IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\n
By listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
All three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n
"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n
"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\n
In conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n
“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\n
We invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\n
Feel free to share this news on social media and help us mark this memorable moment!
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\n
By listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
All three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n
"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n
"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\n
In conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n
“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\n
We invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\n
Feel free to share this news on social media and help us mark this memorable moment!
\n\n
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"1743",leadTitle:null,fullTitle:"Contemporary Issues in Bioethics",title:"Contemporary Issues in Bioethics",subtitle:null,reviewType:"peer-reviewed",abstract:"The main strength of this book is the international exchange of ideas that will not only highlight many of these crucial bioethical issues but will strengthen the discipline of bioethics both nationally and globally. A critical exchange of ideas allows everyone to learn and benefit from the insights gained through others experiences. Analyzing and understanding real medical-ethical issues and cases and how they are resolved is the basis of education in bioethics for those who will have to make these decisions in the future. The more we examine, analyze, and debate these bioethical issues and cases, the more knowledge will be gained and hopefully, we will all gain more practical wisdom.",isbn:null,printIsbn:"978-953-51-0169-7",pdfIsbn:"978-953-51-6855-3",doi:"10.5772/2179",price:119,priceEur:129,priceUsd:155,slug:"contemporary-issues-in-bioethics",numberOfPages:164,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"978cee44b901ff59a20a088f7dcfdbc5",bookSignature:"Peter A. Clark",publishedDate:"March 7th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/1743.jpg",numberOfDownloads:43940,numberOfWosCitations:17,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:20,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:43,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 14th 2011",dateEndSecondStepPublish:"May 12th 2011",dateEndThirdStepPublish:"September 16th 2011",dateEndFourthStepPublish:"October 16th 2011",dateEndFifthStepPublish:"February 15th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"58889",title:"Dr.",name:"Peter A.",middleName:null,surname:"Clark",slug:"peter-a.-clark",fullName:"Peter A. Clark",profilePictureURL:"https://mts.intechopen.com/storage/users/58889/images/system/58889.jpg",biography:"Peter A. Clark, SJ, Ph.D., is the John McShain Chair in Ethics and Director of the Institute of Clinical Bioethics, Saint Joseph’s University, Philadelphia. He is also the bioethicist for the Triunity Health System of Philadelphia, Jefferson Health System, St. Christopher’s Hospital for Children and Shriners Hospital for Children in Philadelphia, St. Agnes Hospital in Baltimore, Mercy Hospital in Baltimore, Catholic Charites of Maryland, and Caritas Baby Hospital in Bethlehem, Palestine. As a bioethicist, Dr. Clark is responsible for the ethical training of the medical fellows, residents, and interns in all the acute care hospitals. He does weekly Ethics Teaching Rounds at the four acute care facilities in the Trinity Health System and the three acute care hospitals in the Jefferson Health System Northeast. He also co-chairs hospital ethics committees, IRBs, and the Corporate Ethics Committee and is on consult 24/7 for all the hospitals. Dr. Clark received his Ph.D. in Medical Ethics from the Loyola University of Chicago. He is the author of numerous articles in medical and bioethics journals on topics including medical futility, pain management, prejudice in the medical profession, the medical use of marijuana, safe injection sites, opioid prevention and education, tube feedings and PVS patients, male circumcision and HIV/AIDS, face transplantation, the Ashley Treatment, and more. He is also the author of To Treat or Not to Treat: The Ethical Methodology of Richard A. McCormick as Applied to Treatment Decisions for Handicapped Newborns and Death With Dignity: Ethical and Practical Considerations for Caregivers of the Terminally Ill. Dr. Clark is also the editor of Contemporary Issues in Bioethics and Bioethics: Medical, Ethical and Legal Perspectives. He is also