Treatment approach in acute osteomyelitis [3].
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\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:"11039",leadTitle:null,fullTitle:"Diabetic Eye Disease - From Therapeutic Pipeline to the Real World",title:"Diabetic Eye Disease",subtitle:"From Therapeutic Pipeline to the Real World",reviewType:"peer-reviewed",abstract:"This book provides a comprehensive overview of current concepts in pathogenesis, diagnosis, and treatment of diabetic retinopathy. It is a collection of chapters written by experts that discuss advances in the understanding of pathophysiology, inflammatory and immunological factors and emerging concepts, clinical aspects, diagnostic management, and treatment strategies.",isbn:"978-1-83969-765-4",printIsbn:"978-1-83969-764-7",pdfIsbn:"978-1-83969-766-1",doi:"10.5772/intechopen.95737",price:119,priceEur:129,priceUsd:155,slug:"diabetic-eye-disease-from-therapeutic-pipeline-to-the-real-world",numberOfPages:294,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"22986eb45c0b2692661bc8f8804045d0",bookSignature:"Giuseppe Lo Giudice",publishedDate:"April 6th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11039.jpg",numberOfDownloads:1332,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:1,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:1,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2021",dateEndSecondStepPublish:"May 6th 2021",dateEndThirdStepPublish:"July 5th 2021",dateEndFourthStepPublish:"September 23rd 2021",dateEndFifthStepPublish:"November 22nd 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"87607",title:"M.D.",name:"Giuseppe",middleName:null,surname:"Lo Giudice",slug:"giuseppe-lo-giudice",fullName:"Giuseppe Lo Giudice",profilePictureURL:"https://mts.intechopen.com/storage/users/87607/images/system/87607.png",biography:"Giuseppe Lo Giudice obtained an MD from the University of Messina, Italy and completed an ophthalmological residency at the Department of Ophthalmology, University of Padua, Italy. He was a fellow at the Ophthalmology Department of the Gironcoli Ophthalmic Center from 2002 to 2004, and an assistant in ophthalmology at Conegliano Hospital Conegliano, Treviso, Italy from 2004 to 2007. Since 2007, he has been a surgeon and vice-director at San Antonio Hospital, University of Padua, Italy. His major fields of interest are treatments for retinal diseases (proliferative retinopathies, AMD, and diabetic retinopathy) and vitreoretinal surgery. He has more than 25 years of experience in clinical research as well as in clinical trials and laboratory research. He has performed more than 10,000 anterior segment surgeries (cataract surgery, glaucoma surgery, corneal transplantation) in the last five years. He has also performed more than 700 vitreo-retinal surgeries for ocular trauma, complicated cataracts, retinal pucker, retinal detachment, and vitreoretinal proliferative disease in the last two years at Saint Antonio Hospital. Dr. Lo Giudice has authored two books and edited two book chapters. He has contributed several research articles and book chapters in national and international books and serves as a reviewer for many ophthalmology journals.",institutionString:"University of Padua",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Azienda Ospedaliera di Padova",institutionURL:null,country:{name:"Italy"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"191",title:"Ophthalmology",slug:"medicine-ophthalmology"}],chapters:[{id:"79540",title:"Pathophysiology of Diabetic Retinopathy",doi:"10.5772/intechopen.100588",slug:"pathophysiology-of-diabetic-retinopathy",totalDownloads:52,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetic retinopathy is a prototypical microvascular disorder. Hyperglycemia causes a multiple pathological changes in the retinal vasculature. It has been suggested that apoptosis of pericytes due to high glucose levels plays a key role in the development of the earliest events during diabetic retinopathy. Advancement of the disease resulted in a progressive vessel leakage leading to edematous distortion of macula and increase in hypoxia inducing development of neovascularization with sight threatening complications. Four basis hypotheses explaining the hyperglycemia harmful effects were suggested: (1) increased glucose flux through the aldose reductase pathway, (2) overproduction of advanced glycation end products, (3) activation of protein kinase C isoforms, and (4) increased glucose flux via the hexosamine pathway. It was admitted as well that apoptosis of neurons and glial cell activation occur even earlier than vascular damage. Disturbance in glial cell functions leads to increase in metabolic abnormalities such as glutamate accumulation, promotion of inflammation, and oxidative stress resulting in neuron apoptosis and deterioration of vascular disorders. Clarification of significant biochemical mechanisms involving in the development of diabetic retinopathy can help to create new effective ways in diabetic retinopathy treatment.",signatures:"Natalia Lobanovskaya",downloadPdfUrl:"/chapter/pdf-download/79540",previewPdfUrl:"/chapter/pdf-preview/79540",authors:[{id:"416183",title:"Ph.D.",name:"Natalia",surname:"Lobanovskaya",slug:"natalia-lobanovskaya",fullName:"Natalia Lobanovskaya"}],corrections:null},{id:"78434",title:"High-Risk Diabetic Maculopathy: Features and Management",doi:"10.5772/intechopen.99748",slug:"high-risk-diabetic-maculopathy-features-and-management",totalDownloads:122,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A substantial group of patients with diabetic macular edema in our clinical practice is at high risk for profound and irreversible vision deterioration. Early identification of modifiable factors with long-term negative impact and their management, close monitoring and timely adjustments in the treatment can significantly reduce the probability of visual disability in the individual patient. This approach can also provide important guidelines for proactive decision making in order to avoid the risk of suboptimal response and unsatisfactory outcome.",signatures:"Maya G. Pandova",downloadPdfUrl:"/chapter/pdf-download/78434",previewPdfUrl:"/chapter/pdf-preview/78434",authors:[{id:"300935",title:"Ph.D.",name:"Maya G.",surname:"Pandova",slug:"maya-g.-pandova",fullName:"Maya G. Pandova"}],corrections:null},{id:"78546",title:"Role of Inflammation in Diabetic Retinopathy",doi:"10.5772/intechopen.100175",slug:"role-of-inflammation-in-diabetic-retinopathy",totalDownloads:113,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"As the global burden of diabetes is increasing there is a corresponding increase in the complications associated with the same. Diabetic retinopathy is a sight threatening complication of diabetes mellitus which was considered to be a microvasculopathy. Recent evidence however, has brought to light that inflammation may be a key player in the pathogenesis of this condition. Levels of inflammatory mediators like Hypoxia inducible factor, TNF-α, IL-6 and IL-1B amongst others have been noted to be elevated in the diabetic vitreous gel. The concept of the neurovascular unit better explains the changes that take place resulting in the breakdown of the blood retinal barriers and how these inflammatory mediators affect the morphology of the retina at a cellular level. Glial cells form a key instrument of this neurovascular structure and are also the cells from where the inflammatory response is initiated. Understanding of the pathogenesis of diabetic retinopathy will help us in finding targeted therapies which may provide long term benefits and possible cure. Few anti-inflammatory medications have shown promise albeit in a small clinical or experimental laboratory setting. However, future research may lead to better understanding of the disease and a better pharmacological intervention.",signatures:"Anuj Sharma and Deepesh Arora",downloadPdfUrl:"/chapter/pdf-download/78546",previewPdfUrl:"/chapter/pdf-preview/78546",authors:[{id:"414916",title:"Dr.",name:"Anuj",surname:"Sharma",slug:"anuj-sharma",fullName:"Anuj Sharma"},{id:"429416",title:"Dr.",name:"Deepesh",surname:"Arora",slug:"deepesh-arora",fullName:"Deepesh Arora"}],corrections:null},{id:"78337",title:"Local Inflammatory Biomarkers and Potential Inflammation-Targeting Therapies in Diabetic Retinopathy",doi:"10.5772/intechopen.99807",slug:"local-inflammatory-biomarkers-and-potential-inflammation-targeting-therapies-in-diabetic-retinopathy",totalDownloads:110,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Diabetic retinopathy (DR) is one of the most frequent microvascular complications of diabetes. A large body of evidence supports the role of inflammation in the development and progression of DR. Currently, DR is diagnosed based on the presence of morphological lesions detected on fundus examination. Yet, there are other laboratory or imaging biomarker whose alteration precede DR lesions. This chapter will first briefly explain the role of inflammation in DR pathogenesis and will analyze the molecules involved. Further, it will discuss significant and recent studies that analyzed local laboratory or imaging inflammatory biomarkers in different DR stages. It will then focus on several potential inflammation-targeting therapies which proved to be effective in animal or human studies. Validation of these reviewed biomarkers would allow the identification of patients who do not respond to the current available treatment and could benefit from an adjunctive therapy.",signatures:"Ioana Damian and Simona Delia Nicoară",downloadPdfUrl:"/chapter/pdf-download/78337",previewPdfUrl:"/chapter/pdf-preview/78337",authors:[{id:"87785",title:"Prof.",name:"Simona-Delia",surname:"Nicoara",slug:"simona-delia-nicoara",fullName:"Simona-Delia Nicoara"},{id:"416521",title:"Dr.",name:"Ioana",surname:"Damian",slug:"ioana-damian",fullName:"Ioana Damian"}],corrections:null},{id:"78682",title:"Role of Lipid, Protein-Derived Toxic Molecules, and Deficiency of Antioxidants behind the Pathogenesis of Diabetic Retinopathy (DR) in Type 2 Diabetes Mellitus",doi:"10.5772/intechopen.99904",slug:"role-of-lipid-protein-derived-toxic-molecules-and-deficiency-of-antioxidants-behind-the-pathogenesis",totalDownloads:80,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"To determine the role of NADPH-oxidase mediated formation of different lipid, protein-derived molecules, and depletion of vitamin-C level in vitreous behind the endothelial dysfunction-induced vascular endothelial growth factor secretion and pathogenesis of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM). Fourteen T2DM patients with mild non-proliferative diabetic retinopathy (MNPDR), 11 patients without diabetic retinopathy (DNR), 17 T2 DM subjects with high-risk proliferative diabetic retinopathy (HRPDR), and 5 healthy individuals without DM underwent vitreous analysis for estimation NADPH oxidase, lipid peroxide like malondialdehyde (MDA), 4-Hydroxy-noneal (HNE) and advanced lipoxidation end product (ALE) like Hexanoyl-lysine (HLY), protein carbonyl compound (PCC), Vitamin-C and concentration of vascular endothelial growth factor (VEGF) secretion following standard spectrophotometric methods and enzyme-linked immunosorbent assay (ELISA). Vitreous concentration of NADPH-oxidase, different protein and lipid-derived molecule, and VEGF were found to be significantly elevated among DNR and of DR subjects with different grades compared to HC subjects whereasthe vitamin-C level was found to be decreased among different DR subjects and DNR subjects in comparison to healthy individuals. Oxidative stress-mediated lipid and protein-derived biomolecules not only add important mediators in the pathogenesis of DR, but also accelerate the progression and severity of microangiopathy.",signatures:"Subhasish Pramanik, Lakshmi Kanta Mondal, Subhankar Chowdhury, Chiranjit Bose, Debgopal Bera and Koena Bhattacharjee",downloadPdfUrl:"/chapter/pdf-download/78682",previewPdfUrl:"/chapter/pdf-preview/78682",authors:[{id:"222949",title:"Prof.",name:"Lakshmi Kanta",surname:"Mondal",slug:"lakshmi-kanta-mondal",fullName:"Lakshmi Kanta Mondal"},{id:"419947",title:"Mr.",name:"Subhasish",surname:"Pramanik",slug:"subhasish-pramanik",fullName:"Subhasish Pramanik"},{id:"419948",title:"Prof.",name:"Subhankar",surname:"Chowdhury",slug:"subhankar-chowdhury",fullName:"Subhankar Chowdhury"},{id:"419949",title:"Mr.",name:"Chiranjit",surname:"Bose",slug:"chiranjit-bose",fullName:"Chiranjit Bose"},{id:"419950",title:"Mr.",name:"Debgopal",surname:"Bera",slug:"debgopal-bera",fullName:"Debgopal Bera"},{id:"419951",title:"Ms.",name:"Koena",surname:"Bhattacharjee",slug:"koena-bhattacharjee",fullName:"Koena Bhattacharjee"}],corrections:null},{id:"79139",title:"Optical Coherence Tomography in Diabetic Retinopathy",doi:"10.5772/intechopen.100587",slug:"optical-coherence-tomography-in-diabetic-retinopathy",totalDownloads:112,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Optical coherence tomography (OCT) has become an indispensable modality of investigation in the assessment of diabetic retinopathy. It is a non-invasive and reliable imaging tool that provides a comprehensive analysis of the retina. The images are obtained very fast. It is