\r\n\tThis book will provide information about current status of soybean production, processing, utilization and actual food safety management system as well as science based approaches defining the future of soybean for human consumption and animal feed.
",isbn:"978-1-83881-019-1",printIsbn:"978-1-83881-018-4",pdfIsbn:"978-1-83881-020-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"4bc6f95dc8630c9a8be84bb46286c445",bookSignature:"Dr. Aleksandra Sudarić",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/6972.jpg",keywords:"soybean, production, processing, development, utilization, trade, breeding, biotechnology,\r\nsoybean food usage, health benefits, food safety, management, risk, legislative",numberOfDownloads:133,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"December 4th 2019",dateEndSecondStepPublish:"December 25th 2019",dateEndThirdStepPublish:"February 23rd 2020",dateEndFourthStepPublish:"May 13th 2020",dateEndFifthStepPublish:"July 12th 2020",remainingDaysToSecondStep:"18 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,editors:[{id:"21485",title:"Dr.",name:"Aleksandra",middleName:null,surname:"Sudarić",slug:"aleksandra-sudaric",fullName:"Aleksandra Sudarić",profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:"Dr Aleksandra Sudarić was born in Osijek, Croatia. \r\n\r\nShe received her MSc in Plant Genetics and Breeding from the University of Zagreb, and Ph.D. in Plant Breeding from the University of Osijek. \r\n\r\nIn addition, she completed the training for the application of DNA-based marker technology at the University of Guelph (Guelph, Canada).\r\nDr. Sudarić has been working at the Agricultural Institute Osijek (Osijek, Croatia) as the senior research scientist. \r\n\r\nShe is the Head of the Department for breeding and genetics of industrial plants. \r\n\r\nThe focus of her scientific work is the soybean breeding with emphasis on the development of soybean varieties for the needs of the producers, processors and customers. \r\n\r\nDr. Sudaric has authored more than 140 scientific, professional and popular articles, three chapters and three books about soybean and more than 20 registered soybean varieties.",institutionString:"Agricultural Institute",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Agricultural Institute Osijek",institutionURL:null,country:{name:"Croatia"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"5",title:"Agricultural and Biological Sciences",slug:"agricultural-and-biological-sciences"}],chapters:[{id:"68701",title:"Nondestructive Evaluation of Inoculation Effects of AMF and Bradyrhizobium japonicum on Soybean under Drought Stress From Reflectance Spectroscopy",slug:"nondestructive-evaluation-of-inoculation-effects-of-amf-and-bradyrhizobium-japonicum-on-soybean-unde",totalDownloads:50,totalCrossrefCites:0,authors:[null]},{id:"69807",title:"Improving Seed Quality of Soybean Suitable for Growing in Europe",slug:"improving-seed-quality-of-soybean-suitable-for-growing-in-europe",totalDownloads:38,totalCrossrefCites:0,authors:[null]},{id:"69396",title:"Soybean Amino Acids in Health, Genetics, and Evaluation",slug:"soybean-amino-acids-in-health-genetics-and-evaluation",totalDownloads:46,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"305835",firstName:"Ketrin",lastName:"Polesak",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/305835/images/9351_n.png",email:"ketrin@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"1484",title:"Soybean",subtitle:"Molecular Aspects of Breeding",isOpenForSubmission:!1,hash:"3bd8fd078e7df24f2eed6dc7bc226475",slug:"soybean-molecular-aspects-of-breeding",bookSignature:"Aleksandra Sudaric",coverURL:"https://cdn.intechopen.com/books/images_new/1484.jpg",editedByType:"Edited by",editors:[{id:"21485",title:"Dr.",name:"Aleksandra",surname:"Sudarić",slug:"aleksandra-sudaric",fullName:"Aleksandra Sudarić"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6418",title:"Hyperspectral Imaging in Agriculture, Food and Environment",subtitle:null,isOpenForSubmission:!1,hash:"9005c36534a5dc065577a011aea13d4d",slug:"hyperspectral-imaging-in-agriculture-food-and-environment",bookSignature:"Alejandro Isabel Luna Maldonado, Humberto Rodríguez Fuentes and Juan Antonio Vidales Contreras",coverURL:"https://cdn.intechopen.com/books/images_new/6418.jpg",editedByType:"Edited by",editors:[{id:"105774",title:"Prof.",name:"Alejandro Isabel",surname:"Luna Maldonado",slug:"alejandro-isabel-luna-maldonado",fullName:"Alejandro Isabel Luna Maldonado"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3794",title:"Swarm Intelligence",subtitle:"Focus on Ant and Particle Swarm Optimization",isOpenForSubmission:!1,hash:"5332a71035a274ecbf1c308df633a8ed",slug:"swarm_intelligence_focus_on_ant_and_particle_swarm_optimization",bookSignature:"Felix T.S. Chan and Manoj Kumar Tiwari",coverURL:"https://cdn.intechopen.com/books/images_new/3794.jpg",editedByType:"Edited by",editors:[{id:"252210",title:"Dr.",name:"Felix",surname:"Chan",slug:"felix-chan",fullName:"Felix Chan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"42845",title:"Imaging Patellar Complications After Knee Arthroplasty",doi:"10.5772/53666",slug:"imaging-patellar-complications-after-knee-arthroplasty",body:'
1. Introduction
Knee arthroplasty, like hip replacement, is becoming increasingly common as the overall population begins to age. The survival rate of the knee implant is also increasing and is now similar to that of hip prostheses (85%-90% at 15 years).
Although complications in knee replacements have been widely reported and discussed, the literature contains few studies about patellar complications after total or partial knee arthroplasty.
Patellar complications after knee arthroplasty are infrequent but they can lead to unsatisfactory clinical outcome. Complications are often underestimated because the femoral component makes visualization of these lesions difficult. Evaluation must begin with a thorough history and physical examination. Laboratory tests and imaging studies can provide additional evidence to support a particular diagnosis.
The aim of this chapter is to describe and analyze complications affecting the patella in patients with total or partial knee arthroplasty and to illustrate some representative examples of the spectrum of findings on different imaging techniques, such as plain-film radiography and ultrasound (US), with the emphasis on plain-film findings.
Together with the clinical examination and follow-up, thorough plain-film and computed tomography (CT) studies should be done before and after the surgery. Later follow-up is directed toward identifying complications such as instability/dislocation, fracture, osteonecrosis, infection, erosion, impingement on the prosthesis, patellar or quadriceps tendon tear, and loosening or rupture of the patellar prosthetic button. One large study demonstrated that obtaining plain-film radiographs immediately after knee arthroplasty is not cost-effective. [1]
In the follow-up, plain-film radiographs usually suffice for the assessment of patellar complications and are helpful for guiding treatment. Some authors recommend a weight-bearing axial radiograph to better assess patellofemoral kinematics. [2-3] Although radiographs are the mainstay in evaluating loosening or infection, they are limited by their less than optimal sensitivity and specificity. [4]
In one study, the sensitivity and specificity of plain-film radiography compared to the findings at surgery were 77% and 90%, respectively, for detecting femoral component loosening, and 83% and 72%, respectively, for detecting tibial component loosening. [5] However, no specific studies about patellar prosthetic button complications are found in the literature.
In the past, the roles of CT and magnetic resonance imaging (MRI) in the assessment of joint prostheses were inconsequential due to image degradation by artifact. However, improvements in techniques and instrumentation have greatly improved the usefulness of CT and MRI in patients with joint replacements. Although no studies have addressed the routine use of these techniques for the follow-up of asymptomatic patients, some authors recommend CT to look for osteolysis in patients with painful knee prostheses with normal or equivocal radiographs and increased uptake on all three phases of a bone scan. [6] Another group of researchers [7]- [8] recommend multidetector CT in cases where osteolysis is likely, such as those with aseptic loosening and gross polyethylene wear. In patients with loosening, CT examination may also be useful to show the extent and width of lucent zones that may be less apparent on radiographs; in these cases, CT makes it possible to assess rotational alignment of components and to detect subtle or occult periprosthetic fractures of the patella. [9-10]
We use CT to assess component alignment and position as well as rotation of the patella with respect to the femur in patients with knee arthroplasty.
In patients with metallic knee prostheses, we use MRI for very specific indications, such as to evaluate the soft tissues surrounding the patella like the patellar and quadriceps tendons, Hoffa’s fat pad, prepatellar subcutaneous tissue, and others. Although MRI is the technique of choice to evaluate the soft tissues [11], its use is seriously limited by drawbacks such as the high cost of acquiring, installing, and maintaining the equipment; magnetic susceptibility; the difficulties of working in a magnetic field; the large number of artifacts; long examination times that may require sedation; discomfort due to the noise inside the scanner; and possible claustrophobia. However, now nearly all implants are non-magnetizable and modern scanners allow images to be manipulated, so magnetic artifacts are no longer a problem. Thus, it could be argued that MRI will eventually supplant US; [12]; for example, MR may be helpful in detecting extracapsular spread of infection and abscess formation. [13]
2. Material and methods
Every year between 1998 and 2011, our hospital carried out more than 200 total knee replacements and 10 to 15 implantations of unicompartmental prostheses of the knee. In some knee replacement procedures, the patella was left intact, but in others patellar resurfacing was performed or a prosthetic button was implanted. When the patella is intervened, it is often resurfaced with high-density polyethylene, which may be metal backed.
We retrospectively reviewed 1400 consecutive examinations in patients treated with total or partial knee arthroplasty in the last two years; 54 (3.7%) patients (35 women and 19 men) presented patellar complications. Mean patient age was 74 years (range, 55-90 years). In some cases, patients had prostheses in both knees.
All patients were followed up immediately after surgery, at 6 months, and then yearly or when necessary, using anteroposterior, lateral, and axial (Merchant view) radiographs. Lateral and axial projections are better for visualizing and evaluating the evolution of the patella after knee replacement.
In certain cases according to the clinical symptoms, patients underwent US, especially to evaluate the morphological integrity of the patellar and quadriceps tendons and other soft-tissue structures around the patella.
3. Results
The patellar complications that we observed following total knee arthroplasty include instability/dislocation, fracture, osteonecrosis, infection, erosion, impingement on the prosthesis, patellar or quadriceps tendon tear, and loosening or rupture of the patellar prosthetic button. The mean interval from total knee replacement to patellar complication was 5 years and 9 months (range, 5 months-15 years).
3.1. Instability/dislocation (n=21)
Patellar instability (n=15) is the commonest complication after knee arthroplasty. In total knee arthroplasty, most complications related to the extensor mechanism are caused by patellar maltracking instability. [14] Patellar maltracking may result from component malpositioning and limb malalignment, excessive femoral component size, prosthetic design, inadequate patellar resection, or soft-tissue imbalance. [15] Patellofemoral instability likely results most frequently from internal malrotation of the femoral or tibial components. [16]
Malpositioning of femoral and tibial components may affect patellar alignment. Although the axial rotation of the femoral component can be determined using plain-film radiographs or MRI, CT is most commonly used for this purpose. [17] Excessive combined internal rotation of tibial and femoral components is associated with patellar complications. [18] Furthermore, one study [19] found the amount of excessive combined internal rotation was directly proportional to the severity of patellofemoral complications. The rotation of the femoral component can be assessed with relation to the transepicondylar axis, the Whiteside line, or the posterior femoral condyles. The femoral component should be parallel to the transepicondylar axis and the tibial component should be in about 18 degrees of internal rotation with relation to the tibial tubercle.
Careful radiographic follow-up should be considered when deep flexion is achieved in a knee with a patella baja after total knee arthroplasty (Figure 1). Patellar dislocation (n=6) is mainly due to direct trauma to the patella or to extensor mechanism rupture [20] (Figure 2).
Figure 1.
Patellar Instability. A 60-year-old man, five years after total knee replacement. Lateral radiograph reveals caudal displacement of the patella (curved arrow).
Figure 2.
Patellar Dislocation. A 71-year-old woman, five years after total knee replacement. Axial radiograph (Merchant view) of the knee prosthesis with cemented prosthetic button of the patella demonstrates lateral patellar displacement on flexion (curved arrow).
Alterations in the patellotibial distance can occur during total knee arthroplasty due to excessive soft-tissue release that requires elevation of the joint to regain stability and placement of the polyethylene patellar component distally on the patella. Another cause of acquired patella baja seen commonly in total knee arthroplasty is elevation of the joint line, referred to as pseudo-patella baja. [21]
Radiographic evaluation of the patella primarily uses the lateral view and the sunrise or Merchant’s view. This projection should show the central ridge of the patella lying at or medial to the bisector of the trochlear angle. This approach is also helpful for evaluating patellar tilt, but not it is very sensitive for determining the cause of patellofemoral pain.
The lateral view reveals the patellar thickness, inferior or superior positioning, as well as adequate fixation and position of the components. The positioning of the patellar component (centralized or tilted in relation to the trochlear sulcus or subluxated/dislocated) is clearly seen and may reveal the cause of instability. Tilt can be defined as medial or lateral, depending on its relation to the femoral condyles. Subluxation can be measured as displacement from the center of the prosthetic femoral intercondylar groove. [22]
3.2. Osteonecrosis (n=5)
Patellar resurfacing during total knee arthroplasty remains controversial. Several patellar complications such as fracture, avascular necrosis, and instability are related to resurfacing. On the other hand, some authors report lower re-operation rates and postoperative pain when the patella is resurfaced. Attention should be directed to the ultimate patellar thickness. Whether or not to resurface should be determined based on the exact initial thickness. A thicker patella is prone to instability, whereas a thinner patella is associated with higher complication rates. Patellar fragmentation and sclerosis of the fragments are presumed to represent osteonecrosis (Figure 3). The osteonecrosis may be due to disruption of the vascular network of the patella during total knee replacement surgery. [23] Medial parapatellar arthrotomy, fat pad removal, and lateral release all contribute to patellar devascularization. Evolutional osteonecrosis may lead to patellar fracture.
Figure 3.
Patellar Necrosis. A 68-year-old man, seven years after total knee replacement. Axial radiograph of the knee prosthesis shows bony sclerosis with fragmentation of the patella (arrow).
3.3. Fracture (n=9)
Patellar fractures in association with total knee replacement are uncommon and occur predominantly in patients with resurfaced patellae. [24] Most fractures appear to occur in the first few years after total knee replacement.
Patient, implant, and technical factors are important predisposing causes of these patellar fractures. Avascularity, trauma, fatigue, and stress also play an etiologic role in some patellar fractures.
Trauma to the patella, either direct or indirect, and increased patellofemoral stress are other causes of fracture. Indirect causes might include an eccentric quadriceps muscle contraction associated with a stumble, resulting in an avulsion fracture (Figure 4).
Figure 4.
Patellar Avulsion Fracture. A 73-year-old woman, seven years after total knee replacement. Lateral radiograph shows a transverse avulsion fracture in the mid-portion of the patella with displacement of its poles in the cranial-caudal direction (arrows).
Patellar fractures are not associated with prior injury. Because patellar fractures are often asymptomatic and discovered incidentally, follow-up radiographs are essential for their detection. Transverse fractures seem to be related to patellar maltracking, and vertical fractures often occur through a fixation hole. CT or MRI can detect some fractures that go undetected on plain-film radiographs.
Prevention is the best treatment. Important outcome criteria include the integrity of the extensor mechanism, patellar implant fixation, and anatomic location. Surgery on patients with patella fractures has a high complication rate and should be avoided if possible. [25-26]
3.4. Infection (n=2)
Although rare, infection can appear in the patella after total or partial replacement of the knee. [27] Unspecific radiological signs of infection include a lytic lesion or osseous sclerosis in the patella or in the joint facet of the femur in the femoropatellar joint (Figure 5). Clinical symptoms may orient the diagnosis of infection.
Figure 5.
Patellar Infection. A 70-year-old man, nine years after partial knee replacement. Axial radiograph (Merchant view) of the knee prosthesis shows osteolysis on the lateral facet of the femur (arrow) with a non-cemented hemiarthroplasty of the knee, corresponding to a focus of infection, with sclerosis in the patella, suspected of infective infiltration. These findings were confirmed during surgery, and excisional debridement of the infection and total patellectomy were performed. Cultures were positive for Pseudomonas aeruginosa.
Plain-film radiographs are usually negative in the first ten days, even when clinical signs raise suspicion of infection. The radiological presentation varies, sometimes including localized rarefaction in the patella with or without sequestrum, or osseous destruction of the patella with or without an irregular bony fragment adjacent.
Surgical biopsy would provide the definitive diagnosis. The treatment of osteolytic lesions of the patella should be surgical.
3.5. Erosion/Impingement (n=6)
Patellar instability can cause erosion (n=2) in the joint facet of the patella due to friction with the femoral component of the knee arthroplasty (Figure 6). The erosion may appear as a lytic lesion that can simulate a subchondral cyst due to any arthritic process or small particle disease. Careful comparison with the pre-arthroplasty plain-films is essential. The erosion should not be confused with a dorsal defect in the posterior surface of the patella that occasionally persists into later life. The dorsal patellar defect is usually well delineated.
Patellar impingement (n=4), the so-called patellar clunk syndrome, results from the formation of a fibrous nodule over the proximal pole of the patella and reportedly occurs in cases of total kneed arthroplasty in which a posterior stabilized design is utilized. [28] Arthroscopic or open resection of the fibrous nodule can eliminate this syndrome.
Figure 6.
Patellar Osteolysis. A 75-year-old man, three years after total knee replacement. Axial radiograph (Merchant view) shows osteolysis of the lateral facet of the patella (black arrow) due to the loosening of both the total knee prosthesis and the patellar prosthetic button (white arrow). There was clinical suspicion of infection but cultures were negative.
Patellar impingement also is seen when patella baja develops after posterior stabilized total knee arthroplasty and when the patella becomes impinged against the femoral component (Figure 7). [29] Patellofemoral complications (osteoarthritis and impingement) are rarely seen after total replacement and even more rarely after unicompartmental arthroplasty [30], so their long-term consequences are not well known.
Figure 7.
Patellar Impingement. A 71-year-old man, four years after total knee replacement. Axial radiograph (Merchant view) shows a reduction in the space between the knee arthroplasty and the patella, with consequent reactive patellar sclerosis (asterisk).
However, in our study the symptoms in knees with patellar impingement were usually more severe than in knees with degenerative changes.
3.7. Loosening or rupture of the patellar prosthetic button (n=7)
A patellar prosthetic button (patellar component) is added to total knee replacement in certain cases. Like all joint prostheses (such as hip, knee, and small joints), the patellar button may loosen or rupture with the same or similar characteristic radiological signs as in the other joints. Loosening of the patellar button (Figure 8) may cause significant anterior pain. Thin fixation pegs, maltracking, and trauma frequently induce component loosening. Revision of a failed patellar component is typically associated with a relatively high complication rate.
Figure 8.
Prosthetic Button Loosening. A 71-year-old woman, two years after total knee replacement. Axial radiograph (Merchant view) shows patellar subluxation with prosthetic button loosening (arrow).
Osseous changes that may be observed in the patellar prosthetic button following total or partial knee arthroplasty include radiolucent lines, osteolysis, change in prosthesis position, and polyethylene wear. Radiolucent lines superimposed on the femoral component can often be obscured by the metal tray if the view is not perfectly tangential to the component surface. Nonprogressive focal radiolucent areas less than 2 mm in size are often insignificant; however, progressive, circumferential, radiolucent areas larger than 2 mm are often indicative of prosthesis loosening.
Rupture of the patellar prosthetic button (Figure 9) is rare but can occur due to polyethylene wear, fusion defects in the polyethylene structure [31], or trauma to the patella. [32] The incidence of wear in patients with all-polyethylene and metal-backed components ranges from 5% to 11%. Congruity, maltracking, and contact force are associated with polyethylene wear. Decreased polyethylene thickness in metal-backed designs is the determining factor for mechanism failure.
Figure 9.
Prosthetic Button Rupture. A 68-year-old woman, four years after total knee replacement. Lateral radiograph shows a rupture of the patellar prosthetic button (arrow) with caudal displacement.
Prosthetic loosening, small particle disease, and infection are the most frequent causes of osteolysis of the patellar component. A change in position of components on serial images is indicative of prosthesis loosening. [33]
3.8. Patellar or quadriceps tendon tear (n=4)
Rupture of patellar or quadriceps ligaments occurs infrequently. However, the complications of an untreated rupture to the extensor mechanism can be extremely disabling. Contributing factors are excessive dissection and knee manipulation, and trauma. The same mechanical causes that produce patellar fractures can produce patellar [34] or quadriceps [35] tendon tear. US is the method of choice for studying the patellar or quadriceps tendons to confirm or rule out tendon tears (Figures 10 &11). An abrupt high patella is seen on lateral radiographs in some patients with clinical suspicion of tendon rupture after total knee replacement, but US is necessary to confirm the diagnosis. Although MRI can also be useful in this context, it is not widely used. Other diagnostic possibilities are chronic tendonitis or tendon laxness. Treatment outcomes for ruptured patellar ligaments are not good.