a reviewer for numerous bioethics journals and is a member of various medical and ethical organizations nationally and internationally.",institutionString:"Saint Joseph's University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Saint Joseph's University",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"979",title:"Applied Ethics",slug:"applied-ethics"}],chapters:[{id:"31741",title:"Two Cautions for a Common Morality Debate: Investigating the Argument from Empirical Evidence Through the Comparative Cultural Study Between Western Liberal Individualist Culture and East Asian Neo-Confucian Culture",doi:"10.5772/34773",slug:"two-cautions-for-a-common-morality-debate-investigating-the-argument-from-empirical-evidence-through",totalDownloads:1793,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Marvin J. H. Lee",downloadPdfUrl:"/chapter/pdf-download/31741",previewPdfUrl:"/chapter/pdf-preview/31741",authors:[{id:"101558",title:"Dr.",name:"Marvin",surname:"Lee",slug:"marvin-lee",fullName:"Marvin Lee"}],corrections:null},{id:"31742",title:"Ethical Resources for the Clinician: Principles, Values and Other Theories",doi:"10.5772/34750",slug:"ethical-resources-for-the-clinician-principles-values-and-other-theories-",totalDownloads:5751,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Thomas M. Donaldson",downloadPdfUrl:"/chapter/pdf-download/31742",previewPdfUrl:"/chapter/pdf-preview/31742",authors:[{id:"101500",title:"Dr.",name:"Tom",surname:"Donaldson",slug:"tom-donaldson",fullName:"Tom Donaldson"}],corrections:null},{id:"31743",title:"Neuroenhancement - A Controversial Topic in Contemporary Medical Ethics",doi:"10.5772/35001",slug:"neuroenhancement-a-controversial-topic-in-medical-ethics",totalDownloads:3930,totalCrossrefCites:3,totalDimensionsCites:6,hasAltmetrics:1,abstract:null,signatures:"Kirsten Brukamp and Dominik Gross",downloadPdfUrl:"/chapter/pdf-download/31743",previewPdfUrl:"/chapter/pdf-preview/31743",authors:[{id:"102555",title:"Dr.",name:"Kirsten",surname:"Brukamp",slug:"kirsten-brukamp",fullName:"Kirsten Brukamp"},{id:"105119",title:"Prof.",name:"Dominik",surname:"Groß",slug:"dominik-gross",fullName:"Dominik Groß"}],corrections:null},{id:"31744",title:"Medical Ethics and Economic Medicalization",doi:"10.5772/35505",slug:"medical-ethics-and-economic-medicalization",totalDownloads:2171,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Geoffrey Poitras",downloadPdfUrl:"/chapter/pdf-download/31744",previewPdfUrl:"/chapter/pdf-preview/31744",authors:[{id:"104754",title:"Prof.",name:"Geoffrey",surname:"Poitras",slug:"geoffrey-poitras",fullName:"Geoffrey Poitras"}],corrections:null},{id:"31745",title:"Decision-Making in Neonatology: An Ethical Analysis from the Catholic Perspective",doi:"10.5772/38924",slug:"ethical-decision-making-in-neonatology-a-catholic-perspective",totalDownloads:1577,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Peter A. Clark",downloadPdfUrl:"/chapter/pdf-download/31745",previewPdfUrl:"/chapter/pdf-preview/31745",authors:[{id:"58889",title:"Dr.",name:"Peter A.",surname:"Clark",slug:"peter-a.-clark",fullName:"Peter A. Clark"}],corrections:null},{id:"31746",title:"Ethics in Pharmaceutical Issues",doi:"10.5772/33046",slug:"ethics-in-pharmaceutical-issues",totalDownloads:21016,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"M. I. Noordin",downloadPdfUrl:"/chapter/pdf-download/31746",previewPdfUrl:"/chapter/pdf-preview/31746",authors:[{id:"93768",title:"Dr.",name:"Mohamed Ibrahim",surname:"Noordin",slug:"mohamed-ibrahim-noordin",fullName:"Mohamed Ibrahim Noordin"}],corrections:null},{id:"31747",title:"Placebo Use in Depression Research: Some Ethical Considerations",doi:"10.5772/35423",slug:"placebo-use-in-depression-research-some-ethical-considerations",totalDownloads:3055,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Ybe Meesters, Martine J. Ruiter and Willem A. Nolen",downloadPdfUrl:"/chapter/pdf-download/31747",previewPdfUrl:"/chapter/pdf-preview/31747",authors:[{id:"104341",title:"Dr.",name:"Ybe",surname:"Meesters",slug:"ybe-meesters",fullName:"Ybe Meesters"},{id:"128304",title:"MSc.",name:"Martine J.",surname:"Ruiter",slug:"martine-j.-ruiter",fullName:"Martine J. Ruiter"},{id:"128305",title:"Prof.",name:"Willem A.",surname:"Nolen",slug:"willem-a.