useful for quantitative as well as qualitative assessment of structural changes that occur in diabetic retinopathy. It also enables the detection of subclinical diabetic macular edema. Various imaging biomarkers have been identified on OCT imaging. These markers help prognosticate the case and determine treatment response. The follow-up imaging helps assess the response to treatment and detect recurrence of disease or need for further treatment.",signatures:"Surabhi Ruia and Koushik Tripathy",downloadPdfUrl:"/chapter/pdf-download/79139",previewPdfUrl:"/chapter/pdf-preview/79139",authors:[{id:"414944",title:"Dr.",name:"Surabhi",surname:"Ruia",slug:"surabhi-ruia",fullName:"Surabhi Ruia"},{id:"424515",title:"Dr.",name:"Koushik",surname:"Tripathy",slug:"koushik-tripathy",fullName:"Koushik Tripathy"}],corrections:null},{id:"79539",title:"Adaptive Optics Imaging Technique in Diabetic Retinopathy",doi:"10.5772/intechopen.101266",slug:"adaptive-optics-imaging-technique-in-diabetic-retinopathy",totalDownloads:91,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Adaptive optics ophthalmoscopy opened a new era in the medical retina field. The possibility of obtaining high-resolution retinal images of photoreceptors and retinal vessels addresses new perspectives in retinal physiology and pathophysiology. The overwhelming incidence of diabetes in the global population justifies the need to develop and refine methods of diagnosing early retinal changes, in order to preserve vision and avoid complications. The current grading of diabetic retinopathy is based on clinical changes only. Nevertheless, imaging tools such as optical coherence tomography and optical coherence tomography angiography are also used for screening of this pathology. The corroboration of the information provided by these imaging methods may lay the foundations for a new approach to the definition and diagnosis of diabetic retinopathy.",signatures:"Florian Baltă, Irina Elena Cristescu and Ioana Teodora Tofolean",downloadPdfUrl:"/chapter/pdf-download/79539",previewPdfUrl:"/chapter/pdf-preview/79539",authors:[{id:"416073",title:"Dr.",name:"Irina",surname:"Elena Cristescu",slug:"irina-elena-cristescu",fullName:"Irina Elena Cristescu"},{id:"416145",title:"Prof.",name:"Florian",surname:"Baltă",slug:"florian-balta",fullName:"Florian Baltă"},{id:"418025",title:"Dr.",name:"Ioana Teodora",surname:"Tofolean",slug:"ioana-teodora-tofolean",fullName:"Ioana Teodora Tofolean"}],corrections:null},{id:"80056",title:"Anatomic and Topographic Vitreous and Vitreoretinal Interface Features during Chromovitrectomy of A, B, C Stages of Proliferative Diabetic Vitreoretinopathy (P. Kroll’s Classification of Proliferative Diabetic Vitreoretinopathy, 2007):Fyodorov’s Eye Micro",doi:"10.5772/intechopen.101724",slug:"anatomic-and-topographic-vitreous-and-vitreoretinal-interface-features-during-chromovitrectomy-of-a-",totalDownloads:80,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Methods and results of the developed vitreous body imaging technique in proliferative diabetic vitreoretinopathy diagnostics using new contrast dye during operation. The P. Kroll”s classification of proliferative diabetic retinopathy was modified after receiving new data about vitreoretinal interface structures during investigation using chromovitrectomy.",signatures:"Natalia Kislitsyna and Sergei Novikov",downloadPdfUrl:"/chapter/pdf-download/80056",previewPdfUrl:"/chapter/pdf-preview/80056",authors:[{id:"415195",title:"Assistant Prof.",name:"Natalia",surname:"Kislitsyna",slug:"natalia-kislitsyna",fullName:"Natalia Kislitsyna"},{id:"423387",title:"MSc.",name:"Sergei",surname:"Novikov",slug:"sergei-novikov",fullName:"Sergei Novikov"}],corrections:null},{id:"79905",title:"Current Management of Diabetic Macular Edema",doi:"10.5772/intechopen.100157",slug:"current-management-of-diabetic-macular-edema",totalDownloads:123,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetic macular edema is a complication of diabetes mellitus (DM) which contributes significantly to the burden of visual impairment amongst persons living with diabetes. Chronic hyperglycemia triggers a cascade of pathologic changes resulting in breakdown of the retinal blood barrier. Understanding the pathophysiological and biochemical changes occurring in diabetes has led to developing novel therapeutics and effective management strategies for treating DME. The clinical utility of optical coherence tomography (OCT) imaging of the retina provides a detailed assessment of the retina microstructure, valid for individualization of patient treatment and monitoring response to treatment. Similarly, OCT angiography (dye-less angiography), another innovation in imaging of DME, provides an understanding of retinal vasculature in DME. From the earlier years of using retinal laser photocoagulation as the gold standard for treating DME, to the current use of intravitreal injection of drugs, several clinical trials provided evidence on safety and efficacy for the shift to intravitreal steroids and anti-vascular endothelial growth factor use. The short durability of available drugs leading to frequent intravitreal injections and frequent clinic visits for monitoring constitute an enormous burden. Therefore, extended durability drugs are being designed, and remote monitoring of DME may be a solution to the current challenges.",signatures:"Ogugua Ndubuisi Okonkwo, Toyin Akanbi and Chineze Thelma Agweye",downloadPdfUrl:"/chapter/pdf-download/79905",previewPdfUrl:"/chapter/pdf-preview/79905",authors:[{id:"243927",title:"Dr.",name:"Ogugua",surname:"Ndubuisi Okonkwo",slug:"ogugua-ndubuisi-okonkwo",fullName:"Ogugua Ndubuisi Okonkwo"},{id:"429205",title:"Dr.",name:"Toyin",surname:"Akanbi",slug:"toyin-akanbi",fullName:"Toyin Akanbi"},{id:"429206",title:"Dr.",name:"Chineze",surname:"Thelma Agweye",slug:"chineze-thelma-agweye",fullName:"Chineze Thelma Agweye"}],corrections:null},{id:"78448",title:"Treatment Algorithm in Proliferative Diabetic Retinopathy - From Protocols to the Real World",doi:"10.5772/intechopen.99843",slug:"treatment-algorithm-in-proliferative-diabetic-retinopathy-from-protocols-to-the-real-world",totalDownloads:111,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetes mellitus is a global epidemic that leads to multiple macrovascular and microvascular complications. The complex interrelated pathophysiological mechanisms triggered by hyperglycemia underlie the development of diabetic retinopathy (DR). Proliferative diabetic retinopathy (PDR) is a microvascular complication, considered the main cause of irreversible blindness in patients of productive age in the world. On the other hand, diabetic macular edema (DME) remains the clinical feature most closely associated with vision loss. In general, both manifestations are due to an increase in inflammatory factors, such as specific pro-inflammatory prostaglandins, interleukins and angiogenic substances including vascular endothelial growth factor (VEGF). Laser photocoagulation and VEGF inhibitors have been shown to be effective in the treatment of PDR and DME. Currently, randomized protocols suggest that VEGF inhibitors therapy could displace laser photocoagulation in the treatment of PDR with and without the presence of DME. The ongoing discussion still prevails about the different treatment modalities for both retinal manifestations in real-world settings.",signatures:"Jesus Hernan Gonzalez-Cortes, Jesus Emiliano Gonzalez-Cantu, Aditya Sudhalkar, Sergio Eustolio Hernandez-Da Mota, Alper Bilgic, Javier Alan Garza-Chavarria and Jesus Mohamed-Hamsho",downloadPdfUrl:"/chapter/pdf-download/78448",previewPdfUrl:"/chapter/pdf-preview/78448",authors:[{id:"271421",title:"Dr.",name:"Jesus Hernan",surname:"Gonzalez-Cortes",slug:"jesus-hernan-gonzalez-cortes",fullName:"Jesus Hernan Gonzalez-Cortes"},{id:"284712",title:"Mr.",name:"Jesus Emiliano",surname:"Gonzalez-Cantu",slug:"jesus-emiliano-gonzalez-cantu",fullName:"Jesus Emiliano Gonzalez-Cantu"},{id:"341004",title:"Dr.",name:"Sergio Eustolio",surname:"Hernandez-Da Mota",slug:"sergio-eustolio-hernandez-da-mota",fullName:"Sergio Eustolio Hernandez-Da Mota"},{id:"415900",title:"Dr.",name:"Aditya",surname:"Sudhalkar",slug:"aditya-sudhalkar",fullName:"Aditya Sudhalkar"},{id:"416049",title:"Dr.",name:"Jesus",surname:"Mohamed-Hamsho",slug:"jesus-mohamed-hamsho",fullName:"Jesus Mohamed-Hamsho"},{id:"421464",title:"Dr.",name:"Javier Alan",surname:"Garza-Chavarria",slug:"javier-alan-garza-chavarria",fullName:"Javier Alan Garza-Chavarria"},{id:"429644",title:"Dr.",name:"Alper",surname:"Bilgic",slug:"alper-bilgic",fullName:"Alper Bilgic"}],corrections:null},{id:"78191",title:"Angiopoietins as Targets for Diabetic Retinopathy Treatment",doi:"10.5772/intechopen.99749",slug:"angiopoietins-as-targets-for-diabetic-retinopathy-treatment",totalDownloads:130,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetic eye diseases, such as diabetic retinopathy (DR) and diabetic macular edema (DME) are among the leading causes of blindness in developed countries. Anti-VEGF therapies such as, ranibizumab, aflibercept and off-label bevacizumab have become first-line treatment for DME. While randomized controlled trials show significant improvement in vision, these anti-VEGF agents have limited durability leading to a significant treatment burden, as reflected in real-world studies, which generally demonstrate under-treatment and less favorable visual acuity outcomes than observed in prospective trials. Alternative pathways, such as the Tie-2 angiopoietin pathway may address unmet needs, with potential for greater efficacy or durability when compared to anti-VEGF monotherapy. While some Tie-2 angiopoietin therapeutic agents, such as nesvacumab, ARP-1536 or AKB-9778, did not meet primary endpoints in clinical trials, other agents have shown promise. One such agent is faricimab, a bispecific antibody inhibiting both VEGF-A and Ang-2. The phase 3 DME trials (YOSEMITE and RHINE) demonstrated favorable safety, visual, and durability outcomes; patients receiving faricimab injection every 4 months achieved similar visual gains as those receiving aflibercept injection every 2 months. Another agent, AXT107 is a peptide that inhibits VEGFR2 and modifies Ang-2 to behave more similarly to Ang-1, promoting vascular stability. This drug is currently undergoing phase 1/2a trials for safety and bioactivity to be completed in May 2022.",signatures:"Lauren M. Ciulla, Nimesh A. Patel, Nicolas A. Yannuzzi and Rehan M. Hussain",downloadPdfUrl:"/chapter/pdf-download/78191",previewPdfUrl:"/chapter/pdf-preview/78191",authors:[{id:"416191",title:"Dr.",name:"Rehan M.",surname:"Hussain",slug:"rehan-m.-hussain",fullName:"Rehan M. Hussain"},{id:"416985",title:"Ms.",name:"Lauren M.",surname:"Ciulla",slug:"lauren-m.-ciulla",fullName:"Lauren M. Ciulla"},{id:"421731",title:"Dr.",name:"Nimesh A.",surname:"Patel",slug:"nimesh-a.-patel",fullName:"Nimesh A. Patel"},{id:"421732",title:"Dr.",name:"Nicolas A.",surname:"Yannuzzi",slug:"nicolas-a.-yannuzzi",fullName:"Nicolas A. Yannuzzi"}],corrections:null},{id:"79169",title:"Diabetic Retinopathy and Stem Cell Therapy",doi:"10.5772/intechopen.100812",slug:"diabetic-retinopathy-and-stem-cell-therapy",totalDownloads:69,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This overview was evaluated by the development of diabetic retinopathy (DR) and the stem cell therapy approach. DR is a microvascular complication of diabetes mellitus, characterized by damage to the retinal blood vessels leading to progressive loss of vision. However, the pathophysiological mechanisms are complicated and not completely understood yet. The current treatment strategies have included medical, laser, intravitreal, and surgical approaches. It is known that the use of mesenchymal stem cells (MSC), which has a great potential, is promising for the treatment of many degenerative disorders, including the eye. In retinal degenerative diseases, MSCs were ameliorated retinal neurons and retinal pigmented epithelial cells in both in vitro and in vivo studies. Stem cell therapies show promise in neurodegenerative diseases. However, it is very important to know which type of stem cell will be used in which situations, the amount of stem cells to be applied, the method of application, and its physiological/neurophysiological effects. Therefore, it is of great importance to evaluate this subject physiologically. After stem cell application, its safety and efficacy should be followed for a long time. In the near future, widespread application of regenerative stem cell therapy may be a standard treatment in DR.",signatures:"Sevil Kestane",downloadPdfUrl:"/chapter/pdf-download/79169",previewPdfUrl:"/chapter/pdf-preview/79169",authors:[{id:"416701",title:"Associate Prof.",name:"Sevil",surname:"Kestane",slug:"sevil-kestane",fullName:"Sevil Kestane"}],corrections:null},{id:"79640",title:"Vitrectomy in Diabetic Retinopathy",doi:"10.5772/intechopen.101358",slug:"vitrectomy-in-diabetic-retinopathy",totalDownloads:139,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Diabetic vitrectomy is a complicated vitreoretinal surgery due to the complex interaction of various factors. Indications of vitrectomy in diabetes patients would comprise of non-resolving vitreous haemorrhage, taut posterior hyaloid causing vitreo-papillary traction, vitreomacular traction, non-resolving macular edema due to epiretinal membrane, posterior pole tractional retinal detachment or combined retinal detachment. Pre-operative systemic evaluation, a thorough clinical evaluation with ancillary investigations like ultrasound and optical coherence tomography are important for planning the surgery. In this chapter, we would be discussing the basic principles of PVD induction, surgical steps and techniques involved in diabetic vitrectomy. Complications associated can be intraoperative or post-operative. Intra-operative complications would include corneal edema, cataract, bleeding and iatrogenic breaks. Post-operative complications can be divided into early and late, which include vitreous cavity bleeding, raised intraocular pressure, reproliferation, epiretinal membrane, cataract, glaucoma and hypotony.",signatures:"Payal Naresh Shah, Mahesh P. Shanmugam and Divyansh K. Mishra",downloadPdfUrl:"/chapter/pdf-download/79640",previewPdfUrl:"/chapter/pdf-preview/79640",authors:[{id:"415783",title:"Dr.",name:"Payal",surname:"Naresh Shah",slug:"payal-naresh-shah",fullName:"Payal Naresh Shah"},{id:"443141",title:"Dr.",name:"Mahesh",surname:"P. Shanmugam",slug:"mahesh-p.