{id:"438277",title:"Ms.",name:"Aparajita",surname:"Kushwaha",slug:"aparajita-kushwaha",fullName:"Aparajita Kushwaha"}],corrections:null},{id:"79063",title:"Evolution of Thyroid Enhancement of Embryogenesis and Early Survival",doi:"10.5772/intechopen.100409",slug:"evolution-of-thyroid-enhancement-of-embryogenesis-and-early-survival",totalDownloads:79,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Iodine imparts protective antioxidant actions that improve the fitness of invertebrate organisms, and peptides carrying iodine initially appear to have served in a defensive capacity. Tyrosine carries multiple iodines in some echinoderms, and these peptides transferred to progeny serve both protective and signaling purposes. This parental relationship appears to be the most likely evolutionary basis for emergence of the vertebrate thyroid endocrine system, and its critically important development-promoting actions in larval and (later) fetal ontogeny. Thyroxine (T4) and Triiodothyronine (T3) induce settlement and stimulate transitions to alternative feeding modes in some echinoderms. This transgenerational relationship has been conserved and elaborated in vertebrates, including humans, which share common ancestry with echinoderms. Thyroid insufficiency is damaging or can be lethal to larval fishes; egg yolk that is insufficiently primed with maternal thyroid hormones (TH) results in compromised development and high mortality rates at the time of first-feeding. Maternally-derived TH supplied to offspring supports the onset of independent feeding in fishes (eye, mouth, lateral line, swim bladder and intestinal maturation) and survival by comparable developmental mechanisms in placental mammals. Fishes evolved precise control of TH secretion and peripheral processing; early metamorphic and feeding mode actions were joined by controlled thermogenesis in homeotherms.",signatures:"Arjay Pataueg, Earl T. Larson and Christopher L. Brown",downloadPdfUrl:"/chapter/pdf-download/79063",previewPdfUrl:"/chapter/pdf-preview/79063",authors:[{id:"422770",title:"Prof.",name:"Christopher L.",surname:"Brown",slug:"christopher-l.-brown",fullName:"Christopher L. Brown"},{id:"428383",title:"Dr.",name:"Earl T.",surname:"Larson",slug:"earl-t.-larson",fullName:"Earl T. Larson"},{id:"428384",title:"MSc.",name:"Arjay",surname:"Pataueg",slug:"arjay-pataueg",fullName:"Arjay Pataueg"}],corrections:null},{id:"80092",title:"Molecular Mechanisms of Glucose Uptake Regulation in Thyroid Cancer",doi:"10.5772/intechopen.101937",slug:"molecular-mechanisms-of-glucose-uptake-regulation-in-thyroid-cancer",totalDownloads:70,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Common capabilities of thyroid malignant cells are accelerating metabolism and increasing glucose uptake to optimize energy supply for growth. In tumor cells, keeping the power load required for cell survival is essential and glucose transporters are capable of promoting this task. GLUT-1 and GLUT3 are promising goals for the development of anti-cancer strategies. The lack of oncosuppressors has dominant effect on the membrane expression of GLUT1 and glucose uptake. Overexpression of hypoxia-inducing factors, in thyroid cancer, modulates the expression of some glucose transporter genes. Although the physiology of the thyroid gland has been excellently explained, metabolic regulation in thyroid cancer is inevitable. In this section, we investigated the proliferation pathways of pivotal regulators and signal molecules around GLUT regulation in thyroid cancer, including PTEN, p53, MicroRNA, iodide, BRAF, HIF-1, PI3K-Akt, TSH, c-Myc, and AMPK. Impaired energy regulation and cell metabolism are the most critical symptoms of most cancers. As a result, understanding the mechanisms of glucose transport in the normal and pathological tissues of the thyroid may be very crucial and offer tremendous insights into the science of analysis and remedy of thyroid disease.",signatures:"Shabnam Heydarzadeh, Ali Asghar Moshtaghie, Maryam Daneshpour and Mehdi Hedayati",downloadPdfUrl:"/chapter/pdf-download/80092",previewPdfUrl:"/chapter/pdf-preview/80092",authors:[{id:"278426",title:"Prof.",name:"Mehdi",surname:"Hedayati",slug:"mehdi-hedayati",fullName:"Mehdi Hedayati"},{id:"415218",title:"Ph.D. Student",name:"Shabnam",surname:"Heydarzadeh",slug:"shabnam-heydarzadeh",fullName:"Shabnam Heydarzadeh"},{id:"450267",title:"Dr.",name:"Ali Asghar",surname:"Moshtaghie",slug:"ali-asghar-moshtaghie",fullName:"Ali Asghar Moshtaghie"},{id:"450268",title:"Dr.",name:"Maryam",surname:"Daneshpoor",slug:"maryam-daneshpoor",fullName:"Maryam Daneshpoor"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6581",title:"Adipose Tissue",subtitle:null,isOpenForSubmission:!1,hash:"85899eab2d8b01653e1297b168c470d7",slug:"adipose-tissue",bookSignature:"Leszek Szablewski",coverURL:"https://cdn.intechopen.com/books/images_new/6581.jpg",editedByType:"Edited by",editors:[{id:"49739",title:"Dr.",name:"Leszek",surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8797",title:"Adipose Tissue",subtitle:"An Update",isOpenForSubmission:!1,hash:"34880b7b450ef96fa5063c867c028b02",slug:"adipose-tissue-an-update",bookSignature:"Leszek Szablewski",coverURL:"https://cdn.intechopen.com/books/images_new/8797.jpg",editedByType:"Edited by",editors:[{id:"49739",title:"Dr.",name:"Leszek",surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6246",title:"Salivary Glands",subtitle:"New Approaches in Diagnostics and Treatment",isOpenForSubmission:!1,hash:"de375ecbd9ac673d6464107a0c416763",slug:"salivary-glands-new-approaches-in-diagnostics-and-treatment",bookSignature:"Işıl Adadan Güvenç",coverURL:"https://cdn.intechopen.com/books/images_new/6246.jpg",editedByType:"Edited by",editors:[{id:"36790",title:"M.D.",name:"Işıl",surname:"Adadan Güvenç",slug:"isil-adadan-guvenc",fullName:"Işıl Adadan Güvenç"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7848",title:"Selected Chapters from the Renin-Angiotensin System",subtitle:null,isOpenForSubmission:!1,hash:"38e89685aa86d8cbff0718f3813ae625",slug:"selected-chapters-from-the-renin-angiotensin-system",bookSignature:"Aleksandar Kibel",coverURL:"https://cdn.intechopen.com/books/images_new/7848.jpg",editedByType:"Edited by",editors:[{id:"183303",title:"Dr.",name:"Aleksandar",surname:"Kibel",slug:"aleksandar-kibel",fullName:"Aleksandar Kibel"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7269",title:"Endocrine Disruptors",subtitle:null,isOpenForSubmission:!1,hash:"571f5c496c8b0e8db9043204fa58be2a",slug:"endocrine-disruptors",bookSignature:"Ahmed R. 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\r\n\tAlthough the diagnosis and overall survival of patients with various cardiac diseases have improved in the last years, there still remains a significant proportion of patients with unfavorable prognoses. The evaluation of these patients necessitates effective imaging techniques in both diagnosis and long-term follow-up. Even though Cardiac Magnetic Resonance imaging is currently the imaging modality of choice for tissue characterization, advanced echocardiography represents a modern alternative. Speckle tracking echocardiography can be used to assess myocardial deformation at both segmental and global levels. Since distinct myocardial pathologies affect deformation differently, information about the underlying tissue can be offered by strain imaging. Echocardiography advances also show promising results in the improvement of diagnostic accuracy, management, and follow-up and a major advantage of echocardiography over other imaging modalities is the ability to use it in real-time, in the cardiac catheterization laboratory, allowing for the performance of imaging immediately before, during, and after interventional procedures. Furthermore, the prevalence of adult congenital heart disease continues to grow due to advances in surgical and diagnostic techniques. Echocardiography has proven to be a useful tool in the diagnosis and follow-up of these patients, both after percutaneous and surgical procedures, and its utility has expanded significantly due to the development of better technology. In addition, stress echocardiography could be useful in the evaluation of several cardiac diseases and should be preferred over other imaging modalities due to the lower cost, wider availability, and radiation-free nature.
\r\n\tThis book intends to provide the reader with a comprehensive overview of the current state-of-the-art novel imaging techniques by focusing on the most important evidence-based developments in this area.
Nosocomial pneumonia (NP) that occurs during a patient’s hospital course has been subclassified into hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). As per the latest Infectious Diseases Society of America (IDSA) and American Thoracic Society guidelines (ATS) [1], the category healthcare-associated pneumonia (HCAP) has been abandoned. The term NP and HAP should not be used interchangingly as before. HAP should be used only for pneumonia that occurs >48 h after admission to a hospital. VAP refers to pneumonia occurring >48 h post-intubation [2]. HAP is the most frequent hospital-acquired infection (HAI) [3]. As per the latest study done in the United States of America (USA), HAP prevalence in ICU was more frequent than VAP, and more than 75% of these patients developed severe respiratory failure due to pneumonia resulting in intubation and mechanical ventilatory support [4]. It is unknown whether the above trend is similar across all medical centers in the USA or is observed only in a few medical centers. Tertiary medical centers may have a different prevalence rate than other medical centers due to the higher presence of immunosuppressed patients (post-transplant). The lack of effective HAP surveillance systems in the USA and other countries adds to this tenuous issue. Also, the lack of definitive diagnostic criteria makes it difficult to identify HAP patients on the floor and in intensive care units, as fever and cough can have multiple diagnostic possibilities postadmission to a hospital.