-nolen",fullName:"Willem A. Nolen"}],corrections:null},{id:"31748",title:"Medical Ethics in Undergraduate Medical Education in Pakistan: Towards a Curricular Change",doi:"10.5772/33900",slug:"medical-ethics-in-undergraduate-medical-education-in-pakistan-towards-a-curricular-change-",totalDownloads:2782,totalCrossrefCites:1,totalDimensionsCites:6,hasAltmetrics:0,abstract:null,signatures:"Ayesha Shaikh and Naheed Humayun",downloadPdfUrl:"/chapter/pdf-download/31748",previewPdfUrl:"/chapter/pdf-preview/31748",authors:[{id:"97665",title:"Prof.",name:"Ayesha",surname:"Humayun",slug:"ayesha-humayun",fullName:"Ayesha Humayun"},{id:"104368",title:"Prof.",name:"Naheed",surname:"Humayun",slug:"naheed-humayun",fullName:"Naheed Humayun"}],corrections:null},{id:"31749",title:'Medical Ethics in the Czech Republic - Experiences in the Post-Totalitarian Country"',doi:"10.5772/33633",slug:"medical-ethics-in-the-czech-republic-experiences-in-post-totalitarian-country-",totalDownloads:1870,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Jiri Simek, Eva Krizova and Lenka Zamykalova",downloadPdfUrl:"/chapter/pdf-download/31749",previewPdfUrl:"/chapter/pdf-preview/31749",authors:[{id:"96446",title:"Dr.",name:"Jiri",surname:"Simek",slug:"jiri-simek",fullName:"Jiri Simek"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:[{id:"65",label:"highly cited contributor"}]},relatedBooks:[{type:"book",id:"5418",title:"Bioethics",subtitle:"Medical, Ethical and Legal Perspectives",isOpenForSubmission:!1,hash:"767abdeb559d66387ad2a75b5d26e078",slug:"bioethics-medical-ethical-and-legal-perspectives",bookSignature:"Peter A. Clark",coverURL:"https://cdn.intechopen.com/books/images_new/5418.jpg",editedByType:"Edited by",editors:[{id:"58889",title:"Dr.",name:"Peter A.",surname:"Clark",slug:"peter-a.-clark",fullName:"Peter A. Clark"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"250",title:"Bioethics in the 21st Century",subtitle:null,isOpenForSubmission:!1,hash:"08402b34b7f530af1fee59d8ad1b976e",slug:"bioethics-in-the-21st-century",bookSignature:"Abraham Rudnick",coverURL:"https://cdn.intechopen.com/books/images_new/250.jpg",editedByType:"Edited by",editors:[{id:"34793",title:"Dr.",name:"Abraham",surname:"Rudnick",slug:"abraham-rudnick",fullName:"Abraham Rudnick"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"242",title:"Euthanasia",subtitle:'The "Good Death" Controversy in Humans and Animals',isOpenForSubmission:!1,hash:"438ac92607fefc3261b3a36c835fdf04",slug:"euthanasia-the-good-death-controversy-in-humans-and-animals",bookSignature:"Josef Kuře",coverURL:"https://cdn.intechopen.com/books/images_new/242.jpg",editedByType:"Edited by",editors:[{id:"30926",title:"Prof.",name:"Josef",surname:"Kuře",slug:"josef-kure",fullName:"Josef Kuře"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"498",title:"Global Bioethics",subtitle:"Perspective for Human Survival",isOpenForSubmission:!1,hash:"7b97154fc118995c01d4a14e0f1d1cda",slug:"global-bioethics-perspective-for-human-survival",bookSignature:"Brunetto Chiarelli",coverURL:"https://cdn.intechopen.com/books/images_new/498.jpg",editedByType:"Edited by",editors:[{id:"39651",title:"Prof.",name:"Brunetto",surname:"Chiarelli",slug:"brunetto-chiarelli",fullName:"Brunetto Chiarelli"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{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"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,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"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],ofsBooks:[]},correction:{item:{id:"79356",slug:"corrigendum-to-rural-landscape-architecture-traditional-versus-modern-fa-ade-designs-in-western-spai",title:"Corrigendum to: Rural Landscape Architecture: Traditional versus Modern Façade Designs in Western Spain",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/66303.pdf",downloadPdfUrl:"/chapter/pdf-download/66303",previewPdfUrl:"/chapter/pdf-preview/66303",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/66303",risUrl:"/chapter/ris/66303",chapter:{id:"57545",slug:"rural-landscape-architecture-traditional-versus-modern-fa-ade-designs-in-western-spain",signatures:"María Jesús Montero-Parejo, Jin Su Jeong, Julio Hernández-Blanco\nand Lorenzo García-Moruno",dateSubmitted:"September 6th 2017",dateReviewed:"October 11th 2017",datePrePublished:"December 20th 2017",datePublished:"September 19th 2018",book:{id:"6066",title:"Landscape Architecture",subtitle:"The Sense of Places, Models and Applications",fullTitle:"Landscape Architecture - The Sense of Places, Models and Applications",slug:"landscape-architecture-the-sense-of-places-models-and-applications",publishedDate:"September 19th 2018",bookSignature:"Amjad Almusaed",coverURL:"https://cdn.intechopen.com/books/images_new/6066.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"110471",title:"Prof.