-shanmugam",fullName:"Mahesh P. Shanmugam"},{id:"443142",title:"Dr.",name:"Divyansh",surname:"K. Mishra",slug:"divyansh-k.-mishra",fullName:"Divyansh K. 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It discusses the different types of brachial plexus injury and advances in surgical treatments.",isbn:"978-1-83969-687-9",printIsbn:"978-1-83969-686-2",pdfIsbn:"978-1-83969-688-6",doi:"10.5772/intechopen.94695",price:119,priceEur:129,priceUsd:155,slug:"brachial-plexus-injury-new-techniques-and-ideas",numberOfPages:176,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"94c1a38f1ee7a078ee6ec640360c39f2",bookSignature:"Jörg Bahm",publishedDate:"January 26th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10723.jpg",keywords:null,numberOfDownloads:1462,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 11th 2021",dateEndSecondStepPublish:"April 8th 2021",dateEndThirdStepPublish:"June 7th 2021",dateEndFourthStepPublish:"August 26th 2021",dateEndFifthStepPublish:"October 25th 2021",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a year",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:"Edited by",kuFlag:!1,biosketch:"A dedicated and experienced microsurgeon focussing on reconstructive microsurgery for upper limb motion disorders, especially brachial plexus lesions and spasticity. Dr. Bahm is a member of the Belgian (BHG) and German (DGH) Association of Hand Surgeons, a Member of the German Plastic Surgeons Association (DGPRÄC), Member of the german “Nerv Club” and “Narakas club” for brachial plexus surgery.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"78207",title:"Prof.",name:"Jörg",middleName:null,surname:"Bahm",slug:"jorg-bahm",fullName:"Jörg Bahm",profilePictureURL:"https://mts.intechopen.com/storage/users/78207/images/system/78207.jpg",biography:"Jörg Bahm obtained an MD in 1987 and a Ph.D. from Université libre de Bruxelles (ULB), Brussels, Belgium in 2011. As a general, plastic, and hand surgeon, Dr. Bahm worked for five years at University Hospital Aachen, Germany. Since 1994, he has focused on brachial plexus surgery. He has been a chief surgeon in the Reconstructive Microsurgery Unit of the Franziskushospital, Aachen, Germany since 2000. In 2020, this unit was transferred into the Aachen University Hospital as the Division for Plexus Surgery within the Department for Plastic, Hand and Burn Surgery. \nSince 2003, Dr. Bahm has been a consultant for peripheral nerves in the Orthopaedic Department, Erasme University Hospital, Brussels, Belgium. He is an active member of the German (DGH) and Belgian (BHG) Hand Surgery Society and of the German Plastic Surgery Society (DGPRÄC). He is a member of the Narakas club for brachial plexus surgery and editor of the online Journal of Brachial Plexus and Peripheral Nerve Injury. He has written more than 50 scientific papers and presented at more than 200 congresses.\nDr. Bahm was president of the BHG in 2012 and 2013 and congress president of the FESSH Hand Surgery congress 2012 in Antwerp, Belgium.\nHis specific interests are peripheral nerve surgery and microsurgical reconstruction of the upper limb.",institutionString:"RWTH University Hospital",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Universitätsklinikum Aachen",institutionURL:null,country:{name:"Germany"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1148",title:"Neurosurgery",slug:"neurosurgery"}],chapters:[{id:"79635",title:"Introductory Chapter: Treatment of Brachial Plexus Lesions - A New Transdisciplinary Approach",slug:"introductory-chapter-treatment-of-brachial-plexus-lesions-a-new-transdisciplinary-approach",totalDownloads:62,totalCrossrefCites:0,authors:[{id:"78207",title:"Prof.",name:"Jörg",surname:"Bahm",slug:"jorg-bahm",fullName:"Jörg Bahm"}]},{id:"77532",title:"Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy",slug:"nerve-transfers-for-restoring-elbow-flexion-in-brachial-plexus-palsy",totalDownloads:172,totalCrossrefCites:0,authors:[{id:"356223",title:"Emeritus Prof.",name:"Teodor",surname:"Stamate",slug:"teodor-stamate",fullName:"Teodor Stamate"},{id:"422017",title:"Dr.",name:"Dan Cristian",surname:"Moraru",slug:"dan-cristian-moraru",fullName:"Dan Cristian Moraru"}]},{id:"77904",title:"Nerve Transfers to Recover External Rotation of the Shoulder after Brachial Plexus Injuries in Adults",slug:"nerve-transfers-to-recover-external-rotation-of-the-shoulder-after-brachial-plexus-injuries-in-adult",totalDownloads:121,totalCrossrefCites:0,authors:[{id:"40328",title:"Dr.",name:"Jean-Noel",surname:"Goubier",slug:"jean-noel-goubier",fullName:"Jean-Noel Goubier"},{id:"414005",title:"Dr.",name:"Frédéric",surname:"Teboul",slug:"frederic-teboul",fullName:"Frédéric Teboul"},{id:"414006",title:"Dr.",name:"Camille",surname:"Echalier",slug:"camille-echalier",fullName:"Camille Echalier"},{id:"414628",title:"Dr.",name:"Elodie",surname:"Dubois",slug:"elodie-dubois",fullName:"Elodie Dubois"}]},{id:"78166",title:"Derotational Osteotomies for The Late Treatment of Brachial Plexus Injury",slug:"derotational-osteotomies-for-the-late-treatment-of-brachial-plexus-injury",totalDownloads:110,totalCrossrefCites:0,authors:[{id:"356769",title:"Associate Prof.",name:"Ahmet Emrah",surname:"Açan",slug:"ahmet-emrah-acan",fullName:"Ahmet Emrah Açan"},{id:"426178",title:"Dr.",name:"Ertuğrul",surname:"Şahin",slug:"ertugrul-sahin",fullName:"Ertuğrul Şahin"}]},{id:"78304",title:"The Role of Functional Electrical Stimulation in Brachial Plexus Injury Repair",slug:"the-role-of-functional-electrical-stimulation-in-brachial-plexus-injury-repair",totalDownloads:395,totalCrossrefCites:0,authors:[{id:"314534",title:"Dr.",name:"Lin",surname:"Yang",slug:"lin-yang",fullName:"Lin Yang"},{id:"414339",title:"Ms.",name:"Jia",surname:"He",slug:"jia-he",fullName:"Jia He"},{id:"414341",title:"MSc.",name:"YaXuan",surname:"Li",slug:"yaxuan-li",fullName:"YaXuan Li"},{id:"414342",title:"Ms.",name:"MengNan",surname:"Jiang",slug:"mengnan-jiang",fullName:"MengNan Jiang"},{id:"421931",title:"BSc.",name:"Qianling",surname:"Zhang",slug:"qianling-zhang",fullName:"Qianling Zhang"}]},{id:"77527",title:"Outcome Measures in OBPP",slug:"outcome-measures-in-obpp",totalDownloads:174,totalCrossrefCites:0,authors:[{id:"414275",title:"Dr.",name:"Aleksandra",surname:"McGrath",slug:"aleksandra-mcgrath",fullName:"Aleksandra McGrath"},{id:"414279",title:"Dr.",name:"Alice",surname:"Chu",slug:"alice-chu",fullName:"Alice Chu"},{id:"418526",title:"B.Sc.",name:"Nivetha",surname:"Srinivasan",slug:"nivetha-srinivasan",fullName:"Nivetha Srinivasan"},{id:"418527",title:"B.Sc.",name:"Jasmine",surname:"Mahajan",slug:"jasmine-mahajan",fullName:"Jasmine Mahajan"},{id:"418529",title:"B.Sc.",name:"Shivani",surname:"Gupta",slug:"shivani-gupta",fullName:"Shivani Gupta"},{id:"422006",title:"B.Sc.",name:"Amy",surname:"Song",slug:"amy-song",fullName:"Amy Song"}]},{id:"77632",title:"Factors of Cortical Plasticity in Brachial Plexus Injury",slug:"factors-of-cortical-plasticity-in-brachial-plexus-injury",totalDownloads:114,totalCrossrefCites:0,authors:[{id:"355641",title:"Associate Prof.",name:"Nora F.",surname:"Dengler",slug:"nora-f.-dengler",fullName:"Nora F. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"47615",title:"Osteomyelitis and Nursing Management",doi:"10.5772/59142",slug:"osteomyelitis-and-nursing-management",body:'Osteomyelitis can be described as the inflammation of bone and bone marrow and it usually indicates the presence of an infection. Although the term of osteomyelitis among children usually expresses acute hematogenous osteomyelitis, it may occur as sub-acute and rarely as chronic. Although bacteria are the main cause for it, fungi, parasites and other microorganisms can also be responsible [1-3].
The incidence of osteomyelitis in the first two decades is the highest. 50% of the cases occur among children under the age of 5. The rate of occurrence among patients with sickle cell anemia and people whose immune system is suppressed is high [4]. Except for the first year of life, the male female incidence rate is 2:1. Prior to the infection among 1/3 of the patients, a minor trauma history is found. Genetic and socio-economic factors are also influential in the process of formation of the disease [2,3].
Osteomyelitis cases among children may occur hematogenously, and more likely the metaphysis of the long bones are involved (especially the distal femur, proximal tibia) [5,6].
Microorganisms may infect bones in three ways:
Direct inoculation (trauma, during surgical operation).
From an infection in a nearby area (like cellulitis), local invasion [7,8].
Hematogenously spreading out (bacterial) is the most common case.
The reason for this is that the capillaries in the metaphysis area show a sinus-like expansion, besides that the endothelial cells that are located around the ven area in the arterioles of the metaphysis lack the ability of phagocytosis. The capillaries in the metaphysis pose a suitable area for the location of microorganisms because the blood current here is low and it is a suitable nourishing place, on the other hand the state that around the capillary veins there are no phagocytic cells may result in a vulnerable environment [4, 9]. As a result, bacteria that come through the blood stream may easily multiply in the metaphysis sinusoids and the sinusoids will become filled with pus and form an abscess. Because of the ischemia caused by the abscess in the medullary bone necrosis will start. As the volume of the abscess increases, so does the intramedullary pressure, and cortical ischemia develops in this area. Later the abscess will reach to the sub-periosteal gap via the Haversian system and cause sub-periosteal abscess. “Sequestra” is the name for bone parts whose blood supply are impaired and are separated from living bone parts, and “involucrum” is called for healthy bone parts surrounding the dead bone parts. Meanwhile, new bone formation continues from the endosteal and periosteal. As a result, in the bones 1) inflammation and formation of abscess (with the influence of bacteria and enzymes) 2) necrosis (vascular obstruction) 3) pathological changes due to new bone formation processes will be observed [7].
Among children the effects of osteomyelitis may show difference according to age. Under the age of two, the nutrition of the epiphysis is obtained by the metaphysis veins that intercross the physis. Through these veins, the infection in the metaphysis may pass to the epiphysis. It may even spread to the joint and be the cause to the septic arthritis. Damage to the physis may be cause to separation of the epiphysis, deformities and extremity shortness. Diaphyseal involvement is rare except very heavy cases. Above two years of age, by taking role as a barrier, the physis borders the metaphysis from the infection, and prevents it from spreading to the epiphysis and the joint cavity. After the closing of the physis, the infection may spread from the metaphysis to the epiphysis, and it may form septic arthritis [2,7,10].
If the infection is not treated in the acute period, chronic osteomyelitis is unavoidable. Then, the surrounding of the infection-focus filled with pus and granulation tissue will be surrounded by a fibrous capsule and sclerosing bone-tissue and the “Brodie” abscess will be formed [9].
The main cause among children at all ages is the
In osteomyelitis, clinical findings vary according to age. Because babies possess a weaker anatomic barrier to limit the spreading of infections among them, they show a tendency for the disease; and together with it, the septic arthritis, soft tissue infection and pseudo-paralysis of the affected extremity are widespread. Among older children, the infection is more focal. Most frequently, there is fever and ache at the infection location. More rarely, there may be loss of appetite, malaise and vomiting. The patient will be reluctant to use the extremity. Depending on the osteomyelitis, deep venous thrombosis may develop and it may be the first consultancy reason [7,10].