HAP can occur in both patients with or without risk factors, and it is critical to realize that all acute care patients have an increased risk of HAP [5]. Specific patient subsets carry an increased risk than others, including elderly patients, chronic lung, cardiac and renal disease, hepatic cirrhosis, obesity, diabetes mellitus, cancer, neurological conditions such as stroke and dementia, malnutrition, and immunosuppressed patients [6, 7]. Specific therapeutic intervention modalities, including medications and procedures such as intubation, gastric tube placements, can increase the risk of HAP. Clinical literature on HAP inside the ICU is suboptimal, whereas on HAP outside the ICU is minuscule. NP accounts for around 21 admits per 1000 admissions to a hospital [8]. NP is responsible for close to 22% of HAI in the USA, and about 61% are HAP compared to VAP [9]. NP results in significant clinical outcomes such as increased healthcare costs, extended hospital stay, excess utilization of health care resources, and higher mortality and morbidity [10]. The actual prevalence rates of HAP and VAP are unknown; however, recent studies allude to a greater prevalence of HAP than VAP by a ratio of close to 2:1 in favor of HAP [11, 12]. A recent state study from Pennsylvania revealed that HAP risk factors and resulting complications are identical to those seen in VAP but were associated with an unfavorable higher economic cost and similar mortality [11]. Recent studies indicate an approximate incidence of 1.22 to 8.9 per 1000 patient days [5, 6, 9, 13, 14]. The total acute care cost for HAP is close to 40,000 dollars, with a hospital stay of 4 to 15.9 days, and the HAP influence on mortality was more significant than VAP [11, 13, 14]. Also, HAP patients, due to their increased occurrence, had a net increased economic cost than VAP and a higher need for postdischarge care [11, 14]. However, this cost did not include the interinstitutional transfer costs involved [14].
As patients diagnosed with HAP are not intubated, they face multiple challenges, including an inability to perform minimally invasive procedures to obtain microbiological specimens from the lower airway leading to the absence of microbiological data and ineffective initial antimicrobial treatment. In a large European trial involving 27 ICU units among HAP patients, only 54.8% of patients had positive microbiology data.
Invasive MSSA* infection risk factors | MRSA** HAP risk factors |
---|---|
1. Cardiac disease | 1. Tobacco abuse |
2. Diabetes mellitus | 2. Illicit drug abuse |
3. Cancer | 3. Recent hospitalization <90 days |
4. Chronic obstructive pulmonary disease | 4. Recent antibiotics |
5. Hemodialysis | 5. Chronic obstructive pulmonary disease |
6. Stroke | 6. Liver disease |
7. Intravenous drug abuse | 7. HIV infection |
8. Rheumatoid arthritis | |
9. Human immunodeficiency viral infection | |
10. Peritoneal dialysis | |
11. Solid organ transplantation | |
12. Systemic lupus erythematosus |
Invasive MSSA infection risk factors, MRSA HAP risk factors.
MSSA—Methicillin-sensitive
MRSA—Methicillin-resistant
“Created with BioRender.”
1. Prior infection with |
2. |
3. Very severe COPD |
4. Bronchiectasis |
5. Tracheostomy |
6. Neutropenia |
7. Burns |
8. Cystic fibrosis |
9. Long term acute care residents |
“Created with BioRender.”
1. Long term acute care residents |
2. Prior colonization/infection |
3. Longer hospital duration stay |
4. Prior antibiotics use |
5. Acinetobacter skin infections |
6. Poor healthcare worker hygeine |
7. Contamined procedure equipment |
“Created with BioRender.”
A prospective study has revealed the intrinsic and extrinsic risk factors for HAP in non-ICU patients, as shown in Table 4 [6]. Demographically age > 60 years and males are at higher risk of acquiring HAP.
Intrinsic risk factors | Extrinsic risk factors |
---|---|
1. Cancer | 1. Duration of hospitalization >5 days |
2. Chronic obstructive pulmonary disease | 2. Prior antibiotic therapy |
3. Diabetes mellitus | 3. H2 antagonist |
4. Congestive heart failure | 4. Steroids |
5. Chronic renal failure | 5. Antacids |
6. Depression | 6. Chemotherapy |
7. Neutropenia | 7. Prior endotracheal intubation |
8. Obesity | 8. Nasogstric tube |
9. Malnutrition | 9. Nebulization |
10. Liver cirrhosis | 10. Abdominal surgery |
11. Human immunodeficiency virus infection | 11. Prior ICU admission |
12. Thoracic surgery | |
13. Head and neck surgery | |
14. Tracheotomy |
Intrinsic and extrinsic risk factors for HAP in non ICU patients.
“Created with BioRender.com.”
The upper airway and the oropharynx are usually colonized with nonpathogenic microorganisms, including the virulent
Pathophysiology of HAP.
The clinical features of HAP have been summarized as follows in Table 5.
Clinical symptoms | Clinical signs |
---|---|
1. Fever | 1. Tachycardia |
2. Dyspnea | 2. Hypotension |
3. Cough | 3. Tachypnea |
4. Tachypnea | 4. Hypoxia |
5. Chest pain | 5. Rales |
6. Purulent sputum | 6. Wheezing |
7. Hypothermia | 7. Use of accessory respiratory muscles |
8. Generalized weakness | 8. Absent/decreased breath sounds |
9. Confusion | 9. Altered mental status |
Clinical features of hospital-acquired pneumonia.
“Created with BioRender.”
Due to the lack of diagnostic criteria, clinical features need to be supplemented by imaging or laboratory tests for a HAP diagnosis. Imaging is often a portable or a two-view chest radiograph that reveals new pulmonary infiltrates, cavitation, abscess, or pleural effusion. Chest computed tomography (CT) is a gold standard in comparison and has better sensitivity than chest X-rays [34]. Recently, bedside ultrasound has been used to identify new pulmonary infiltrates with 94% sensitivity and 96% specificity [35]. A retrospective trial has revealed that biomarkers procalcitonin and C-reactive protein correlate well with HAP severity and could be a better prognostic marker for mortality and morbidity than neutrophil/lymphocyte count ratio [36]. A complete blood count may demonstrate leukocytosis. The differential count is essential in identifying any neutrophilia, neutropenia, eosinophilia, and a peripheral smear may demonstrate Dohle bodies that are more suggestive of ongoing infection. Microbiological workup can be invasive or noninvasive. Blood cultures with the help of MALDI BioTyper and FilmArray BCID can help rapidly identify the bacteria [37]. In transplant patients, a fungal blood culture would be ideal. Urine legionella and Streptococcal antigens can help identify the cause of pneumonia. Serum Aspergillus antigen assay and β-D-glucan assay is a must in transplant and immunosuppressed individuals when suspected. Nasopharyngeal swab polymerase chain reaction (PCR), also called a respiratory pathogen panel, can be utilized to identify some of the common respiratory bacterial and viral pathogens causing community-acquired pneumonia, which can also cause HAP due to significant exposure prior to admission and in the hospital.
The sputum gram stain, sputum specimen PCR, and culture should be done to identify the suspected etiological agent. If there is a lack of sputum, production then it can be induced by inhaled hypertonic saline. Sputum PCR using BioFire FilmArray Pneumonia or Pneumonia plus panel yields excellent sensitivity and specificity but must be adopted judiciously, and it could provide appropriate clinical information for antimicrobial stewardship [38, 39]. It can also detect atypical bacteria, common viral causes of pneumonia, common mechanisms of resistance and provide semiquantitative results for the common colonizers [40]. It provides valuable data for the clinician to deescalate the antibiotics to a narrow spectrum. This PCR test does not detect oral anaerobes, and they need to be considered with positive imaging and a negative PCR test to cover them with appropriate antibiotics. The PCR test should be done early in the clinical course to avoid false negatives and must be corroborated with the culture as much as possible. A sputum fungal culture or stain also might be helpful in transplant patients.
The invasive strategy involves performing a fibreoptic bronchoscopy, obtaining a bronchioalveolar lavage (BAL) sample, and performing BAL tests, including gram stain, fungal stain, cytology with methenamine stain, and quantitative culture (bacterial and fungal). BAL Aspergillus antigen assay, β-D-glucan assay, fungal and viral PCR assays can detect the causative agent in immunosuppressed or transplant patients. Invasive tests are done seldomly in stable patients as most of these patients are sick, unstable and the procedure may clinically deteriorate them [41]. If the patient during his clinical course gets intubated, then a BAL should be obtained to obtain more clinical information.