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"221245",title:"Dr.",name:"María Jesús",middleName:null,surname:"Montero-Parejo",fullName:"María Jesús Montero-Parejo",slug:"maria-jesus-montero-parejo",email:"cmontero@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223556",title:"Dr.",name:"Jin Su",middleName:null,surname:"Jeong",fullName:"Jin Su Jeong",slug:"jin-su-jeong",email:"jsbliss@gmail.com",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223557",title:"Prof.",name:"Julio",middleName:null,surname:"Hernández-Blanco",fullName:"Julio Hernández-Blanco",slug:"julio-hernandez-blanco",email:"juliohb@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223558",title:"Prof.",name:"Lorenzo",middleName:null,surname:"García-Moruno",fullName:"Lorenzo García-Moruno",slug:"lorenzo-garcia-moruno",email:"lgmoruno@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]}},chapter:{id:"57545",slug:"rural-landscape-architecture-traditional-versus-modern-fa-ade-designs-in-western-spain",signatures:"María Jesús Montero-Parejo, Jin Su Jeong, Julio Hernández-Blanco\nand Lorenzo García-Moruno",dateSubmitted:"September 6th 2017",dateReviewed:"October 11th 2017",datePrePublished:"December 20th 2017",datePublished:"September 19th 2018",book:{id:"6066",title:"Landscape Architecture",subtitle:"The Sense of Places, Models and Applications",fullTitle:"Landscape Architecture - The Sense of Places, Models and Applications",slug:"landscape-architecture-the-sense-of-places-models-and-applications",publishedDate:"September 19th 2018",bookSignature:"Amjad Almusaed",coverURL:"https://cdn.intechopen.com/books/images_new/6066.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"110471",title:"Prof.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"221245",title:"Dr.",name:"María Jesús",middleName:null,surname:"Montero-Parejo",fullName:"María Jesús Montero-Parejo",slug:"maria-jesus-montero-parejo",email:"cmontero@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223556",title:"Dr.",name:"Jin Su",middleName:null,surname:"Jeong",fullName:"Jin Su Jeong",slug:"jin-su-jeong",email:"jsbliss@gmail.com",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223557",title:"Prof.",name:"Julio",middleName:null,surname:"Hernández-Blanco",fullName:"Julio Hernández-Blanco",slug:"julio-hernandez-blanco",email:"juliohb@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}},{id:"223558",title:"Prof.",name:"Lorenzo",middleName:null,surname:"García-Moruno",fullName:"Lorenzo García-Moruno",slug:"lorenzo-garcia-moruno",email:"lgmoruno@unex.es",position:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},book:{id:"6066",title:"Landscape Architecture",subtitle:"The Sense of Places, Models and Applications",fullTitle:"Landscape Architecture - The Sense of Places, Models and Applications",slug:"landscape-architecture-the-sense-of-places-models-and-applications",publishedDate:"September 19th 2018",bookSignature:"Amjad Almusaed",coverURL:"https://cdn.intechopen.com/books/images_new/6066.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"110471",title:"Prof.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"12271",leadTitle:null,title:"Symmetry Concepts",subtitle:null,reviewType:"peer-reviewed",abstract:"This book will be a self-contained collection of scholarly papers targeting an audience of practicing researchers, academics, PhD students and other scientists. The contents of the book will be written by multiple authors and edited by experts in the field.",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"a8b4d6bde031e722c7f14ff75f508b5a",bookSignature:"",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/12271.jpg",keywords:null,numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 9th 2022",dateEndSecondStepPublish:"May 30th 2022",dateEndThirdStepPublish:"July 29th 2022",dateEndFourthStepPublish:"October 17th 2022",dateEndFifthStepPublish:"December 16th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:1,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"15",title:"Mathematics",slug:"mathematics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:null},relatedBooks:[{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],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:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],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:"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:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3569",title:"Biodegradation",subtitle:"Life of Science",isOpenForSubmission:!1,hash:"bb737eb528a53e5106c7e218d5f12ec6",slug:"biodegradation-life-of-science",bookSignature:"Rolando Chamy and Francisca Rosenkranz",coverURL:"https://cdn.intechopen.com/books/images_new/3569.jpg",editedByType:"Edited by",editors:[{id:"165784",title:"Dr.",name:"Rolando",surname:"Chamy",slug:"rolando-chamy",fullName:"Rolando Chamy"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"81192",title:"Use of Non-Vitamin K-Dependent Oral Anticoagulants in Elderly and Fragile Patients with Atrial Fibrillation",doi:"10.5772/intechopen.103033",slug:"use-of-non-vitamin-k-dependent-oral-anticoagulants-in-elderly-and-fragile-patients-with-atrial-fibri",body:'
1. Introduction
Atrial fibrillation (AF) is the most common supraventricular arrhythmia in the elderly in daily medical practice, with a correlation of decade-by-decade growth in the world population, being the onset and may also be part of various concomitant diseases that worsen the health of the population.