Newborn Form: Among newborns, findings are very weak, when the affected extremity is touched or moved, the baby becomes disturbed. Around the pseudo-paralysis, there may develop a swelling. The newborn osteomyelitis consists of residual deformities, frequent infections of the multiple bones, and the involvement of the joints, facial bones and the proximal humerus. The onset is often hidden, following umbilical artery catheterization or the taking heel blood swelling or decreased activity may occur. There may be no fever or leukocytosis. Although there is an inclusion of a large number of bacteria species Staphylococcus aureus, Candida albicans and the group B Streptococci are observed as the most common pathogens [10].
Bone scans can detect clinically undefined points. Any joint affected is drained immediately. In newborns, usually in the bone cortex, a window-like drilling surgery is not necessary [10].
Baby form: it occurs among patients younger than the age of 1, and it often spreads from the epiphysis to the metaphysis and joints while the veins of the diaphysis enter into the epiphysis. The periosteum often becomes rapidly perforated and it becomes rapidly pierced. The cover (new bone development belonging to one periosteum) formation may be large but due to absorption and reformation, it is temporary. If it inhibits a long bone, with the shortening of the organ, the epiphyseal growth centers may become damaged [10].
Childhood Form: This type generally occurs among patients from 1 year of age until puberty. It is usually settled in the metaphysis and doesn´t spread to the epiphysis, as the veins do not enter the epiphyseal plaque. It rarely damages the growth cartilage or the joint [10].
Adult Form: This type reveals after the age of 16. The growth cartilage dissolves and the metaphyseal infection may spread to the epiphysis and the joint. Chronic infection is more common among adults in comparison to children [10].
Long bones: For long bones, acute hematogenous osteomyelitis is typical. In around 70% of the cases, the femur or tibia are affected. When there is no osteomyelitis area, it is more difficult to diagnose, usually it is in the metaphysis but it occurs in the diaphysis rather more (in the center) or epiphysis (in the center) of the long bone. To diagnose osteomyelitis of the femoral neck is difficult since negative findings in the joint resemble hip arthritis. Besides interruption of blood supply to the femoral head or as a result of the insertion penetration the osteomyelitis in the femoral neck area may be the cause to heavy hip-joint complications [7,10].
Feet: Puncture wounds of the foot, especially those in the metatarsal area may result in soft tissue, bone and particularly of the cartilage
Clavicle: Particularly among drug addicts, clavicle or a sternoclavicular joint is sometimes an area where sub-acute infection is built up. Osteomyelitis of the clavicle occurs also among children [10].
Patella: Patella osteomyelitis may be confused with suprapatellar bursitis for it is very seldom [10].
Fingers: Pyogenic osteomyelitis arises in many fingertip abscesses as a complication. Without a neighbor that is infected, the osteomyelitis of a finger bone may lead to a secondary tuberculosis case [10].
Rib: Rib excision will dry the osteomyelitis and secrete the agent to prevent the Ewing\'s sarcoma or other tumors. Generally, it will be accompanied by chest pain and fever [10].
Pelvis: Pelvic osteomyelitis will include pubis, ilium and ischium. Often, there will be fever, abnormal gait and severe sensitivity in the affected bone area. Roentgenographic changes may last from 10 days to 10 weeks.
Vertebra: Vertebral body infection is rare in children. But, intervertebral disc infection, i.e. discitis is common. Generally, the source can’t be found [10].
Other Bones: Cranial osteomyelitis typically is an extension of otitis externa, mastoiditis, or sinusitis. It occurs after multiple antibiotics use and usually causes Pseudomonas aeruginosa [10].
Several microbiological, haematological, serological and radiological tests are useful in the clinical diagnosing and the determination of the causative factors of the disease [6]. In an age in which the prevalence of antibiotic-resistant microorganisms is increasing, extreme effort is required to determine the specific etiology of the disease. For directing the anti-microbial treatment, it is imperative to obtain pathogen sensitivity tests. The diagnostic methods described below can be applied to all forms of osteomyelitis [7,9].
In osteomyelitis laboratory findings are nonspecific. The erythrocyte sedimentation rate (ESR) is usually measured in the range of 40-60 mm/hr; it reaches the highest rate within 3-5 days of the treatment, and it returns to normal within 3 weeks. As ESR gradually decreases with successful treatment, elevated ESR is a perfect parameter for monitoring the response to the treatment. The rise of the C-reactive protein (CRP) level is the highest on 2nd day of the treatment (mean 83 mg/L) and it drops to normal in 1 week. This, together with the ESR, is used for monitoring response to the treatment [3].
The etiologic diagnosis of osteomyelitis is performed by isolating the microorganism from the bone, sub-periosteal exudate and joint fluid [3].
Blood cultures should be obtained from all patients with possible osteomyelitis. The blood cultures of approximately 50% of the patients with acute hematogenous osteomyelitis are positive. Newborn osteomyelitis is often characterized with bacteremia. As in other osteomyelitis forms, the probability of the blood cultures to be positive is lower in osteomyelitis that is developing from the neighboring focus, like the osteomyelitis that is accompanying chronic osteomyelitis and peripheral vascular disease. In this context, blood culture is a limited guide. A separate set of two or four cultures should be taken [9].
There may be leukocytosis but cases in which the leukocyte number is normal or slightly higher occur often, and therefore it cannot be used to rule out the osteomyelitis diagnosis [9].
Conventional radiography for diagnosis of pediatric patients is necessary. In osteomyelitis, the usual development sequence of radiographic changes is as follows:
In the early stages of the disease, the direct radiographs are normal. At this stage, bone scintigraphy can detect abnormal findings. However, if there is bone destruction, further imaging is not necessary.
Stage: 3 days after the onset of symptoms in the metaphyseal area, a localized deep soft tissue swelling is observed. Soft tissue swelling and an increase in the subperiost are the earliest detected abnormalities.
After 3 to 7 days of the onset, swelling in the muscles and a deletion in the translucent oil lines is observed.
Stage: 10-21 days after the start of the findings of bone destruction, lytic lesions, periosteal removal due to the accumulation of purulent subcortical and periosteal new bone formation becomes apparent. Lytic changes may not be visible in direct graphics until the 30% to 50% of the bone disappears and are not detectable until after 2-6 weeks of the onset of the disease. Sclerotic changes may occur weeks after the onset of the disease after the formation of the new matrix due to a delay in mineralization. Sclerotic changes associated with periosteal new bone formation (involucrum) indicate the presence of a more chronic process [9].
Magnetic Resonance imaging is a suitable method for the examination of the bone, and in comparison to computed tomography, it will better reveal the pus accumulation in subperiosteal and soft tissues. This is the preferred method for the diagnosis of vertebral osteomyelitis. In the diagnosis of acute osteomyelitis, its sensitivity is close to 100% and, in addition to this, it is useful in the differentiation of acute and chronic osteomyelitis. Radionuclide studies are helpful in early stage diagnosis even when there are no findings with plain radiography. However, its use is limited among newborns [7].
In comparison to radiologic examinations, bone scintigraphy is more valuable for osteomyelitis [2,7,9,10]. Among technetium radio-phosphate, scintigraphic methods especially the three-phase are the most used ones. Radiation exposure is approximately the same as the standard radiography and children patients are not contraindicated. Because of referred pain or the probability of a multifocal infection, the whole-body scintigraphy of patients who are suspected to have osteomyelitis should be done. Afterwards, a more thorough detailed radiologic investigation of the suspected areas can be made. Scintigraphy done with indium-labeled leukocytes is an excellent sensitivity and specificity method in the determination of early osteomyelitis. This method is technically a little more difficult, and has more radiation levels when compared with the bone scintigraphies with technetium [9].
Needle aspiration must be practiced to every patient whose absolute diagnosis has not been performed via blood cultures to obtain sample cultures from lesions inside bones, from the collection of soft tissues, from the abscesses under the periosteum. Preferably, needle aspiration should be practiced prior to giving antibiotics. If there is joint effusion together with it, synovial fluid tests should be performed. The aspired effusion should be investigated regarding the cells it contains, and in terms of biochemistry, Gram straining and culture [9].
Patients among whom the exact etiology cannot be determined despite the blood cultures or needle aspiration, especially when tuberculosis, fungal or a malignant disease is suspected, open biopsy may be considered. The biopsy samples should be reserved for histopathological analysis and for cultures that are regarded necessary [7,9].
In cases with possible high fever, pain and sensitivity in the extremities, the differential diagnosis should be performed. Rheumatic fever, septicemia, septic arthritis, cellulitis, Ewing\'s sarcoma, metastatic neuroblastoma, leukemia, reflex neurovascular dystrophy, to thrombophlebitis hemoglobinopathies connected bone infarcts and toxic synovitis can be counted to be in these cases [2,3].
The initial treatment can be intense. Inadequate treatment of acute osteomyelitis can result in relapse and the development of chronic disease [3,11]. The treatment should be adjusted to the patient’s characteristics (Table 1 and 2).
The basic choice of antibiotics and although the number of comparative studies for the determination of the duration of the treatment is few, antibiotics are the mainstay of the treatment [9].
Usually in the beginning of the treatment, to be sure of the harmony and to reach the necessary bone levels, parenteral agents are recommended. Because the passage of antibiotics to the bone is low, these agents are generally given in high doses [6]. The passage of antibiotics is linked to the vascularization of the bone (e.g., the surfaces in spongiform bone tissue are higher than in cortical bone). The levels of antibiotics in diseased bone are even higher. Penicillin, cephalosporins, gentamicin, vancomycin, clindamycin and ciprofloxacin reach to a level that exceeds the Minimal Inhibitory Concentration (MIC) of many of the susceptible microorganisms that lead to osteomyelitis [12]. When the obtained serum levels are considered, especially clindamycin and ciprofloxacin pass well into the bone. Indeed, whether you give these agents intravenously or orally, the treatment of them has been proven for all forms of osteomyelitis [2,9].
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Empirical treatment | \n\t\t\tStaphylococcus aureus Haemophilus influenzae type b | \n\t\t\tnafcillin/clindamycin/ vancomycin (MRSA*) cefuroxime/cefotaxime/ ceftriaxone/chloramphenicol | \n\t\t
Newborn | \n\t\t\tS. Aureus Group B streptococcus Gram negative enteric bacteria | \n\t\t\tnafcillin* cefotaxime/gentamicin | \n\t\t
<5 years | \n\t\t\tS. Aureus Streptococci H. influenza type | \n\t\t\tnafcillin + Cefotaxime/Ceftriaxone OR Cefuroxime OR Ampicillin-sulbactam | \n\t\t
>5 years | \n\tGram positive cocci | \n\tNafcillin OR Clindamycin OR Cefazolin | \n
Sickle cell anemia | \n\tS. Aureus Coliform bacteria | \n\tNafcillin/Clindamycin+ Cefotaxime/Ceftriaxone | \n
Puncture injuries Partially broken | \n\tS. Aureus Anaerobe bacteria | \n\tClindamycin | \n
Immunosuppressed patients | \n\tMRSA Pseudomonas aeruginasa | \n\tVancomycin + ceftazidime ticarcillin-clavulanate | \n
Puncture foot injury | \n\tP. Aeruginasa | \n\tCeftazidime/mezlosilin+ Aminoglycosides AND Surgical Debridement | \n
Remained in the hospital for a long time preterm | \n\tMRSA Resistant gram negative bacteria Antifungal agents | \n\tVancomycin Carbapenems Fungus | \n
Treatment approach in acute osteomyelitis [3].
MRSA* : methicillin-resistant Staphylococcus aureus
\n\t\t\t | \n\t\t\n\t\t\t | \n\t\t\n\t\t\t | \n\t
Nafcillin | \n\t\t150 | \n\t\t4 | \n\t
Clindamycin | \n\t\t30 | \n\t\t3-4 | \n\t
Cephazolin | \n\t\t100 | \n\t\t3 | \n\t
Cefotaxime | \n\t\t150 | \n\t\t4 | \n\t
Ceftriaxone | \n\t\t100 | \n\t\t2 | \n\t
Cefuroxime | \n\t\t150 | \n\t\t3 | \n\t
Ampicillin-Sulbactam | \n\t\t300 | \n\t\t4 | \n\t
Gentamicin | \n\t\t5-7.5 | \n\t\t3 | \n\t
Antibiotics doses in acute osteomyelitis [3]
Patients will be treated with intravenous antibiotics for 5-10 days. After a good clinical response, the treatment of the patient is changed into a high-dose oral treatment and this continues for at least 3 weeks. One should especially focus on some aspects of the oral treatment.
For susceptibility tests, one should obtain an active organism and it should be sensitive to the selected agent. In vitro sensitivity tests help to select the appropriate treatment. As a long-term treatment is necessary in this disease, it is vital that sensitivity tests are performed carefully. Because, combinations of antibiotics may lead to additional toxicity, if sensitivity combinations are not well known, the best way is to stay away from such combinations.
Surgical debridement and drainage should be performed in a suitable manner.
One should be certain about the harmony. If there is a doubt about the patient’s adhering to the treatment, then treating the patient outside the hospital should be avoided.
Some professionals defend that the serum bactericidal levels should be used in order to observe the effectiveness of the treatment. In this method, blood is taken from the patient just before and right after giving the antibiotics. Later on, serial dilutions of the serum are analyzed for the bactericidal activity to the active microorganism. But, as there is no standard protocol and there are no large studies to support this test, its real value is not known.