Figure 10.
a-c).- Quadriceps\n\t\t\t\t\t\t\tTendon Rupture. A 73-year-old woman, ten years after total knee replacement. Lateral radiograph (a) shows patellar displacement and rotation with clinical suspicion of quadriceps tendon tear (black arrow). US (b) confirms a disrupted quadriceps tendon (long white arrow) with a suprapatellar fluid collection (short white arrow) and a 5 cm gap between the end of the tendon and the patella. Compare with the sonogram of the contralateral knee showing a normal quadriceps tendon (fine black arrow) with total knee replacement (c) in the same patient, who had rheumatoid arthritis.
Figure 11.
Patellar Tendon Rupture with Patellar Avulsion Fracture. A 69-year-old woman, twelve years after total knee replacement and two years after revision knee replacement with long femoral and tibial stems. Lateral radiograph shows cranial displacement with transverse avulsion fracture in the mid-portion of the patella (long arrow). Note the extensive soft-tissue edema in the patellar area (short arrows), leading to suspected patellar tendon rupture, which was confirmed at ultrasonography (not shown).
4. Conclusion
Patellar complications following knee arthroplasty are generally uncommon but often of potential clinical significance. Plain-film radiographs are essential for the evaluation of patellar complications after surgery and should be the initial imaging study performed. Careful attention to initial prosthesis placement and comparison of follow-up images will allow subtle abnormalities to be detected in patellar complications. US may have a special role in the evaluation of soft-tissue structures around the patella.
UDIAT Diagnostic Center, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
'}],corrections:null},book:{id:"3394",title:"Arthroplasty",subtitle:"Update",fullTitle:"Arthroplasty - Update",slug:"arthroplasty-update",publishedDate:"February 20th 2013",bookSignature:"Plamen Kinov",coverURL:"https://cdn.intechopen.com/books/images_new/3394.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"64690",title:"Prof.",name:"Plamen",middleName:null,surname:"Kinov",slug:"plamen-kinov",fullName:"Plamen Kinov"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"42802",title:"Surgical Approaches to the Hip Joint and Its Clinical Implications in Adult Hip Arthroplasty",slug:"surgical-approaches-to-the-hip-joint-and-its-clinical-implications-in-adult-hip-arthroplasty",totalDownloads:5573,totalCrossrefCites:0,signatures:"Hiran Amarasekera",authors:[{id:"67634",title:"Dr.",name:"Hiran",middleName:"Wimal",surname:"Amarasekera",fullName:"Hiran Amarasekera",slug:"hiran-amarasekera"}]},{id:"43073",title:"Preoperative Planning of Total Knee Replacement",slug:"preoperative-planning-of-total-knee-replacement",totalDownloads:4622,totalCrossrefCites:0,signatures:"A.O. Erdogan, N.S. Gokay and A. Gokce",authors:[{id:"160902",title:"Associate Prof.",name:"Alper",middleName:null,surname:"Gokce",fullName:"Alper Gokce",slug:"alper-gokce"}]},{id:"42804",title:"Special Considerations in Asian Knee Arthroplasty",slug:"special-considerations-in-asian-knee-arthroplasty",totalDownloads:2761,totalCrossrefCites:2,signatures:"Ali Sina Shahi, Hamid Reza Seyyed Hosseinzadeh, Gholam Hossein Kazemian, Aidin Masoudi, Mehrnoush Hassas Yeganeh, Usama Hassan, Samih Tarabichi and Hamid Reza Seyyed Hossein Zadeh Ardebili",authors:[{id:"166905",title:"Dr.",name:"Hamid Reza",middleName:null,surname:"Seyyed Hossein Zadeh Ardebili",fullName:"Hamid Reza Seyyed Hossein Zadeh Ardebili",slug:"hamid-reza-seyyed-hossein-zadeh-ardebili"},{id:"166906",title:"Dr.",name:"Samih",middleName:null,surname:"Tarabichi",fullName:"Samih Tarabichi",slug:"samih-tarabichi"},{id:"166907",title:"Dr.",name:"Usama",middleName:null,surname:"Hassan",fullName:"Usama Hassan",slug:"usama-hassan"},{id:"166909",title:"Dr.",name:"Mehrnoush",middleName:null,surname:"Hassas Yeganeh",fullName:"Mehrnoush Hassas Yeganeh",slug:"mehrnoush-hassas-yeganeh"},{id:"166924",title:"Dr.",name:"Aidin",middleName:null,surname:"Masoudi",fullName:"Aidin Masoudi",slug:"aidin-masoudi"},{id:"167302",title:"Dr.",name:"Gholam Hossein",middleName:null,surname:"Kazemian",fullName:"Gholam Hossein Kazemian",slug:"gholam-hossein-kazemian"},{id:"173207",title:"Dr.",name:"Alisina",middleName:null,surname:"Shahi",fullName:"Alisina Shahi",slug:"alisina-shahi"}]},{id:"42805",title:"Predictors of Pain and Function Following Total Joint Replacement",slug:"predictors-of-pain-and-function-following-total-joint-replacement",totalDownloads:2322,totalCrossrefCites:0,signatures:"Michelle M. Dowsey and Peter F. M. Choong",authors:[{id:"80820",title:"Prof.",name:"Peter",middleName:null,surname:"Choong",fullName:"Peter Choong",slug:"peter-choong"},{id:"82173",title:"Dr.",name:"Michelle",middleName:"Maree",surname:"Dowsey",fullName:"Michelle Dowsey",slug:"michelle-dowsey"}]},{id:"42808",title:"The Acrylic Bone Cement in Arthroplasty",slug:"the-acrylic-bone-cement-in-arthroplasty",totalDownloads:6399,totalCrossrefCites:4,signatures:"Hamid Reza Seyyed Hosseinzadeh, Mohammad Emami, Farivarabdollahzadeh Lahiji, Ali Sina Shahi, Aidin Masoudi and Sina Emami",authors:[{id:"166924",title:"Dr.",name:"Aidin",middleName:null,surname:"Masoudi",fullName:"Aidin Masoudi",slug:"aidin-masoudi"},{id:"173207",title:"Dr.",name:"Alisina",middleName:null,surname:"Shahi",fullName:"Alisina Shahi",slug:"alisina-shahi"},{id:"74857",title:"Dr.",name:"Hamid Reza",middleName:null,surname:"Seyyed Hosseinzadeh",fullName:"Hamid Reza Seyyed Hosseinzadeh",slug:"hamid-reza-seyyed-hosseinzadeh"},{id:"167054",title:"Prof.",name:"Mohammad",middleName:null,surname:"Emami",fullName:"Mohammad Emami",slug:"mohammad-emami"},{id:"167055",title:"Prof.",name:"Farivar",middleName:null,surname:"Abdollahzadeh Lahiji",fullName:"Farivar Abdollahzadeh Lahiji",slug:"farivar-abdollahzadeh-lahiji"},{id:"167098",title:"Dr.",name:"Sina",middleName:null,surname:"Emami",fullName:"Sina Emami",slug:"sina-emami"}]},{id:"42810",title:"All Ceramic Tripolar THA to Prevent Dislocations in Risky Patients",slug:"all-ceramic-tripolar-tha-to-prevent-dislocations-in-risky-patients",totalDownloads:1929,totalCrossrefCites:1,signatures:"Jean-Yves Lazennec, Adrien Brusson and Marc Antoine Rousseau",authors:[{id:"70553",title:"Prof.",name:"Jean Yves",middleName:null,surname:"Lazennec",fullName:"Jean Yves Lazennec",slug:"jean-yves-lazennec"}]},{id:"42811",title:"Short-Stem Hip Arthroplasty",slug:"short-stem-hip-arthroplasty",totalDownloads:2436,totalCrossrefCites:2,signatures:"Kálmán Tóth and Gellért Sohár",authors:[{id:"158675",title:"Prof.",name:"Kalman",middleName:null,surname:"Tóth",fullName:"Kalman Tóth",slug:"kalman-toth"}]},{id:"42812",title:"“Neck-Sparing” Total Hip Arthroplasty",slug:"-neck-sparing-total-hip-arthroplasty",totalDownloads:2199,totalCrossrefCites:0,signatures:"Lee E. Rubin, Scott A. Ritterman and Timothy McTighe",authors:[{id:"163014",title:"Dr.",name:"Lee E.",middleName:null,surname:"Rubin",fullName:"Lee E. Rubin",slug:"lee-e.-rubin"},{id:"167666",title:"Dr.",name:"Scott",middleName:null,surname:"Ritterman",fullName:"Scott Ritterman",slug:"scott-ritterman"},{id:"167667",title:"Mr.",name:"Timothy",middleName:null,surname:"McTighe",fullName:"Timothy McTighe",slug:"timothy-mctighe"}]},{id:"42816",title:"The Evolution of Modern Total Knee Prostheses",slug:"the-evolution-of-modern-total-knee-prostheses",totalDownloads:4314,totalCrossrefCites:6,signatures:"Eun-Kyoo Song, Jong-Keun Seon, Jae-Young Moon and Yim Ji- Hyoun",authors:[{id:"68210",title:"Prof.",name:"Eun Kyoo",middleName:null,surname:"Song",fullName:"Eun Kyoo Song",slug:"eun-kyoo-song"},{id:"161076",title:"Prof.",name:"Jong-Keun",middleName:null,surname:"Seon",fullName:"Jong-Keun Seon",slug:"jong-keun-seon"},{id:"161085",title:"Dr.",name:"Ji-Hyeon",middleName:null,surname:"Yim",fullName:"Ji-Hyeon Yim",slug:"ji-hyeon-yim"}]},{id:"42817",title:"Optimization of Tuberosity Healing in Prosthetic Reconstruction of Proximal Humerus Fractures",slug:"optimization-of-tuberosity-healing-in-prosthetic-reconstruction-of-proximal-humerus-fractures",totalDownloads:1389,totalCrossrefCites:0,signatures:"Moby Parsons",authors:[{id:"69566",title:"Dr.",name:"Moby",middleName:null,surname:"Parsons",fullName:"Moby Parsons",slug:"moby-parsons"}]},{id:"42824",title:"The LP-ESP Lumbar Disc Prosthesis: Concept, Development and Clinical Experience",slug:"the-lp-esp-lumbar-disc-prosthesis-concept-development-and-clinical-experience",totalDownloads:1619,totalCrossrefCites:0,signatures:"Jean-Yves Lazennec, Alain Aaron, Adrien Brusson, Jean Patrick Rakover and Marc Antoine Rousseau",authors:[{id:"70553",title:"Prof.",name:"Jean Yves",middleName:null,surname:"Lazennec",fullName:"Jean Yves Lazennec",slug:"jean-yves-lazennec"}]},{id:"43065",title:"X-Ray Digital Tomosynthesis Imaging: An Appropriate Reconstruction Algorithm for Arthroplasty",slug:"x-ray-digital-tomosynthesis-imaging-an-appropriate-reconstruction-algorithm-for-arthroplasty",totalDownloads:1623,totalCrossrefCites:0,signatures:"Tsutomu Gomi, Hiroshi Hirano and Masahiro Nakajima",authors:[{id:"64408",title:"Dr.",name:"Tsutomu",middleName:null,surname:"Gomi",fullName:"Tsutomu Gomi",slug:"tsutomu-gomi"},{id:"119815",title:"BSc.",name:"Hiroshi",middleName:null,surname:"Hirano",fullName:"Hiroshi Hirano",slug:"hiroshi-hirano"},{id:"166287",title:"Mr.",name:"Masahiro",middleName:null,surname:"Nakajima",fullName:"Masahiro Nakajima",slug:"masahiro-nakajima"}]},{id:"42825",title:"Hip and Knee Arthroplasty in the Patient with Inflammatory Arthritis",slug:"hip-and-knee-arthroplasty-in-the-patient-with-inflammatory-arthritis",totalDownloads:1744,totalCrossrefCites:0,signatures:"Andrew Gordon, Hosam Matar and Mark Wilkinson",authors:[{id:"69506",title:"Mr.",name:"Mark",middleName:null,surname:"Wilkinson",fullName:"Mark Wilkinson",slug:"mark-wilkinson"},{id:"74362",title:"Mr.",name:"Andrew",middleName:null,surname:"Gordon",fullName:"Andrew Gordon",slug:"andrew-gordon"},{id:"167479",title:"Mr.",name:"Hosam",middleName:"E",surname:"Matar",fullName:"Hosam Matar",slug:"hosam-matar"}]},{id:"41036",title:"Total Joint Arthroplasty for Hemophilia",slug:"total-joint-arthroplasty-for-hemophilia",totalDownloads:1433,totalCrossrefCites:0,signatures:"Hideyuki Takedani",authors:[{id:"162212",title:"Dr",name:null,middleName:null,surname:"Takedani",fullName:"Takedani",slug:"takedani"}]},{id:"42826",title:"Revision Hip Arthroplasty: Management of Bone Loss",slug:"revision-hip-arthroplasty-management-of-bone-loss",totalDownloads:3545,totalCrossrefCites:1,signatures:"Plamen Kinov and Peter Tivchev",authors:[{id:"64690",title:"Prof.",name:"Plamen",middleName:null,surname:"Kinov",fullName:"Plamen Kinov",slug:"plamen-kinov"},{id:"66007",title:"Dr.",name:"Peter",middleName:null,surname:"Tivchev",fullName:"Peter Tivchev",slug:"peter-tivchev"}]},{id:"42831",title:"Ankle Osteoarthritis and Arthroplasty",slug:"ankle-osteoarthritis-and-arthroplasty",totalDownloads:1923,totalCrossrefCites:0,signatures:"Nadr M. Jomha, Angela Scharfenberger, Gordon Goplen and M. Elizabeth Pedersen",authors:[{id:"161311",title:"Dr.",name:"Nadr M.",middleName:null,surname:"Jomha",fullName:"Nadr M. Jomha",slug:"nadr-m.-jomha"},{id:"161403",title:"Dr.",name:"M. Elizabeth",middleName:null,surname:"Pedersen",fullName:"M. Elizabeth Pedersen",slug:"m.-elizabeth-pedersen"},{id:"161404",title:"Dr.",name:"Angela",middleName:null,surname:"Scharfenberger",fullName:"Angela Scharfenberger",slug:"angela-scharfenberger"},{id:"161405",title:"Dr.",name:"Gordon",middleName:null,surname:"Goplen",fullName:"Gordon Goplen",slug:"gordon-goplen"}]},{id:"42832",title:"Complications Following Total Hip Arthroplasty",slug:"complications-following-total-hip-arthroplasty",totalDownloads:4143,totalCrossrefCites:1,signatures:"Asim Rajpura and Tim Board",authors:[{id:"68456",title:"Mr.",name:"Timothy",middleName:null,surname:"Board",fullName:"Timothy Board",slug:"timothy-board"},{id:"160699",title:"Mr.",name:"Asim",middleName:null,surname:"Rajpura",fullName:"Asim Rajpura",slug:"asim-rajpura"}]},{id:"42586",title:"Periprosthetic Femoral Fractures in Total Knee Arthroplasty",slug:"periprosthetic-femoral-fractures-in-total-knee-arthroplasty",totalDownloads:2313,totalCrossrefCites:0,signatures:"Vladan Stevanović, Zoran Vukašinović, Zoran Baščarević, Branislav Starčević, Dragana Matanović and Duško Spasovski",authors:[{id:"69143",title:"Prof.",name:"Zoran",middleName:"Stanisa",surname:"Vukasinovic",fullName:"Zoran Vukasinovic",slug:"zoran-vukasinovic"},{id:"74257",title:"Prof.",name:"Zoran",middleName:null,surname:"Bascarevic",fullName:"Zoran Bascarevic",slug:"zoran-bascarevic"},{id:"161041",title:"Dr.",name:"Vladan",middleName:null,surname:"Stevanovic",fullName:"Vladan Stevanovic",slug:"vladan-stevanovic"},{id:"167734",title:"Dr.",name:"Dusko",middleName:null,surname:"Spasovski",fullName:"Dusko Spasovski",slug:"dusko-spasovski"},{id:"167735",title:"Dr.",name:"Branislav",middleName:null,surname:"Starcevic",fullName:"Branislav Starcevic",slug:"branislav-starcevic"},{id:"167736",title:"Dr.",name:"Dragana",middleName:null,surname:"Matanovic",fullName:"Dragana Matanovic",slug:"dragana-matanovic"}]},{id:"42845",title:"Imaging Patellar Complications After Knee Arthroplasty",slug:"imaging-patellar-complications-after-knee-arthroplasty",totalDownloads:3863,totalCrossrefCites:0,signatures:"Pietro Melloni, Maite Veintemillas, Anna Marin and Rafael Valls",authors:[{id:"158984",title:"Ph.D.",name:"Pietro",middleName:null,surname:"Melloni",fullName:"Pietro Melloni",slug:"pietro-melloni"},{id:"164413",title:"Dr.",name:"Maite",middleName:null,surname:"Veintemillas",fullName:"Maite Veintemillas",slug:"maite-veintemillas"},{id:"164414",title:"Dr.",name:"Anna",middleName:null,surname:"Marin",fullName:"Anna Marin",slug:"anna-marin"},{id:"164415",title:"Dr.",name:"Rafael",middleName:null,surname:"Valls",fullName:"Rafael Valls",slug:"rafael-valls"}]},{id:"42882",title:"Extensor Mechanism Complications After Patellar Resurfacing in Knee Replacement – Can They Justify Non-Patellar Resurfacing?",slug:"extensor-mechanism-complications-after-patellar-resurfacing-in-knee-replacement-can-they-justify-non",totalDownloads:1449,totalCrossrefCites:0,signatures:"Antonio Silvestre, Raúl Lopez, Fernando Almeida, Pablo Renovell, Francisco Argüelles and Oscar Vaamonde",authors:[{id:"68120",title:"Dr.",name:"Antonio",middleName:null,surname:"Silvestre",fullName:"Antonio Silvestre",slug:"antonio-silvestre"},{id:"119391",title:"Dr.",name:"Fernando",middleName:null,surname:"Almeida",fullName:"Fernando Almeida",slug:"fernando-almeida"},{id:"119552",title:"Dr.",name:"Pablo",middleName:null,surname:"Renovell",fullName:"Pablo Renovell",slug:"pablo-renovell"},{id:"119554",title:"Mr.",name:"Raúl",middleName:null,surname:"Lopez",fullName:"Raúl Lopez",slug:"raul-lopez"},{id:"161189",title:"Dr.",name:"Oscar",middleName:null,surname:"Vaamonde",fullName:"Oscar Vaamonde",slug:"oscar-vaamonde"},{id:"166417",title:"Dr.",name:"Francisco",middleName:null,surname:"Argüelles",fullName:"Francisco Argüelles",slug:"francisco-arguelles"}]},{id:"42849",title:"Glenoid Loosening in Total Shoulder Arthroplasty",slug:"glenoid-loosening-in-total-shoulder-arthroplasty",totalDownloads:1379,totalCrossrefCites:0,signatures:"Nahum Rosenberg, Maruan Haddad and Doron Norman",authors:[{id:"68911",title:"Dr.",name:"Nahum",middleName:null,surname:"Rosenberg",fullName:"Nahum Rosenberg",slug:"nahum-rosenberg"},{id:"166292",title:"Dr.",name:"Maruan",middleName:null,surname:"Haddad",fullName:"Maruan Haddad",slug:"maruan-haddad"},{id:"166293",title:"Dr.",name:"Doron",middleName:null,surname:"Norman",fullName:"Doron Norman",slug:"doron-norman"}]},{id:"42848",title:"Peri-Prosthetic Joint Infection: Prevention, Diagnosis and Management",slug:"peri-prosthetic-joint-infection-prevention-diagnosis-and-management",totalDownloads:2252,totalCrossrefCites:1,signatures:"Adrian J. Cassar Gheiti and Kevin J. Mulhall",authors:[{id:"42138",title:"Dr.",name:"Adrian J",middleName:null,surname:"Cassar Gheiti",fullName:"Adrian J Cassar Gheiti",slug:"adrian-j-cassar-gheiti"},{id:"161549",title:"Prof.",name:"Kevin J",middleName:null,surname:"Mulhall",fullName:"Kevin J Mulhall",slug:"kevin-j-mulhall"}]},{id:"42850",title:"Management of Prosthetic Infection According to Organism",slug:"management-of-prosthetic-infection-according-to-organism",totalDownloads:2881,totalCrossrefCites:1,signatures:"Trisha Peel, Kirsty Buising, Michelle Dowsey and Peter Choong",authors:[{id:"80820",title:"Prof.",name:"Peter",middleName:null,surname:"Choong",fullName:"Peter Choong",slug:"peter-choong"},{id:"82173",title:"Dr.",name:"Michelle",middleName:"Maree",surname:"Dowsey",fullName:"Michelle Dowsey",slug:"michelle-dowsey"},{id:"160634",title:"Dr.",name:"Trisha",middleName:null,surname:"Peel",fullName:"Trisha Peel",slug:"trisha-peel"},{id:"160770",title:"Dr.",name:"Kirsty",middleName:null,surname:"Buising",fullName:"Kirsty Buising",slug:"kirsty-buising"}]},{id:"42851",title:"Periprosthetic Infection Following Total Knee Arthroplasty",slug:"periprosthetic-infection-following-total-knee-arthroplasty",totalDownloads:2524,totalCrossrefCites:0,signatures:"Michael Soudry, Arnan Greental, Gabriel Nierenberg, Mazen Falah and Nahum Rosenberg",authors:[{id:"137553",title:"Prof.",name:"Michael",middleName:null,surname:"Soudry",fullName:"Michael Soudry",slug:"michael-soudry"}]},{id:"41445",title:"Articulating Spacers in Infection of Total Knee Arthroplasty — State of the Art",slug:"articulating-spacers-in-infection-of-total-knee-arthroplasty-state-of-the-art",totalDownloads:2319,totalCrossrefCites:1,signatures:"Manuel Villanueva-Martínez, Antonio Ríos-Luna, Francisco Chana- Rodriguez, Jose A. De Pedro and Antonio Pérez-Caballer",authors:[{id:"78752",title:"Dr.",name:"Antonio",middleName:null,surname:"Ríos-Luna",fullName:"Antonio Ríos-Luna",slug:"antonio-rios-luna"},{id:"119692",title:"Dr.",name:"Antonio J",middleName:null,surname:"Pérez Caballer",fullName:"Antonio J Pérez Caballer",slug:"antonio-j-perez-caballer"},{id:"160046",title:"Associate Prof.",name:"Manuel",middleName:null,surname:"Villanueva",fullName:"Manuel Villanueva",slug:"manuel-villanueva"},{id:"160048",title:"Dr.",name:"Francisco",middleName:null,surname:"Chana-Rodriguez",fullName:"Francisco Chana-Rodriguez",slug:"francisco-chana-rodriguez"},{id:"160049",title:"Prof.",name:"Jose-Antonio",middleName:null,surname:"De Pedro",fullName:"Jose-Antonio De Pedro",slug:"jose-antonio-de-pedro"}]},{id:"42854",title:"The Role of Knee Arthrodesis After TKA Infection",slug:"the-role-of-knee-arthrodesis-after-tka-infection",totalDownloads:2132,totalCrossrefCites:0,signatures:"Pablo