In the elderly patient, AF anticoagulation is used to prevent systemic embolic events (SEE) and stroke phenomena and their consequences; vascular dementia; worsening of heart failure (HF) and kidney function, among other pathologies.
In the indication of anticoagulation, the use of direct oral anticoagulants (DOACs) is gaining ground over treatment with vitamin K antagonist (VKA), this is due to their easy use of the indicated medication, their wide therapeutic window, the few adverse effects, and extensive support of scientific information that supports them.
The four large randomized pivotal works in Non-Valvular Atrial Fibrillation (NVAF) on anticoagulation [1, 2, 3, 4] have included approximately 27,000 patients, mostly under 75 years of age, so later works were generated with observational evidence from the database in different countries on patients over 75 years of age, octogenarians and, a little less, in nonagenarians and patients over 90 years old.
Frailty has taken on a notorious relevance in recent decades due to the increase in life expectancy, thanks to improvements in the care of elderly patients, better medical treatments, and early diagnoses of comorbidities.
The age segment of nonagenarians has constant growth worldwide, and in addition, this group of patients, who suffer greater comorbidities and increase in embolic episodes, which can be prevented, gives rise to a dilemma that we hope to clarify, the fears of anticoagulation and the benefits of using DOACs.
2. An elderly patient with AF
2.1 Epidemiology
The elderly world population >65 years old in 2004 was 461 million, and it is estimated that it will grow 4.3 times by 2050 [5].
The challenge proposed by diagnosing a supraventricular arrhythmia, as frequent as atrial fibrillation (AF), is important to avoid future complications, such as systemic embolism (SEE) diseases, stroke, heart failure, tachycardiomyopathies, worsening cognitive disorders and dementia, increased fragility syndrome, and polypharmacy.
AF screening in the elderly population is of paramount importance. It is at 4.6% which positions it in a perfect cost-benefit balance (it takes only 70 elderly individuals to find a patient with AF) [6].
2.2 Diagnosis of AF in the elderly
AF can be detected in the patient in different medical areas, such as in an emergency service, in clinical consultation, in a pre-competitive check-up for sports, and in an immediate postoperative period.
Semiology should be used with the simple manual pulse socket or with different devices; electrical tensiometers, smartwatches, and in those who have some type of external monitoring the multi parameters, Holter, etc., or some instrument for internal monitoring are the loop recover, pacemakers, defibrillators, etc. In this way, it is about looking for, when interrogating these devices, the atrial high-frequency episodes (AHFE) characteristic of AF, which will then be corroborated with 12-lead electrocardiogram “Gold Standard” to be able to make the diagnosis of clinical AF and if it cannot be compared with ECG, it will be a subclinical AF.
In elderly patients, it is recommended to use the nominal classification of AF; previously undiagnosed AF, paroxysmal AF, persistent AF, long-term persistent AF, and permanent AF. All AF modalities must be anticoagulated or look for all the tools to be able to do so, except those that are contraindicated [6].
One term that falls into disuse is Non-Valvular Atrial Fibrillation (NVAF) [6, 7] which encompasses all AF except those for which anticoagulation with DOACs does not represent a benefit; moderate or severe mitral stenosis and those concomitant with mechanical heart valves.
In an elderly patient with NVAF, the thromboembolic probability he/she suffers must be weighted, by using the CHA2DS2VASc scale [8] where it is established that the elderly patient who is ≥75 years old, provides information to establish a crucial score of 2, with an embolic probability of 4% per year, and if the patient is also female, 1 point with this sum of data, anticoagulation is a priority (Class I A) [9].
When the stroke prevention score is established, the probability of bleeding should be assessed with the HAS-BLED scale, which is a daily example of a 65-year-old patient with knee osteoarthritis, added to this a history of the previous stroke, who drinks wine daily and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), gives a count of four with a probability of bleeding of 4.9–1.9% annually. But it is advisable to suppress alcohol consumption and change the type of painkillers to non-NSAIDs, the eventuality of future bleeding is reduced to 1.88–3.2% per year [10].