The betaLACTA test (BLT) detects GNB insensitivity to third-generation cephalosporins due to carbapenemases, ESBL (extended-spectrum beta-lactamases), and beta-lactamases from acquired AmpC carbapenemases in less than 20 min after exposure to respiratory bacterial cell pellets via chromogenic analysis [42]. The test detects GNB resistance via a colorimetric indicator and can quickly be used for antibiotic de-escalation [43]. It is currently being evaluated for its clinical efficaciousness in France’s multicenter randomized controlled trial (RCT) called BLUE-CarbA [44].
A clinical diagnosis of HAP is currently considered with a new lung infiltrate and two of the four findings, including new-onset temperature > 38 degrees celsius, purulent sputum, and leukocytosis or leukopenia [45]. Most clinical diagnostic scores, including modified clinical pulmonary infection score (CPIS), the older National safety health network (NHSN) pneumonia definition, and the new infection-related Ventilator-associated complication (IVAC), have been used extensively in VAP and not in HAP. NHSN does suggest using the pneumonia definition for nonventilated adult patients for surveillance purposes (Table 6). However, the long-term clinical utility of its use is unknown due to its lack of accuracy and consistency in VAP [46].
1. Two or more serial chest imaging test results with at least one of the following new and persistent or Progressive and persistent (Radiological criteria) |
*Infiltrate/Consolidation/Cavitation |
PLUS |
2. Atleast one of the following (Systemic criteria) |
• Fever (>38.0°C or > 100.4°F) |
• Leukopenia (≤4000 WBC/mm3) or leukocytosis (≥12,000 WBC/mm3) |
• For adults ≥70 years old, altered mental status with no other recognized cause |
PLUS |
3. And at least two of the following (Pulmonary criteria) |
• New onset of purulent sputum or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements |
• New onset or worsening cough, or dyspnea, or tachypnea |
• Rales6 or bronchial breath sounds |
• Worsening gas exchange (for example: O2 desaturations (for example: PaO2/FiO2 ≤ 240)7, increased oxygen requirements, or increased ventilator demand) |
National health safety network definition of pneumonia (NHSN PNEU).
Clinical conditions that may simulate HAP and may need to be considered part of the differential diagnosis are mentioned in Table 7.
1. Pulmonary contusion |
2. Pulmonary inhalation injuries |
3. Atelectasis |
4. Pleural effusion |
5. Pulmonary edema |
6. Pulmonary hemorrhage |
7. Drug-induced pneumonitis |
8. Pulomary infarct/embolism |
9. Vasculitis |
10. Primary or secondary pulmonary neoplasm |
Differential diagnosis of HAP.
Initial inappropriate antibiotic regimens and MDRO are independent indicators of ICU mortality and related to a longer mechanical ventilation duration [47]. Physicians always face a clinical scenario where they have to treat a patient with no lower respiratory specimen with the possibility of pending acute respiratory failure requiring mechanical ventilation [41]. Empirical antibiotic therapy can be based either on institutional epidemiology or a surveillance culture report updated annually. Although they yield similar results, the use of surveillance culture report results in reduced broad-spectrum antibiotics uses even in the presence of higher MDRO risk factors [48]. Individual patient risk factors need to be considered before an initial empirical regimen is started for HAP [49]. A suggestion is to use the local antibiogram in deciding the initial regimen. Most regimens include a broad-spectrum gram-positive coverage (vancomycin or linezolid) and a gram-negative coverage (carbapenem or fourth-generation cephalosporin or a piperacillin-tazobactam). It is prudent to use an antipseudomonal agent to cover gram-negative bacteria in the empirical regimen. MRSA screening of nares has a 96.1% negative predictive value for respiratory cultures [50]. Gram-positive bacterial coverage can be deescalated to MSSA coverage with a negative MRSA nasal screen if the clinical condition warrants it.
For de-escalation, at 48 to 72 h postadmission, procalcitonin plus C-reactive protein and a positive microbiological workup assist the clinical criteria [2]. De-escalation involves a transition from broad-spectrum to narrow-spectrum antimicrobial therapy. For atypical organism coverage, if suspected, rarely responsible for HAP, azithromycin or fluoroquinolone, or doxycycline can be used in addition to the empirical therapy. For
The utilization of any preventive measures to halt HAP should effectively alter the pathophysiology of the disease. Multiple measures have been carried out over the last few decades to prevent HAP or, preferably, VAP with variable degrees of success (Table 8).
Active measures taken | Effectiveness of measure |
---|---|
A. Exposure reduction: All the below-mentioned measures need further evaluation in HAP patients [54]. | |
Limit admission to hospital as much as possible | Increased hospitalization duration is associated with increased sepsis warning scores and increased exposure to HAP pathogens [55]. The risk in elderly patients increases at a rate of 0.3% per day [56]. Decreased duration of hospitalization results in decreased exposure and risk; however, this needs prospective assessment. |
Healthcare worker and equipment hygiene | It prevents microbial spread between patients, health care workers, and essential equipment and improves VAP and catheter-associated bloodstream infection rates [57]. Stethoscopes and portable procedure equipment cleaning with chlorhexidine or alcohol-based sanitizer are ideal [58, 59]. The use of a portable stethoscope separately for each patient is another option [60]. Minimally invasive procedure equipment such as endoscopes and bronchoscopes should be sterilized with stringent protocols. Low compliance is frequent in healthcare workers and needs to be improved with structured educational programs and timely reinforcements [61]. |
Isolation measures | Standard isolation precautions such as universal gowns and gloves are ineffective in preventing the transmission of infections caused by MDRO [62]. However, they are highly effective in preventing |
B. Aspiration reduction: As mentioned above, the below-mentioned measures need validation in HAP patients. | |
Prevent and reduce xerostomia | Xerostomia or oral dryness correlates with fever in dysphagia patients, but its association with HAP is unknown [64]. Also, the effect of xerostomia prevention and treatment with sialogogues on HAP incidence and prevalence is unknown [65]. |
Timely identification of dysphagia | Identifying patients with a higher risk of dysphagia promptly by a higher screening adherence results in lower HAP rates [66]. This is especially important in patients with neurological disorders. Dysphagia evaluation by a speech therapist can lead to modified diets in specific population subsets with a lower incidence of pneumonia [67]. |
Feeding via enteral tubes | Jejunostomy tubes compared to gastric ones result in lower VAP and HAP rates [68]. The use of a motility agent has lead to variable results in a systematic review, and its benefit is questionable [69]. |
Patient position modification | A semi-recumbent position (30° to 45°) during feeding decreases acid reflux and the risk of aspiration with a decline in VAP rates [70]. |
Mobilization | Earlier mobilization stops the functional decline, improves airway clearance, and prevents HAP [71]. Family member’s training helps in extending this benefit outside of the healthcare environment [72]. |
C. Active interventions | |
Oral hygiene | Bad oral hygiene results in increased colonization with airway pathogens and periodontal disease [73]. It can diminish cough reflex and impair airway hygiene leading to pneumonia [74, 75]. Interventions to improve oral hygiene are the best known cost-effective preventive strategy for HAP [5, 76]. Adequate training of nursing staff in oral care practices is critical with timely reinforcements. |
Decontamination of oral, digestive, and skin | Skin decontamination with chlorhexidine decreases VAP, HAI but its effect on HAP is unknown [77]. Oral decontamination with chlorhexidine diminishes VAP rates and increases mortality; however, its implication on HAP is unknown [12, 78]. Selective digestive decontamination (SDD) with oral, topical, and intravenous antibiotics decreased VAP and is thought to be adequate in HAP [79]. SDD use was in countries with lower antibiotic resistance levels, and its long-term effects are unknown [12]. |
Vaccination | Vaccination against hospital pathogens is ineffective [80], whereas monoclonal antibodies have shown promise adjunctively with antibiotics in early trials for |
Medications and other factors | As medications preventing gastric-acid secretions are linked to increased HAP rates, preventing their indiscriminate use is necessary [82]. Adequate glucose control preventing hypo and hyperglycemia is critical in halting airway colonization and pneumonia risk [83, 84]. Probiotics may decrease the HAP rate; however, they have not been evaluated in HAP. |
Airway hygiene | When done preemptively in postoperative and hospitalized pneumonia patients, chest physical therapy has revealed modest preventive effects [85, 86]. |
Respiratory support | Noninvasive ventilation (NIV) decreased nosocomial pneumonia and improved outcomes in specific patient subsets [87]. Although it allows for better airway clearance and comfort, high-flow nasal cannula use did not decrease HAP incidence in two small randomized controlled trials [88, 89]. Recent helmet use in NIV did not decrease HAP rates compared to facemask [90]. |
Staffing practices | Increased nursing staff to patient ratio results in lower HAP and HAI rates [91]. The presence of daytime intensivists correlates with improved mortality overall [92]. The effect of 24 h physician staffing on the HAP rates is unknown. |
HAP preventive measures.