Renovell, Antonio Silvestre and Oscar Vaamonde",authors:[{id:"68120",title:"Dr.",name:"Antonio",middleName:null,surname:"Silvestre",fullName:"Antonio Silvestre",slug:"antonio-silvestre"},{id:"119552",title:"Dr.",name:"Pablo",middleName:null,surname:"Renovell",fullName:"Pablo Renovell",slug:"pablo-renovell"},{id:"167473",title:"Dr.",name:"Oscar",middleName:null,surname:"Vaamonde",fullName:"Oscar Vaamonde",slug:"oscar-vaamonde"}]},{id:"42861",title:"Proximal Interphalangeal Joint Arthrodesis with Tendon Transfer of the Flexor Digitorum Brevis",slug:"proximal-interphalangeal-joint-arthrodesis-with-tendon-transfer-of-the-flexor-digitorum-brevis",totalDownloads:1973,totalCrossrefCites:0,signatures:"Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias and Miguel Fuentes Rodriguez",authors:[{id:"157691",title:"Prof.",name:"Ricardo",middleName:null,surname:"Becerro De Bengoa Vallejo",fullName:"Ricardo Becerro De Bengoa Vallejo",slug:"ricardo-becerro-de-bengoa-vallejo"},{id:"157693",title:"Prof.",name:"Marta Elena",middleName:null,surname:"Losa Iglesias",fullName:"Marta Elena Losa Iglesias",slug:"marta-elena-losa-iglesias"},{id:"157695",title:"Prof.",name:"Miguel",middleName:null,surname:"Fuentes Rodriguez",fullName:"Miguel Fuentes Rodriguez",slug:"miguel-fuentes-rodriguez"}]}]},relatedBooks:[{type:"book",id:"938",title:"Recent Advances in Arthroplasty",subtitle:null,isOpenForSubmission:!1,hash:"617e868a5450ec0c9d233121177ca61e",slug:"recent-advances-in-arthroplasty",bookSignature:"Samo K. Fokter",coverURL:"https://cdn.intechopen.com/books/images_new/938.jpg",editedByType:"Edited by",editors:[{id:"68181",title:"Dr.",name:"Samo",surname:"Fokter",slug:"samo-fokter",fullName:"Samo Fokter"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"26854",title:"Postoperative Cognitive Dysfunction (POCD) and Markers of Brain Damage After Big Joints Arthroplasty",slug:"postoperative-cognitive-dysfunction-pocd-and-markers-of-brain-damage-after-big-joints-arthroplasty",signatures:"Dariusz Tomaszewski",authors:[{id:"67648",title:"Dr",name:"Dariusz",middleName:null,surname:"Tomaszewski",fullName:"Dariusz Tomaszewski",slug:"dariusz-tomaszewski"}]},{id:"26855",title:"The Stress Response and Its Functional Implications in the Immune Response After Surgery in Patients with Chronic Inflammation Undergoing Arthroplasty",slug:"the-stress-response-and-its-functional-3-implications-in-the-immune-response-after-surgery-in-patien",signatures:"Barbara Lisowska",authors:[{id:"66397",title:"Prof.",name:"Barbara",middleName:null,surname:"Lisowska",fullName:"Barbara Lisowska",slug:"barbara-lisowska"}]},{id:"26856",title:"Provider Volumes and Surgical Outcomes in Total Hip and Knee Replacement",slug:"provider-volumes-and-surgical-outcomes-in-total-hip-and-knee-replacement",signatures:"S. Rodriguez-Elizalde, R. Jenkinson, H. Kreder and J.M. Paterson",authors:[{id:"68794",title:"Dr.",name:"Richard",middleName:null,surname:"Jenkinson",fullName:"Richard Jenkinson",slug:"richard-jenkinson"},{id:"83838",title:"Dr.",name:"Sebastian",middleName:null,surname:"Rodriguez-Elizalde",fullName:"Sebastian Rodriguez-Elizalde",slug:"sebastian-rodriguez-elizalde"},{id:"83841",title:"Dr.",name:"Michael",middleName:null,surname:"Paterson",fullName:"Michael Paterson",slug:"michael-paterson"},{id:"83842",title:"Dr.",name:"Hans",middleName:null,surname:"Kreder",fullName:"Hans Kreder",slug:"hans-kreder"}]},{id:"26857",title:"Gait Analysis in Patients with Gonarthrosis Treated by Total Knee Arthroplasty (TKA)",slug:"gait-analysis-in-patients-with-gonarthrosis-treated-by-total-knee-arthroplasty-tka-",signatures:"Katarzyna Ogrodzka and Tadeusz Niedźwiedzki",authors:[{id:"68030",title:"Dr.",name:"Katarzyna",middleName:null,surname:"Ogrodzka",fullName:"Katarzyna Ogrodzka",slug:"katarzyna-ogrodzka"},{id:"73453",title:"Prof.",name:"Tadeusz",middleName:null,surname:"Niedźwiedzki",fullName:"Tadeusz Niedźwiedzki",slug:"tadeusz-niedzwiedzki"}]},{id:"26858",title:"Hip-Spine Relations: An Innovative Paradigm in THR Surgery",slug:"hip-spine-relations-an-innovative-paradigm-in-thr-surgery",signatures:"Jean Yves Lazennec, Adrien Brusson and Marc-Antoine Rousseau",authors:[{id:"70553",title:"Prof.",name:"Jean Yves",middleName:null,surname:"Lazennec",fullName:"Jean Yves Lazennec",slug:"jean-yves-lazennec"},{id:"148821",title:"Dr.",name:"Marc-Antoine",middleName:null,surname:"Rousseau",fullName:"Marc-Antoine Rousseau",slug:"marc-antoine-rousseau"},{id:"148822",title:"MSc.",name:"Adrien",middleName:null,surname:"Brusson",fullName:"Adrien Brusson",slug:"adrien-brusson"}]},{id:"26859",title:"X-Ray Digital Linear Tomosynthesis Imaging of Arthoroplasty",slug:"x-ray-digital-linear-tomosynthesis-imaging-of-arthoroplasty",signatures:"Tsutomu Gomi, Hiroshi Hirano and Masahiro Nakajima",authors:[{id:"64408",title:"Dr.",name:"Tsutomu",middleName:null,surname:"Gomi",fullName:"Tsutomu Gomi",slug:"tsutomu-gomi"},{id:"119815",title:"BSc.",name:"Hiroshi",middleName:null,surname:"Hirano",fullName:"Hiroshi Hirano",slug:"hiroshi-hirano"},{id:"119816",title:"BSc.",name:"Masahiro",middleName:null,surname:"Nakajima",fullName:"Masahiro Nakajima",slug:"masahiro-nakajima"}]},{id:"26860",title:"Blood Transfusion in Knee Arthroplasty",slug:"blood-transfusion-in-knee-arthroplasty",signatures:"Oscar Ares, Montserrat Tio, Juan Carlos Martinez Pastor, Luis Lozano, Josep Maria Segur, Francisco Macule and Santiago Suso",authors:[{id:"68215",title:"Dr.",name:"Oscar",middleName:null,surname:"Ares",fullName:"Oscar Ares",slug:"oscar-ares"}]},{id:"26861",title:"Acoustic Emission Studies in Hip Arthroplasty – Peak Stress Impact In Vitro Cemented Prosthesis",slug:"acoustic-emission-studies-in-hip-arthroplasty-peak-stress-impact-in-vitro-cemented-prosthesis",signatures:"N. Gueiral and E. Nogueira",authors:[{id:"66306",title:"MSc.",name:"Nuno",middleName:null,surname:"Gueiral",fullName:"Nuno Gueiral",slug:"nuno-gueiral"},{id:"73976",title:"Dr.",name:"Elisabete",middleName:null,surname:"Nogueira",fullName:"Elisabete Nogueira",slug:"elisabete-nogueira"}]},{id:"26862",title:"Titanium as a Biomaterial for Implants",slug:"titanium-as-a-biomaterial-for-implants",signatures:"Carlos Oldani and Alejandro Dominguez",authors:[{id:"70012",title:"Dr.",name:"Carlos",middleName:null,surname:"Oldani",fullName:"Carlos Oldani",slug:"carlos-oldani"},{id:"73445",title:"MSc.",name:"Alejandro",middleName:"Anibal",surname:"Dominguez",fullName:"Alejandro Dominguez",slug:"alejandro-dominguez"}]},{id:"26863",title:"The Bearing Surfaces in Total Hip Arthroplasty – Options, Material Characteristics and Selection",slug:"the-bearing-surfaces-in-total-hip-arthroplasty-options-material-characteristics-and-selection",signatures:"Hamid Reza Seyyed Hosseinzadeh, Alireza Eajazi and Ali Sina Shahi",authors:[{id:"66361",title:"Dr.",name:"Alireza",middleName:null,surname:"Eajazi",fullName:"Alireza Eajazi",slug:"alireza-eajazi"},{id:"74857",title:"Dr.",name:"Hamid Reza",middleName:null,surname:"Seyyed Hosseinzadeh",fullName:"Hamid Reza Seyyed Hosseinzadeh",slug:"hamid-reza-seyyed-hosseinzadeh"},{id:"173207",title:"Dr.",name:"Alisina",middleName:null,surname:"Shahi",fullName:"Alisina Shahi",slug:"alisina-shahi"}]},{id:"26864",title:"The Use of PEEK in Spine Arthroplasty",slug:"the-use-of-peek-in-spine-arthroplasty",signatures:"T. Brown, Qi-Bin Bao and Hansen A. Yuan",authors:[{id:"71708",title:"MSc.",name:"Tim",middleName:null,surname:"Brown",fullName:"Tim Brown",slug:"tim-brown"},{id:"121163",title:"Dr.",name:"Qi-Bin",middleName:null,surname:"Bao",fullName:"Qi-Bin Bao",slug:"qi-bin-bao"}]},{id:"26865",title:"The Biology of Bone Grafts",slug:"the-biology-of-bone-grafts",signatures:"Carlos Roberto Galia and Luis Fernando Moreira",authors:[{id:"69910",title:"Prof.",name:"Carlos",middleName:"Roberto",surname:"Galia",fullName:"Carlos Galia",slug:"carlos-galia"},{id:"69999",title:"Prof.",name:"Luis",middleName:null,surname:"Moreira",fullName:"Luis Moreira",slug:"luis-moreira"}]},{id:"26866",title:"Cross-Linked Gelatin Microcapsules for Drug Delivery in a Arthritic TMJ",slug:"cross-linked-gelatin-microcapsules-for-drug-delivery-in-a-arthritic-tmj",signatures:"P. R. Kramer, Brian Windsor, Kenneth Carson and Larry Bellinger",authors:[{id:"71582",title:"Prof.",name:"Phillip",middleName:null,surname:"Kramer",fullName:"Phillip Kramer",slug:"phillip-kramer"},{id:"71586",title:"Prof.",name:"Larry",middleName:null,surname:"Bellinger",fullName:"Larry Bellinger",slug:"larry-bellinger"},{id:"71587",title:"Mr.",name:"Brian",middleName:null,surname:"Windsor",fullName:"Brian Windsor",slug:"brian-windsor"}]},{id:"26867",title:"Risk Factors for Aseptic Loosening Following Total Hip Arthroplasty",slug:"risk-factors-for-aseptic-loosening-following-total-hip-arthroplasty",signatures:"Scott J. MacInnes, Andrew Gordon and J. Mark Wilkinson",authors:[{id:"68458",title:"Mr.",name:"Scott",middleName:null,surname:"MacInnes",fullName:"Scott MacInnes",slug:"scott-macinnes"},{id:"69506",title:"Mr.",name:"Mark",middleName:null,surname:"Wilkinson",fullName:"Mark Wilkinson",slug:"mark-wilkinson"},{id:"74362",title:"Mr.",name:"Andrew",middleName:null,surname:"Gordon",fullName:"Andrew Gordon",slug:"andrew-gordon"}]},{id:"26868",title:"Evidence Linking Elevated Oxidative Stress and Aseptic Loosening of Hip Arthroplasty",slug:"evidence-linking-elevated-oxidative-stress-and-aseptic-loosening-of-hip-arthroplasty",signatures:"Plamen Kinov and Peter Tivchev",authors:[{id:"64690",title:"Prof.",name:"Plamen",middleName:null,surname:"Kinov",fullName:"Plamen Kinov",slug:"plamen-kinov"},{id:"66007",title:"Dr.",name:"Peter",middleName:null,surname:"Tivchev",fullName:"Peter Tivchev",slug:"peter-tivchev"}]},{id:"26869",title:"Aseptic Loosening of Total Hip Arthroplasty as a Result of Local Failure of Tissue Homeostasis",slug:"aseptic-loosening-of-total-hip-arthroplasty-as-a-result-of-local-failure-of-tissue-homeostasis",signatures:"Jiri Gallo, Yrjö T. Konttinen, Stuart B. Goodman, Jacob P. Thyssen, Emmanuel Gibon, Jukka Pajarinen, Yuya Takakubo, Peter Schalock, Zygmunt Mackiewicz, Eemeli Jämsen, Martin Petrek, Rihard Trebse, Andrei Coer and Michiaki Takagi",authors:[{id:"64650",title:"Dr.",name:"Jiri",middleName:null,surname:"Gallo",fullName:"Jiri Gallo",slug:"jiri-gallo"},{id:"74189",title:"Prof.",name:"Martin",middleName:null,surname:"Petrek",fullName:"Martin Petrek",slug:"martin-petrek"},{id:"74191",title:"Prof.",name:"Yrjö",middleName:null,surname:"Konttinen",fullName:"Yrjö Konttinen",slug:"yrjo-konttinen"},{id:"74279",title:"Prof.",name:"Michiaki",middleName:null,surname:"Takagi",fullName:"Michiaki Takagi",slug:"michiaki-takagi"},{id:"74907",title:"Prof.",name:"Stuart",middleName:null,surname:"Goodman",fullName:"Stuart Goodman",slug:"stuart-goodman"},{id:"77760",title:"Dr.",name:"Jacob",middleName:null,surname:"Thyssen",fullName:"Jacob Thyssen",slug:"jacob-thyssen"},{id:"80164",title:"Dr.",name:"Peter",middleName:"C",surname:"Schalock",fullName:"Peter Schalock",slug:"peter-schalock"},{id:"95020",title:"Prof.",name:"Andrej",middleName:null,surname:"Cör",fullName:"Andrej Cör",slug:"andrej-cor"},{id:"127301",title:"Prof.",name:"Zygmunt",middleName:null,surname:"Mackiewicz",fullName:"Zygmunt Mackiewicz",slug:"zygmunt-mackiewicz"},{id:"127302",title:"Dr.",name:"Emmanuel",middleName:null,surname:"Gibon",fullName:"Emmanuel Gibon",slug:"emmanuel-gibon"},{id:"127303",title:"Dr.",name:"Rihard",middleName:null,surname:"Trebse",fullName:"Rihard Trebse",slug:"rihard-trebse"},{id:"127304",title:"Dr.",name:"Jukka",middleName:null,surname:"Pajarinen",fullName:"Jukka Pajarinen",slug:"jukka-pajarinen"},{id:"127305",title:"Dr.",name:"Yuya",middleName:null,surname:"Takakubo",fullName:"Yuya Takakubo",slug:"yuya-takakubo"},{id:"127306",title:"Mr.",name:"Eemeli",middleName:null,surname:"Jamsen",fullName:"Eemeli Jamsen",slug:"eemeli-jamsen"}]},{id:"26870",title:"Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy",slug:"current-possibilities-for-detection-of-loosening-of-total-hip-replacements-and-how-intelligent-impla",signatures:"Cathérine Ruther, Ulrich Timm, Hartmut Ewald, Wolfram Mittelmeier, Rainer Bader, Rico Schmelter, Armin Lohrengel and Daniel Kluess",authors:[{id:"10706",title:"Dr.",name:"Daniel",middleName:null,surname:"Kluess",fullName:"Daniel Kluess",slug:"daniel-kluess"},{id:"61241",title:"Prof.",name:"Rainer",middleName:null,surname:"Bader",fullName:"Rainer Bader",slug:"rainer-bader"},{id:"64492",title:"Ms.",name:"Catherine",middleName:null,surname:"Ruther",fullName:"Catherine Ruther",slug:"catherine-ruther"},{id:"73898",title:"Prof.",name:"Hartmut",middleName:null,surname:"Ewald",fullName:"Hartmut Ewald",slug:"hartmut-ewald"},{id:"73899",title:"Prof.",name:"Wolfram",middleName:null,surname:"Mittelmeier",fullName:"Wolfram Mittelmeier",slug:"wolfram-mittelmeier"},{id:"73901",title:"Mr.",name:"Rico",middleName:null,surname:"Schmelter",fullName:"Rico Schmelter",slug:"rico-schmelter"},{id:"73903",title:"Prof.",name:"Armin",middleName:null,surname:"Lohrengel",fullName:"Armin Lohrengel",slug:"armin-lohrengel"},{id:"119653",title:"Dr.",name:"Ulrich",middleName:null,surname:"Timm",fullName:"Ulrich Timm",slug:"ulrich-timm"}]},{id:"26871",title:"Management of Bone Loss in Primary and Revision Knee Replacement Surgery",slug:"management-of-bone-loss-in-primary-and-revision-knee-replacement-surgery",signatures:"Matteo Fosco, Rida Ben Ayad, Luca Amendola, Dante Dallari and Domenico Tigani",authors:[{id:"68505",title:"Dr.",name:"Matteo",middleName:null,surname:"Fosco",fullName:"Matteo Fosco",slug:"matteo-fosco"},{id:"73048",title:"Dr.",name:"Rida",middleName:null,surname:"Ben Ayad",fullName:"Rida Ben Ayad",slug:"rida-ben-ayad"},{id:"73049",title:"Dr.",name:"Luca",middleName:null,surname:"Amendola",fullName:"Luca Amendola",slug:"luca-amendola"},{id:"73052",title:"Dr.",name:"Dante",middleName:null,surname:"Dallari",fullName:"Dante Dallari",slug:"dante-dallari"},{id:"119571",title:"Dr.",name:"Domenico",middleName:null,surname:"Tigani",fullName:"Domenico Tigani",slug:"domenico-tigani"}]},{id:"26872",title:"Infection in Primary Hip and Knee Arthroplasty",slug:"infection-in-primary-hip-and-knee-arthroplasty",signatures:"Michelle M. Dowsey, Trisha N. Peel and Peter F.M. Choong",authors:[{id:"80820",title:"Prof.",name:"Peter",middleName:null,surname:"Choong",fullName:"Peter Choong",slug:"peter-choong"},{id:"82173",title:"Dr.",name:"Michelle",middleName:"Maree",surname:"Dowsey",fullName:"Michelle Dowsey",slug:"michelle-dowsey"},{id:"96112",title:"Dr.",name:"Trisha",middleName:null,surname:"Peel",fullName:"Trisha Peel",slug:"trisha-peel"}]},{id:"26873",title:"Infections in Hip and Knee Arthroplasty: Challenges to and Chances for the Microbiological Laboratory",slug:"infections-in-hip-and-knee-arthroplasty-challenges-to-and-chances-for-the-microbiological-laboratory",signatures:"Peter Schäfer, Bernd Fink, Dieter Sandow and Lars Frommelt",authors:[{id:"65326",title:"Dr",name:"Peter",middleName:null,surname:"Schäfer",fullName:"Peter Schäfer",slug:"peter-schafer"},{id:"73692",title:"Prof.",name:"Bernd",middleName:null,surname:"Fink",fullName:"Bernd Fink",slug:"bernd-fink"},{id:"73693",title:"Prof.",name:"Dieter",middleName:null,surname:"Sandow",fullName:"Dieter Sandow",slug:"dieter-sandow"},{id:"73694",title:"Dr",name:"Lars",middleName:"E.",surname:"Frommelt",fullName:"Lars Frommelt",slug:"lars-frommelt"}]},{id:"26874",title:"Staphylococcus Infection Associated with Arthroplasty",slug:"staphylococcus-infection-associated-with-arthroplasty",signatures:"Weisheng Ye, Wei Shang and Yaqiong Yang",authors:[{id:"64538",title:"Prof.",name:"Weisheng",middleName:null,surname:"Ye",fullName:"Weisheng Ye",slug:"weisheng-ye"},{id:"149402",title:"Dr.",name:"Wei",middleName:null,surname:"Shang",fullName:"Wei Shang",slug:"wei-shang"},{id:"149403",title:"Dr.",name:"Yaqiong",middleName:null,surname:"Yang",fullName:"Yaqiong Yang",slug:"yaqiong-yang"}]},{id:"26875",title:"Arthroplasty in HIV/SCD Carriers",slug:"arthroplasty-in-hiv-scd-carriers",signatures:"J. Bahebeck, D. Handy Eone, B. Ngo Nonga and T. Kingue Njie",authors:[{id:"66353",title:"Prof.",name:"Jean",middleName:null,surname:"Bahebeck",fullName:"Jean Bahebeck",slug:"jean-bahebeck"},{id:"149344",title:"Dr.",name:"Ndjie Kingue",middleName:null,surname:"Thompson",fullName:"Ndjie Kingue Thompson",slug:"ndjie-kingue-thompson"},{id:"149345",title:"Dr.",name:"Eone Daniel",middleName:null,surname:"Handy",fullName:"Eone Daniel Handy",slug:"eone-daniel-handy"},{id:"149346",title:"Dr.",name:"Ngo Nonga",middleName:null,surname:"Bernadette",fullName:"Ngo Nonga Bernadette",slug:"ngo-nonga-bernadette"}]},{id:"26876",title:"Cervical Disc Arthroplasty",slug:"cervical-disc-arthroplasty",signatures:"Bruce V. Darden",authors:[{id:"74274",title:"Dr.",name:"Bruce V.",middleName:null,surname:"Darden",fullName:"Bruce V. Darden",slug:"bruce-v.-darden"}]},{id:"26877",title:"Lumbar Spinal Arthroplasty: Clinical Experience",slug:"lumbar-spinal-arthroplasty-clinical-experience",signatures:"Fred H. Geisler",authors:[{id:"68455",title:"Dr.",name:"Fred",middleName:null,surname:"Geisler",fullName:"Fred Geisler",slug:"fred-geisler"}]},{id:"26878",title:"Shoulder Hemiarthroplasty in Proximal Humerus Fractures",slug:"shoulder-hemiarthroplasty-in-proximal-humerus-fractures",signatures:"José Hernández Enríquez, Xavier A. Duralde and Antonio J. Pérez Caballer",authors:[{id:"71769",title:"Dr.",name:"José",middleName:null,surname:"Hernández-Enríquez",fullName:"José Hernández-Enríquez",slug:"jose-hernandez-enriquez"},{id:"119690",title:"Dr.",name:"Xavier A",middleName:null,surname:"Duralde",fullName:"Xavier A Duralde",slug:"xavier-a-duralde"},{id:"119692",title:"Dr.",name:"Antonio J",middleName:null,surname:"Pérez Caballer",fullName:"Antonio J Pérez Caballer",slug:"antonio-j-perez-caballer"}]},{id:"26879",title:"Postoperative Therapy for Metacarpophalangeal Arthroplasty",slug:"postoperative-therapy-for-metacarpophalangeal-arthroplasty",signatures:"Nicola Massy-Westropp",authors:[{id:"64417",title:"Dr.",name:"Nicola",middleName:null,surname:"Massy-Westropp",fullName:"Nicola Massy-Westropp",slug:"nicola-massy-westropp"}]},{id:"26880",title:"Humeral Hemiarthroplasty with Spherical Glenoid Reaming: Theory and Technique of The Ream and Run Procedure",slug:"humeral-hemiarthroplasty-with-spherical-glenoid-reaming-theory-and-technique-of-the-ream-and-run-pro",signatures:"Moby Parsons",authors:[{id:"69566",title:"Dr.",name:"Moby",middleName:null,surname:"Parsons",fullName:"Moby Parsons",slug:"moby-parsons"}]},{id:"26881",title:"Development of Proprioception After Shoulder Arthroplasty",slug:"development-of-proprioception-after-shoulder-arthroplasty",signatures:"Michael W. Maier and Philip Kasten",authors:[{id:"66316",title:"Dr.",name:"Michael",middleName:"W.",surname:"Maier",fullName:"Michael Maier",slug:"michael-maier"},{id:"71292",title:"Prof.",name:"Philip",middleName:null,surname:"Kasten",fullName:"Philip Kasten",slug:"philip-kasten"}]}]}]},onlineFirst:{chapter:{type:"chapter",id:"69898",title:"Gut Microbiome: A New Organ System in Body",doi:"10.5772/intechopen.89634",slug:"gut-microbiome-a-new-organ-system-in-body",body:'\n