The extension of the treatment is very important and the use of the antibiotics should be continued for at least 4-6 weeks. The rate of healing is expected to be more than 90% [9].
\n\t\t\t | \n\t\t\n\t\t\t | \n\t\t\n\t\t\t | \n\t
Amoxicillin | \n\t\t100 | \n\t\t4 | \n\t
Cefaclor | \n\t\t150 | \n\t\t4 | \n\t
Cephalexin | \n\t\t100-150 | \n\t\t4 | \n\t
Chloramphenicol | \n\t\t75 | \n\t\t3 | \n\t
Clindamycin | \n\t\t30-40 | \n\t\t3 | \n\t
Cloxacillin | \n\t\t125 | \n\t\t4 | \n\t
Dicloxacillin | \n\t\t75-100 | \n\t\t4 | \n\t
Penicillin V | \n\t\t125 | \n\t\t6 | \n\t
Oral antibiotics doses in acute osteomyelitis [3]
Nearly all of the hematogenous osteomyelitis will heal without surgery when treated with suitable doses of antibiotics. In the treatment after 3 to 5 days from the beginning of the disease, the results are even better. Yet, these patients should be monitored by an orthopedic surgeon in the future to evaluate a surgical necessity [9].
The surgical indications include the following:
Diagnosis: When pathogens are not determined in blood cultures for sure, diagnostic aspiration should be performed routinely.
Hip joint involvement (osteomyelitis of femoral metaphysis): In these cases, it is imperative to drain early because of the tearing risk of the cortex and the possibility of the infection to spread into the hip joint.
The neurological complications of vertebral or cranial osteomyelitis.
Poor response or non-response to the treatment: If patients do not respond well clinically after 48-72 hours of the treatment, drainage operation is necessary. Among patients whose disease has occurred with gram-negative enteric bacilli, drainage is more often a requisite. A collection of pus under the periosteum that does not respond has to be drained too. A culture should be taken from all the surgical samples.
Sequestrum: They need to be removed surgically [9].
Even in the case of a suitable antibiotics treatment among children and adolescents with CA-MRSA (Community-associated methicillin-resistant S. Aureus), incision and drainage were found to be necessary in osteomyelitis. Besides, when the child doesn´t respond to the antibiotics treatment, surgical drainage should be considered. In such a case, surgical initiative can enhance the healing. In addition to this, surgical initiative will allow microbiological evaluation of the tissue collection to confirm the diagnosis of histological analysis of unusual causes of osteomyelitis [13].
The treatment results of children with acute hematogenous osteomyelitis who do not have complications are fine. Together with this, the prognosis is in relation with different factors. These factors include the active organism, the duration of the symptoms before the treatment, age and the duration of the antibiotics treatment [2].
Sufficient antibiotics treatment is essential. Among 10% to 20% of the patients who are treated for acute hematogenous osteomyelitis, recurrence is observed [2].
Among patients who have osteomyelitis due to gram-negative organisms, the recurrence rate is higher [2].
For completely healing, the best opportunity is the initial treatment. Only 50% of recurrent infection patients with full debridement and intravenous antibiotics for 4-6 weeks can heal. To prevent acute osteomyelitis chronic infections, one should be treated in an effective way and in adequate time interval [2,9].
Before the start of antibiotics, acute hematogenous osteomyelitis was a disease with a high morbidity and mortality rate. With the discovery of ways of diagnosis and cure and in a changing world, the mortality rate of the disease have become unimportant. Despite this, for various reasons, the clinical course of children with acute hematogenous osteomyelitis makes it difficult to apply standard treatment recommendations. The treatment should be always individualized with a team approach that include pediatric infection professionals and orthopedists [13].
Without regarding the attainability of all new microbial agents, the major therapeutic concern in all forms of osteomyelitis is to start with the most appropriate treatment as soon as possible. In this context two concepts are important; the first one, the difficulty in certifying the existence at the appropriate time, and the second one is the determination of the alleged pathogen and the opportunity to assess the antibiotics resistance [13].
The patient was previously treated for osteomyelitis at the same location. The prognosis is worse than acute osteomyelitis. Treatment failure rate is higher than with the acute form and the way of treatment is different [9].
The patient rarely shows acute symptoms. Systemic symptoms like fever are not common. Except for drainage from the sinus or the wound, regional signs and findings are less common [2].
Among the causes,
The full treatment of chronic osteomyelitis is difficult to define, because relapses are frequent and after a very aggressive treatment, it may occur after months or years. After intensive attempts for a full treatment, sometimes the extremity-threatening surgical operation, occasionally a long-term treatment with toxic and expensive antibiotics is required.
Surgical intervention may be necessary to obtain culture material, and for the subtraction of sequestra, for removal of necrotic tissue and dead matter [10].
In 1995, Dr. Charles Lautenbach performed the
Other advantages of the system:
To provide the most appropriate concentration of the antibiotics in the area of the infection, 2 or more couples of lumen tube are used.
For the control of the organisms, samples are taken from fluid of the washed medullary canals; and according to their susceptibility, the antibiotics are adjusted.
Without a systematic side effect, a high dose of antibiotics can be dispensed through tubes. The antibiotics are dispensed only if the patient shows the systematic effects of the disease.
For the evaluation of the course of the healing and the treatment, sinus dimensions can be taken.
The irrigation should be continued for at least 3 and at most 6 weeks. Before the tubes are removed, the criteria that are expected to be achieved are the following:
Clean washing water
Zero cavity dimensions
In the washing water samples taken in sequence, no breeding of organisms should be observed
Stable blood parameters [14].
Primarily it is seen among adults, and the occurrence among children is rare. While in almost all of the cases
Newborn osteomyelitis is rare. Prematurity, low birth weight, another accompanying infection, blood transfusion, the presence of umbilical catheter may be considered as risk factors. Usually it is observed together in multiple bone and arthritis [3,10]. Because of nonspecific symptoms, the diagnosis may be delayed. As the most common S. aureus (> 90%), group B streptococci (especially in the postnatal 2-4 weeks) and enteric gram-negative bacilli may be the cause. There is no leukocytosis; ESR and CRP will have been increased. Mostly lytic bone lesions are seen in plain graphy. It may cause permanent disorders in joints and disturbance in the skeletal growth [3].
The susceptibility in the sickle cell hemoglobinopathies to bacterial infections has increased. During the sickling, due to microscopic infarcts, the blood invasion of intestinal microorganisms is facilitated. Besides, there is also splenic dysfunction. Of all the agents salmonella and gram-negative enteric bacilli factors (<70%), S. aureus are responsible. The diaphysis of the long bones, flat bones, the small bones of the hands and feet are often held. Acute vaso-occlusive crisis of the table is difficult to differentiate. It is difficult to distinguish the picture from an acute vaso-occlusive crisis. In both cases, there is fever, bone ache and leukocytosis. With MRI, one cannot distinguish an infection from an infarct. In a crisis attack, no response is obtained, needle aspiration and culture should be performed. A long-term (6-8 weeks) antibiotics treatment may be necessary for healing [3,9].
Traumatic osteomyelitis develops as secondary in animal bites (especially due to Pasteurella multocida), and when blood is taken from newborns heel with needle sticking, during bone marrow aspiration, puncture injuries (especially when standing by
Postoperative osteomyelitis may develop in the process that follows the reduction of closed fractures, craniotomies, median sternotomies and other bone surgeries [10].
Postoperative is mainly multifocal. Drug addiction may cause multifocal osteomyelitis. The scanning of multifocal hot spots on the bone may reveal multiple tumors, too [10].
This is observed in childhood and among young adults. Girls are more frequently affected. There are attacks that show similarity to osteomyelitis, recurrent high fever, swelling in bones, ache and radiologic visions. Palmoplantar pustulosis, psoriasis, arthritis, sacroiliitis, and inflammatory intestinal disease may occur together with the Sweet\'s syndrome. The SAPHO syndrome observed among adults (synovitis, acne, pustulosis, hyperostosis, and osteitis/osteomyelitis) is believed to be equivalent to the ones of childhood. Most frequently, the clavicle and the calcaneus are affected.
Bone cultures are sterile. Clear benefits of antibiotics cannot be shown, steroids and anti-inflammatory treatment is recommended. Although the etiology is unknown, the prognosis is positive [10].
Any organism (a rare one or superficial fungi) can cause osteomyelitis in these patients [10].
Infective emboli
Side effects of the antibiotics treatment (hematological, renal, hepatic) [15].
Fluid Volume Deficiency Risk with regard to excessive fluid loss [16,17].
Change in comfort depending on the infection, swelling, and hyperthermia process in the bone [15].
Pain and discomfort, Physical Restriction of Movement associated with musculoskeletal disorders [16,17].
Less Nutrition than the Body Requirements related to loss of appetite [15].
Risk of Deterioration in Skin Integrity in relation to physical immobilization [15].
Change in health condition, Anxiety in relation to hospitalization [16,17].
Risk of Injury in relation to immobilization because of spread of infections [16,17].
Limited physical activity, Social Isolation in relation to therapeutic isolation [16, 17].
Risk of Colonic Constipation due to immobility [15].
Deficit in Entertainment Activities due to long-term hospitalization and insufficient mobility [15].
Poor Nutrition: Change in Nutrition due to anorexia that is secondary to the infection process [15].
Risk of Deficiency in Skin Integrity due to the mechanical irritation of the plaster/splint [15].
Risk of Trauma depending on the Process of the Disease: Pathologic Fractures [15].
The situation is Risk of Ineffective Management of Therapeutical Regime due to the lack of knowledge on wound care, activity limitations, symptoms and findings of complications, follow-up of pharmacological treatment and care (check-up) [15].
The nursing of children who suffer from heavy musculoskeletal infections; for a wide range of evaluation it requires a multidisciplinary team approach that consists of as well as the hospital staff and services, pediatricians, orthopedists and infectious diseases specialists [18].
The main objectives of nursing care; to avoid possible complications, reduce pain, to inform the children and their families about the process of the disease and the treatment management. In the acute stage of the disease, restriction of movement may be observed in the affected joints. However, by supporting the affected joint, the child will be in a comfortable position. Cautiously and gently moving the patient will reduce the pain. Pain treatment will relieve the patient. Vital findings are taken and recorded. If important changes may occur in the measurements, then this is shared with the team members [19].
In the antibiotic treatment, careful observation should be performed; the vascular pathway area and the intravenous sets should be observed. Generally, several antibiotics are used together. One should consider that the used drugs are compatible with each other. The use of drugs that are not compatible should be avoided. For long-term antibiotics treatment, intermittent infusion devices or a central catheter (PICC) with peripheral input is used. The antibiotics therapy is often continued at home [19].
Isolation should be applied to children with an open wound. In wound care, the prescribed medicines are used. In addition, the insertion of antibiotic solutions into the wound care is very effective [19].
The received-removed fluid amount is continuously measured and recorded. Moreover, the wound drainage is also recorded. The state of healing of the wound tissue is evaluated and recorded [19].
To provide immobility, plaster is used and in such cases, routine plaster maintenance is performed [19].
The following are among nursing initiatives: Teaching the child to walk with crutches when necessary, ensuring that the child is kept away from slippery floors, preventing the child from moving in an uncontrolled manner during risk of insufficient mobility due to the plaster, and during the
Supporting the child to use his/her extremity without plaster in case of a
Nursing Initiatives in
In
The affected area, whether in plaster or not is evaluated for color, edema, heat and sensitivity [19].
In the first stage of the treatment the child has no appetite. For a healthy diet, until the patient feels better, one is encouraged to consume high calorie liquids, fruit juice, ice cream and jelly. In order to have bone growth and healing, an adequate nutrition has to be provided [19].
After the treatment in the acute stage, the child will feel better. As a result of this, the appetite of the child will increase, and s/he will communicate socially. For this reason, the nurse may start entertaining and curative activities for the children in this period. However, these activities should be mostly in bed. Because resting of the child usually after the acute period is imperative. However, when isolation and bed-rest may not be required for a long term, moving in a wheelchair may be allowed [19].
The role of nurses is to provide information to patients and caregivers about the treatment, to support and to help for the treatment plan [14].
For providing the patient to go through the hospitalization period as comfortable as possible they are encouraged to share their fears and concerns [14].
Psychosocial evaluation leads to the possibility of self-recognition, coping mechanisms and to reveal the sources of motivation of the patient. This is for the creation of an appropriate and effective care-plan by the whole team. The patient should be informed about the contents of the processes, that the infection could not be eliminated successfully, risk factors like the development of a new infection, problems related to prolonged bed-rest and regarding a secondary reconstructive surgery. Patients that have become aware of being not sufficiently informed or being not included in the decision taking will be prone to depression. Regarding the information given, feedback from patients and caregivers should be taken. The preparation of the treatment facilities should be presented; and plenty of opportunities should be given to ask questions frequently [14].
In recent years, wireless communication equipment has been rapidly researched and developed such as Internet of Things (IoT), wireless local area network (LAN), and 5G, and it is expected that the demand for wireless communication equipment will become more widespread in the future. Along with this, various microwave circuit elements mounted on wireless communication devices are also required to have higher performance, such as miniaturization, low loss, high integration, and wideband/multiband. The authors are paying attention to the power divider/combiner that divides/combines microwave signals among various microwave circuit elements. The reason is that the power divider/combiner is considered to be an important circuit element that is directly linked to its performance in microwave circuits.