A constant surveillance system absence regarding HAP has prevented effective detection and monitoring of HAP rates in the USA. An objective assessment is hampered by the lack of standard diagnostic criteria, microbiologic and diagnostic coding data [54]. Also, only a few preventive measures have been validated, and the remaining lack adequate clinical data for physicians to implement them successfully. It requires multidisciplinary team involvement for the effective implementation of these preventive measures.
The administratively coded data (ACD) used for billing is limited, and its accuracy is imprecise in HAP detection and surveillance [14]. A better approach to this problem will be to use proven assessed techniques, and this practice should be utilized in HAP detection. The approach should start with creating a specific diagnostic criterion followed by evidence-based guidelines to help in decreasing its incidence and prevalence with additional stress on earlier detection and prevention.
“No external funds were utilized in the manuscript preparation.”
“The author declares no conflict of interest.”
“I thank the editor for letting me author this manuscript.”
Nosocomial pneumonia
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Intensive care unit
Infectious Diseases Society of America
Healthcare-associated pneumonia
Hospital-acquired infections
United States of America
Multi-drug Resistance
Multi-drug Resistance Organism
Human Immunodeficiency virus
Methicillin-sensitive
Methicillin-resistant
Chronic obstructive pulmonary disease
Gram-negative bacilli
Computed tomography
Matrix-assisted laser desorption ionization
Blood Culture ID Panel
Polymerase chain reaction
Bronchioalveolar lavage
betaLACTA test
Extended-spectrum beta-lactamase
Randomized controlled trial
Clinical pulmonary infection score
National health safety network
Infection-related Ventilator-associated complication
Carbapenemase resistance
Selective digestive decontamination
Noninvasive ventilation
Administratively coded data
Rates of pediatric obesity are escalating worldwide. Increasing rates of childhood obesity are likely to translate into a high cumulative incidence of metabolic disease (i.e., type 2 diabetes mellitus (T2D)) and further exacerbate the strain on the healthcare system, public health, and global economy [1]. The development of obesity is often attributed to a combination of genetic and acquired environmental factors. It is well established that the epigenetic transmission of metabolic diseases to offspring will increase their risk for the development of metabolic disorders later in life [2]. Accordingly, environmental exposures (i.e., overnutrition) experienced by parents during intrauterine and early postnatal life will have profound effects on offspring health. Because of the increasing rates of obesity among individuals of child-bearing age, it is critical to develop strategies to prevent the transgenerational propagation of metabolic disease.
It is widely understood that physical activity induces an array of positive metabolic changes that can delay and/or reverse the deleterious effects of obesity. While the mechanisms of action behind the benefits of regular physical exercise are well-documented, research has mostly focused on the person performing the exercise. Consequently, there is limited understanding in the mechanisms by which regular maternal exercise influences the metabolic phenotype of offspring. Further, while studies regarding the effects of maternal exercise on pregnancy, maternal, and offspring outcomes are available and reviewed [3, 4, 5, 6, 7, 8], data which characterizes the mediating factors affecting offspring developmental programming is limited [9]. This is partly due to limitations in revealing the cellular and molecular mechanisms behind maternal exercise-derived benefits that stem from the inability to obtain neonate tissue samples (i.e., skeletal muscle (SkM)).
An understanding of the explicit alterations that maternal exercise causes in the offspring phenotype would allow for the characterization of novel targets and could be used to render different therapeutics for metabolic diseases. Further, elucidating the specific biological mechanisms induced by different exercise modalities could permit this lifestyle intervention to serve analogous to a targeted therapy. Thus, there is potential for different exercise modalities to be used in a prescription-like manner to generate a unique set of metabolic adaptations suitable for treating and/or reducing offspring predispositions to metabolic disease. In view of this possibility, the focus of this chapter will be on describing the mechanisms behind the effects of the maternal exercise on offspring metabolic programing. Emphasis will be on the analysis of the biological mechanisms behind specific metabolic adaptations that promote imperviousness to metabolic challenges (i.e., overnutrition) leading to obesity and T2D. Further, considering that mitochondrial dysfunction and insulin resistance (IR) are major constituents of these metabolic diseases, a focus will be on the alterations in offspring mitochondrial bioenergetics and glycemic control.
The use of rodent models has allowed researchers to study how various environmental factors during critical windows of prenatal and early postnatal development alter metabolic phenotype and elicit tissue specific adaptations in progeny. Considering the ever-increasing rates of obesity, dietary habits, particularly overnutrition, during gestation have a critical role in fetal development and are often the focus of investigations. Maternal obesity and often concomitant IR increase the propensity of the development and transmission of metabolic disease onto progeny. A maternal obesogenic diet during fetal life readily programs first and second generation offspring into a T2D-like phenotype, even without additional dietary insults (i.e., overnutrition) administered to these generations [10].
Maternal obesity elicits multifaceted effects on offspring behavioral habits and physiology. Offspring from obese mothers have a tendency to be physically inactive and hyperphagic [11, 12]. Further, offspring adopt a metabolic syndrome-like phenotype with impaired glucose tolerance, higher blood triglycerides, cholesterol, and leptin, but lower adiponectin levels, which increases offspring predisposition for the development of cardiometabolic disease later in life [11, 12]. Maternal obesogenic diet consumption during gestation increases offspring adiposity primarily through adipocyte hypertrophy [12, 13, 14]. Adipocyte hypertrophy, rather than hyperplasia, is associated with lower insulin responsiveness, inflammation, and an overall dysregulation of systemic energy metabolism [15]. Increased adiposity is further accompanied by a greater intramuscular fat accretion associated with higher PPARγ mRNA expression which could contribute to the development of lipotoxicity-induced SkM IR observed in these offspring [13]. Offspring from obese mothers have a restricted SkM growth potential which subsequently decreases their SkM cross-sectional area [13]. These alterations combined with lower GLUT4 and insulin receptor mRNA expression, as observed in SkM of offspring from obese mothers, attenuates their potential for insulin-stimulated glucose uptake and increase the propensity of offspring to develop hyperglycemia [13]. Considering that SkM is responsible for the majority of postprandial glucose uptake, these alterations have a profound effect on glucose homeostasis and could increase the risk for the development of T2D. Finally, maternal overnutrition leads to the downregulation of pathways associated with mitochondrial oxidation and lowers mitochondrial electron transport protein expression, leading to mitochondrial dysfunction [14].
Together, these alterations can lead to derangements in energy metabolism later in offspring life and increase their proclivity for metabolic disease. In view of this, it is essential to explore the effects of different lifestyle interventions that can alleviate the detrimental effects of maternal obesity on offspring metabolic dysregulation. Regular exercise is known to be protective against metabolic derangements observed in obesity and T2D in mother and offspring. Accordingly, illumination of the effects of maternal exercise on offspring body composition, glycemic control, and mitochondrial functioning will underline mechanistic alterations behind enhanced metabolic phenotype.
While most studies support the notion that exercise before and during gestation has an effect on offspring body weight (BW), findings are inconsistent [9]. Reports remain divided between maternal exercise causing a decrease [16, 17, 18, 19, 20], increase [21, 22], or having no effect on litter [23, 24, 25] or pup BW [26, 27, 28, 29, 30]. Additionally, these studies remain divided between maternal exercise leading to less weight gain with aging in offspring or having no effect on age-related weight gain. For example, Quiclet and associates found no effect of maternal exercise on male offspring BW at weaning or at 7 months of age; however, in their subsequent study, a decrease in BW was observed at weaning and 3 months of age, despite using the same animal and exercise model [17, 28]. Similarly, despite the use of the same animal species and exercising method across studies, change in BW is inconsistent in male offspring from exercising mothers at ~12 months of age [29, 30]. In addition to BW, discrepancies regarding the effect of maternal exercise on body composition have been observed across studies and offspring gender [16, 17, 18, 21, 23, 24, 25, 27, 28, 29, 31]. Carter et al. [26] reported an increase in lean mass and subsequent decrease in fat mass in males ~12 months of age; however, this was not observed in female offspring. Conversely, lower body fat percentages in female offspring have been shown in other studies [16, 19, 31]. Nonetheless, it is worth noting that body composition changes seem to be more prominent in male offspring. This is potentially because of a tendency for greater weight gain with aging; however, the exact reason for the sex-specific differences remains unknown [9].
With consideration of these inconsistencies, it is difficult to determine if offspring BW is a causal factor or is determined by alterations in the metabolic phenotype of the offspring. Interestingly, it has been observed that the alterations in BW, lean and fat mass are secondary to other metabolic improvements and often develop later in offspring life. For instance, improvements in glucose metabolism have been observed in multiple studies regardless of inconsistencies in BW and body composition changes between studies [16, 26, 29, 31]. This suggests that metabolic reprograming is, at least in part, independent of body composition changes and is more likely causal of these alterations with aging or subsequent metabolic challenges (i.e., overnutrition). Accordingly, significantly smaller BW and fat mass gains were observed in sedentary pups from exercised mothers who were fed a high-fat-high-sugar diet (HFHS) compared to HFHS-diet fed pups from non-exercising mothers [17, 20]. This suggests that subsequent nutritional manipulations in offspring may be needed to elicit changes in BW and body composition and to better understand the relationship between changes in BW and metabolic reprogramming.