\n
1. Introduction
\n
Certain microorganisms have the unique ability to populate the human gastrointestinal tract and thus generally referred as gut microbiota. Gut microbiota is always non-pathological, and hence, the immune system is not triggered because of their presence. Humans co-evolved with a huge number of intestinal microbial species that offer to the host certain benefits by playing an important role in preventing them from pathogenic activities [1]. In addition to metabolic benefits, symbiotic bacteria benefit the host with various functions like boosting the immune homeostasis and inhibiting the colonization by other pathogenic microorganisms. The ability of symbiotic bacteria to inhibit pathogen colonization particularly in the gut is mediated via several mechanisms including direct killing of pathogen, competition for limited nutrients, and enhancement of immune responses [2]. The intestinal microorganisms also co-evolved and have strong affiliations and association towards each other. In this evolutionary process, the persistent and enduring members of this microflora become more competent during unsettling influences and thereby become essential for human health [3]. Definite composition of human microbiome varies between individuals [4] particularly among lean and obese people. The microbiome is also affected by the dietary modifications adapted for the weight loss [5]. Examination of metabolic profiles of human infant microbiota revealed that ingestion, storage and digestion of dietary lipids were explicitly regulated by the microbiome [6, 7].
\n
The human gut microbial communities are a mixture of microorganisms. The classes of microbes that constitute the gut microbiome communities differ between hosts. The difference is attributed to factors such as, inability of a microorganism to migrate between different hosts, intense environmental conditions inside and outside host’s gut and host inconsistency in terms of genotype, diet, and colonization history [8]. The co-evolution of humans and their symbiotic microorganism has created bilateral interactions which are important for the health of humans, and any genetic or ecological change in this bilateral interaction can result in pathological conditions like infection [8]. Gut microbial communities are important for diverse host functions, including metabolism, fertility, development, immunity, and even antioxidant activities which promote health and fitness of the host [9, 10, 11, 12]. The gut microbiome has a much larger genetic variety compared to the genome of the host, e.g., human genome is comprised of 20-25,000 genes whereas microbiome inhabiting the body is estimated to be in trillions. Almost 1010 microorganisms enter the human body daily and with the progress of co-evolution of gut microbes in humans, the capability of microbes to exchange their genes and associated functions with the environment are some of the main factors leading to host adaptation. Therefore, the “hologenome” model appraises the host and its microbes genomes as one unit under assortment [13, 14]. It is acknowledged that host-symbiont co-evolution is accountable for basic biological aspects. In this chapter we aim to discuss the importance of gut microbiomes as a new organ system because of its association with the genetics and its role in the disease and health condition of the host. Moreover, the involvement of these microbiomes in shaping the overall health and constructing a symbiotic relationship with their host species is discussed as well as the co-evolution of gut microbes with the human body.
\n
\n
\n
2. Inheritance of microbiome
\n
\n
2.1 Microbiome
\n
A microbiome is the community of microbes dwelling collectively in a selected habitat. Humans, animals, vegetation, soils, oceans or even buildings have their own specific microbiome [15].
\n
\n
\n
2.2 Host genetics and gut microbiome
\n
The human gut environment is extremely complex with a unique ecology which comprises of trillion of microbiota with approximately 1.5 kg in mass. By using genetic techniques like 16S sequencing, 1000 microorganisms have been identified within the gut, with approx. 200 (0.5%) defining the core of the intestine microbiome [16]. These bacteria protect the gut epithelial cells against external pathogens. They also help the breakdown of indigestible dietary polysaccharides in the gut and thus supply a quick chain of fatty acids, including acetate, butyrate, and propionate, which serve as vital metabolites for direct energy source of intestinal epithelial cells, prevention of insulin resistance and modulators of insulin secretion [17] (Figure 1).
\n
Figure 1.
Core human microbiome.
\n
The genetic makeup of humans is virtually identical, yet the small differences in DNA give rise to remarkable phenotypic assortment across the human population. The trillions of microbes inhabit our bodies and create complex, body-habitat-specific, adaptive ecosystems that are finely tuned to frequently changing host physiology [18]. A healthy “functional core” is actually a complement of metabolic and other molecular functions that are performed by the microbiome within a particular habitat but are not necessarily provided by the same organisms in different people [19].
\n
\n
\n
2.3 Inherited microbiomes
\n
The gastrointestinal tract (GIT) of humans is colonized by a vast variety of microbial population that can be understood as a complex and polygenetic trait which has been interacting and co-evolved with their host genetic environment [20, 21, 22]. It was previously considered that fetus lives in a germ free environment in the mother womb and the gut microbiota are transferred to the baby from mother’s birth canal and body via horizontal transmission only [23]. But advanced researches have revealed that microbiota are also vertically transmitted to the infants from their mothers [24]. Presence of microbes in the meconium of the babies born by cesarean section clearly demonstrates that the gut microbes are not only derived after the birth [25, 26]. Moreover, presence of many microbes in the umbilical cord blood of the preterm babies and in the amniotic fluid substantiate the findings that the fetus in the mother womb is not totally sterile [27, 28]. Many gut bacterial genera are shared among the mammal species. The microbiomes of mice show strong fidelity throughout the generations and reiterate the intrinsic significance of these microorganisms in health.
\n
\n
\n
2.4 Relationship of environment in shaping the microbiome
\n
As mentioned above human intestinal microbiome composition is shaped by multiple factors like genetics, diet, environment and lifestyle. Several studies point towards stronger contribution by the environmental factors in shaping the gut microbial composition compared to the genetic factor [29]. It has also been speculated that gut microbial diversity affects the prediction accuracy for certain human traits including glucose and obesity problems, as compared to different animal models that use only host genetic and environmental factors [30].
\n
\n
\n
2.5 Co-evolution and co-differentiation of host microbe interaction in exploring new drug targets
\n
Horizontal gene transfer (HGT), genomic and metagenomics are possible approaches to identify drug targets that may also be considered as an evidence of co-evolution of hosts and their symbionts. Symbionts have the capacity to perform many metabolic activities including fermentation of dietary carbohydrates, drug metabolism, antimicrobial protection and immunomodulation, which is primarily due to the presence of genes in their genome which are missing in mammalian genomes. Therefore, horizontal gene transfer mechanisms are potential targets for drug discovery that become more evident with the use of gnotobiotics (germ free animal) in experimental trial to unveil the microbial function in the complex GIT microenvironment, and to investigate how orally administered drugs impact the gut microbial ecology in long term. HGT has gained immense interest in medical field as it contributes to the spreading of antibiotic resistance genes as well as it may cause closely related microbial strains to differ drastically in terms of clinical parameters [31]. Genetic variation in intestinal microbes may trigger the production of metabolites, but it may also generate changes in host’s genome that may increase metabolite uptake or prevent their further synthesis. Co-evolution may lead to co-differentiation since permanent association of host and symbiont lineage can result in diversification [32]. The co-differentiation correlate resemblances in the microbial symbiont and the host [33, 34] which can be extended to an entire microbial community that passes vertically from host to offspring. Over the course of speciation, the microbial communities differentiate as a mirror to host phylogeny (such situation would be expected in hosts where parents immunize their offspring with microbial clique, e.g., Koala bear mother inoculate “pap” with dropping to shift young one from milk to eucalyptus leaves diet) [35]. Fecal microbiome from healthy humans is a mirror of distal gut microbiome which is highly rich in genes involved in the vitamin synthesis, breakdown of nutrients, and metabolism of xenobiotics as compared to already sequenced human genome and microbes genome [4]. The presence of conjugate transposons in gut microbiome is another important source of horizontal gene transfer in bacteria [36]. The HGT is involved not only in spreading antibiotic resistance genes, but also as a source of clinical response of closely related microbial strains of Salmonella enterica [37] such as the secretory system type III pathogenicity islands encoded by SPI-I and SPI-II (virulence genes are present in pathogenicity islands, and play a key role in the pathogenesis of Salmonella infections through invasion in host cell. Currently, 12 Salmonella pathogenicity islands have been investigated with common motifs) [38].
\n
Novel strategies in drug discovery are being pursued by targeting horizontal gene transfer involved in the resistance to antibiotic [39] as well as virulence [40]. Targeting virulence factors with Salmonellosis inhibitors causes less damage to indigenous microbes compared to traditional antibiotic therapy, less selective pressure for evolution and transfer of resistance and may be more effective against divergent organisms that have acquired a particular virulence factor by HGT. Genomic islands which are a good source of genes and gene transfer systems are also being targeted with small molecule inhibitors that are co-administered with antibiotics to prevent resistance factors by targeted pathogenesis during the therapy [41].
\n
\n
2.5.1 Co-evolution of drug transporters in host and microbes
\n
It has been established that the majority of molecules possessing physiological or pharmacological features are either transported into and or out of the cells by transporting proteins rather than by a passive transport mechanism where drug molecules cross cell membranes through solute transporters that are already involved in the movement of different metabolic intermediary molecules through channels. More than 1000 different types of transporting proteins (transporters) are present in humans [42] comprising solute carriers (SLC) and ATP binding cassettes (ABC) transporters involved in the transport of a broad range of substrates [43].
\n
Human intestinal peptide transporter 1 (hPepT1) belonging to the proton-coupled oligopeptide transporter (POT) family which is also known as solute carrier 15A (SLC15A) is present in the enterocytes, the PepT2 (oligopeptide transporter 2, SLC15A2) in kidney, the PHT1 (peptide histidine transporter 1, SLC15A4) in brain and the PHT2 (peptide histidine transporter 2, SLC15A3) located in spleen, lungs and thymus. Both hPepT1 and PepT2 mediate the transport of di−/tri-peptides and a broad range of peptidomimetics in the organisms, whereas PHT1 and PHT2 mediate the translocation of histidine and with a few selected di- and tri-peptides [44]. The hPepT1, an oligopeptide transporter 1 located in the enterocystes of the small intestine, has low affinity and high capacity transporter protein to transport 400–800 different dipeptides and tripeptides and drugs like ACE’1 (Enalapril) and antiviral (acyclovir) [45]. The hPepT1 is also found in microbes like Escherichia coli residing the gut [46, 47] to uptake amino acids and on the microbial outer membrane channels (OmpC and OmpF) present in E coli [48] S. typhi [49] and H. influenza to uptake small and hydrophilic nutrients possessing a molecular weight lower than 600 kDa [50, 51].
\n
Passive diffusion and secondary transport mechanisms in bacteria may involve uptake of drug into bacterial cytoplasm [52, 53]. In the inner membrane of E. coli, four protein transporters (PTR) namely YdgR or permease A (DtpA), YjdL, YhiP, and YbgH have been characterized as family members belonging to POT. Among these peptide transporters, the DtpA mediates the transport of dipeptides and tripeptides, thereby exhibiting peptide selectivity very similar to the human oligopeptide transporter (hPepT1) in gut enterocytes [54, 55]. These findings emphasize the potential of modifications of the human physiological state by indirectly modifying the microbiome through drugs [56].
\n
\n
\n
\n
\n
3. Microbiome association with diseases
\n
As described above microorganisms present in the gut of the living organisms contribute to health or cause disease of these organisms by interplay with their immune system. Microbiome is developed at birth according to host interaction but later it is evolved and modified by surrounding factors like environmental and diet. The variation in genetic expression of different individuals is thought to be linked with different microbial composition [57]. Genotype of the host affects the composition of gut microbes. Even mutation of a single gene can cause modification in the structure of gut microbiota. The exact mechanism of association between the gut microbes and the genotype of host is still unknown. Bifidobacteria are highly prevalent beneficial bacteria in gut microbiome and are associated with lactase non-persistent genotype. This genotype is responsible for the synthesis of lactase enzyme which helps to digest the lactose, present in the milk. Absence of this enzyme leads to lactose intolerance in different organisms. So it is important to investigate susceptibility of different underlying pathological conditions by studying microbiomes association with genotype and environmental factors that vary among different human populations [58].
\n
Different studies showed that metabolic disorders are largely congenital and are associated with different microbiomes. For example, gut microbiomes have been linked to metabolic disorders and obesity [59].
\n
\n
3.1 Gut microbes and gastrointestinal tract (GIT) diseases
\n
In gut microbiome, dysbiosis (imbalance of microbial flora) can be induced by host factors and/or external factors such as the intake of antibiotics, mental and physical stress, and nutrients in the diet. Dysbiosis is likely to impair the regular gut microbiota and the appearance of pathobionts and the production of metabolites which may be dangerous to the host or may deregulate beneficial microbial-derived metabolites. The microbial symbiosis has a significant role in the development of many diseases [60] such as the gastrointestinal diseases [61, 62], infections [63], metabolic disorders, liver diseases [64], autoimmune diseases [65], mental or psychological diseases [66] and respiratory diseases [67].
\n
\n
3.1.1 Inflammatory bowel disease
\n
The inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), has for quite some time been suspected to be a host reaction to its gut microbiota. CD represents the chronic inflammation of the GIT (involving any part from mouth to anus) with idiopathic etiology while UC is the chronic inflammation of the large bowel of the GIT with no known cause. Numerous aspects of the microbiota’s association in IBD have been inspected in recent years. About 10–20% of adults and adolescents worldwide are affected by IBD [68]. The precise cause of IBD is unidentified, but it is believed to be a multifactorial disease. Inflammation, infection, visceral hypersensitivity, immunity, genetic factors, motor dysfunction of the GIT as well as psychopathological factors are suspected to play a role in its development [69]. Moreover, abnormal gut microbiota has been noticed in the IBD patients and in animals with intestinal inflammatory disease [70, 71, 72, 73]. Some of the metabolically active anaerobic bacteria in the colon and terminal part of ileum interact with the immune system of epithelium and mucosal layer of the host intestine. Continuous stimulation of these microbial antigens promote pathogenic immune responses and may cause defects in the barrier functions of mucous layer by killing some beneficial bacteria or by immune dysregulation, consequently resulting in UC and CD. Moreover, disrupted microbiota structure and function in inflammatory bowel disease intensify the immune response of the host causing dysfunction of epithelium and increased permeability of the mucous layer of the intestine [74].
\n
It is difficult to identify a single factor responsible of IBD; however, several observations have demonstrated a change in the gut microbial composition in IBD patients, both CD and UC [70]. Even though the gut microbiota has been recognized as responsible for the IBD establishment in non-predisposed hosts, numerous researches have revealed a high rate of pathogenic E. coli in ileal biopsies of CD patients [74]. Mycobacterium avium subspecies paratuberculosis is another bacterial species that has been commonly associated with the CD etiology [75]. Also, in IBD patients, large quantity of Enterobacteriaceae and a decline in Faecalibacterium prausnitzii was demonstrated to be related to the CD confined to the ileum [76]. However, it is not yet clear whether the IBD-related changes in the gut microbiota are the reason or the result of the disease.