As a power divider/combiner for a three-port network, the Wilkinson power divider (hereinafter referred to as a conventional circuit) composed of two quarter wavelength transmission lines at a design frequency and an absorption resistor connected between two output ports is widely used at several microwave/millimeter-wave circuit system such as a balanced amplifier, a mixer, a phase shifter, an antenna feeding network, and so on [1]. However, since the circuit size depends on the wavelength due to the distributed circuit configuration, there arises a problem that the area occupied by the circuit system becomes especially large in a low-frequency band. As a method for reducing the size of a microwave circuit, a method of replacing a transmission line with a Π-type/T-type circuit equivalent to that at the design frequency is often used, but the equivalence between the two circuits is guaranteed only at the design frequency [2]. Therefore, such a circuit generally has a narrow band characteristic. In addition to that, as a method of shortening the transmission line, methods of loading parallel capacitances or parallel open-circuited stubs at both ends or the center of the transmission line have been reported [3, 4, 5, 6]. In addition, some miniaturization design methods using composite right-/left-handed transmission lines and lumped elements have also been proposed [7, 8, 9, 10]. However, their operation bands are still narrower than that of the conventional circuit. Therefore, it is considered difficult to achieve both miniaturization and wide bandwidth of the circuit at the same time. On the other hand, our research group proposes a configuration using an LC-ladder circuit as a lumped-element circuit type Wilkinson power divider. It has been analytically and experimentally clarified that a configuration using a two-stage LC-ladder circuit on the input side can realize frequency characteristics equal to or higher than those of the conventional circuit. Furthermore, ultra-wideband power dividers, unequal power dividers, and
This chapter shows how to design a power divider that can be matched at arbitrary two frequencies with a simple circuit configuration with 9 lumped elements. The circuit is designed for application in IoT (920 MHz) and 5G (sub6 band: 3.7 GHz). The influence of the self-resonant frequency of the chip element used in the circuit configuration is considered in the SHF-band, so the inductance is realized using a meander line or a bent line. Electromagnetic field simulations and prototype experiments confirm the effectiveness of the two-frequency matching circuit with a quasi-lumped-element circuit configuration. It should be noted that this circuit also has a feature that high-pass or low-pass characteristics can be selected by replacing the inductance L and the capacitance C of the components.
In the circuit configuration described above, the frequency characteristic of either the high-frequency or the low-frequency band becomes a narrow band. Therefore, the number of stages of the LC-ladder circuit was increased, and a circuit with 15 elements in which an LC-ladder circuit and an LR/CR circuit were connected in parallel between the output ports enabled three-frequency matching. It was shown that by moving the matching frequency in the middle of the three matching frequencies closer to the low-frequency side or the high-frequency side, a divider having an absolute constant bandwidth in the low-frequency and high-frequency bands becomes possible.
Furthermore, ultra-wideband characteristics are possible by increasing the number of stages in the LC-ladder circuit. As a method for widening the bandwidth of impedance transformers, quarter wavelength multistage transformers are also described in Pozer’s book and are often used. By using the concept of this multistage impedance transformer [16] and L-type matching circuit [17], a circuit with a relative bandwidth exceeding 100% in the UHF band was realized. Specifically, we have experimentally confirmed an ultra-wideband divider with a relative bandwidth of 100% or more, which covers the 80 MHz–370 MHz band used for public radio in Japan, with a lumped-element circuit configuration.
This section shows a lumped-element power divider that realizes the same frequency characteristics as the conventional Wilkinson power divider. Furthermore, a two-frequency matching divider operating in the UHF and the SHF band will be described.
Figure 1a shows the dual-band power divider with arbitrary two matching frequencies treated in this section [18, 19]. This circuit consists of an LC-ladder circuit (
Circuit configuration. (a) Schematic of two-section LC-ladder divider and (b) its equivalent circuit with onefold symmetry.
When a signal of the same phase and amplitude is applied to each output port Port2/3 of the equivalent circuit shown in Figure 1b, the plane AA’ becomes a magnetic wall. It is not necessary to consider the inflow of current to the L and RLC parallel circuits, and the signal applied to the output port propagates to the input port side while maintaining its potential. Therefore, the equivalent circuit can be simplified as shown in Figure 2a. The following equation expresses the signal non-reflection condition at the input end for conjugate matching of the terminal resistance of Port1 and the input impedance seen from Port1 according to the theorem of maximum power supply.
Equivalent circuits at (a) even- and (b) odd-mode excitations.
For each of the real and imaginary parts, by determining the parameters, so that Eq. (1) is satisfied with two matching frequencies, the circuit parameters on the input side
In the odd-mode excitation in which a signal of opposite phase and the same amplitude is applied to the output port of the circuit shown in Figure 1b, the plane AA’ becomes an electric wall, and when the potential becomes 0 on the plane AA’. Therefore, the inflow of current to the input side can be ignored. Therefore, in this case, the equivalent circuit can be simplified as shown in Figure 2b.
By satisfying Eq. (2) for the real and imaginary parts and designing it to operate as an impedance transformer at the design frequency, the circuit parameters on the output port side
The above operation can derive all parameters, and it is possible to design an equal power divider that matches at arbitrary two frequencies. Table 1 shows the normalized circuit parameters for some design frequency ratios.
Frequency ratio | 0.8/1.2 | 0.6/1.4 | 0.4/1.6 |
---|---|---|---|
1.23 | 1.52 | 2.46 | |
1.20 | 1.11 | 0.90 | |
1.20 | 1.11 | 0.90 | |
0.61 | 0.76 | 1.23 | |
0.54 | 0.96 | 1.85 | |
1.74 | 2.14 | 3.46 | |
1.93 | 1.24 | 0.83 | |
1.62 | 1.12 | 0.92 |
Normalized circuit parameters for each design frequency ratio.
The normalized circuit parameters obtained by the above procedure are
Frequency characteristics of scattering parameters for two-section LC-ladder dividers with several matching frequency ratios. (a) Input/output port reflection, (b) isolation, and (c) power division characteristics.
In order to confirm the validity of the circuit design method, we designed a broadband power divider in the 920 MHz band using a commercial electromagnetic simulator (Sonnet em). The design conditions are a dielectric substrate with a relative permittivity of 2.2, a thickness of 0.787 mm, and each port has a microstrip line configuration with a characteristic impedance of 50 Ω. Since the commercially available 1005 size chip inductor has a self-resonant frequency in the UHF/SHF bands, it is difficult to use it in circuit design above the UHF band. Therefore, as a lumped element model, the circuit pattern is designed using a spiral inductor that directly reproduces the metal pattern on the dielectric substrate and a commercially available chip capacitor. In addition, the circuit pattern was determined by trial and error to reduce the influence of the land pattern on the characteristics while securing the land pattern for soldering required for the chip element. In addition,
Experimental results for broadband divider. (a) Simulation pattern, (b) its analysis result, (c) photograph of fabricated circuit, and (d) measured S-parameters.
Considering the practical application of the proposed circuit, a prototype experiment was conducted under the same conditions using the circuit pattern shown in Figure 4a. A conductor pattern was formed on the dielectric substrate Rogers/Duroid 5880 using a substrate processing machine (ProtoMat S63) made by LPKF. The chip elements used are the same 1005 size commercially available chip capacitors (GRM series) and thick film chip resistors (MCR series) used in the simulation and soldered to the conductor pattern. In addition, the via hole part of the simulation pattern is short-circuited with the ground conductor by making a hole with a diameter of 0.3 mm at the desired position, inserting silver paste, and sintering it. Figure 4c shows a prototype circuit photograph. Figure 4d shows the frequency characteristics of the scattering matrix of the prototype circuit measured using a vector network analyzer. From the figure, the measured results are almost the same as the electromagnetic simulation results, but the relative bandwidth with reflection characteristics and isolation characteristics of −18 dB or less is about 45.9%, and some deterioration can be seen. This is thought to be due to the tolerance of each chip element and manufacturing error of the spiral inductor. However, in the actual measurement, it was confirmed that the two frequencies were matched, and the power division characteristics were flat around the matching frequency band, and the maximum output phase difference was 2.6°.
On the other hand, by separating the matching two frequencies, it is possible to realize a divider that operates in two bands. Here, the results of electromagnetic field simulations and prototype experiments for the divider shown by the green line in Figure 3 are introduced. The two matching frequencies are selected as 920 MHz and 3.68GHz used in IoT and 5G (sub6 band). Figure 5a shows the simulation pattern and its analysis results, and Figure 5b shows the prototype circuit photograph and measurement results. It can be confirmed that the matching frequency on the low-frequency side is slightly shifted to the higher side, and the matching frequency on the high-frequency side is slightly different. However, the measurement results and the simulation results are in good agreement.
Experimental results for dual-band divider. (a) Simulation pattern and its analysis result and (b)photograph of fabricated circuit and its measured S-parameters.
This section has proposed a design method for a Wilkinson-type dual-band power divider with a new configuration using an LC-ladder circuit. It is known that a power divider using lumped elements in order to reduce the circuit area in a relatively low-frequency band generally has a narrow band frequency characteristic. We conducted a trial experiment of a power divider with lumped elements design in the 920 MHz band and showed that a wide operating frequency band with a relative bandwidth of about 45.9% could be obtained. Furthermore, it was shown that a divider operating in two separate bands (920 MHz/3.68GHz) could be realized. The proposed circuit is useful in reducing the circuit area in the UHF/SHF band. Next, we will conduct a prototype experiment in the 5G (Sub6) band to confirm its usefulness further.
Since research on circuits and devices that support multiband systems is also actively conducted [20, 21], this section describes power dividers that can be matched at arbitrary three frequencies. Further, as an application thereof, it is shown that a dual-band power divider having an absolute constant bandwidth can be realized by moving the middle frequency closer to the low-frequency side among any three matching frequencies.
Figure 6a shows the circuit configuration of a power divider with three sections of LC-ladder circuits at the input port side [22]. The circuit parameters are normalized as described above. In designing a circuit using the even-/odd-mode excitation methods, consider an equivalent circuit having a onefold symmetry with respect to the plane AA’ in Figure 6b. Each input/output port is represented as a terminal resistor. When the circuit structure is vertically symmetrical,
(a) Schematic of LC-ladder divider with three matching frequencies and (b) its equivalent circuit with onefold symmetry.
Since the circuit in Figure 6b is also symmetric with respect to the plane AA’, the even-/odd-mode analysis can be applied as in 2.2.1 and 2.2.2. Figure 7 shows equivalent circuits at even-/odd-mode excitations. The conditional equations for obtaining the circuit parameters are as follows.
Equivalent circuit of
All parameters can be derived by the above operation, and an equal power divider with arbitrary three matching frequencies can be designed.
If the three normalized matching frequencies
Frequency ratio | 0.4/0.6/1.6 | 0.4/0.8/1.6 | 0.4/1.0/1.6 | 0.4/0.45/1.6 |
---|---|---|---|---|
2.07 | 1.75 | 1.42 | 1.51 | |
1.11 | 4.62 | 2.41 | 0.93 | |
0.97 | 1.40 | 1.83 | 1.24 | |
1.92 | 2.74 | 2.55 | 2.49 | |
2.12 | 7.61 | 8.13 | 1.87 | |
2.02 | 1.64 | 1.43 | 1.52 | |
1.26 | 1.02 | 0.81 | 0.64 | |
0.65 | 0.63 | 0.75 | 0.09 | |
1.49 | 1.43 | 1.38 | 1.49 | |
0.57 | 0.70 | 0.77 | 0.46 | |
1.49 | 1.15 | 0.84 | 0.21 | |
1.05 | 0.89 | 1.01 | 1.04 |
Normalized circuit parameters for LC-ladder divider with various three matching frequencies.
Scattering matrix of LC-ladder divider with three matching frequencies. (a) Reflection, (b) power division, and (c) isolation characteristics.
Scattering matrix of LC-ladder divider with constant absolute bandwidth.
Based on the circuit analysis using the even-/odd-mode excitation method mentioned above, we are studying the circuit pattern on the dielectric substrate by an electromagnetic analysis as a preliminary step to the trial production. The circuit pattern is shown in Figure 10a. The design frequency is 0.4/0.45/1.6 with a frequency ratio to the center frequency of 2.3 GHz, that is, 920 MHz/1.03 GHz/3.68 GHz, and the conditions for the electromagnetic simulation are the same as in Section 2.3. Assume the use of GRM Series and MCR series for capacitors and resistors, respectively. Assuming the influence of the self-resonant frequency of the element on the circuit characteristics, the inductor is arranged by the bending pattern of the line instead of the chip element. In Figure 10a, the circuit size is 7.0 × 9.3 mm2 excluding the input/output ports. The frequency characteristics of the scattering matrix obtained by the electromagnetic simulation of the circuit pattern in Figure 10a are shown in Figure 10b. In addition to good reflection/isolation characteristics and division characteristics at the desired design frequency, the absolute constant bandwidth based on the center frequency in the UHF/SHF band is about 8.6%/7.4%. A prototype experiment is being conducted under the same conditions for the circuit pattern examined by the electromagnetic simulation above. A circuit is realized by forming a conductor pattern on a dielectric substrate using a commercially available substrate processing machine (ProtoMat S63/LPKF) and soldering each element to a predetermined position. A conductor pin is inserted into the via hole with a diameter of 0.3 mm and sintered to connect to the ground conductor. Figure 10c shows a photograph of the prototype circuit. The frequency characteristics of this circuit were measured using a vector network analyzer. The results are shown in Figure 10d. Good characteristics are almost identical to the analysis results, and the absolute bandwidth of 5.6%/4.8% can be confirmed in both operating bands.