Since SkM and liver metabolic alterations have a profound impact on the development of systemic metabolic disease, it is important to address how maternal exercise alters metabolism of these tissues. Exercise prior to and during pregnancy increases glucose tolerance and insulin sensitivity across offspring lifespan independent of changes in BW [16, 17, 19, 26, 27, 30, 31] and persist in second generation progeny [32]. Interestingly, in offspring from metabolically healthy exercising mothers, improvements in glucose tolerance are mostly observed in adulthood of the animal rather than early stages of life (i.e., at weaning) [16, 18, 25, 26]. This might be the case considering that the effects of maternal exercise are “diluted” in offspring from metabolically healthy mothers, and therefore these effects might be more pronounced in offspring from mothers with obesity, considering the previously described metabolic derangements that maternal obesity elicits. Accordingly, offspring and maternal glucose intolerance stemming from maternal obesity can be rescued by maternal pregestational and gestation exercise, and this effect is evident in early offspring life [18, 25, 29, 30, 31, 33]. These findings suggest that maternal exercise could enhance the ability of offspring to resist the future development of IR; however, these improvements may not be readily observed in healthy offspring before adulthood or without a subsequent metabolic challenge.
Multiple
Maternal exercise lowers SkM and liver triglyceride content in offspring from both healthy and obese mothers [24, 29, 31]. Lower SkM and liver triglyceride content will decrease the chance of lipid accumulation-induced impairments with insulin signaling and are suggestive of an enhanced oxidative capacity. Maternal exercise increases offspring SkM mitochondrial density, length, and mitochondrial DNA content [19, 34]. These mitochondrial alterations predominantly stem from the effects of maternal exercise on PGC-1α, a key mediator of mitochondrial functioning and biogenesis [19, 34]. Maternal exercise before and during pregnancy attenuates high-fat diet (HFD) induced PGC-1α promoter hypermethylation in offspring SkM, and is able to rescue a HFD induced decrease in PGC-1α gene expression [19, 27]. Interestingly, the effect of maternal exercise on PGC-1α expression has only been observed in adult offspring [27]. This, however, may be an artifact of the rapid proliferation and differentiation of SkM cells during early growth compared to mature SkM, when myogenic cells are quiescent and transcription of genes is predominantly influenced by gene methylation [27]. Higher PGC-1α expression in SkM increases expression of its downstream targets including cytochrome C, a central component of the electron transport chain, which potentiates improvements in the regulation of oxidative phosphorylation [27]. Additionally, in SkM of offspring from exercising mothers, greater cytochrome C oxidase and citrate synthase activities have been observed [34], suggesting that maternal exercise has an effect on mitochondrial oxidative capacity. It is worth noting that similar hypermethylation and lower mRNA expression of PGC-1α is seen in SkM of individuals with T2D [35]. This points to maternal exercise as a potential therapy to ameliorate the transgenerational transmission of mitochondrial dysfunction in humans, by increasing the oxidative capacity as well.
In liver, the maternal exercise induced increase in PGC-1α mRNA expression is accompanied by higher protein expression of phosphorylated AMP-activated protein kinase (AMPK), which is considered to be a master regulator of energy metabolism [36]. This AMPK-PGC-1α axis and its increase is paralleled by an increase in PPARα mRNA expression and is suggestive of a greater potential for fatty acid oxidation. Specifically, maternal exercise enhances gene expression of Acox1 and Acacb, enzymes involved in fatty acid handling and oxidation [36]. Interestingly, while improving the capacity for fatty acid oxidation, maternal exercise simultaneously decreases the potential for fatty acid storage by lowering PPARγ mRNA expression, a gene associated with hepatic steatosis [36, 37]. Further, greater phosphorylated AMPK expression in offspring from exercising mothers leads to greater phosphorylation of acetyl-CoA carboxylase which lowers the availability of malonyl-CoA, a precursor for fatty acid synthesis [36]. It is important to note that these adaptations on a cellular level extend to elicit whole-body protection and lead to lower BW gain and hepatic steatosis after pups are challenged with an obesogenic diet [36]. Overall, maternal exercise driven improvements of offspring mitochondrial bioenergetics are often seen as vital for proper metabolic functioning and resilience to metabolic challenges in adult life. These adaptations could influence the predisposition for the development of metabolic disease by altering mitochondrial substrate “preference” and oxidation capacity.
Maternal exercise increases the affinity for pyruvate and palmitoyl-CoA in offspring SkM mitochondria suggesting easier access of these substrates for the oxidative phosphorylation system (OXPHOS) [17]. Further, maternal exercise has no effect on the Km for palmitoyl-carnitine, which suggests that maternal exercise might be acting specifically on CPT-1, a commonly altered enzyme in obesity-related diseases. Finally, a larger decrease in enzyme affinity is seen for palmitoyl-CoA compared to pyruvate suggesting that maternal exercise increases offspring SkM preference for fatty acid oxidation and potentially explains the previously described decrease in triglyceride content [17, 29]. In addition to altering SkM metabolic pathways, offspring from exercising mothers exhibit greater levels of liver mRNA expression of genes involved in pyruvate metabolism (Pklr, Pcx), the tricarboxylic acid cycle (Pdha1, Pdk4, CS, Idh3a, Mdh2), and fatty acid transport and oxidation (Cd36, Fatp4, Acox, Cpt1) [31]. Together, this data shows that maternal exercise induces an array of adaptations that enhance substrate handling and subsequently increase resilience against future metabolic disease.
Data regarding maternal exercise and offspring OXPHOS capacity is limited. Maternal exercise decreases complex II and III activity and increases complex IV activity [22]. Additionally, when ADP-stimulated respiration is measured in SkM mitochondria from offspring of exercising mothers, there seems to be no effect on complex I and complex I + II respiration; however, data regarding respiration through complex II only is inconsistent with maternal exercise resulting in a decrease or having no effect on complex II maximal respiration [22, 23]. Interestingly, in isolated liver mitochondria from offspring of exercising mothers, lower complex II and higher complex IV activity and content is observed, and accompanied by lower maximal respiration through complex I, II, and I + II. Interestingly, respiratory control ratio (RCR) is lower in offspring mitochondria from both liver and SkM when respiration is supported through complex I and complex I + II [22]. As an index of how coupled respiration is to ADP phosphorylation, this would suggest a lower capacity for phosphorylating respiration to offset electron leak; however, implications about the effect of maternal exercise on offspring mitochondrial efficiency cannot be made as RCR, when used as a proxy of mitochondrial coupling, does not always match the ATP/O ratio, which is a direct measure of mitochondrial coupling [38]. Data regarding alterations in offspring energy efficiency come from oxygen consumption rates in free living conditions. Accordingly, on the level of the whole organism, maternal exercise increases the basal oxygen consumption rate, subsequently protecting offspring from overnutrition-induced obesity by increasing their energy expenditure [20, 30] Together, the limited data suggests that maternal exercise results in adaptations in mitochondrial respiration, but no conclusive remarks can be made considering the inconsistencies between and limited number of studies.
While mitochondria are often described predominantly in the light of energy metabolism, it is important to recognize their function in maintaining redox homeostasis. Mitochondria are mediators of redox balance, and this is influenced by alterations to pro- and antioxidant systems. Disruption of the redox balance due to alterations in mitochondrial bioenergetics or the redox buffering capacity are considered to be an integral part in the etiology of metabolic disease (i.e., IR) [39]. Maternal exercise lowers hydrogen peroxide production with complex II only and complex I + II supporting substrates in both SkM and liver mitochondria [22]; however, the effects seen in SkM are inconsistent across studies indicating maternal exercise may not affect hydrogen peroxide emission [23]. Interestingly, SkM and liver mitochondria from offspring of exercising mothers are protected from reverse electron transport linked hydrogen peroxide emission [22]. Hydrogen peroxide emission via reverse electron flow is often associated with overnutrition and suggests that maternal exercise has a protective effect on offspring redox balance during future metabolic challenges such as overnutrition [39]. In addition to lower hydrogen peroxide emission and subsequently lower reactive oxygen species (ROS) production, maternal exercise enhances glutathione activity in blood and liver [22]. Further, offspring from exercising mothers have lower blood thiol content suggestive of a higher antioxidant capacity. These adaptations are paralleled with higher offspring liver alpha-tocopherol which increases free radical scavenging ability and decreases lipid peroxidation [40, 41, 42]. Maternal exercise further induces a mitochondrial fatty acid profile shift by increasing short-chain and decreasing long-chain fatty acid content [22]. These changes can be beneficial considering that short-chain fatty acids are more resistant to free radical attack and peroxidation and have a positive influence on redox signaling [43, 44]. Finally, maternal exercises increases offspring LON protease (an oxidative stress induced mitochondrial degradation catalyst) and TFAM induced autophagy; these changes are suggestive of a greater mitochondrial turnover rate and overall lower susceptibility to oxidative stress induced mitochondrial dysfunction [24, 34]. Together, these findings suggest that maternal exercise increases antioxidant capacity, decreases ROS production, and lowers the potential accumulation of less functional mitochondria in offspring.