Glomerular Filtration Rate (GFR) is another important factor to be able to assess renal function with a calculation formula, “Crockoft Goul formula” (CG) estimated by the patient’s serum creatinine, age, weight, and a constant numeric denominator. The result of this equation is corrected in the case of female patients [9, 11].
When studying healthy elderly people aged 70–101 years, a significant correlation between age and GFR measured with CG was observed, where it was concluded that GFR figures decrease by 1.01 ml/min per year [12].
An anticoagulation card was designed to be taken to each medical consultation and which includes useful tools to help decide on anticoagulation and to make dose corrections at each medical visit if the patient required it (Figure 1).
Figure 1.
Anticoagulation card. Anticoagulation card to be used by the patient at each medical visit.
Once it is decided to treat with anticoagulant an elderly patient, the challenge is to choose the right anticoagulant for each patient. DOACs or Warfarin? If you choose the first one, the options are—dabigatran, rivaroxaban, apixaban, or edoxaban. An attempt will be made to bring the right option closer during this chapter.
2.3 Elderly anticoagulated patient
In the pivotal trials on anticoagulation in patients with NVAF, individuals with an average age of 70 years, small ethnic groups, with a lower percentage of women, and none with renal failure on dialysis enrolled.
The four large studies, such as ARISTOTLE included 3658 patients >75 (31%); in RE-LAY, n = 7258 (40%); in a subgroup of ROCKET-AF, N = 6259 (44%) and in the ENGAGE AF-TIMI 48 trial, n = 8474, (40.05%).
All this forceful but scarce information in relation to the elderly led to multiple analyses of real-life data.
In 2017, a group of patients (n = 110) who were between 66 and 100 years old (average age of 80.4 years) was studied, of which 45% were women. The use of apixaban at maximum doses of 5 mg every 12 hours or doses lower than 2.5 every 12 hours was observed when they met 2 of 3 criteria stipulated in the ARISTOTLE study (>80 years, weight < 60 kg, and plasma creatinine >1.5 mg/dl).
Patients who received the maximum recommended doses, approximately 10% had drug concentrations above the expected range, as did 2/3 of the patients who used apixaban 2.5 mg every 12 hours.
Differences in the proportion of apixaban concentrations within or outside the expected ranges were not significantly different. However, four patients had apixaban dosage above the expected range.
This increase in drug concentrations found in this small group of elderly people could allow the possibility of a blood dosage of the anticoagulant drug, to minimize inconveniences, since these patients, old as such, have not been taken into account in large randomized studies [13].
In a Canadian meta-analysis of three cohorts (n = 227,579) in which different DOACs were compared (rivaroxaban vs. dabigatran, apixaban vs. dabigatran, and apixaban vs. rivaroxaban). It served to assess each other’s effectiveness and safety.
The follow-up period was approximately 5 years, with an average participation age close to 75 years, with a low percentage of women, CHA2SD2VASC = 2.5. These patients were treated with high doses and reduced doses of non-vitamin K antagonist oral anticoagulants (NOACs).
The meta-analysis concludes that apixaban in these elderly patients was associated with fewer ischemic stroke events and systemic embolic (ES). When compared to rivaroxaban, a 15% decrease was found, and with respect to major bleeding (MB) the data obtained in favor of apixaban was 39% [14].
Regarding dabigatran in the RE-LAY study compared to warfarin when segmented by age in over 75 years of age (n = 7258), it significantly reduced stroke and intracerebral hemorrhage (ICH) and was also shown that at a dose of 110 mg every 12 hours it is a safe option for patients >80 years old when it comes to reducing the slight increase in extracranial bleeding [15].
Based on the ROCKET-AF study, where 44% of patients were >75 years old, rivaroxaban prevented stroke and reduced bleeding in life-threatening critical anatomical areas and bleeding from all causes. The reduction of the hemorrhagic stroke was 41%, with a p < 0.02). This group of patients was more polymorphic and they benefit from the use of rivaroxaban if they had the previous stroke as history, both young and elderly patients [16].
In 2015, 30,655 patients >75 years old were recruited in eight studies published as a meta-analysis. The different DOACs vs. warfarin (two studies for apixaban, n = 2850; one study for dabigatran, n = 2466; two studies for edoxaban, n = 2838; three studies for rivaroxaban, n = 3082) were compared with a follow-up of 3 months to 2.8 years.