Experiment of LC-ladder divider with constant absolute bandwidth. (a) Simulation pattern, (b) its analysis results, (c) photograph of fabricated divider, and (d) experimental results.
As mentioned above, the usefulness of the circuit that can be designed by arbitrarily determining the three matching frequencies using the LC-ladder type configuration was examined. It was analytically and experimentally shown that a dual-band power divider with an absolute constant bandwidth in the UHF/SHF (sub6) band can be realized by closing the two matching frequencies to each other on the low-frequency side. The design method in this study is considered to be very useful in the situation where the use of the SHF band becomes more active due to social factors such as the spread of 5G. In the future, we plan to conduct an experimental study on the design of power dividers in the higher frequency range, such as the X-Band.
By increasing the number of stages of the LC-ladder circuit, the operating band can be expanded, corresponding to the number of stages. In this section, the number of stages of the LC-ladder circuit on the input side is set to 8, and the ultra-wideband (relative bandwidth 100% over), an equal power division circuit with characteristics, will be described.
As a design method that uses lumped elements and realizes wideband characteristics while avoiding an increase in circuit size, there is a method that uses an LC-ladder impedance transformer. Here, we show the design method of the multiband LC-ladder divider proposed by Okada et al. and focus on the viewpoint of wideband and multiband. Figure 11a shows a multiband power divider consisting of multiple LC-ladder circuits and an RL series circuit on the output side. The figure shows an
(a) Schematic of N-section LC-ladder divider and (b) its equivalent circuit with onefold symmetry.
Frequency characteristics of scattering parameters for N-section LC-ladder dividers: (a) four-section, (b) six-section, and (c) eight-section LC-ladder dividers.
Figure 13 is a photograph of the prototype circuit of the circuit shown in Figure 12 and the measurement result of its
Photographs of fabricated circuits and their measurement results for N-section LC-ladder dividers: (a) four-section, (b) six-section, and (c) eight-section LC-ladder dividers.
As mentioned above, it has been shown that the operating band of the power divider is expanded by increasing the number of stages of the LC-ladder circuit. Setting eight stages, an ultra-wideband circuit with a relative bandwidth exceeding 100% becomes possible. The effectiveness was also shown experimentally in a prototype experiment in the VHF band. With a wideband characteristic of over 100%, it is available for public radio in Japan.
By using a multistage impedance transformer and an L-type matching circuit design method to downsize the microwave power divider, the characteristics are equal to or higher than those of the conventional Wilkinson power divider designed based on the distributed circuit theory. First, it was shown that in a circuit capable of dual-band operation, a wideband circuit or two-frequency operation is possible by moving the operating two frequencies closer to or further away from each other. Next, a circuit configuration that enables three-frequency matching is shown, and by utilizing the feature that the frequency at the center of the three matching frequencies can be arbitrarily selected, a divider having an absolute constant bandwidth in the UHF/SHF band was made possible. Finally, it was shown that the operating band can be expanded by increasing the number of stages of the LC-ladder circuit and that an ultra-wideband circuit exceeding 100% can be realized if the number of stages is 8. These results have been clarified analytically and experimentally.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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This chapter documents some of the studies on antibiotic usage in poultry farming; with specific focus on some selected bacterial species, their economic importance to poultry farming and reports of resistances of isolated species from poultry settings (farms and poultry products) to essential antibiotics.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Christian Agyare, Vivian Etsiapa Boamah, Crystal Ngofi Zumbi and\nFrank Boateng Osei",authors:[{id:"182058",title:"Dr.",name:"Christian",middleName:null,surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"261271",title:"MSc.",name:"Crystal Ngofi",middleName:null,surname:"Zumbi",slug:"crystal-ngofi-zumbi",fullName:"Crystal Ngofi Zumbi"},{id:"261272",title:"MSc.",name:"Frank Boateng",middleName:null,surname:"Osei",slug:"frank-boateng-osei",fullName:"Frank Boateng Osei"},{id:"261273",title:"Dr.",name:"Vivian Etsiapa",middleName:null,surname:"Boamah",slug:"vivian-etsiapa-boamah",fullName:"Vivian Etsiapa Boamah"}]},{id:"39599",doi:"10.5772/50046",title:"Encapsulation Technology to Protect Probiotic Bacteria",slug:"encapsulation-technology-to-protect-probiotic-bacteria",totalDownloads:12448,totalCrossrefCites:45,totalDimensionsCites:87,abstract:null,book:{id:"3145",slug:"probiotics",title:"Probiotics",fullTitle:"Probiotics"},signatures:"María Chávarri, Izaskun Marañón and María Carmen Villarán",authors:[{id:"150285",title:"Dr.",name:"María",middleName:null,surname:"Chávarri Hueda",slug:"maria-chavarri-hueda",fullName:"María Chávarri Hueda"},{id:"151613",title:"MSc.",name:"Izaskun",middleName:null,surname:"Marañon",slug:"izaskun-maranon",fullName:"Izaskun Marañon"},{id:"151621",title:"Dr.",name:"Mª Carmen",middleName:null,surname:"Villarán",slug:"ma-carmen-villaran",fullName:"Mª Carmen Villarán"}]},{id:"39607",doi:"10.5772/50121",title:"Recent Application of Probiotics in Food and Agricultural Science",slug:"recent-application-of-probiotics-in-food-and-agricultural-science",totalDownloads:10168,totalCrossrefCites:32,totalDimensionsCites:77,abstract:null,book:{id:"3145",slug:"probiotics",title:"Probiotics",fullTitle:"Probiotics"},signatures:"Danfeng Song, Salam Ibrahim and Saeed Hayek",authors:[{id:"107905",title:"Prof.",name:"Salam",middleName:null,surname:"Ibrahim",slug:"salam-ibrahim",fullName:"Salam Ibrahim"},{id:"150202",title:"Dr.",name:"Danfeng",middleName:null,surname:"Song",slug:"danfeng-song",fullName:"Danfeng Song"},{id:"151025",title:"MSc.",name:"Saeed",middleName:null,surname:"Hayek",slug:"saeed-hayek",fullName:"Saeed Hayek"}]},{id:"49246",doi:"10.5772/61300",title:"Chitosan as a Biomaterial — Structure, Properties, and Electrospun Nanofibers",slug:"chitosan-as-a-biomaterial-structure-properties-and-electrospun-nanofibers",totalDownloads:4720,totalCrossrefCites:27,totalDimensionsCites:63,abstract:"Chitosan is a polysaccharide derived from chitin; chitin is the second most abundant polysaccharide in the world, after cellulose. Chitosan is biocompatible, biodegradable and non-toxic, so that it can be usedin medicalapplications such as antimicrobial and wound healing biomaterials. It also used as chelating agent due to its ability to bind with cholesterol, fats, proteins and metal ions.",book:{id:"4648",slug:"concepts-compounds-and-the-alternatives-of-antibacterials",title:"Concepts, Compounds and the Alternatives of Antibacterials",fullTitle:"Concepts, Compounds and the Alternatives of Antibacterials"},signatures:"H. M. Ibrahim and E.M.R. El- Zairy",authors:[{id:"90645",title:"Dr.",name:"Hassan",middleName:null,surname:"Ibrahim",slug:"hassan-ibrahim",fullName:"Hassan Ibrahim"},{id:"175694",title:"Dr.",name:"Enas",middleName:null,surname:"El- Zairy",slug:"enas-el-zairy",fullName:"Enas El- Zairy"}]},{id:"51065",doi:"10.5772/63499",title:"Role of the Biofilms in Wastewater Treatment",slug:"role-of-the-biofilms-in-wastewater-treatment",totalDownloads:6849,totalCrossrefCites:28,totalDimensionsCites:61,abstract:"Biological wastewater treatment systems play an important role in improving water quality and human health. This chapter thus briefly discusses different biological methods, specially biofilm technologies, the development of biofilms on different filter media, factors affecting their development as well as their structure and function. It also tackles various conventional and modern molecular techniques for detailed exploration of the composition, diversity and dynamics of biofilms. These data are crucial to improve the performance, robustness and stability of biofilm-based wastewater treatment technologies.",book:{id:"5197",slug:"microbial-biofilms-importance-and-applications",title:"Microbial Biofilms",fullTitle:"Microbial Biofilms - Importance and Applications"},signatures:"Shama Sehar and Iffat Naz",authors:[{id:"180364",title:"Dr.",name:"Iffat",middleName:null,surname:"Naz",slug:"iffat-naz",fullName:"Iffat Naz"},{id:"183345",title:"Dr.",name:"Shama",middleName:null,surname:"Sehar",slug:"shama-sehar",fullName:"Shama Sehar"}]}],mostDownloadedChaptersLast30Days:[{id:"65613",title:"The Methods for Detection of Biofilm and Screening Antibiofilm Activity of Agents",slug:"the-methods-for-detection-of-biofilm-and-screening-antibiofilm-activity-of-agents",totalDownloads:9257,totalCrossrefCites:15,totalDimensionsCites:26,abstract:"Biofilm producer microorganisms cause nosocomial and recurrent infections. Biofilm that is a sticky exopolysaccharide is the main virulence factor causing biofilm-related infections. Biofilm formation begins with attachment of bacteria to biotic surface such as host cell or abiotic surface such as prosthetic devices. After attachment, aggregation of bacteria is started by cell-cell adhesion. Aggregation continues with the maturation of biofilm. Dispersion is started by certain conditions such as phenol-soluble modulins (PSMs). By this way, sessile bacteria turn back into planktonic form. Bacteria embedded in biofilm (sessile form) are more resistant to antimicrobials than planktonic bacteria. So it is hard to treat biofilm-embedded bacteria than planktonic forms. For this reason, it is important to detect biofilm. There are a few biofilm detection and biofilm production methods on prosthetics, methods for screening antibacterial effect of agents against biofilm-embedded microorganism and antibiofilm effect of agents against biofilm production and mature biofilm. The aim of this chapter is to overview direct and indirect methods such as microscopy, fluorescent in situ hybridization, and Congo red agar, tube method, microtiter plate assay, checkerboard assay, plate counting, polymerase chain reaction, mass spectrometry, MALDI-TOF, and biological assays used by antibiofilm researches.",book:{id:"8427",slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods"},signatures:"Sahra Kırmusaoğlu",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}]},{id:"62553",title:"Antibiotic Use in Poultry Production and Its Effects on Bacterial Resistance",slug:"antibiotic-use-in-poultry-production-and-its-effects-on-bacterial-resistance",totalDownloads:7313,totalCrossrefCites:42,totalDimensionsCites:89,abstract:"A surge in the development and spread of antibiotic resistance has become a major cause for concern. Over the past few decades, no major new types of antibiotics have been produced and almost all known antibiotics are increasingly losing their activity against pathogenic microorganisms. The levels of multi-drug resistant bacteria have also increased. It is known that worldwide, more than 60% of all antibiotics that are produced find their use in animal production for both therapeutic and non-therapeutic purposes. The use of antimicrobial agents in animal husbandry has been linked to the development and spread of resistant bacteria. Poultry products are among the highest consumed products worldwide but a lot of essential antibiotics are employed during poultry production in several countries; threatening the safety of such products (through antimicrobial residues) and the increased possibility of development and spread of microbial resistance in poultry settings. This chapter documents some of the studies on antibiotic usage in poultry farming; with specific focus on some selected bacterial species, their economic importance to poultry farming and reports of resistances of isolated species from poultry settings (farms and poultry products) to essential antibiotics.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Christian Agyare, Vivian Etsiapa Boamah, Crystal Ngofi Zumbi and\nFrank Boateng Osei",authors:[{id:"182058",title:"Dr.",name:"Christian",middleName:null,surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"261271",title:"MSc.",name:"Crystal Ngofi",middleName:null,surname:"Zumbi",slug:"crystal-ngofi-zumbi",fullName:"Crystal Ngofi Zumbi"},{id:"261272",title:"MSc.",name:"Frank Boateng",middleName:null,surname:"Osei",slug:"frank-boateng-osei",fullName:"Frank Boateng Osei"},{id:"261273",title:"Dr.",name:"Vivian Etsiapa",middleName:null,surname:"Boamah",slug:"vivian-etsiapa-boamah",fullName:"Vivian Etsiapa Boamah"}]},{id:"65914",title:"Introductory Chapter: The Action Mechanisms of Antibiotics and Antibiotic Resistance",slug:"introductory-chapter-the-action-mechanisms-of-antibiotics-and-antibiotic-resistance",totalDownloads:4414,totalCrossrefCites:6,totalDimensionsCites:10,abstract:null,book:{id:"8427",slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods"},signatures:"Sahra Kırmusaoğlu, Nesrin Gareayaghi and Bekir S. Kocazeybek",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"},{id:"248288",title:"Prof.",name:"Bekir",middleName:null,surname:"Kocazeybek",slug:"bekir-kocazeybek",fullName:"Bekir Kocazeybek"},{id:"406463",title:"Dr.",name:"Nesrin",middleName:null,surname:"Gareayaghi",slug:"nesrin-gareayaghi",fullName:"Nesrin Gareayaghi"}]},{id:"50992",title:"Probiotics: A Comprehensive Review of Their Classification, Mode of Action and Role in Human Nutrition",slug:"probiotics-a-comprehensive-review-of-their-classification-mode-of-action-and-role-in-human-nutrition",totalDownloads:5418,totalCrossrefCites:16,totalDimensionsCites:28,abstract:"Probiotics are live microorganisms that live in gastrointestinal (GI) tract and are beneficial for their hosts and prevent certain diseases. In this chapter, after a complete introduction to probiotics, definition, mechanism of action, and their classification, currently used organisms will be discussed in detail. Moreover, different kinds of nutritional synthetic products of probiotics along with their safety and drug interaction will be noticed. This chapter mentions all clinical trial studies that have been done to evaluate probiotic efficacy with a focus on gastrointestinal diseases.