Together, maternal exercise will protect offspring from maternal obesity induced metabolic derangements and has the capacity to increase offspring resilience against future metabolic challenges. Further, offspring metabolic adaptations (Figure 1) as a result of maternal exercise seem to be independent of body composition alterations. These adaptations include improvements in offspring glucose and fatty acid metabolism across two major metabolically active tissues, the liver and SkM. In part, these adaptations are linked to mitochondrial structure remodeling, enhanced bioenergetic function, and greater redox capacity. Finally, it is imperative to keep in mind that cellular metabolic programing precedes improvements detected at the whole-body level making
Maternal exercise enhances offspring metabolism across two major metabolically active tissues, the liver and SkM. Offspring from exercising mothers have lower body weight (BW) and body fat (BF%) gain with age and exhibit enhanced whole body glucose tolerance. Additionally, maternal exercise leads to greater insulin sensitivity, mitochondrial remodeling, and improved bioenergetic function and substrate metabolism in peripheral tissue. Abbreviations: BW, body weight; BF%, body fat percentage; and OXPHOS, oxidative phosphorylation.
While rodent models provide an insight into the effects of maternal exercise on progeny, a major obstacle is analogizing human and animal research considering the vast physiological difference between species. In humans, maternal obesity rates are rising and are in parallel with those of the general population [45, 46]. Pre-pregnancy obesity is likely to translate into excessive gestational weight gain, pre-eclampsia, gestational diabetes, and a greater propensity towards postpartum weight retention [47]. Moreover, maternal obesity increases the risk for congenital anomalies, fetal death, stillbirth, and neonatal, perinatal, and infant death [48, 49]. Increased maternal pre-pregnancy body mass index corelates with increased risk of offspring obesity [50]. Specifically, maternal obesity increases the odds of offspring obesity by 264%, while maternal overweight increases odds by 89% [50]. Neonates born to obese mothers are often large for gestational age with increased adiposity being a major determinant of fetal overgrowth [47]. Besides increasing adiposity, neonates of obese mothers have a higher propensity towards IR independent of maternal glycemia [51, 52]. Finally, maternal obesity is associated with an adverse lipid profile in offspring and an inclination towards the development of metabolic syndrome [53, 54, 55]. While this relationship between maternal and offspring metabolism is readily accepted, limitations in the understanding of epigenetic mechanisms governing infant metabolic reprograming remain. Moreover, the biological mechanisms behind metabolic adaptations that govern offspring metabolic phenotypes remain to be elucidated.
The use of umbilical cord derived mesenchymal stem cells (MSCs) has been recognized as a model for the investigation of metabolic programming of the human offspring donor. This model capitalizes on the multilineage potential of MSCs and their ability to differentiate into various lineages of mesenchymal tissue (muscle, fat, etc.) [56, 57, 58, 59, 60, 61]. The phenotype of MSCs reflects that of the donor rendering it as an advantageous
Prenatal maternal exercise elicits an array of positive benefits for both mother and offspring. Maternal aerobic exercise lowers the risk for the development of gestational diabetes mellitus and lowers gestational weight gain in both healthy and mothers with gestational diabetes [5, 7, 8, 70]. Further, there is an inverse relationship between gestational weight gain and exercise duration and volume with benefits increasing as exercise volume approaches American College of Obstetricians and Gynecologists (ACOG) recommendations of 500 MET-minute weekly [7, 8, 71]. Maternal exercise alone reduces the risk of macrosomia and offspring being large for gestational age without increasing risk of pre-term birth or low birth weight [8, 72, 73]. Further, maternal exercise may have a greater influence on birth weight reduction in maternal obesity, however, evidence remains weak [72, 73]. Similarly, the association of maternal exercise and birth weight remains weeak across multiple meta-analysis including women of all body mass index categories and seems to be driven predominantly by exercise volume [8, 72, 73]. Accordingly, the exercise-induced reduction of offspring birth weight is predominantly observed with exercise volumes over 810 MET-min, which is much greater than the 500 MET-min per week recommendation by ACOG [72]. Finally, birth weight reductions observed with maternal exercise are often not clinically significant (i.e., >300 g) making it hard to conclude if prenatal exercise has a significant effect on fetal birth weight [74, 75]. Additionally, while body weight can be influenced by fat and lean mass, maternal exercise does not seem to effect child morphometrics based on two recent meta-analyses [73, 76]. Nonetheless, while alterations in birth weight are not significant, there is evidence to support the beneficial effects of a prenatal healthy lifestyle (i.e., normal BMI, regular exercise, etc.) on the risk of offspring childhood (child age of 9–14) obesity [77]. Overall, while prenatal exercise influences maternal gestational weight gain, the effects of maternal exercise on offspring birth weight and body composition seem to be minimal. Accordingly, and in line with rodent studies, exercise induced body composition alterations might be secondary to other metabolic improvements and may decrease the risk of obesity development with aging.
The positive effects of exercise extend to maternal metabolic health through improvements in lipid and glucose metabolism. Data suggests that maternal exercise improves maternal metabolism during pregnancy and subsequently alters pregnancy outcomes and the metabolic phenotype of offspring. Physical activity during pregnancy reduces the rise of low density lipoprotein and triglyceride, and lowers delivery and neonatal complications [78, 79, 80, 81, 82]. Maternal blood lipids are associated with infant adiposity and alterations in MSC metabolism in offspring from mothers with obesity [63, 64, 78] suggesting a potential
Aerobic exercise during pregnancy significantly improves maternal glucose metabolism with a greater effect in women with overweight, obesity, and gestational diabetes [84, 85]. In particular, maternal aerobic exercise lowers insulin levels late in pregnancy and reduces the increase in blood insulin levels from 15- to 36-weeks of gestation [86]. Maternal dysglycemia, with or without gestational or type 2 diabetes, has been associated with adverse pregnancy outcomes (i.e., preeclampsia), offspring outcomes (i.e., excessive fetal growth, congenital abnormalities), and an overall increase in postpartum risk of development of T2D in both mother and offspring [87, 88, 89]. Evidence for maternal dysglycemia altering offspring metabolism can be further observed at the level of MSCs where metabolic derangements coincide with derangements in maternal glycemic control (i.e., HOMA-IR) [64]. Further, maternal aerobic exercise increases insulin-mediated glycogen synthesis rates in undifferentiated MSCs suggestive of greater insulin sensitivity [83]. This effect was paralleled with greater insulin-mediated phosphorylation of signaling marker GSK-3β in undifferentiated MSCs. Together, these promising effects could counter the previously described transmission of IR in the case of maternal glucose dysglycemia (i.e., during obesity). In addition to glycogen synthesis, enhanced glucose oxidation efficiency and partitioning of glucose towards oxidation is observed in both undifferentiated and myogenically differentiated MSCs from offspring of aerobically trained mothers. Interestingly, a trend towards a greater capacity for glucose oxidation was observed in myogenically differentiated but not undifferentiated MSCs [83]. It is worth noting that there is greater expression of complex I in myogenically differentiated MSCs, which could in part influence the greater glucose oxidation rates considering that glucose oxidation increases the input of electrons to complex I of mitochondria [83]; however, this effect needs to be further elucidated. As previously described, obesity driven metabolic derangements lead to less efficient mitochondria with a lower oxidative capacity; thus, it is possible that a greater capacity to oxidize glucose may attenuate the transmission of decrements in glucose metabolism across generations. The partitioning of glucose towards oxidation, rather than glycolytic intermediates (i.e., lactate), would lower the propensity towards metabolic disease considering that a lower oxidation capacity and greater lactate production have been linked with T2D [90, 91, 92]. While this data is associative in nature, the importance of exercise in improving the metabolism of both mother and offspring is clear (Figure 2).
Maternal obesity increases pregnancy complications and introduces an array of metabolic derangements in mother and offspring health. Maternal gestational exercise improves many aspects of obesity-induced metabolic alterations and enhances maternal and offspring metabolism. Abbreviations: GWG, gestational weight gain; GDM, gestational diabetes mellitus; MSCs, mesenchymal stem cells; FA, fatty acid; AMPK, AMP-activated protein kinase; and IR, insulin resistance.
The effects of exercise, both acute and chronic, are partly mediated through the production and secretion of bioactive molecules termed cytokines. With exercise, an array of these metabolic factors are released by SkM influencing muscle metabolism as well as crosstalk between SkM and other organs. While extensive reviews have been published on this topic [93, 94], it is worth mentioning that these factors could mediate fetal programing as well. However, this is contingent on their placental blood barrier permeability. Many cytokines (i.e., IL-15, BAIBA, BDNF, Irisin, etc.) have an influence on energy metabolism and an overall positive effect on metabolic disease [93, 94]; however, the involvement of these cytokines in regulating offspring metabolic phenotypes is not yet understood. Recently, the effects of cytokine apelin have been shown to drive maternal exercise-induced metabolic reprogramming in offspring [19, 95]. Maternal exercise elevates apelin signaling which facilitates fetal muscle development and subsequently increases PGC-1α promoter demethylation, mitochondrial biogenesis and remodeling, and mitochondrial capacity [95]. This data suggests that maternal exercise-induced cytokine release could have a direct effect on fetal development by inducing specific adaptations that will later shape offspring metabolism. Accordingly, it is reasonable to postulate that different modes of exercise, based on their differences in cytokine expression profiles and differential metabolic demands [96, 97, 98], could have differing effects on offspring metabolic reprograming.