\n
\n
\n
3.1.2 Gastric cancer
\n
For gastric cancer, H. pylori-associated chronic inflammation is considered as a risk factor and WHO has classified H. pylori as a class I carcinogen. In about 660,000 new cases every year of gastric cancer, H. pylori infection is identified as the major cause leading to the acid-producing parietal cells loss, and thereby prompting the gastric atrophy, metaplasia, dysplasia, and finally the formation of carcinoma [77]. The H. pylori elimination before the chronic atrophic gastritis may defend against gastric cancer [78]. The cancer-causing risk might be identified with the phylogenetic source of the H. pylori strain, host reaction, and host-microorganism communication [79, 80].
\n
\n
\n
3.1.3 Colorectal cancer
\n
Worldwide, the colorectal cancer (CRC) is the fourth most common cause of death associated with cancer [81]. Like other cancers, the CRC is a complex disease related to environmental and genetic factors. Ongoing research has proposed that gut microbiota assumes a role in the convergence of these factors, likely through forming a tumor-advancing environment.
\n
In certain studies, by using a germ-free mice model of adenomatous polyposis coli (APC), a markedly reduced incidence of colonic tumor and a lower tumor load was revealed when compared to normally raised mice. Further other distinct CRC phenotypes such as bleeding from rectum and iron deficiency has also been shown with an invasion of inflammatory cells emerging from an intestinal epithelial barrier dysfunction. Therefore, it seems that the microbiome and host factors (for example, age and genetic predisposition) are important to the CRC growth and progression [82].
\n
\n
\n
\n
3.2 Role of gut microbiota in cardiovascular diseases
\n
Cardiovascular and metabolic disorders are collectively known as cardiometabolic diseases and are associated with high morbidity and mortality along with significant health care expenditures [83]. The gut-derived and endogenously produced endotoxins including indoxyl sulfate, para-cresyl sulfate and lipopolysaccharides have been found to be involved in the development of pathological conditions ranging from atherosclerosis to cardio-renal failure or dysfunction [84, 85]. Furthermore, the development of some complex metabolic disorders including insulin resistance and obesity is also associated with differences in the composition of gut microbiota [86]. The metabolites L-carnitine, choline and phosphatidylcholine are metabolized by intestinal microbiota to generate TMA (trimethylamine) which then undergoes oxidation in liver to produce the proatherogenic metabolite known as TMAO (trimethylamine-N-oxide). Moreover, in atherosclerotic plaques was detected bacterial DNA of the intestinal microbiome indicating the direct involvement of intestinal microbiota in the development of atherosclerosis. Therefore, inhibition of intestinal microbiota-mediated TMAO production through dietary modulation has been suggested as a potential approach for treating atherosclerotic cardiovascular diseases [87]. In some earlier research studies, a significantly low synthetic capacity to produce TMA and TMAO from dietary L-carnitine as well as a subsequent lower plasma levels of TMAO have been observed in vegetarians as compared to omnivores. Likewise, significant variations in microbial communities have also been reported in vegetarians as compared to omnivores [88, 89] suggesting that chronic dietary exposure, i.e., omnivores vs. vegetarians, leads to shift of microbial composition with a selective advantage for bacterial species having potential for increased TMA production, and, thus, may interfere with treatment of atherosclerotic cardiovascular diseases.
\n
\n
\n
3.3 Microbiota and integumentary system
\n
The gastrointestinal (GI) system and skin are highly vascularized and densely innervated organs with crucial neuroendocrine and immune roles which are uniquely related to the normal function of skin [90]. Evidence of bidirectional and intimate connection between the gut and skin health as well as a close link between GI health to skin allostasis and homeostasis has been established [91]. GI disturbances resulted often in cutaneous manifestations and the GI system, especially the gut microbiota, appears to participate in the pathophysiology of many inflammatory diseases, i.e., acne, atopic dermatitis and psoriasis [92, 93].
\n
\n
3.3.1 Role of the gut microbiota in skin homeostasis
\n
The mechanism by which GI flora exert their effect on skin homeostasis is still unknown; however it is postulated that probably such effect may be related to the modulatory influence of gut commensals on the systemic immunity [94]. Certain gut microbiota and their metabolites, i.e., polysaccharide A, retinoic acid from Faecalibacterium prausnitzii, Bacteroides fragilis, and bacteria belonging to the Clostridium cluster IV and XI potentiate the accumulation of the lymphocytes and regulatory T cells which assist in the anti-inflammatory responses [90]. In addition to this immunomodulatory effect there is recent evidence that the intestinal microbiota may influence cutaneous pathology, physiology and more directly the modification of the immune response by the metastasis of gut microbiome and their metabolic activity [95].
\n
In cases of disturbance in intestinal barriers, it was found that intestinal bacteria and their metabolites may have the propensity to accumulate in the skin and have also access to the bloodstream which ultimately disrupts skin homeostasis. In fact, DNA of intestinal microbes has been separated from the plasma of psoriatic patients, thus showing a direct connection between the gut microbiota and skin homeostasis [90]. The short chain fatty acids (SCFAs), i.e., acetate, butyrate and propionate resulting from the fermentation of the fibers in GIT are believed to play an important role in the maintenance of certain skin microbiota which consequently affect cutaneous immune defense system. For example, propionic acid has an antimicrobial effect against the most common community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Previous literature also demonstrates that SCFAs in skin play an important role in affecting the predominant residence of bacteria on normal human skin. It has been found that P. acnes and S. epidermidis have higher ability to tolerate the propionic acid than other pathogens. Thus, P. acnes and S. epidermis fermentation may have a low risk of disrupting the balance of skin microbiome. Altogether, these findings may provide supportive evidence for a functional interactive mechanistic approach between the skin and gut [96].
\n
\n
\n
3.3.2 Dyshomeostasis due to dysbiosis
\n
Intestinal dysbiosis may have the negative potential to affect the skin function since gut microbial flora has a huge potential to produce molecules, both harmful and beneficial, that could then reach the circulation and influence skin. Metabolic products of aromatic amino acids, i.e., p-cresol and free-phenols are considered biomarkers of a disturbed gut environment as their production is due to pathogenic bacteria such as Clostridium difficile. These metabolites may preferentially accumulate in the skin, enter the circulation blood and disrupt the epidermal differentiation and integrity of the skin barrier [90]. Indeed, high level of p-cresol and free-phenols is associated with impaired keratinization and decreased skin hydration [97]. Also, the intestinal dysbiosis is responsible for the increased permeability of epithelium which ultimately modulate the immune response by disrupting their balance with immunosuppressive regulatory T cells and thereby triggers the activation of T cells effectors. It has also been observed that epithelial permeability is further enhanced by the pro-inflammatory cytokines and result in chronic systemic inflammation [98].
\n
\n
\n
\n
3.4 Gut microbiome and pulmonary health
\n
Infectious diseases of the respiratory tract including pneumonia and influenza result in deaths of approximately 3.25 million people annually [99]. The majority of the therapies being used currently are suboptimal because the problems of efficiency, toxicity and antibiotic resistance are difficult to overcome [100]. Most of the respiratory tract infections represent failure of host’s immune defense. Recently, it was suggested that gut microbiota plays a crucial role in the initiation and adaptation of the immune response in other distal mucosal sites including lungs. Therefore, it is of interest to understand the underlying mechanisms that regulate the interplay between lung defense and gastrointestinal tract and how this interaction aids in achieving optimal lung health.
\n
\n
3.4.1 Asthma and allergies
\n
An abnormal T-helper type 2 (Th2) cell responses is often associated with asthma and allergies. The Th2 cells are recognized by their ability to synthesize inflammatory cytokines including IL-13, IL-9, IL-5 and IL-4 [101] Evidence suggests that the development of allergic diseases in lung is directly affected by alteration in gut immune response [65]. In fact, a single oral dose of Candida albicans administered to antibiotic treated mice resulted in dysbiosis, i.e., an altered composition of the gut microbiome. These treated mice exhibited more CD4 cell mediated inflammation response in lung after aerosol administration of an allergen in comparison to those mice having normal intestinal flora [102], suggesting that an immunological predisposition to respiratory allergies can be facilitated by an altered gut microbiome. There is also an increasing interest in understanding the role of Th9 and Th17 cells in the development of asthma and allergies.
\n
\n
\n
3.4.2 Viral and bacterial respiratory infections
\n
Gut microbiota also plays a critical role in the immune response to respiratory tract viral infections like influenza. In infected mice, the CD8 and CD4 T cell subpopulations are directly influenced by the intestinal microbiota [103]. It has also been suggested that an intact intestinal microbiota is necessary for the expression of pro-inflammatory cytokines including pro-IL-18 and pro-IL-1β, which are essential for clearance of influenza [104]. This indicates that microbial signals are provided by gut microbiota which are crucial for the shaping and priming the immune response to viral pneumonia.
\n
Similar findings regarding the role of gut microbiome in immune response to respiratory bacterial infections have also been observed in germ-free mice. These mice were found to be more susceptible to pulmonary infection caused by bacterial pathogen Klebsiella pneumonia, showing increased levels of IL-10 and suppressed recruitment of neutrophil that allows dissemination and growth of pathogens [105].
\n
\n
\n
\n
3.5 Gut microbiome and pregnancy
\n
All systems of the body including maternal microbiome are affected by pregnancy. Changes in gut and vaginal microbiome during gestation are of particular significance because during vaginal delivery there is vertical transmission of microbes to the newborn [106, 107, 108]. During pregnancy the vaginal microbiota composition changes throughout the gestation period. In addition to vaginal microbiome, the maternal intestinal microbiome also undergoes change during pregnancy. It has been reported that bacterial diversity decreases in women as the pregnancy progresses [107]. Particularly, the ratio of pro-inflammatory Proteobacteria, which includes the Streptococcus genus and Enterobacteriaceae family, reduces during first and third trimester, while an increase in the anti-inflammatory Faecalibacterium prausnitzii occurs during these trimesters of pregnancy. These changes in microbiome are independent of body weight during pregnancy, diet, antibiotic use and gestational diabetes, suggesting the association of these changes with normal physiological pregnancy-related alteration in maternal immune and endocrine systems [109].
\n
The consequences of changes in maternal vaginal and gut microbiota on mother health are not clear; however, the gestational changes in fecal and vaginal microbiota are considered to be important for the adaptive response necessary for protection as well as to promote the fetus health. These changes also help in providing a particular microbial inoculum to the newborn at birth before its exposure to other environmental microbes. Also the microbial communities’ composition in maternal vagina and gut are not independent of each other. In fact, in pregnant women of 35–37 weeks of gestation most of bacteria, including species of Bifidobacterium and Lactobacillus, are common between vagina and rectum [110].
\n
Some research studies reported that shift in gut microbiota of mother during pregnancy may be an adaptive response for the mother and newborn health. In mice, an increase in the gut bacteria associated with gestational age, promotes body weight gain indicating a co-evolution of these microbes with their hosts during pregnancy [107]. Moreover, during vaginal delivery, the vertical transmission of these maternal gut microbiomes to the neonate may help the newborn to get an immediate access to microbiota at birth [107, 111].
\n
\n
\n
\n
4. Role of gut-microbiome in brain physiology
\n
Both extrinsic and intrinsic factors play an important role to regulate the development and maturation of the central nervous system (CNS) in humans. In germ-free and antibiotic-treated animals the physiology of the CNS can be affected by neurochemistry as well as by specific microbiota [112]. Evidences for interaction between neuropsychiatric and gastrointestinal pathology in humans have been reported in different psychiatric conditions including autism, depression and anxiety [113].
\n
The role of gut-brain interaction in the nervous system development is also recognized. Gut-brain axis actually establishes a relationship between gut-microbiota and their interaction with brain leading to changes in the status of the CNS. The dysbiosis in microbial species of the gut may lead to induce imbalance in host homeostasis, atypical immune signaling and ultimately progression of CNS diseases [114].
\n
The permeable blood brain barrier (BBB) and functional lymphatic vessels residing in dura meningeal membrane may serve as a gateway for transmission of signals [115]. The exposure to several environmental factors can affect the generation of neurons during the development of the CNS [113]. It has been suggested that maternal-fetal interface permeability permits regulatory factors from the gut microbiota to stimulate Toll-like receptor 2 (TLR2) that helps to promote neural development of fetus and also impart its effects on cognitive function during adulthood [116].
\n
The combination of microbial strains (especially the probiotic) can actively counteract the deficient neurogenesis which further strengthen the developmental link of microbiome to the hippocampal neuronal generation [117]. The brain-blood barrier (BBB) is a highly selective and semipermeable barricade that permits the passage of neutral, low molecular weight and lipidic soluble molecules [118]. In the development of the structural components and growth of vasculature, BBB requires arachidonic acid (AA) and decohexaenoic acid (DHA) which are provided as polyunsaturated fatty acids (PUFA) by gut microbiome [119]. It has been demonstrated that the restoration of BBB is possible in germ-free mice by colonization of Clostridium tyrobutyricum that produce high level of butyrates [120].
\n
\n
\n
5. Impact of different environmental conditions on gut microbiome
\n
The most important environmental factors that may lead to dysbiosis include (i) Physical or psychological stress, (ii) use of antibiotics, and (iii) diet (Figure 2).
\n
Figure 2.
Environmental factors influencing gut microbiota.
\n
\n
5.1 Physical or psychological stress
\n
Stress is usually defined as homeostasis disruption due to physical, psychological or environmental stimuli known as stressors leading to adaptive behavioral and physiological response in order to restore homeostasis [121]. The effect of both psychological and physical stress on gut microbiome is widely recognized and has been observed in both humans as well as animals [122]. Some research conducted in mice has shown that the microbial composition in the cecum was altered in response to the exposure of a social stressor by placing an aggressive male mouse into the cages of non-aggressive mice. Furthermore, the plasma concentration of stress hormones such as adrenocorticotropic hormone (ACTH) and corticosterone was found to be significantly higher in germ-free mice as compared to specific pathogen-free mice. In addition, several stressors including acoustic stress, self-control conditions and food deprivation have a negative impact on the gut microbiome resulting in the impairment of the immune system [123, 124].
\n
\n
\n
5.2 Use of antibiotics
\n
It has been observed in both humans and animals that the treatment with antibiotics can result in a decreased population of beneficial bacteria including Lactobacilli and Bifidobacteria along with the increased population of potential pathogenic bacteria like Clostridium difficile and the pathogenic yeast Candida albicans. The GI symptoms for example diarrhea, abdominal pain, bloating as well as yeast infections may occur in response to microbial shifts or dysbiosis. However, more serious and long-lasting consequences have been suggested. For example, it was reported that at the end of a 5-day treatment with the antibiotic ciprofloxacin, most of the gut bacteria was restored to the pre-treatment levels in 4 weeks, but some intestinal bacteria failed to recover even after 6-months. Moreover, a 7-day treatment with clindamycin, a drug of choice for treatment of Bacteroides infections, resulted in disrupted gut microbiome for up to 2 years [125].
\n
\n
\n
5.3 Diet and obesity
\n
Food is metabolized by the gut microbial species to extract nutrients, but some microbial species are more efficient in extracting nutrients from food as compared to other species. As different individuals have slightly different microbial populations, it is probable that more nutrients are harvested by some people’s gut microbes making them perhaps more prone to become overweight. A high percentage of Firmicutes was found in the gut microbiome of genetically obese mice while a high percentage of Bacteriodetes were observed in lean mice. Similar observation was reported in lean and obese human volunteers. Moreover, it was also seen that the obese people who used a low-caloric diet to lose weight, their gut microbiota shifted to a similar bacterial population as observed in lean people [125].
\n
\n
\n
\n
6. Conclusions
\n
The human body is a super-organism consisting of 10 times more microbial cells than our own body cells. The body’s assortment of microorganisms is mainly in gastrointestinal tract, collectively called the gut microbiota. It can be comparable to an organ in because it performs functions necessary for our survival by contributing directly and/or indirectly in various physiological processes. For the past decade, human gut microbiota has been extensively studied as many scientists believe that human health mainly depends on microbes that are living on or in our body apart from our own genome. Recently, research findings have suggested that gut microbiome is evolving as a new organ system mainly due to its specific biochemical interaction with its host which affirm its systemic integration into the host physiology as gut bacteria are not only critical for regulating gut metabolism, but also important for other systems of host including immune system. The focus of this chapter was to highlight the importance of gut microorganisms as a new organ system and their possible involvement with host systems as well as the metabolism of different drugs and nutrients in the gut by these microbes. So, in this chapter, we have reviewed opinions of different researchers about the role of gut microbiota in maintaining health as well as its contributory role in different ailments. However, literature revealed that the involvement of gut microbiota in altering host genetics effecting disease progression needs further investigations.