This meta-analysis evaluated the efficacy of each drug in elderly people with stroke events and systemic embolisms (ES), also MB and clinically nonrelevant mayor bleeding (CNRMB).
All DOACs compared to warfarin were significantly better, by an average of 29%. Regarding safety, edoxaban and apixaban turned out to be more beneficial in this group of elderly. Dabigatran in doses of 150 mg and 110 mg, both in two daily doses, had a higher number of gastrointestinal (GI) bleeding, along with rivaroxaban, which also had a lower safety profile (Figures 2 and 3) [17].
Figure 2.
Stroke and systemic embolism in subjects older than 75 years with DOACs.
Figure 3.
Major bleeding and clinically nonrelevant bleeding in patients over 75 years of age with DOACs.
Based on data collected in the Norwegian patient registry and the database of the same country, from 2012 to 2017, where the use of NOACs (standard dose and reduced doses) vs. warfarin is compared, it was observed.
The total population studied was 31,041 of >75 years (average 82 years), 52% women with an average of CHA2DS2VASC = 4.5.
The use of DOACs in standard and reduced doses decreased stroke and systemic embolism like warfarin, but the administration of low doses of DOACs is either similar or reduces bleeding complications. A door could be opened for future randomized subdose studies [18].
Three prespecified groups of edoxaban vs. warfarin were studied, with a follow-up of approximately 2.8 years, in patients with NVAF. The third group, >75 years old, had 52% permanent AF. The direct oral factor Xa inhibitor was used in the standard and reduced doses, the latter by 41%.
About 2.3% stroke and SEE were observed, 4.8% of MB with significant data. Embolisms were reduced by 17% and the same percentage of reduction was achieved in bleeding, so a safety tool is provided in the elderly when compared to younger patient groups [19].
START T Register 2, studied in people over 85 years of age, showed that using DOACs there was low mortality, similar bleeding when compared to warfarin treatment. In addition, a small increase was observed in very elderly patients with embolic events with the use of direct oral anticoagulants [20].
The use of warfarin has its disadvantages in long-lived patients; such as the need for frequent measurements of the International Normalized Ratio (INR), which is not always in a standardized window, and therefore has the difficulty in entering the Time in Therapeutic Range (TTR).
Warfarin interrupts the necessary recycling of vitamin K, which is an essential cofactor for the carboxylation of glutamic residues responsible for producing proteins indispensable for clotting. An example of this is the decrease in protein C levels, which can favor calcium deposits in the skin and other organs; as well as, this vitamin is required in the primary phases of bone matrix formation, effects of paramount importance in this advanced age group [21, 22].
In a database, a retrospective cohort of the city of Taiwan was observed (n = 17,008), an average of 28% reduction in osteoporosis was observed when comparing DOACs vs. warfarin.
DOACs, especially the use of apixaban, minimize osteoporosis by 62% and rivaroxaban also does so by 32%, a decrease that is not statistically significant in those compared to dabigatran [23].
DOACs do not deteriorate the γ-carboxylation of osteoclastine and do not disfavor the formation of the bone matrix, a very interesting topic for good “bone health.”
3. Frail patient with AF
3.1 Epidemiology
The collection of information and quantification on fragility syndrome leads to analyzing a wide range of data dispersion, from different ethnic groups, various forms of measurements, in addition to the disparate life expectancy in different countries.
Fragility in the US has a higher incidence in white ethnicity [24], in Latin America and the Caribbean, there is data of great percentage disintegration, from 7.7 to 42%, with an average of 19.6% (data surpassed in North America, Europe, and Oceania) [25].
Atrial fibrillation (AF) is the unprevalent supraventricular arrhythmia in the young population, 2–3 cases per 1000 inhabitants, but the number of cases grows considerably to 50–90 per 1000 people ranging from 62 to 92 years [26, 27], and its number will multiply by 2.5 times by 2050 [9, 28], the product of its greater emphasis on the detection of arrhythmia.
The finding can range from the simple taking of the pulse looking for its classic irregularity to the need to search for information through the use of implanted devices (pacemaker, cardio-defibrillators, loop recorder) or diagnostic methods, such as 24-hour Holter, smartwatches, pulse meters.
In fragile patients, AF is more frequent, although the data can widely vary from 4.4–75% by different measurement modalities [29].
In a systematic review that included 21 studies, from 1998 to 2010 on four continents, with a total of 61,500 participants over 65 years of age, a variable range of data ranging from 4.0% to 59.1% was found with a fragility prevalence of 10.7% (95% CI = 10.5–10.9). As is already known, this percentage increases with age and female sex with significant statistical data of p < 0.001; and when talking about pre-fragility, the percentage found is close to 42% [30].