Exercise modes separate into aerobic and muscular strength training where activity is performed against a low resistance for a longer time or against high resistance for a short duration, respectively. These exercise modalities differ in the adaptations they elicit and are driven by the different energetic demands experienced during activity. During an acute bout of exercise, substrate oxidation is predominantly driven by the intensity and duration of exercise. There is a shift from predominantly fatty acid oxidation during prolonged low-moderate intensity exercise towards an almost exclusive reliance on glycolytic substrates during high-intensity exercise bouts. Aerobic training is often associated with improvements in cardiorespiratory fitness via an increase in maximal oxygen consumption and mitochondrial biogenesis. Specifically, aerobic exercise increases SkM mitochondrial protein synthesis, density, and oxidative function, which subsequently improves endurance capacity [99]. With this, it is not surprising that aerobic exercise results in a greater abundance of proteins involved in mitochondrial ATP production, TCA cycle, transport, and oxidation of fatty acids which are predominantly regulated through PGC-1α expression [99]. In contrast, while the effects of resistance exercise on these parameters are minimal, resistance training increases muscle size, strength, myofibrillar protein synthesis, and anaerobic capacity significantly more than aerobic exercise [99]. Both modalities improve glucose handling and are beneficial for improving glucose control predominantly through enhancing insulin sensitivity (i.e., greater GLUT4 expression) [99, 100, 101]. Additionally, aerobic training improves cardiovascular profiles and decreases adiposity, while resistance training seemingly has a very limited effect on either of these parameters [99]. Overall, while both modalities reduce the risk and lower the derangements of metabolic disease (i.e., obesity), the effects by which aerobic and resistance training influence metabolism vary to a great extent. With this in mind, it is reasonable to postulate that depending on the maternal exercise mode, effects on offspring metabolic reprograming will differ; however, research directly comparing the effects of maternal exercise modes on offspring metabolic health outcomes remains scarce especially with maternal muscular strength training.
While muscular strength training during pregnancy is safe and recommended, most research assessing the effects of prenatal exercise on offspring metabolic health utilizes aerobic only or a combination of aerobic and strength training. While these two exercise modes are beneficial for both maternal and offspring health, a delineation of their independent effects on offspring metabolic health is currently not possible [70]. Further, a comparison of the independent effects of maternal aerobic or strength training on offspring metabolism is primarily limited due to the lack of the studies utilizing maternal strength training [69]. To date, it is shown that a combination of aerobic and strength training during pregnancy increases cardiorespiratory fitness and muscle strength more so than aerobic or strength training alone [70]. Further, combined training has the most significant impact on decreasing gestational weight gain; however, more studies are needed to confirm these findings [70]. Evidence is similarly weak with inconsistent findings on the effects of combined training on improvements in birth weight; however, it is important to note that all exercise interventions increase the chance of the offspring having a normal birth weight and reduce the risk of macrosomia [70]. In conclusion, gestational exercise is safe and recommended considering the resulting array of positive metabolic changes in both mother and offspring.
Considering the prevalence and burden of obesity and T2D in today’s society, it is crucial to identify new targets and treatment approaches to combat these diseases. As discussed, maternal exercise before and/or during pregnancy has a critical influence on offspring metabolism and can decrease their risk of development of metabolic disease later in life. While the current understanding of the precise mechanisms underlying these developmental influences is not fully understood, future work in this area holds immense potential to prevent and alleviate instances of obesity and improve the life-long health of the child.
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\\n\\nIntechOpen has collaborated with Enago, through its sister company, Ulatus – one of the world’s leading providers of book translation services. The services are designed to convey the essence of your work seamlessly to readers from across the globe in their own language. Enago’s expert translators incorporate cultural nuances in translations to make the content relevant for local audiences while retaining the original meaning and style. With a high degree of linguistic and subject expertise, Enago translators are equipped to handle all complex and multiple overlapping themes encompassed in a single book to deliver a superior quality of translation.
\\n\\nIntechOpen Authors that wish to use this service will receive a 20% discount on all translation work. For more information or a quote, please visit: https://www.enago.com/intech.
\\n\\nFUNDING
\\n\\nWe feel that financial barriers should never prevent researchers from publishing their research. Please consult our Open Access Funding page to explore funding opportunities and learn more about how you can finance your IntechOpen publication.
\\n\\nBENEFITS
\\n\\nPUBLISHING PROCESS STEPS
\\n\\nSee a complete overview and description of the steps involved in the publishing process here.
\\n\\nSEND YOUR PROPOSAL
\\n\\nIf you are interested in publishing your book with IntechOpen, please submit your book proposal by completing the Publishing Proposal Form.
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\n\nCOMPACTS-SHORT FORM MONOGRAPH
\n\nCOST
\n\n4,000 GBP Compacts Monograph - Short Form
\n\nThe final price will depend on the volume of the publication and includes project management, editorial and peer-review services, technical editing, language copyediting, cover design, book layout, book promotion and ISBN assignment.
\n\n*The price does not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate applicable in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT by providing us with their VAT registration number. This is made possible by the EU reverse charge method.
\n\nOptional Services
\n\nIntechOpen has collaborated with Enago, through its sister company, Ulatus – one of the world’s leading providers of book translation services. The services are designed to convey the essence of your work seamlessly to readers from across the globe in their own language. Enago’s expert translators incorporate cultural nuances in translations to make the content relevant for local audiences while retaining the original meaning and style. With a high degree of linguistic and subject expertise, Enago translators are equipped to handle all complex and multiple overlapping themes encompassed in a single book to deliver a superior quality of translation.
\n\nIntechOpen Authors that wish to use this service will receive a 20% discount on all translation work. For more information or a quote, please visit: https://www.enago.com/intech.
\n\nFUNDING
\n\nWe feel that financial barriers should never prevent researchers from publishing their research. Please consult our Open Access Funding page to explore funding opportunities and learn more about how you can finance your IntechOpen publication.
\n\nBENEFITS
\n\nPUBLISHING PROCESS STEPS
\n\nSee a complete overview and description of the steps involved in the publishing process here.
\n\nSEND YOUR PROPOSAL
\n\nIf you are interested in publishing your book with IntechOpen, please submit your book proposal by completing the Publishing Proposal Form.