\n
\n\n',keywords:"gut microbiota, probiotics, metabolic disorders, gut health, drug metabolism",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/69898.pdf",chapterXML:"https://mts.intechopen.com/source/xml/69898.xml",downloadPdfUrl:"/chapter/pdf-download/69898",previewPdfUrl:"/chapter/pdf-preview/69898",totalDownloads:39,totalViews:0,totalCrossrefCites:0,dateSubmitted:"March 6th 2019",dateReviewed:"September 9th 2019",datePrePublished:"November 5th 2019",datePublished:null,readingETA:"0",abstract:"The gut microbiome is comprised of various types of bacteria, fungi, protozoa, and viruses naturally occurring in humans and animals as normal microflora. Gut microorganisms are typically host specific, and their number and type vary according to different host species and environment. Gut microbes contribute directly and/or indirectly to various physiological processes including immune modulation, regulation of various neurotransmitter, and hormones, as well as production of many antioxidants and metabolites. They also play a role as antibiotic, anti-inflammatory, anti-diabetic, and anti-carcinogenic agents. Moreover, the ability of gut microbes to attenuate various systemic diseases like coronary heart disease, irritable bowel syndrome, metabolic diseases like diabetes mellitus, and infectious diseases like diarrhea has recently been reported. Current research findings have enough evidence to suggest that gut microbiome is a new organ system mainly due to the microorganisms’ specific biochemical interaction with their hosts and their systemic integration into the host biology. Investigations into the potential ability of gut microbiome to influence metabolism inside their host via biochemical interaction with antibiotics and other drugs has recently been initiated. This chapter specifically focuses on the importance of gut microorganisms as a new organ system.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/69898",risUrl:"/chapter/ris/69898",signatures:"Haseeb Anwar, Shahzad Irfan, Ghulam Hussain, Muhammad Naeem Faisal, Humaira Muzaffar, Imtiaz Mustafa, Imran Mukhtar, Saima Malik and Muhammad Irfan Ullah",book:{id:"9025",title:"Parasitology and Microbiology Research",subtitle:null,fullTitle:"Parasitology and Microbiology Research",slug:null,publishedDate:null,bookSignature:"Dr. Gilberto Antonio Bastidas Pacheco and Dr. Asghar Ali Kamboh",coverURL:"https://cdn.intechopen.com/books/images_new/9025.jpg",licenceType:"CC BY 3.0",editedByType:null,editors:[{id:"238219",title:"Dr.",name:"Gilberto Antonio",middleName:null,surname:"Bastidas Pacheco",slug:"gilberto-antonio-bastidas-pacheco",fullName:"Gilberto Antonio Bastidas Pacheco"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Inheritance of microbiome",level:"1"},{id:"sec_2_2",title:"2.1 Microbiome",level:"2"},{id:"sec_3_2",title:"2.2 Host genetics and gut microbiome",level:"2"},{id:"sec_4_2",title:"2.3 Inherited microbiomes",level:"2"},{id:"sec_5_2",title:"2.4 Relationship of environment in shaping the microbiome",level:"2"},{id:"sec_6_2",title:"2.5 Co-evolution and co-differentiation of host microbe interaction in exploring new drug targets",level:"2"},{id:"sec_6_3",title:"2.5.1 Co-evolution of drug transporters in host and microbes",level:"3"},{id:"sec_9",title:"3. Microbiome association with diseases",level:"1"},{id:"sec_9_2",title:"3.1 Gut microbes and gastrointestinal tract (GIT) diseases",level:"2"},{id:"sec_9_3",title:"3.1.1 Inflammatory bowel disease",level:"3"},{id:"sec_10_3",title:"3.1.2 Gastric cancer",level:"3"},{id:"sec_11_3",title:"3.1.3 Colorectal cancer",level:"3"},{id:"sec_13_2",title:"3.2 Role of gut microbiota in cardiovascular diseases",level:"2"},{id:"sec_14_2",title:"3.3 Microbiota and integumentary system",level:"2"},{id:"sec_14_3",title:"3.3.1 Role of the gut microbiota in skin homeostasis",level:"3"},{id:"sec_15_3",title:"3.3.2 Dyshomeostasis due to dysbiosis",level:"3"},{id:"sec_17_2",title:"3.4 Gut microbiome and pulmonary health",level:"2"},{id:"sec_17_3",title:"3.4.1 Asthma and allergies",level:"3"},{id:"sec_18_3",title:"3.4.2 Viral and bacterial respiratory infections",level:"3"},{id:"sec_20_2",title:"3.5 Gut microbiome and pregnancy",level:"2"},{id:"sec_22",title:"4. Role of gut-microbiome in brain physiology",level:"1"},{id:"sec_23",title:"5. Impact of different environmental conditions on gut microbiome",level:"1"},{id:"sec_23_2",title:"5.1 Physical or psychological stress",level:"2"},{id:"sec_24_2",title:"5.2 Use of antibiotics",level:"2"},{id:"sec_25_2",title:"5.3 Diet and obesity",level:"2"},{id:"sec_27",title:"6. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Van den Abbeele P et al. The host selects mucosal and luminal associations of coevolved gut microorganisms: A novel concept. FEMS Microbiology Reviews. 2011;35(4):681-704\n'},{id:"B2",body:'Pickard JM et al. Gut microbiota: Role in pathogen colonization, immune responses, and inflammatory disease. Immunological Reviews. 2017;279(1):70-89\n'},{id:"B3",body:'Faust K et al. Microbial co-occurrence relationships in the human microbiome. PLoS Computational Biology. 2012;8(7):e1002606\n'},{id:"B4",body:'Gill SR et al. Metagenomic analysis of the human distal gut microbiome. Science. 2006;312(5778):1355-1359\n'},{id:"B5",body:'Ley RE et al. Microbial ecology: Human gut microbes associated with obesity. Nature. 2006;444(7122):1022\n'},{id:"B6",body:'Chen Z et al. Incorporation of therapeutically modified bacteria into gut microbiota inhibits obesity. The Journal of Clinical Investigation. 2014;124(8):3391-3406\n'},{id:"B7",body:'Martin FPJ et al. A top-down systems biology view of microbiome-mammalian metabolic interactions in a mouse model. Molecular Systems Biology. 2007;3(1):112\n'},{id:"B8",body:'Dethlefsen L, McFall-Ngai M, Relman DA. An ecological and evolutionary perspective on human–microbe mutualism and disease. Nature. 2007;449(7164):811\n'},{id:"B9",body:'Sison-Mangus MP, Mushegian AA, Ebert D. Water fleas require microbiota for survival, growth and reproduction. The ISME Journal. 2015;9(1):59\n'},{id:"B10",body:'Sampson TR, Mazmanian SK. Control of brain development, function, and behavior by the microbiome. Cell Host & Microbe. 2015;17(5):565-576\n'},{id:"B11",body:'McKenney PT, Pamer EG. From hype to hope: The gut microbiota in enteric infectious disease. Cell. 2015;163(6):1326-1332\n'},{id:"B12",body:'Nicholson JK et al. Host-gut microbiota metabolic interactions. Science. 2012;336(6086):1262-1267\n'},{id:"B13",body:'Zilber-Rosenberg I, Rosenberg E. Role of microorganisms in the evolution of animals and plants: The hologenome theory of evolution. FEMS Microbiology Reviews. 2008;32(5):723-735\n'},{id:"B14",body:'Rosenberg E, Zilber-Rosenberg I. The Hologenome Concept: Human, Animal and Plant Microbiota. Switzerland: Springer; 2014\n'},{id:"B15",body:'Blaser MJ, Cardon ZG, Cho MK, Dangl JL, Donohue TJ, Green JL et al. Toward a predictive understanding of Earth’s microbiomes to address 21st century challenges. mBio. 2016;7(3):e00714-16.\n'},{id:"B16",body:'Izard J, Rivera M. Metagenomics for Microbiology. Academic Press Elsevier Science; 2014\n'},{id:"B17",body:'Macia L et al. Microbial influences on epithelial integrity and immune function as a basis for inflammatory diseases. Immunological Reviews. 2012;245(1):164-176\n'},{id:"B18",body:'Falony G et al. Population-level analysis of gut microbiome variation. Science. 2016;352(6285):560-564\n'},{id:"B19",body:'Heinken A, Thiele I. Systematic prediction of health-relevant human-microbial co-metabolism through a computational framework. Gut Microbes. 2015;6(2):120-130\n'},{id:"B20",body:'Ley RE, Peterson DA, Gordon JI. Ecological and evolutionary forces shaping microbial diversity in the human intestine. Cell. 2006;124(4):837-848\n'},{id:"B21",body:'Sansonetti PJ, Medzhitov R. Learning tolerance while fighting ignorance. Cell. 2009;138(3):416-420\n'},{id:"B22",body:'Yang L et al. Gut microbiota co-microevolution with selection for host humoral immunity. Frontiers in Microbiology. 2017;8:1243\n'},{id:"B23",body:'Tissier H. Recherches sur la flore intestinale des nourrissons: (état normal et pathologique). G. Carre and C. Naud, Paris, France; 1900\n'},{id:"B24",body:'Blaser MJ. Who are we? Indigenous microbes and the ecology of human diseases. EMBO Reports. 2006;7(10):956-960\n'},{id:"B25",body:'Ardissone AN et al. Meconium microbiome analysis identifies bacteria correlated with premature birth. PLoS One. 2014;9(3):e90784\n'},{id:"B26",body:'Moles L et al. Bacterial diversity in meconium of preterm neonates and evolution of their fecal microbiota during the first month of life. PLoS One. 2013;8(6):e66986\n'},{id:"B27",body:'DiGiulio DB et al. Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: A molecular and culture-based investigation. PLoS One. 2008;3(8):e3056\n'},{id:"B28",body:'Moeller AH et al. Transmission modes of the mammalian gut microbiota. Science. 2018;362(6413):453-457\n'},{id:"B29",body:'Rothschild D et al. Environment dominates over host genetics in shaping human gut microbiota. Nature. 2018;555(7695):210\n'},{id:"B30",body:'Madupu R, Szpakowski S, Nelson KE. Microbiome in human health and disease. Science Progress. 2013;96(2):153-170\n'},{id:"B31",body:'Zaneveld J et al. Host-bacterial coevolution and the search for new drug targets. Current Opinion in Chemical Biology. 2008;12(1):109-114\n'},{id:"B32",body:'Moran NA. Symbiosis as an adaptive process and source of phenotypic complexity. Proceedings of the National Academy of Sciences. 2007;104(Suppl. 1):8627-8633\n'},{id:"B33",body:'Charleston MA, Perkins SL. Traversing the tangle: Algorithms and applications for cophylogenetic studies. Journal of Biomedical Informatics. 2006;39(1):62-71\n'},{id:"B34",body:'Stevens J. Computational aspects of host–parasite phylogenies. Briefings in Bioinformatics. 2004;5(4):339-349\n'},{id:"B35",body:'Osawa R, Blanshard W, Ocallaghan P. Microbiological studies of the intestinal microflora of the koala, Phascolarctos cinereus. 2. Pap, a special maternal feces consumed by juvenile koalas. Australian Journal of Zoology. 1993;41(6):611-620\n'},{id:"B36",body:'Kurokawa K et al. Comparative metagenomics revealed commonly enriched gene sets in human gut microbiomes. DNA Research. 2007;14(4):169-181\n'},{id:"B37",body:'Hansen-Wester I, Stecher B, Hensel M. Analyses of the evolutionary distribution of Salmonella translocated effectors. Infection and Immunity. 2002;70(3):1619-1622\n'},{id:"B38",body:'Hensel M. Evolution of pathogenicity islands of Salmonella enterica. International Journal of Medical Microbiology. 2004;294(2-3):95-102\n'},{id:"B39",body:'Lujan SA et al. Disrupting antibiotic resistance propagation by inhibiting the conjugative DNA relaxase. Proceedings of the National Academy of Sciences. 2007;104(30):12282-12287\n'},{id:"B40",body:'Dahlgren MK et al. Design, synthesis, and multivariate quantitative structure− activity relationship of Salicylanilides potent inhibitors of type III secretion in Yersinia. Journal of Medicinal Chemistry. 2007;50(24):6177-6188\n'},{id:"B41",body:'Hsiao WW et al. Evidence of a large novel gene pool associated with prokaryotic genomic islands. PLoS Genetics. 2005;1(5):e62\n'},{id:"B42",body:'Ekins S et al. Computational modeling to accelerate the identification of substrates and inhibitors for transporters that affect drug disposition. Clinical Pharmacology & Therapeutics. 2012;92(5):661-665\n'},{id:"B43",body:'Dobson PD, Kell DB. Carrier-mediated cellular uptake of pharmaceutical drugs: An exception or the rule? Nature Reviews Drug Discovery. 2008;7(3):205\n'},{id:"B44",body:'Rubio-Aliaga I, Daniel H. Peptide transporters and their roles in physiological processes and drug disposition. Xenobiotica. 2008;38(7-8):1022-1042\n'},{id:"B45",body:'Ma K, Hu Y, Smith DE. Peptide transporter 1 is responsible for intestinal uptake of the dipeptide glycylsarcosine: Studies in everted jejunal rings from wild-type and Pept1 null mice. Journal of Pharmaceutical Sciences. 2011;100(2):767-774\n'},{id:"B46",body:'Sussman A, Gilvarg C. Peptide transport and metabolism in bacteria. Annual Review of Biochemistry. 1971;40(1):397-408\n'},{id:"B47",body:'payne JW. Peptide Transport in Bacteria: Methods, Mutants and Energy Coupling. Biochemical Society Transactions. Portland Press Limited. 1983;11:794-798\n'},{id:"B48",body:'Mortimer PG, Piddok LJ. The accumulation of five antibacterial agents in porin-deficient mutants of Escherichia coli. Journal of Antimicrobial Chemotherapy. 1993;32(2):195-213\n'},{id:"B49",body:'Toro CS et al. Clinical isolate of a porinless Salmonella typhi resistant to high levels of chloramphenicol. Antimicrobial Agents and Chemotherapy. 1990;34(9):1715-1719\n'},{id:"B50",body:'Burns JL, Smith AL. A major outer-membrane protein functions as a porin in Haemophilus influenzae. Microbiology. 1987;133(5):1273-1277\n'},{id:"B51",body:'Srikumar R et al. Porins of Haemophilus influenzae type b mutated in loop 3 and in loop 4. Journal of Biological Chemistry. 1997;272(21):13614-13621\n'},{id:"B52",body:'Lewinson O et al. The Escherichia coli multidrug transporter MdfA catalyzes both electrogenic and electroneutral transport reactions. Proceedings of the National Academy of Sciences. 2003;100(4):1667-1672\n'},{id:"B53",body:'Abdel-Sayed S. Transport of chloramphenicol into sensitive strains of Escherichia coli and Pseudomonas aeruginosa. Journal of Antimicrobial Chemotherapy. 1987;19(1):7-20\n'},{id:"B54",body:'Harder D et al. DtpB (YhiP) and DtpA (TppB, YdgR) are prototypical proton-dependent peptide transporters of Escherichia coli. The FEBS Journal. 2008;275(13):3290-3298\n'},{id:"B55",body:'Casagrande F et al. Projection structure of DtpD (YbgH), a prokaryotic member of the peptide transporter family. Journal of Molecular Biology. 2009;394(4):708-717\n'},{id:"B56",body:'Garber K. Drugging the Gut Microbiome. Nature Publishing Group; 2015;33:228-231\n'},{id:"B57",body:'Pessione E. Lactic acid bacteria contribution to gut microbiota complexity: Lights and shadows. Frontiers in Cellular and Infection Microbiology. 2012;2:86\n'},{id:"B58",body:'Goodrich JK et al. The relationship between the human genome and microbiome comes into view. Annual Review of Genetics. 2017;51:413-433\n'},{id:"B59",body:'Snyder M. Genomics and Personalized Medicine: What Everyone Needs to Know. England: Oxford University Press; 2016\n'},{id:"B60",body:'Bassi C, Larvin M, Villatoro E. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. The Cochrane Database of Systematic Reviews. 2003;4:CD002941\n'},{id:"B61",body:'Bik EM et al. Bacterial diversity in the oral cavity of 10 healthy individuals. The ISME Journal. 2010;4(8):962\n'},{id:"B62",body:'Bik EM et al. Molecular analysis of the bacterial microbiota in the human stomach. Proceedings of the National Academy of Sciences. 2006;103(3):732-737\n'},{id:"B63",body:'Bates JM et al. Intestinal alkaline phosphatase detoxifies lipopolysaccharide and prevents inflammation in zebrafish in response to the gut microbiota. Cell Host & Microbe. 2007;2(6):371-382\n'},{id:"B64",body:'Beutler B, Rietschel ET. Innate immune sensing and its roots: The story of endotoxin. Nature Reviews Immunology. 2003;3(2):169\n'},{id:"B65",body:'Björkstén B et al. Allergy development and the intestinal microflora during the first year of life. Journal of Allergy and Clinical Immunology. 2001;108(4):516-520\n'},{id:"B66",body:'Björkbacka H et al. Reduced atherosclerosis in MyD88-null mice links elevated serum cholesterol levels to activation of innate immunity signaling pathways. Nature Medicine. 2004;10(4):416\n'},{id:"B67",body:'Bingham S. Diet and Colorectal Cancer Prevention. Portland Press Limited; 2000\n'},{id:"B68",body:'Longstreth GF et al. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-1491\n'},{id:"B69",body:'Ghoshal UC et al. The gut microbiota and irritable bowel syndrome: Friend or foe? International Journal of Inflammation. 2012:151085\n'},{id:"B70",body:'Peterson DA et al. Metagenomic approaches for defining the pathogenesis of inflammatory bowel diseases. Cell Host & Microbe. 2008;3(6):417-427\n'},{id:"B71",body:'Frank DN, Pace NR. Gastrointestinal microbiology enters the metagenomics era. Current Opinion in Gastroenterology. 2008;24(1):4-10\n'},{id:"B72",body:'Frank DN et al. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proceedings of the National Academy of Sciences. 2007;104(34):13780-13785\n'},{id:"B73",body:'Lupp C et al. Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae. Cell Host & Microbe. 2007;2(2):119-129\n'},{id:"B74",body:'Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology. 2008;134(2):577-594\n'},{id:"B75",body:'Packey CD, Sartor RB. Commensal bacteria, traditional and opportunistic pathogens, dysbiosis and bacterial killing in inflammatory bowel diseases. Current Opinion in Infectious Diseases. 2009;22(3):292\n'},{id:"B76",body:'Willing B et al. Twin studies reveal specific imbalances in the mucosaassociated microbiota of patients with ileal Crohn\'s disease. Inflammatory Bowel Diseases. 2008;15(5):653-660\n'},{id:"B77",body:'De Martel C et al. Global burden of cancers attributable to infections in 2008: A review and synthetic analysis. The Lancet Oncology. 2012;13(6):607-615\n'},{id:"B78",body:'Wong BC-Y et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: A randomized controlled trial. JAMA. 2004;291(2):187-194\n'},{id:"B79",body:'El-Omar EM et al. Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature. 2000;404(6776):398\n'},{id:"B80",body:'de Sablet T et al. Phylogeographic origin of Helicobacter pylori is a determinant of gastric cancer risk. Gut. 2011;60(9):1189-1195\n'},{id:"B81",body:'Arnold M et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683-691\n'},{id:"B82",body:'Li Y et al. Gut microbiota accelerate tumor growth via c-jun and STAT3 phosphorylation in APC Min/+ mice. Carcinogenesis. 2012;33(6):1231-1238\n'},{id:"B83",body:'Aron-Wisnewsky J, Clément K. The gut microbiome, diet, and links to cardiometabolic and chronic disorders. Nature Reviews Nephrology. 2016;12(3):169\n'},{id:"B84",body:'Buffie CG, Pamer EG. Microbiota-mediated colonization resistance against intestinal pathogens. Nature Reviews Immunology. 2013;13(11):790\n'},{id:"B85",body:'Collins SM. A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 2014;11(8):497\n'},{id:"B86",body:'Turnbaugh PJ et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(7122):1027\n'},{id:"B87",body:'Wang Z et al. Non-lethal inhibition of gut microbial trimethylamine production for the treatment of atherosclerosis. Cell. 2015;163(7):1585-1595\n'},{id:"B88",body:'Koeth RA et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine. 2013;19(5):576\n'},{id:"B89",body:'Huijbers MM et al. Flavin dependent monooxygenases. Archives of Biochemistry and Biophysics. 2014;544:2-17\n'},{id:"B90",body:'O\'Neill CA et al. The gut-skin axis in health and disease: A paradigm with therapeutic implications. BioEssays. 2016;38(11):1167-1176\n'},{id:"B91",body:'Levkovich T et al. Probiotic bacteria induce a ‘glow of health’. PLoS One. 2013;8(1):e53867\n'},{id:"B92",body:'Shah KR et al. Cutaneous manifestations of gastrointestinal disease: Part I. Journal of the American Academy of Dermatology. 2013;68(2):189. e1-189. e21\n'},{id:"B93",body:'Salem I et al. The gut microbiome as a major regulator of the gut-skin axis. Frontiers in Microbiology. 2018;9:1459\n'},{id:"B94",body:'Forbes JD, Van Domselaar G, Bernstein CN. The gut microbiota in immune-mediated inflammatory diseases. Frontiers in Microbiology. 2016;7:1081\n'},{id:"B95",body:'Samuelson DR, Welsh DA, Shellito JE. Regulation of lung immunity and host defense by the intestinal microbiota. Frontiers in Microbiology. 2015;6:1085\n'},{id:"B96",body:'Schwarz A, Bruhs A, Schwarz T. The short-chain fatty acid sodium butyrate functions as a regulator of the skin immune system. Journal of Investigative Dermatology. 2017;137(4):855-864\n'},{id:"B97",body:'Miyazaki K et al. Bifidobacterium fermented milk and galacto-oligosaccharides lead to improved skin health by decreasing phenols production by gut microbiota. Beneficial Microbes. 2013;5(2):121-128\n'},{id:"B98",body:'Kosiewicz MM et al. Relationship between gut microbiota and development of T cell associated disease. FEBS Letters. 2014;588(22):4195-4206\n'},{id:"B99",body:'Ruberto I et al. The availability and consistency of dengue surveillance data provided online by the World Health Organization. PLoS Neglected Tropical Diseases. 2015;9(4):e0003511\n'},{id:"B100",body:'Keely S, Talley NJ, Hansbro PM. Pulmonary-intestinal cross-talk in mucosal inflammatory disease. Mucosal Immunology. 2012;5(1):7\n'},{id:"B101",body:'McLoughlin RM, Mills KH. Influence of gastrointestinal commensal bacteria on the immune responses that mediate allergy and asthma. Journal of Allergy and Clinical Immunology. 2011;127(5):1097-1107\n'},{id:"B102",body:'Noverr MC et al. Role of antibiotics and fungal microbiota in driving pulmonary allergic responses. Infection and Immunity. 