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Amirreza Khalighi, Reza Behdani and Shabnam Kouhestani",authors:[{id:"179560",title:"Dr.",name:"Amirreza",middleName:null,surname:"Khalighi",slug:"amirreza-khalighi",fullName:"Amirreza Khalighi"},{id:"185238",title:"Dr.",name:"Reza",middleName:null,surname:"Behdani",slug:"reza-behdani",fullName:"Reza Behdani"},{id:"185239",title:"Dr.",name:"Shabnam",middleName:null,surname:"Kouhestani",slug:"shabnam-kouhestani",fullName:"Shabnam Kouhestani"}]},{id:"56849",title:"Physiology and Pathology of Innate Immune Response Against Pathogens",slug:"physiology-and-pathology-of-innate-immune-response-against-pathogens",totalDownloads:6205,totalCrossrefCites:21,totalDimensionsCites:28,abstract:"Pathogen infections are recognized by the immune system, which consists of two types of responses: an innate immune response and an antigen-specific adaptive immune response. The innate response is characterized by being the first line of defense that occurs rapidly in which leukocytes such as neutrophils, monocytes, macrophages, eosinophils, mast cells, dendritic cells, etc., are involved. These cells recognize the pathogen-associated molecular patterns (PAMPs), which have been evolutionarily conserved by the diversity of microorganisms that infect humans. Recognition of these pathogen-associated molecular patterns occurs through pattern recognition receptors such as Toll-like receptors and some other intracellular receptors such as nucleotide oligomerization domain (NOD), with the aim of amplifying the inflammation and activating the adaptive cellular immune response, through the antigenic presentation. In the present chapter, we will review the importance of the main components involved in the innate immune response, such as different cell types, inflammatory response, soluble immune mediators and effector mechanisms exerted by the immune response against bacteria, viruses, fungi, and parasites; all with the purpose of eliminating them and eradicating the infection of the host.",book:{id:"5975",slug:"physiology-and-pathology-of-immunology",title:"Physiology and Pathology of Immunology",fullTitle:"Physiology and Pathology of Immunology"},signatures:"José Luis Muñoz Carrillo, Flor Pamela Castro García, Oscar\nGutiérrez Coronado, María Alejandra Moreno García and Juan\nFrancisco Contreras Cordero",authors:[{id:"214236",title:"Dr.",name:"Jose Luis",middleName:null,surname:"Muñoz-Carrillo",slug:"jose-luis-munoz-carrillo",fullName:"Jose Luis Muñoz-Carrillo"},{id:"216080",title:"Dr.",name:"Alejandra",middleName:null,surname:"Moreno-García",slug:"alejandra-moreno-garcia",fullName:"Alejandra Moreno-García"},{id:"216081",title:"Dr.",name:"Oscar",middleName:null,surname:"Gutiérrez-Coronado",slug:"oscar-gutierrez-coronado",fullName:"Oscar Gutiérrez-Coronado"},{id:"216082",title:"Dr.",name:"Pamela",middleName:null,surname:"Castro-García",slug:"pamela-castro-garcia",fullName:"Pamela Castro-García"},{id:"220717",title:"Dr.",name:"Juan Francisco",middleName:null,surname:"Contreras Cordero",slug:"juan-francisco-contreras-cordero",fullName:"Juan Francisco Contreras Cordero"}]}],onlineFirstChaptersFilter:{topicId:"13",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82972",title:"Actinomycosis: Diagnosis, Clinical Features and Treatment",slug:"actinomycosis-diagnosis-clinical-features-and-treatment",totalDownloads:0,totalDimensionsCites:0,doi:"10.5772/intechopen.104698",abstract:"Actinomycosis is a filamentous bacterium that forms part of the normal human flora of the gastrointestinal, oropharynx and female genitalia. This indolent infection is characterized by abscess formation, widespread granulomatous disease, fibrosis, cavitary lung lesions and mass-like consolidations, simulating an active malignancy or systemic inflammatory diseases. It is subacute, chronic and variable presentation may delay diagnosis due to its capability to simulate other conditions. An accurate diagnostic timeline is relevant. Early diagnosis of pulmonary actinomycosis decreases the risk of indolent complications. Proper treatment reduces the need for invasive surgical methods. Actinomycosis can virtually involve any organ system, the infection spread without respecting anatomical variables as metastatic disease does, making malignancy an important part of the differential diagnosis. As it is normal gastrointestinal florae, it is difficult to cultivate, and share similar morphology to other organisms such as Nocardia and fungus. It is often difficult to be identified as the culprit of disease. Its true imitator capability makes this infectious agent a remarkable organism within the spectra of localized and disseminated disease. In this chapter, we will discuss different peculiarities of actinomycosis as an infectious agent, most common presentation in different organ systems, and challenging scenarios.",book:{id:"10893",title:"Actinobacteria",coverURL:"https://cdn.intechopen.com/books/images_new/10893.jpg"},signatures:"Onix J. Cantres-Fonseca, Vanessa Vando-Rivera, Vanessa Fonseca-Ferrer, Christian Castillo Latorre and Francisco J. Del Olmo-Arroyo"},{id:"82412",title:"Potential of Native Microalgae from the Peruvian Amazon on the Removal of Pollutants",slug:"potential-of-native-microalgae-from-the-peruvian-amazon-on-the-removal-of-pollutants",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105686",abstract:"Environmental pollution is a severe and common problem in all the countries worldwide. Various physicochemical technologies and organisms (e.g., plants, microorganisms, etc.) are used to address these environmental issues, but low-cost, practical, efficient, and effective approaches have not been available yet. Microalgae offer an attractive, novel, and little-explored bioremediation alternative because these photosynthetic organisms can eliminate pathogenic microorganisms and remove heavy metals and toxic organic compounds through processes still under study. Our research team has conducted some experiments to determine the bioremediation potential of native microalgae on some pollutant sources (i.e., leachate and wastewater) and its ability to remove hazardous chemical compounds. Therefore, in this chapter, we provide the results of our research and updated information about this exciting topic. Experiments were conducted under controlled culture conditions using several native microalgae species, variable time periods, different pollutant sources, and hazardous chemicals such as ethidium bromide. The results indicated that native microalgae can remove pollutants (i.e., phosphorus, ammonia, etc.) of wastewater, leachate, and some hazardous chemical compounds such as ethidium bromide. In conclusion, native microalgae have an excellent potential for removing several pollutants and, consequently, could be used to develop bioremediation technologies based on native microalgae from the Peruvian Amazon.",book:{id:"11366",title:"Microalgae",coverURL:"https://cdn.intechopen.com/books/images_new/11366.jpg"},signatures:"Marianela Cobos, Segundo L. Estela, Carlos G. Castro, Miguel A. Grandez, Alvaro B. Tresierra, Corayma L. Cabezudo, Santiago Galindo, Sheyla L. Pérez, Angélica V. Rios, Jhon A. Vargas, Roger Ruiz, Pedro M. Adrianzén, Jorge L. Marapara and Juan C. Castro"},{id:"81859",title:"Respiratory Syncytial Virus",slug:"respiratory-syncytial-virus",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.104771",abstract:"Respiratory Syncytial Virus (RSV)-driven bronchiolitis is one of the most common causes of pediatric hospitalization. Every year, we face 33.1 million episodes of RSV-driven lower respiratory tract infection without any available vaccine or cost-effective therapeutics since the discovery of RSV eighty years before. RSV is an enveloped RNA virus belonging to the pneumoviridae family of viruses. This chapter aims to elucidate the structure and functions of the RSV genome and proteins and the mechanism of RSV infection in host cells from entry to budding, which will provide current insight into the RSV-host relationship. In addition, this book chapter summarizes the recent research outcomes regarding the structure of RSV and the functions of all viral proteins along with the RSV life cycle and cell-to-cell spread.",book:{id:"11369",title:"RNA Viruses Infection",coverURL:"https://cdn.intechopen.com/books/images_new/11369.jpg"},signatures:"Sattya Narayan Talukdar and Masfique Mehedi"},{id:"82148",title:"Mosquito Population Modification for Malaria Control",slug:"mosquito-population-modification-for-malaria-control",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.104907",abstract:"Malaria is a mosquito-borne disease that kills millions of people every year. Existing control tools have been insufficient to eliminate the disease in many endemic regions and additional approaches are needed. Novel vector-control strategies using genetic engineering to create malaria-resistant mosquitoes (population modification) can potentially contribute a new set of tools for mosquito control. Here we review the current mosquito control strategies and the development of transgenic mosquitoes expressing anti-parasite effector genes, highlighting the recent improvements in mosquito genome editing with CRISPR-Cas9 as an efficient and adaptable tool for gene-drive systems to effectively spread these genes into mosquito populations.",book:{id:"11379",title:"Mosquito Research - Recent Advances in Pathogen Interactions, Immunity, and Vector Control Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11379.jpg"},signatures:"Rebeca Carballar-Lejarazú, Taylor Tushar, Thai Binh Pham and Anthony James"},{id:"81934",title:"Lactobacillus Use for Plant Fermentation: New Ways for Plant-Based Product Valorization",slug:"lactobacillus-use-for-plant-fermentation-new-ways-for-plant-based-product-valorization",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104958",abstract:"Today, plant production is increasing, but most industrial processes generate a lot of waste and by-products for which, in the current context, it is a priority to recycle or valorize them. One of the cheapest valorization routes is fermentation, in particular lactic fermentation by Lactobacillus species, which produces lactic acid and other molecules of industrial interest such as bioactive compounds such as anthocyanin, organic acid, peptides, or phenol, which are widely found in the plant matrix, mainly in cereals, grass, fruits, and vegetables. Bioactive compounds may exert beneficial health effects, such as antioxidant, anti-inflammatory, antimicrobial, or prebiotic activities. In addition, lactic acid fermentation can improve existing products and lead to new applications in food, livestock feeding and biotechnology, such as the production of lactic acid, protein, or silage. This chapter reviews the use of Lactobacillus strains in the fermentation process of many plant bioresources or by-products through their different bioactivities, active molecules, and applications.",book:{id:"11372",title:"Lactobacillus - A Multifunctional Genus",coverURL:"https://cdn.intechopen.com/books/images_new/11372.jpg"},signatures:"Morgan Le Rouzic, Pauline Bruniaux, Cyril Raveschot, François Krier, Vincent Phalip, Rozenn Ravallec, Benoit Cudennec and François Coutte"},{id:"82672",title:"Removal of Microcystins from Drinking Water by Electrocoagulation: Upscaling, Challenges, and Prospects",slug:"removal-of-microcystins-from-drinking-water-by-electrocoagulation-upscaling-challenges-and-prospects",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.105751",abstract:"Microcystins (MCs) belong to a family of stable monocyclic heptapeptide compounds responsible for hazardous toxins in drinking water. Although several methods have been applied to remove MCs from drinking water (e.g., activated carbon filtration, ion exchange resins, high-pressure membranes, and electrochemistry), upscaling laboratory experiments to benefit municipal water treatment is still a major challenge. This chapter is a follow-up study designed to test three electrocoagulation (EC) techniques for decomposing MC by UV-ozone purification (laboratory), electrocoagulation (field unit), and coupled UV-ozone-electrocoagulation (municipal treatment). The chemistry and efficiency of the treatments were first examined followed by comparison with activated carbon filtration. Electrocoagulation outperformed activated carbon filtration by nearly 40%. When the laboratory treatments were evaluated at the municipal scale, effectiveness of the technique deteriorated by 10–20% because of UV pulse dissipation, vapor-ion plasma under-functioning, and limitations of polymer fiber filters. We confirmed previously published studies that pollutant coagulation and MC decomposition are affected by physicochemical factors such as radiation pulse density, electrical polarity, pH, and temperature dynamics. The results have relevant applications in wastewater treatment and chemical recycling.",book:{id:"11800",title:"Cyanobacteria - Recent Advances and New Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11800.jpg"},signatures:"Stephen Opoku-Duah, Dennis Johnson, Dan Blair and Jeff Dimick"}],onlineFirstChaptersTotal:101},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:18,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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