\n\nNot sure if this is the right option for you? Please refer back to the main Publish with IntechOpen page or feel free to contact us directly at book.department@intechopen.com
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Previous dark-matter-only simulations have represented the large-scale structure of the Universe. However, nowadays, hydro-dynamical simulations with baryonic models, which can directly present realistic galaxies, may twist these results from dark-matter-only simulations. In this chapter, we mainly focus on these three statistical methods: power spectrum, two-point correlation function and halo mass function, which are normally used to characterize the large-scale structure of the Universe. We review how these baryon processes influence the cosmology structures from very large scale to quasi-linear and non-linear scales by comparing dark-matter-only simulations with their hydro-dynamical counterparts. 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People construct anthropological cosmologies (notions about the way the world works), drawing in scientific theories in order to construct models for activities in disciplines, such as politics and psychology. In addition, the arts (literature, film and painting, for example) comment on cosmological ideas and use them to develop plot lines and content. This chapter illustrates examples of such work, arguing that scientific cosmology should be understood as a significant cultural influence.",book:{id:"5918",slug:"trends-in-modern-cosmology",title:"Trends in Modern Cosmology",fullTitle:"Trends in Modern Cosmology"},signatures:"Nicholas Campion",authors:[{id:"200410",title:"Dr.",name:"Nicholas",middleName:null,surname:"Campion",slug:"nicholas-campion",fullName:"Nicholas Campion"}]},{id:"60664",doi:"10.5772/intechopen.75877",title:"Galactic Cosmic Rays from 1 MeV to 1 GeV as Measured by Voyager beyond the Heliopause",slug:"galactic-cosmic-rays-from-1-mev-to-1-gev-as-measured-by-voyager-beyond-the-heliopause",totalDownloads:1241,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Voyager 1 has now been beyond the heliopause for over 5 years since its seminal crossing of this boundary in August of 2012. During its epic 40 year journey of ~122 AU out to this boundary and beyond this spacecraft has passed through several regions of the heliosphere including the heliosheath of extent ~30 AU just inside the heliopause (HP), where extremely large and variable intensities of protons, helium and oxygen nuclei as well as electrons between 1 and 100 MeV were observed. Then, suddenly these particles completely vanished and new and completely different spectra of particles between 1 MeV up to ~1 GeV and beyond, instantly recognizable as those for galactic cosmic rays were observed. These spectra and intensities at all energies have remained constant to within ±1% for 5 years corresponding to 20 AU beyond the HP.",book:{id:"6768",slug:"cosmic-rays",title:"Cosmic Rays",fullTitle:"Cosmic Rays"},signatures:"William R. Webber",authors:[{id:"114311",title:"Prof.",name:"William R",middleName:null,surname:"Webber",slug:"william-r-webber",fullName:"William R Webber"}]}],mostDownloadedChaptersLast30Days:[{id:"54580",title:"The Importance of Cosmology in Culture: Contexts and Consequences",slug:"the-importance-of-cosmology-in-culture-contexts-and-consequences",totalDownloads:3316,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Scientific cosmology is the study of the universe through astronomy and physics. However, cosmology also has a significant cultural impact. People construct anthropological cosmologies (notions about the way the world works), drawing in scientific theories in order to construct models for activities in disciplines, such as politics and psychology. In addition, the arts (literature, film and painting, for example) comment on cosmological ideas and use them to develop plot lines and content. This chapter illustrates examples of such work, arguing that scientific cosmology should be understood as a significant cultural influence.",book:{id:"5918",slug:"trends-in-modern-cosmology",title:"Trends in Modern Cosmology",fullTitle:"Trends in Modern Cosmology"},signatures:"Nicholas Campion",authors:[{id:"200410",title:"Dr.",name:"Nicholas",middleName:null,surname:"Campion",slug:"nicholas-campion",fullName:"Nicholas Campion"}]},{id:"55416",title:"Constraining the Parameters of a Model for Cold Dark Matter",slug:"constraining-the-parameters-of-a-model-for-cold-dark-matter",totalDownloads:1292,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter aims at reviewing how modeling cold dark matter as weakly interacting massive particles (WIMPs) gets increasingly constrained as models have to face stringent cosmological and phenomenological experimental results as well as internal theoretical requirements like those coming from a renormalization-group analysis. The review is based on the work done on a two-singlet extension of the Standard Model of elementary particles. We conclude that the model stays viable in physically meaningful regions that soon will be probed by direct-detection experiments.",book:{id:"5918",slug:"trends-in-modern-cosmology",title:"Trends in Modern Cosmology",fullTitle:"Trends in Modern Cosmology"},signatures:"Abdessamad Abada and Salah Nasri",authors:[{id:"54894",title:"Prof.",name:"Salah",middleName:null,surname:"Nasri",slug:"salah-nasri",fullName:"Salah Nasri"},{id:"61340",title:"Dr.",name:"Abdessamad",middleName:null,surname:"Abada",slug:"abdessamad-abada",fullName:"Abdessamad Abada"}]},{id:"69434",title:"Applications of the Abelian Vortex Model to Cosmic Strings and the Universe Evolution",slug:"applications-of-the-abelian-vortex-model-to-cosmic-strings-and-the-universe-evolution",totalDownloads:794,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Due to the wide range of applications and effects of the Abelian vortex model of Nielsen and Olesen in the many areas of physics, ranging from condensed matter to astrophysical effects, some work in the literature is necessary to approach this topic in a succinct form that the undergraduate student in both physics and related areas has the possibility to know and understand. The mechanisms associated with this vortex model indicate him as a strong candidate for the source for the topological defects proposed by Vilenkin.",book:{id:"7357",slug:"new-ideas-concerning-black-holes-and-the-universe",title:"New Ideas Concerning Black Holes and the Universe",fullTitle:"New Ideas Concerning Black Holes and the Universe"},signatures:"Mikael Souto Maior de Sousa and Anderson Alves de Lima",authors:[{id:"274390",title:"Dr.",name:"Mikael Souto",middleName:null,surname:"Maior De Sousa",slug:"mikael-souto-maior-de-sousa",fullName:"Mikael Souto Maior De Sousa"},{id:"284103",title:"Dr.",name:"Anderson",middleName:null,surname:"Alves De Lima",slug:"anderson-alves-de-lima",fullName:"Anderson Alves De Lima"}]},{id:"54849",title:"Superfluid Quantum Space and Evolution of the Universe",slug:"superfluid-quantum-space-and-evolution-of-the-universe",totalDownloads:1813,totalCrossrefCites:5,totalDimensionsCites:6,abstract:"We assume that dark energy and dark matter filling up the whole cosmic space behave as a special superfluid, here named “superfluid quantum space.” We analyze the relationship between intrinsic pressure of SQS (dark energy's repulsive force) and gravity, described as an inflow of dark energy into massive particles, causing a negative pressure gradient around massive bodies. Since no superfluid has exact zero viscosity, we analyze the consequences of SQS’s viscosity on light propagation, and we show that a static Universe could be possible, by solving a modified Navier-Stokes equation. Indeed, Hubble’s law may actually refer to tired light, though described as energy loss due to SQS’s nonzero viscosity instead of Compton scattering, bypassing known historical problems concerning tired light. We see that SQS’s viscosity may also account for the Pioneer anomaly. Our evaluation gives a magnitude of the anomalous acceleration aP = −HΛc = −8.785°10−10 ms−2. Here, HΛ is the Hubble parameter loaded by the cosmological constant Λ. Furthermore, the vorticity equation stemming from the modified Navier-Stokes equation gives a solution for flat profile of the orbital speed of spiral galaxies and discloses what one might call a breathing of galaxies due to energy exchange between the galactic vortex and dark energy.",book:{id:"5918",slug:"trends-in-modern-cosmology",title:"Trends in Modern Cosmology",fullTitle:"Trends in Modern Cosmology"},signatures:"Valeriy I. Sbitnev and Marco Fedi",authors:[{id:"93881",title:"Dr.",name:"Valeriy",middleName:null,surname:"Sbitnev",slug:"valeriy-sbitnev",fullName:"Valeriy Sbitnev"},{id:"200600",title:"Dr.",name:"Marco",middleName:null,surname:"Fedi",slug:"marco-fedi",fullName:"Marco Fedi"}]},{id:"60002",title:"Cosmic Ray Muons as Penetrating Probes to Explore the World around Us",slug:"cosmic-ray-muons-as-penetrating-probes-to-explore-the-world-around-us",totalDownloads:1400,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Secondary cosmic muons provide a powerful probe to explore various aspects of the world around us. Various physical processes have been employed over the last years for such applications. Muon absorption was used to probe the interior of natural and man-made structures, from the Egypt pyramids to big volcanoes, contributing to interdisciplinary studies. Multiple scattering was employed to reconstruct the location of scattering centres, producing 2D and 3D images of the interior of hidden volumes (muon tomography). Additional possibilities of cosmic muons have been exploited even for the alignment of large civil structures and in the study of their stability. All these applications benefit from the development of advanced detection techniques and improvement in software algorithms. This contribution surveys the state of the art of these applications, with special emphasis on their possibilities and limitations.",book:{id:"6768",slug:"cosmic-rays",title:"Cosmic Rays",fullTitle:"Cosmic Rays"},signatures:"Paola La Rocca, Domenico Lo Presti and Francesco Riggi",authors:[{id:"18197",title:"Dr.",name:"Francesco",middleName:null,surname:"Riggi",slug:"francesco-riggi",fullName:"Francesco Riggi"},{id:"18200",title:"Dr.",name:"Paola",middleName:null,surname:"La Rocca",slug:"paola-la-rocca",fullName:"Paola La Rocca"},{id:"243971",title:"Dr.",name:"Domenico",middleName:null,surname:"Lo Presti",slug:"domenico-lo-presti",fullName:"Domenico Lo Presti"}]}],onlineFirstChaptersFilter:{topicId:"221",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:11,numberOfPublishedChapters:91,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:333,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:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:126,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,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:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:13,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. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Rosa María Martínez-Espinosa is a Full Professor of Biochemistry and Molecular Biology at the University of Alicante, Spain, and has been the vice president of International Relations and Development Cooperation at this university since 2010. She created the research group in applied biochemistry in 2017 (https://web.ua.es/en/appbiochem/), and from 1999 to the present has made more than 200 contributions to Spanish and international conferences. Furthermore, she has around seventy-five scientific publications in indexed journals, eighty book chapters, and one patent to her credit. Her research work focuses on microbial metabolism (particularly on extremophile microorganisms), purification and characterization of enzymes with potential industrial and biotechnological applications, protocol optimization for genetically manipulating microorganisms, gene regulation characterization, carotenoid (pigment) production, and design and development of contaminated water and soil bioremediation processes by means of microorganisms. This research has received competitive public grants from the European Commission, the Spanish Ministry of Economy and Competitiveness, the Valencia Region Government, and the University of Alicante.",institutionString:"University of Alicante",institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"312999",title:"Dr.",name:"Bernard O.",middleName:null,surname:"Asimeng",slug:"bernard-o.-asimeng",fullName:"Bernard O. Asimeng",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}}]}},subseries:{item:{id:"19",type:"subseries",title:"Animal Science",keywords:"Animal Science, Animal Biology, Wildlife Species, Domesticated Animals",scope:"The Animal Science topic welcomes research on captive and wildlife species, including domesticated animals. The research resented can consist of primary studies on various animal biology fields such as genetics, nutrition, behavior, welfare, and animal production, to name a few. 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