2004;72(9):4996-5003\n'},{id:"B103",body:'Ichinohe T et al. Microbiota regulates immune defense against respiratory tract influenza a virus infection. Proceedings of the National Academy of Sciences. 2011;108(13):5354-5359\n'},{id:"B104",body:'Ichinohe T, Pang IK, Iwasaki A. Influenza virus activates inflammasomes via its intracellular M2 ion channel. Nature Immunology. 2010;11(5):404\n'},{id:"B105",body:'Fagundes CT et al. Transient TLR activation restores inflammatory response and ability to control pulmonary bacterial infection in germfree mice. The Journal of Immunology. 2012;188(3):1411-1420\n'},{id:"B106",body:'Aagaard K et al. A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One. 2012;7(6):e36466\n'},{id:"B107",body:'Koren O et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell. 2012;150(3):470-480\n'},{id:"B108",body:'Romero R et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome. 2014;2(1):4\n'},{id:"B109",body:'Mueller NT et al. The infant microbiome development: Mom matters. Trends in Molecular Medicine. 2015;21(2):109-117\n'},{id:"B110",body:'El Aila NA et al. Identification and genotyping of bacteria from paired vaginal and rectal samples from pregnant women indicates similarity between vaginal and rectal microflora. BMC Infectious Diseases. 2009;9(1):167\n'},{id:"B111",body:'Pantoja-Feliciano IG et al. Biphasic assembly of the murine intestinal microbiota during early development. The ISME Journal. 2013;7(6):1112\n'},{id:"B112",body:'Smith PA. The tantalizing links between gut microbes and the brain. Nature News. 2015;526(7573):312\n'},{id:"B113",body:'Sharon G et al. The central nervous system and the gut microbiome. Cell. 2016;167(4):915-932\n'},{id:"B114",body:'Cussotto S et al. The neuroendocrinology of the microbiota-gut-brain axis: A behavioural perspective. Frontiers in Neuroendocrinology. 2018;51:80-101\n'},{id:"B115",body:'Quail DF, Joyce JA. The microenvironmental landscape of brain tumors. Cancer Cell. 2017;31(3):326-341\n'},{id:"B116",body:'Humann J et al. Bacterial peptidoglycan traverses the placenta to induce fetal neuroproliferation and aberrant postnatal behavior. Cell Host & Microbe. 2016;19(3):388-399\n'},{id:"B117",body:'Möhle L et al. Ly6Chi monocytes provide a link between antibiotic-induced changes in gut microbiota and adult hippocampal neurogenesis. Cell Reports. 2016;15(9):1945-1956\n'},{id:"B118",body:'Wolak DJ, Thorne RG. Diffusion of macromolecules in the brain: Implications for drug delivery. Molecular Pharmaceutics. 2013;10(5):1492-1504\n'},{id:"B119",body:'Crawford M et al. The potential role for arachidonic and docosahexaenoic acids in protection against some central nervous system injuries in preterm infants. Lipids. 2003;38(4):303-315\n'},{id:"B120",body:'Braniste V et al. The gut microbiota influences blood-brain barrier permeability in mice. Science Translational Medicine. 2014;6(263):263ra158\n'},{id:"B121",body:'Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: Implications for health. Nature Reviews Immunology. 2005;5(3):243\n'},{id:"B122",body:'Caso JR, Leza JC, Menchen L. The effects of physical and psychological stress on the gastrointestinal tract: Lessons from animal models. Current Molecular Medicine. 2008;8(4):299-312\n'},{id:"B123",body:'Bailey MT et al. Exposure to a social stressor alters the structure of the intestinal microbiota: Implications for stressor-induced immunomodulation. Brain, Behavior, and Immunity. 2011;25(3):397-407\n'},{id:"B124",body:'Sudo N et al. Postnatal microbial colonization programs the hypothalamic–pituitary–adrenal system for stress response in mice. The Journal of Physiology. 2004;558(1):263-275\n'},{id:"B125",body:'Phillips ML. Gut reaction: Environmental effects on the human microbiota. National Institute of Environmental Health Sciences. 2009;117(5):A198–A205\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Haseeb Anwar",address:"drhaseebanwar@gcuf.edu.pk",affiliation:'
Department of Physiology, Government College University, Pakistan
Department of Pathobiology, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Pakistan
'}],corrections:null},book:{id:"9025",title:"Parasitology and Microbiology Research",subtitle:null,fullTitle:"Parasitology and Microbiology Research",slug:null,publishedDate:null,bookSignature:"Dr. Gilberto Antonio Bastidas Pacheco and Dr. Asghar Ali Kamboh",coverURL:"https://cdn.intechopen.com/books/images_new/9025.jpg",licenceType:"CC BY 3.0",editedByType:null,editors:[{id:"238219",title:"Dr.",name:"Gilberto Antonio",middleName:null,surname:"Bastidas Pacheco",slug:"gilberto-antonio-bastidas-pacheco",fullName:"Gilberto Antonio Bastidas Pacheco"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"207942",title:"Dr.",name:"Ana Luisa",middleName:null,surname:"Pereira",email:"anapereira271268@yahoo.com",fullName:"Ana Luisa Pereira",slug:"ana-luisa-pereira",position:null,biography:"Dr. Ana Luisa Pereira graduated from the Faculty of Sciences, University of Lisbon, in 1996. She obtained her Ph.D. in Biology at the University of Lisbon in 2007 with research using the symbiosis between Azolla and Anabaena azollae. She also made postdoctoral research at CIIMAR (Porto, Portugal) and Centre for Functional Ecology (University of Coimbra). Ana Pereira has experience in microscopy, cellular biology, microbiology, genetics, phylogenetics, proteomics, extraction of compounds and their bioactivity and ecotoxicology. She worked with plant–cyanobacteria symbiosis (Azolla and Cycas), cyanobacteria and their cyanotoxins, plant growth promoting bacteria, aromatic plants, wild orchids, microalgae and bacteria from bovines. She participated in several projects as team member, attended many conferences and has several publications.",institutionString:"University of Lisbon",profilePictureURL:"https://mts.intechopen.com/storage/users/207942/images/system/207942.jpg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:{name:"University of Lisbon",institutionURL:null,country:{name:"Portugal"}}},booksEdited:[],chaptersAuthored:[{title:"The Unique Symbiotic System between a Fern and a Cyanobacterium, Azolla-Anabaena azollae: Their Potential as Biofertilizer, Feed, and Remediation",slug:"the-unique-symbiotic-system-between-a-fern-and-a-cyanobacterium-azolla-anabaena-azollae-their-potent",abstract:"The free-floating aquatic fern Azolla is small and heterosporic, with a worldwide distribution in quiet waters (rivers, dams, creeks, etc.) and is considered an invasive species. This is the only known fern with a permanent symbiotic association with the heterocystic nitrogen-fixing cyanobacterium Anabaena azollae where the cyanobiont is transmitted through the Azolla generations without a de novo infection. The cyanobiont and other bacteria genera inhabit an ovoid cavity in each dorsal lobe of the leaf. The cyanobiont has a high rate of nitrogen fixation and thus this symbiosis was analyzed regarding its biofertilization (incorporated in soil or as manure). In addition, due to the amino acids and protein contents, this fern can also be used as food, and due to the high ability to uptake heavy metals and other pollutants, it can be used as phytoremediator. Since this fern is grown in tropical and subtropical zones where most of the countries have problems regarding the living conditions (health, sanitary, and food, among others) of people, this fern can be a very useful and cheap tool to cope with the severe problems that they face.",signatures:"Ana L. Pereira",authors:[{id:"207942",title:"Dr.",name:"Ana Luisa",surname:"Pereira",fullName:"Ana Luisa Pereira",slug:"ana-luisa-pereira",email:"anapereira271268@yahoo.com"}],book:{title:"Symbiosis",slug:"symbiosis",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"105767",title:"Dr.",name:"Jer-Ming",surname:"Hu",slug:"jer-ming-hu",fullName:"Jer-Ming Hu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Taiwan University",institutionURL:null,country:{name:"Taiwan"}}},{id:"114694",title:"Prof.",name:"Omrane",surname:"Belhadj",slug:"omrane-belhadj",fullName:"Omrane Belhadj",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"169165",title:"Dr.",name:"Mabrouk",surname:"Yassine",slug:"mabrouk-yassine",fullName:"Mabrouk Yassine",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"193503",title:"Dr.",name:"Issam",surname:"Ben Salem",slug:"issam-ben-salem",fullName:"Issam Ben Salem",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"203025",title:"Dr.",name:"Imen",surname:"Hemissi",slug:"imen-hemissi",fullName:"Imen Hemissi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"203027",title:"Prof.",name:"Mouldi",surname:"Saidi",slug:"mouldi-saidi",fullName:"Mouldi Saidi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"206658",title:"Dr.",name:"Viktor",surname:"Tsyganov",slug:"viktor-tsyganov",fullName:"Viktor Tsyganov",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"All-Russian Research Institute of Agricultural Microbiology",institutionURL:null,country:{name:"Russia"}}},{id:"207970",title:"Dr.",name:"Anna",surname:"Tsyganova",slug:"anna-tsyganova",fullName:"Anna Tsyganova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"208135",title:"Mr.",name:"Chen-Jui",surname:"Yang",slug:"chen-jui-yang",fullName:"Chen-Jui Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"219610",title:"Dr.",name:"Sonia",surname:"Mejri",slug:"sonia-mejri",fullName:"Sonia Mejri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"sponsors-humans-in-space-program",title:"Sponsors",intro:"
“Scientific progress is fueled by collaboration. By democratizing the world’s scientific research, making it freely available to all, we want to inspire greater opportunity for collaboration, speed of discovery and scientific progress.”
\n\n
--IntechOpen
",metaTitle:"Sponsors",metaDescription:"“Scientific progress is fueled by collaboration. By democratizing the world’s scientific research,\nmaking it freely available to all, we want to inspire greater opportunity for collaboration, speed of discovery and scientific progress.”\n\n--IntechOpen",metaKeywords:null,canonicalURL:"/page/sponsors-humans-in-space-program",contentRaw:'[{"type":"htmlEditorComponent","content":"
Open Access is in the heart of the Humans in Space program as it removes barriers and allows everyone to freely access the research published. However, open access publishing fees also pose a barrier to many talented authors who just can’t afford to pay.
\\n\\n
Humans in Space program aims to remove this barrier and pursue a model under which none of our authors will need to pay for publication and the editors will receive a budget for their editorial work.
\\n\\n
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor the program, we’d love to hear from you. Contact: Natalia Reinic Babic at natalia@intechopen.com. All of our IntechOpen sponsors are in good company The research in past IntechOpen books and chapters have been funded / sponsored by:
\\n\\n
\\n\\t
Colgate
\\n\\t
Kappa Bioscience
\\n\\t
Japanese Society for Regenerative Medicine
\\n\\t
Royal Military Academy of Belgium
\\n\\t
Nagoya University
\\n\\t
Max Planck Institute
\\n\\t
United Nations (Secretariat of the Convention on Biological Diversity)
Open Access is in the heart of the Humans in Space program as it removes barriers and allows everyone to freely access the research published. However, open access publishing fees also pose a barrier to many talented authors who just can’t afford to pay.
\n\n
Humans in Space program aims to remove this barrier and pursue a model under which none of our authors will need to pay for publication and the editors will receive a budget for their editorial work.
\n\n
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor the program, we’d love to hear from you. Contact: Natalia Reinic Babic at natalia@intechopen.com. All of our IntechOpen sponsors are in good company The research in past IntechOpen books and chapters have been funded / sponsored by:
\n\n
\n\t
Colgate
\n\t
Kappa Bioscience
\n\t
Japanese Society for Regenerative Medicine
\n\t
Royal Military Academy of Belgium
\n\t
Nagoya University
\n\t
Max Planck Institute
\n\t
United Nations (Secretariat of the Convention on Biological Diversity)
\n\t
European Commission
\n\t
Bill and Melinda Gates Foundation
\n\t
Wellcome Trust
\n\t
National Institute of Health (NIH)
\n\t
National Science Foundation (NSF)
\n\t
Research Councils United Kingdom (RCUK)
\n\t
Chinese Academy of Sciences
\n\t
German Research Foundation (DFG)
\n\t
Austrian Science Fund (FWF)
\n\t
Australian Research Council (ARC)
\n
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:null},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5314},{group:"region",caption:"Middle and South America",value:2,count:4818},{group:"region",caption:"Africa",value:3,count:1466},{group:"region",caption:"Asia",value:4,count:9363},{group:"region",caption:"Australia and Oceania",value:5,count:837},{group:"region",caption:"Europe",value:6,count:14778}],offset:12,limit:12,total:108152},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{topicId:"18"},books:[{type:"book",id:"7136",title:"Blood-Brain Barrier",subtitle:null,isOpenForSubmission:!0,hash:"a78e14b6ae2f895c53eca505f0b2fc97",slug:null,bookSignature:"Dr. Megha Bansal",coverURL:"https://cdn.intechopen.com/books/images_new/7136.jpg",editedByType:null,editors:[{id:"305695",title:"Dr.",name:"Megha",surname:"Bansal",slug:"megha-bansal",fullName:"Megha Bansal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7817",title:"Neurorehabilitation (and Neural Repair) - Advanced Diagnosis and Recovery Options",subtitle:null,isOpenForSubmission:!0,hash:"ae8aea8a335321c74f86d44c73307143",slug:null,bookSignature:"Prof. Denis Larrivee",coverURL:"https://cdn.intechopen.com/books/images_new/7817.jpg",editedByType:null,editors:[{id:"206412",title:"Prof.",name:"Denis",surname:"Larrivee",slug:"denis-larrivee",fullName:"Denis Larrivee"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7958",title:"Hallucination",subtitle:null,isOpenForSubmission:!0,hash:"6fdc24db4e3a8f26f2ab95aba724e040",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/7958.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8059",title:"Neuromodulation and Neurostimulation",subtitle:null,isOpenForSubmission:!0,hash:"8cc2c649900edf37ff3374fdc96a1586",slug:null,bookSignature:"Prof. Denis Larrivee",coverURL:"https://cdn.intechopen.com/books/images_new/8059.jpg",editedByType:null,editors:[{id:"206412",title:"Prof.",name:"Denis",surname:"Larrivee",slug:"denis-larrivee",fullName:"Denis Larrivee"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8103",title:"Lymph Nodes",subtitle:null,isOpenForSubmission:!0,hash:"48382ac3a987abd738e500a9cd344e2a",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/8103.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8151",title:"Grey Matter",subtitle:null,isOpenForSubmission:!0,hash:"bed14b9822f229181057df4f97d92cc7",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/8151.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8942",title:"Hippocampus",subtitle:null,isOpenForSubmission:!0,hash:"e3b98380a5f3940fec680ae0d35f7664",slug:null,bookSignature:"Dr. Marco Cascella",coverURL:"https://cdn.intechopen.com/books/images_new/8942.jpg",editedByType:null,editors:[{id:"199335",title:"Dr.",name:"Marco",surname:"Cascella",slug:"marco-cascella",fullName:"Marco Cascella"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9637",title:"Schwann Cells",subtitle:null,isOpenForSubmission:!0,hash:"499d26b78258d9dae2b57c0190550ce3",slug:null,bookSignature:"Emeritus Prof. Stavros J. Baloyannis",coverURL:"https://cdn.intechopen.com/books/images_new/9637.jpg",editedByType:null,editors:[{id:"156098",title:"Emeritus Prof.",name:"Stavros",surname:"Baloyannis",slug:"stavros-baloyannis",fullName:"Stavros Baloyannis"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9638",title:"Cerebral Cortex",subtitle:null,isOpenForSubmission:!0,hash:"e15c84025136707d6e9e094b16c27bc0",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/9638.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9656",title:"Brain Injury",subtitle:null,isOpenForSubmission:!0,hash:"4b3237689c0f4d9fc4746d9825aa2a4d",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/9656.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9667",title:"Neuroimmunology",subtitle:null,isOpenForSubmission:!0,hash:"ed83d79ad237ec09240b04734a5078dc",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/9667.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9854",title:"The Science of Flavor",subtitle:null,isOpenForSubmission:!0,hash:"356cf9b61a816977cb3027c83be0dd22",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/9854.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:35},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:32},{group:"topic",caption:"Business, Management and Economics",value:7,count:9},{group:"topic",caption:"Chemistry",value:8,count:29},{group:"topic",caption:"Computer and Information Science",value:9,count:26},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:14},{group:"topic",caption:"Engineering",value:11,count:75},{group:"topic",caption:"Environmental Sciences",value:12,count:13},{group:"topic",caption:"Immunology and Microbiology",value:13,count:3},{group:"topic",caption:"Materials Science",value:14,count:37},{group:"topic",caption:"Mathematics",value:15,count:14},{group:"topic",caption:"Medicine",value:16,count:142},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:5},{group:"topic",caption:"Neuroscience",value:18,count:6},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:8},{group:"topic",caption:"Physics",value:20,count:20},{group:"topic",caption:"Psychology",value:21,count:2},{group:"topic",caption:"Robotics",value:22,count:6},{group:"topic",caption:"Social Sciences",value:23,count:14},{group:"topic",caption:"Technology",value:24,count:10},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:3},{group:"topic",caption:"Intelligent System",value:535,count:1}],offset:12,limit:12,total:15},popularBooks:{featuredBooks:[{type:"book",id:"7878",title:"Advances in Extracorporeal Membrane Oxygenation",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"f95bf990273d08098a00f9a1c2403cbe",slug:"advances-in-extracorporeal-membrane-oxygenation-volume-3",bookSignature:"Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/7878.jpg",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7614",title:"Fourier Transforms",subtitle:"Century of Digitalization and Increasing Expectations",isOpenForSubmission:!1,hash:"ff3501657ae983a3b42fef1f7058ac91",slug:"fourier-transforms-century-of-digitalization-and-increasing-expectations",bookSignature:"Goran S. Nikoli? and Dragana Z. Markovi?-Nikoli?",coverURL:"https://cdn.intechopen.com/books/images_new/7614.jpg",editors:[{id:"23261",title:"Prof.",name:"Goran",middleName:"S.",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8299",title:"Timber Buildings and Sustainability",subtitle:null,isOpenForSubmission:!1,hash:"bccf2891cec38ed041724131aa34c25a",slug:"timber-buildings-and-sustainability",bookSignature:"Giovanna Concu",coverURL:"https://cdn.intechopen.com/books/images_new/8299.jpg",editors:[{id:"108709",title:"Dr.",name:"Giovanna",middleName:null,surname:"Concu",slug:"giovanna-concu",fullName:"Giovanna Concu"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7062",title:"Rhinosinusitis",subtitle:null,isOpenForSubmission:!1,hash:"14ed95e155b1e57a61827ca30b579d09",slug:"rhinosinusitis",bookSignature:"Balwant Singh Gendeh and Mirjana Turkalj",coverURL:"https://cdn.intechopen.com/books/images_new/7062.jpg",editors:[{id:"67669",title:"Prof.",name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7087",title:"Tendons",subtitle:null,isOpenForSubmission:!1,hash:"786abac0445c102d1399a1e727a2db7f",slug:"tendons",bookSignature:"Hasan Sözen",coverURL:"https://cdn.intechopen.com/books/images_new/7087.jpg",editors:[{id:"161402",title:"Dr.",name:"Hasan",middleName:null,surname:"Sözen",slug:"hasan-sozen",fullName:"Hasan Sözen"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7955",title:"Advances in Hematologic Malignancies",subtitle:null,isOpenForSubmission:!1,hash:"59ca1b09447fab4717a93e099f646d28",slug:"advances-in-hematologic-malignancies",bookSignature:"Gamal Abdul Hamid",coverURL:"https://cdn.intechopen.com/books/images_new/7955.jpg",editors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7701",title:"Assistive and Rehabilitation Engineering",subtitle:null,isOpenForSubmission:!1,hash:"4191b744b8af3b17d9a80026dcb0617f",slug:"assistive-and-rehabilitation-engineering",bookSignature:"Yves Rybarczyk",coverURL:"https://cdn.intechopen.com/books/images_new/7701.jpg",editors:[{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",slug:"yves-rybarczyk",fullName:"Yves Rybarczyk"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7837",title:"Geriatric Medicine and Gerontology",subtitle:null,isOpenForSubmission:!1,hash:"e277d005b23536bcd9f8550046101979",slug:"geriatric-medicine-and-gerontology",bookSignature:"Edward T. Zawada Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/7837.jpg",editors:[{id:"16344",title:"Dr.",name:"Edward T.",middleName:null,surname:"Zawada Jr.",slug:"edward-t.-zawada-jr.",fullName:"Edward T. Zawada Jr."}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,isOpenForSubmission:!1,hash:"61c627da05b2ace83056d11357bdf361",slug:"current-topics-in-neglected-tropical-diseases",bookSignature:"Alfonso J. Rodriguez-Morales",coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",editors:[{id:"131400",title:"Dr.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7610",title:"Renewable and Sustainable Composites",subtitle:null,isOpenForSubmission:!1,hash:"c2de26c3d329c54f093dc3f05417500a",slug:"renewable-and-sustainable-composites",bookSignature:"António B. Pereira and Fábio A. O. Fernandes",coverURL:"https://cdn.intechopen.com/books/images_new/7610.jpg",editors:[{id:"211131",title:"Prof.",name:"António",middleName:"Bastos",surname:"Pereira",slug:"antonio-pereira",fullName:"António Pereira"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8416",title:"Non-Equilibrium Particle Dynamics",subtitle:null,isOpenForSubmission:!1,hash:"2c3add7639dcd1cb442cb4313ea64e3a",slug:"non-equilibrium-particle-dynamics",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/8416.jpg",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8463",title:"Pediatric Surgery, Flowcharts and Clinical Algorithms",subtitle:null,isOpenForSubmission:!1,hash:"23f39beea4d557b0ae424e2eaf82bf5e",slug:"pediatric-surgery-flowcharts-and-clinical-algorithms",bookSignature:"Sameh Shehata",coverURL:"https://cdn.intechopen.com/books/images_new/8463.jpg",editors:[{id:"37518",title:"Prof.",name:"Sameh",middleName:null,surname:"Shehata",slug:"sameh-shehata",fullName:"Sameh Shehata"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4386},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"7878",title:"Advances in Extracorporeal Membrane Oxygenation",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"f95bf990273d08098a00f9a1c2403cbe",slug:"advances-in-extracorporeal-membrane-oxygenation-volume-3",bookSignature:"Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/7878.jpg",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7614",title:"Fourier Transforms",subtitle:"Century of Digitalization and Increasing Expectations",isOpenForSubmission:!1,hash:"ff3501657ae983a3b42fef1f7058ac91",slug:"fourier-transforms-century-of-digitalization-and-increasing-expectations",bookSignature:"Goran S. Nikoli? and Dragana Z. Markovi?-Nikoli?",coverURL:"https://cdn.intechopen.com/books/images_new/7614.jpg",editors:[{id:"23261",title:"Prof.",name:"Goran",middleName:"S.",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8299",title:"Timber Buildings and Sustainability",subtitle:null,isOpenForSubmission:!1,hash:"bccf2891cec38ed041724131aa34c25a",slug:"timber-buildings-and-sustainability",bookSignature:"Giovanna Concu",coverURL:"https://cdn.intechopen.com/books/images_new/8299.jpg",editors:[{id:"108709",title:"Dr.",name:"Giovanna",middleName:null,surname:"Concu",slug:"giovanna-concu",fullName:"Giovanna Concu"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7062",title:"Rhinosinusitis",subtitle:null,isOpenForSubmission:!1,hash:"14ed95e155b1e57a61827ca30b579d09",slug:"rhinosinusitis",bookSignature:"Balwant Singh Gendeh and Mirjana Turkalj",coverURL:"https://cdn.intechopen.com/books/images_new/7062.jpg",editors:[{id:"67669",title:"Prof.",name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7087",title:"Tendons",subtitle:null,isOpenForSubmission:!1,hash:"786abac0445c102d1399a1e727a2db7f",slug:"tendons",bookSignature:"Hasan Sözen",coverURL:"https://cdn.intechopen.com/books/images_new/7087.jpg",editors:[{id:"161402",title:"Dr.",name:"Hasan",middleName:null,surname:"Sözen",slug:"hasan-sozen",fullName:"Hasan Sözen"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7955",title:"Advances in Hematologic Malignancies",subtitle:null,isOpenForSubmission:!1,hash:"59ca1b09447fab4717a93e099f646d28",slug:"advances-in-hematologic-malignancies",bookSignature:"Gamal Abdul Hamid",coverURL:"https://cdn.intechopen.com/books/images_new/7955.jpg",editors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7701",title:"Assistive and Rehabilitation Engineering",subtitle:null,isOpenForSubmission:!1,hash:"4191b744b8af3b17d9a80026dcb0617f",slug:"assistive-and-rehabilitation-engineering",bookSignature:"Yves Rybarczyk",coverURL:"https://cdn.intechopen.com/books/images_new/7701.jpg",editors:[{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",slug:"yves-rybarczyk",fullName:"Yves Rybarczyk"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7837",title:"Geriatric Medicine and Gerontology",subtitle:null,isOpenForSubmission:!1,hash:"e277d005b23536bcd9f8550046101979",slug:"geriatric-medicine-and-gerontology",bookSignature:"Edward T. Zawada Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/7837.jpg",editors:[{id:"16344",title:"Dr.",name:"Edward T.",middleName:null,surname:"Zawada Jr.",slug:"edward-t.-zawada-jr.",fullName:"Edward T. Zawada Jr."}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,isOpenForSubmission:!1,hash:"61c627da05b2ace83056d11357bdf361",slug:"current-topics-in-neglected-tropical-diseases",bookSignature:"Alfonso J. Rodriguez-Morales",coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",editors:[{id:"131400",title:"Dr.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7610",title:"Renewable and Sustainable Composites",subtitle:null,isOpenForSubmission:!1,hash:"c2de26c3d329c54f093dc3f05417500a",slug:"renewable-and-sustainable-composites",bookSignature:"António B. Pereira and Fábio A. O. Fernandes",coverURL:"https://cdn.intechopen.com/books/images_new/7610.jpg",editors:[{id:"211131",title:"Prof.",name:"António",middleName:"Bastos",surname:"Pereira",slug:"antonio-pereira",fullName:"António Pereira"}],productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"8463",title:"Pediatric Surgery, Flowcharts and Clinical Algorithms",subtitle:null,isOpenForSubmission:!1,hash:"23f39beea4d557b0ae424e2eaf82bf5e",slug:"pediatric-surgery-flowcharts-and-clinical-algorithms",bookSignature:"Sameh Shehata",coverURL:"https://cdn.intechopen.com/books/images_new/8463.jpg",editedByType:"Edited by",editors:[{id:"37518",title:"Prof.",name:"Sameh",middleName:null,surname:"Shehata",slug:"sameh-shehata",fullName:"Sameh Shehata"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7187",title:"Osteosarcoma",subtitle:"Diagnosis, Mechanisms, and Translational Developments",isOpenForSubmission:!1,hash:"89096359b754beb806eca4c6d8aacaba",slug:"osteosarcoma-diagnosis-mechanisms-and-translational-developments",bookSignature:"Matthew Gregory Cable and Robert Lawrence Randall",coverURL:"https://cdn.intechopen.com/books/images_new/7187.jpg",editedByType:"Edited by",editors:[{id:"265693",title:"Dr.",name:"Matthew Gregory",middleName:null,surname:"Cable",slug:"matthew-gregory-cable",fullName:"Matthew Gregory Cable"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7955",title:"Advances in Hematologic Malignancies",subtitle:null,isOpenForSubmission:!1,hash:"59ca1b09447fab4717a93e099f646d28",slug:"advances-in-hematologic-malignancies",bookSignature:"Gamal Abdul Hamid",coverURL:"https://cdn.intechopen.com/books/images_new/7955.jpg",editedByType:"Edited by",editors:[{id:"36487",title:"Prof.",name:"Gamal",middleName:null,surname:"Abdul Hamid",slug:"gamal-abdul-hamid",fullName:"Gamal Abdul Hamid"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7701",title:"Assistive and Rehabilitation Engineering",subtitle:null,isOpenForSubmission:!1,hash:"4191b744b8af3b17d9a80026dcb0617f",slug:"assistive-and-rehabilitation-engineering",bookSignature:"Yves Rybarczyk",coverURL:"https://cdn.intechopen.com/books/images_new/7701.jpg",editedByType:"Edited by",editors:[{id:"72920",title:"Prof.",name:"Yves",middleName:"Philippe",surname:"Rybarczyk",slug:"yves-rybarczyk",fullName:"Yves Rybarczyk"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7726",title:"Swarm Intelligence",subtitle:"Recent Advances, New Perspectives and Applications",isOpenForSubmission:!1,hash:"e7ea7e74ce7a7a8e5359629e07c68d31",slug:"swarm-intelligence-recent-advances-new-perspectives-and-applications",bookSignature:"Javier Del Ser, Esther Villar and Eneko Osaba",coverURL:"https://cdn.intechopen.com/books/images_new/7726.jpg",editedByType:"Edited by",editors:[{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8256",title:"Distillation",subtitle:"Modelling, Simulation and Optimization",isOpenForSubmission:!1,hash:"c76af109f83e14d915e5cb3949ae8b80",slug:"distillation-modelling-simulation-and-optimization",bookSignature:"Vilmar Steffen",coverURL:"https://cdn.intechopen.com/books/images_new/8256.jpg",editedByType:"Edited by",editors:[{id:"189035",title:"Dr.",name:"Vilmar",middleName:null,surname:"Steffen",slug:"vilmar-steffen",fullName:"Vilmar Steffen"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7240",title:"Growing and Handling of Bacterial Cultures",subtitle:null,isOpenForSubmission:!1,hash:"a76c3ef7718c0b72d0128817cdcbe6e3",slug:"growing-and-handling-of-bacterial-cultures",bookSignature:"Madhusmita Mishra",coverURL:"https://cdn.intechopen.com/books/images_new/7240.jpg",editedByType:"Edited by",editors:[{id:"204267",title:"Dr.",name:"Madhusmita",middleName:null,surname:"Mishra",slug:"madhusmita-mishra",fullName:"Madhusmita Mishra"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8299",title:"Timber Buildings and Sustainability",subtitle:null,isOpenForSubmission:!1,hash:"bccf2891cec38ed041724131aa34c25a",slug:"timber-buildings-and-sustainability",bookSignature:"Giovanna Concu",coverURL:"https://cdn.intechopen.com/books/images_new/8299.jpg",editedByType:"Edited by",editors:[{id:"108709",title:"Dr.",name:"Giovanna",middleName:null,surname:"Concu",slug:"giovanna-concu",fullName:"Giovanna Concu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7062",title:"Rhinosinusitis",subtitle:null,isOpenForSubmission:!1,hash:"14ed95e155b1e57a61827ca30b579d09",slug:"rhinosinusitis",bookSignature:"Balwant Singh Gendeh and Mirjana Turkalj",coverURL:"https://cdn.intechopen.com/books/images_new/7062.jpg",editedByType:"Edited by",editors:[{id:"67669",title:"Prof.",name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7837",title:"Geriatric Medicine and Gerontology",subtitle:null,isOpenForSubmission:!1,hash:"e277d005b23536bcd9f8550046101979",slug:"geriatric-medicine-and-gerontology",bookSignature:"Edward T. Zawada Jr.",coverURL:"https://cdn.intechopen.com/books/images_new/7837.jpg",editedByType:"Edited by",editors:[{id:"16344",title:"Dr.",name:"Edward T.",middleName:null,surname:"Zawada Jr.",slug:"edward-t.-zawada-jr.",fullName:"Edward T. Zawada Jr."}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"792",title:"Soil Science",slug:"engineering-environmental-engineering-soil-science",parent:{title:"Environmental Engineering",slug:"engineering-environmental-engineering"},numberOfBooks:1,numberOfAuthorsAndEditors:11,numberOfWosCitations:0,numberOfCrossrefCitations:6,numberOfDimensionsCitations:13,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"engineering-environmental-engineering-soil-science",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"5778",title:"Engineering Applications of Biochar",subtitle:null,isOpenForSubmission:!1,hash:"f44a0ca1585cac59fe30c0449f22caa0",slug:"engineering-applications-of-biochar",bookSignature:"Wu-Jang Huang",coverURL:"https://cdn.intechopen.com/books/images_new/5778.jpg",editedByType:"Edited by",editors:[{id:"26467",title:"Prof.",name:"Wu-Jang",middleName:null,surname:"Huang",slug:"wu-jang-huang",fullName:"Wu-Jang Huang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:1,mostCitedChapters:[{id:"55175",doi:"10.5772/intechopen.68253",title:"Biochar Adsorption Treatment for Typical Pollutants Removal in Livestock Wastewater: A Review",slug:"biochar-adsorption-treatment-for-typical-pollutants-removal-in-livestock-wastewater-a-review",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:5,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Yaxin Deng, Tao Zhang and Qiming Wang",authors:[{id:"185487",title:"Associate Prof.",name:"Tao",middleName:null,surname:"Zhang",slug:"tao-zhang",fullName:"Tao Zhang"}]},{id:"55378",doi:"10.5772/intechopen.68803",title:"Biochar: The Black Diamond for Soil Sustainability, Contamination Control and Agricultural Production",slug:"biochar-the-black-diamond-for-soil-sustainability-contamination-control-and-agricultural-production",totalDownloads:1173,totalCrossrefCites:2,totalDimensionsCites:4,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Ahmed A. Abdelhafez, Mohamed H.H. Abbas and Jianhua Li",authors:[{id:"196849",title:"Dr.",name:"Ahmed",middleName:null,surname:"Abdelhafez",slug:"ahmed-abdelhafez",fullName:"Ahmed Abdelhafez"},{id:"196851",title:"Dr.",name:"Mohamed",middleName:null,surname:"Abass",slug:"mohamed-abass",fullName:"Mohamed Abass"},{id:"209004",title:"Prof.",name:"Li",middleName:null,surname:"Jianhua",slug:"li-jianhua",fullName:"Li Jianhua"}]},{id:"54712",doi:"10.5772/intechopen.68221",title:"Conversion of Municipal Solid Wastes into Biochar through Hydrothermal Carbonization",slug:"conversion-of-municipal-solid-wastes-into-biochar-through-hydrothermal-carbonization",totalDownloads:821,totalCrossrefCites:1,totalDimensionsCites:3,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Daegi Kim, Ki Young Park and Kunio Yoshikawa",authors:[{id:"197981",title:"Dr.",name:"Daegi",middleName:null,surname:"Kim",slug:"daegi-kim",fullName:"Daegi Kim"},{id:"205227",title:"Prof.",name:"Ki Young",middleName:null,surname:"Park",slug:"ki-young-park",fullName:"Ki Young Park"}]}],mostDownloadedChaptersLast30Days:[{id:"55175",title:"Biochar Adsorption Treatment for Typical Pollutants Removal in Livestock Wastewater: A Review",slug:"biochar-adsorption-treatment-for-typical-pollutants-removal-in-livestock-wastewater-a-review",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:5,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Yaxin Deng, Tao Zhang and Qiming Wang",authors:[{id:"185487",title:"Associate Prof.",name:"Tao",middleName:null,surname:"Zhang",slug:"tao-zhang",fullName:"Tao Zhang"}]},{id:"55378",title:"Biochar: The Black Diamond for Soil Sustainability, Contamination Control and Agricultural Production",slug:"biochar-the-black-diamond-for-soil-sustainability-contamination-control-and-agricultural-production",totalDownloads:1173,totalCrossrefCites:2,totalDimensionsCites:4,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Ahmed A. Abdelhafez, Mohamed H.H. Abbas and Jianhua Li",authors:[{id:"196849",title:"Dr.",name:"Ahmed",middleName:null,surname:"Abdelhafez",slug:"ahmed-abdelhafez",fullName:"Ahmed Abdelhafez"},{id:"196851",title:"Dr.",name:"Mohamed",middleName:null,surname:"Abass",slug:"mohamed-abass",fullName:"Mohamed Abass"},{id:"209004",title:"Prof.",name:"Li",middleName:null,surname:"Jianhua",slug:"li-jianhua",fullName:"Li Jianhua"}]},{id:"56141",title:"Introductory Chapter: How We Could Use Biochar in Engineering",slug:"introductory-chapter-how-we-could-use-biochar-in-engineering",totalDownloads:695,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Wu‐Jang Huang",authors:[{id:"26467",title:"Prof.",name:"Wu-Jang",middleName:null,surname:"Huang",slug:"wu-jang-huang",fullName:"Wu-Jang Huang"}]},{id:"54712",title:"Conversion of Municipal Solid Wastes into Biochar through Hydrothermal Carbonization",slug:"conversion-of-municipal-solid-wastes-into-biochar-through-hydrothermal-carbonization",totalDownloads:821,totalCrossrefCites:1,totalDimensionsCites:3,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Daegi Kim, Ki Young Park and Kunio Yoshikawa",authors:[{id:"197981",title:"Dr.",name:"Daegi",middleName:null,surname:"Kim",slug:"daegi-kim",fullName:"Daegi Kim"},{id:"205227",title:"Prof.",name:"Ki Young",middleName:null,surname:"Park",slug:"ki-young-park",fullName:"Ki Young Park"}]},{id:"54854",title:"Effects of Biochar on Plant Growth and Cadmium Uptake: Case Studies on Asian Lotus (Nelumbo nucifera) and Chinese Sage (Salvia miltiorrhiza)",slug:"effects-of-biochar-on-plant-growth-and-cadmium-uptake-case-studies-on-asian-lotus-nelumbo-nucifera-a",totalDownloads:588,totalCrossrefCites:1,totalDimensionsCites:1,book:{slug:"engineering-applications-of-biochar",title:"Engineering Applications of Biochar",fullTitle:"Engineering Applications of Biochar"},signatures:"Daike Tian, Amei Liu and Yanci Xiang",authors:[{id:"198362",title:"Prof.",name:"Daike",middleName:null,surname:"Tian",slug:"daike-tian",fullName:"Daike Tian"},{id:"198363",title:"MSc.",name:"Amei",middleName:null,surname:"Liu",slug:"amei-liu",fullName:"Amei Liu"},{id:"198364",title:"Prof.",name:"Yanci",middleName:null,surname:"Xiang",slug:"yanci-xiang",fullName:"Yanci Xiang"}]}],onlineFirstChaptersFilter:{topicSlug:"engineering-environmental-engineering-soil-science",limit:3,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"6837",title:"Lithium-ion Batteries - Thin Film for Energy Materials and Devices",subtitle:null,isOpenForSubmission:!0,hash:"ea7789260b319b9a4b472257f57bfeb5",slug:null,bookSignature:"Prof. Mitsunobu Sato, Dr. Li Lu and Dr. Hiroki Nagai",coverURL:"https://cdn.intechopen.com/books/images_new/6837.jpg",editedByType:null,editors:[{id:"179615",title:"Prof.",name:"Mitsunobu",middleName:null,surname:"Sato",slug:"mitsunobu-sato",fullName:"Mitsunobu Sato"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9423",title:"Applications of Artificial Intelligence in Process Industry Automation, Heat and Power Generation and Smart Manufacturing",subtitle:null,isOpenForSubmission:!0,hash:"10ac8fb0bdbf61044395963028653d21",slug:null,bookSignature:"Prof. Konstantinos G. Kyprianidis and Prof. Erik Dahlquist",coverURL:"https://cdn.intechopen.com/books/images_new/9423.jpg",editedByType:null,editors:[{id:"35868",title:"Prof.",name:"Konstantinos",middleName:"G.",surname:"Kyprianidis",slug:"konstantinos-kyprianidis",fullName:"Konstantinos Kyprianidis"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9428",title:"New Trends in the Use of Artificial Intelligence for the Industry 4.0",subtitle:null,isOpenForSubmission:!0,hash:"9e089eec484ce8e9eb32198c2d8b34ea",slug:null,bookSignature:"Dr. Luis Romeral Martinez, Dr. Roque A. Osornio-Rios and Dr. Miguel Delgado Prieto",coverURL:"https://cdn.intechopen.com/books/images_new/9428.jpg",editedByType:null,editors:[{id:"86501",title:"Dr.",name:"Luis",middleName:null,surname:"Romeral Martinez",slug:"luis-romeral-martinez",fullName:"Luis Romeral Martinez"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10107",title:"Artificial Intelligence in Oncology Drug Discovery & Development",subtitle:null,isOpenForSubmission:!0,hash:"043c178c3668865ab7d35dcb2ceea794",slug:null,bookSignature:"Dr. John Cassidy and Dr. Belle Taylor",coverURL:"https://cdn.intechopen.com/books/images_new/10107.jpg",editedByType:null,editors:[{id:"244455",title:"Dr.",name:"John",middleName:null,surname:"Cassidy",slug:"john-cassidy",fullName:"John Cassidy"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8903",title:"Carbon Based Material for Environmental Protection and Remediation",subtitle:null,isOpenForSubmission:!0,hash:"19da699b370f320eca63ef2ba02f745d",slug:null,bookSignature:"Dr. Mattia Bartoli and Dr. Marco Frediani",coverURL:"https://cdn.intechopen.com/books/images_new/8903.jpg",editedByType:null,editors:[{id:"188999",title:"Dr.",name:"Mattia",middleName:null,surname:"Bartoli",slug:"mattia-bartoli",fullName:"Mattia Bartoli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10132",title:"Applied Computational Near-surface Geophysics - From Integral and Derivative Formulas to MATLAB Codes",subtitle:null,isOpenForSubmission:!0,hash:"38cdbbb671df620b36ee96af1d9a3a90",slug:null,bookSignature:"Dr. Afshin Aghayan",coverURL:"https://cdn.intechopen.com/books/images_new/10132.jpg",editedByType:null,editors:[{id:"311030",title:"Dr.",name:"Afshin",middleName:null,surname:"Aghayan",slug:"afshin-aghayan",fullName:"Afshin Aghayan"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10110",title:"Advances and Technologies in Building Construction and Structural Analysis",subtitle:null,isOpenForSubmission:!0,hash:"df2ad14bc5588577e8bf0b7ebcdafd9d",slug:null,bookSignature:"Dr. Ali Kaboli and Dr. Sara Shirowzhan",coverURL:"https://cdn.intechopen.com/books/images_new/10110.jpg",editedByType:null,editors:[{id:"309192",title:"Dr.",name:"Ali",middleName:null,surname:"Kaboli",slug:"ali-kaboli",fullName:"Ali Kaboli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10175",title:"Ethics in Emerging Technologies",subtitle:null,isOpenForSubmission:!0,hash:"9c92da249676e35e2f7476182aa94e84",slug:null,bookSignature:"Prof. Ali Hessami",coverURL:"https://cdn.intechopen.com/books/images_new/10175.jpg",editedByType:null,editors:[{id:"108303",title:"Prof.",name:"Ali",middleName:null,surname:"Hessami",slug:"ali-hessami",fullName:"Ali Hessami"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:16},humansInSpaceProgram:{},teamHumansInSpaceProgram:{},route:{name:"profile.detail",path:"/profiles/207942/ana-luisa-pereira",hash:"",query:{},params:{id:"207942",slug:"ana-luisa-pereira"},fullPath:"/profiles/207942/ana-luisa-pereira",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()