The Framingham Heart Study shows us that age as a solitary variable is sufficient predictive value in elderly people aged 80–90 years to increase the probability of suffering a stroke or transient ischemic attack (stroke/TIA) by 23.5%. In this population follow-up, one in three people of European descent will suffer from AF throughout their lives [31, 32].
In the totality of patients over 85 years of age, between a quarter and half of the patients are fragile, so it could be considered, who expect that two-thirds of the long-lived population could be prevented or detected to avoid disabilities.
3.2 Definition
Fragility as a syndrome is more frequent in patients in the last decades of their lives. It is characterized by a state of greater vulnerability, where different stressors contribute to the loss of physiological reserves, with the subsequent rupture of the homeostatic balance.
The most frequent stressors that trigger this physiological harmony can be of different characteristics; from chronic conditions, such as diabetes mellitus, chronic obstructive disease, skin infections, such as erysipelas, respiratory sequelae left by COVID-19, heart failure, atrial fibrillation, hip fracture, and long periods of bed rest, stroke, loss of loved ones, widowhood, loneliness, and low economic level.
Fried et al. in 2004 [33] establishes a clinical syndrome, describing the presence of three or more criteria that are summarized in Figure 4.
Figure 4.
Clinical characteristics of fragility.
When the loss of physiological reserves is affected by two noxas, it is called pre-fragility, which when new noxas are added to them, becomes fragility syndrome. Subsequently, if more decompensating factors are added, a dreaded disability could arise (Figure 5) [34].
Figure 5.
Progressive deteriorate of independent patient.
3.3 Fragile patient assessment tools
To recognize fragility early, a comprehensive assessment is needed, using clinical, functional, behavioral and biological markers [35, 36] that can help measure or quantify through the weighting Activity of Daily Living (ADLs), using the Katz index (eating, clothing, personal hygiene, bathroom use, continence management, and mobility). At earlier stages, you can use the assessment of the Instrumental Activity of Daily Living (IADLs), measured by the LOWTON index (use of the phone, shopping, preparing meals, take care of your home, laundry, use of transport, the correct taking of your own medication, the management of the home economy) [37] and the Charlson comorbidity index [38, 39].
If the evolution of the clinical phenotype of fragility is followed at 3 years, F patients with lower economic resources suffer greater comorbidities, such as frequent falls, stroke, thus worsening mobility and ADLs [40].
3.4 Fragility and anticoagulation
The interest in information on anticoagulation and fragility is growing, thanks to more available information and a better understanding on the subject that being elderly is not the same as having fragility syndrome. Although many elderly individuals suffer from three frequent criteria, such as physical fatigue, weight loss, and slowness when traveling, these items can be reversed if patients are educated in better nutrition, regulated weekly physical activity, if possible with the supervision of trained staff (aquagym, hiking, Tai Chi, etc.) and in turn prevent sarcopenia with improvements in postural balancing and in this way, falls would be avoided [41].
Age ≥ 75 years provides the crucial points to prevent the probabilities of thromboembolism (TE) and stroke with anticoagulants (OACs), according to the CHA2DS2VASCS score in patients with NVAF.
This data is relevant, since, for example, it was observed in 2018, in Argentina, it had registered 31,700 visits per year to a Hospital Emergency Service with a large dispersion in the age range, the average age of 75 years was recorded [42].
Fumagalli et al. studied frail elderly patients older than 70 years with AF (10%) in 14 European countries; they were divided into three age groups. It was observed that 37% of patients, medicated with DOAC (37%) and 5.7% of individuals who cannot be given anticoagulants, were treated with left atrial appendage closure (LAAC).
Less than 11% of the treating physicians considered age as an individual factor for not medicating with anticoagulants, a fact not sufficiently explained by the authors [43].
In a survey conducted in 41 European centers, patients considered fragile and their influence on the management of arrhythmia was studied. AF was found in 72% of patients.
About 57% were diagnosed as fragile patients; 29% were pre-fragile; and 8% of the studied population was >85 years old, which had a higher number of comorbidities and higher rate of drug use, data that reached statistical significance [44].
In relation to falls and the use of DOACs, two studies were carried out; the first was a retrospective subanalysis of ARISTOTLE. It included 753 patients aged 65–74 years, who suffered falls and had a greater number of comorbidities. An 80% benefit was observed in terms of the reduction of intracerebral hemorrhage (ICH) when compared to this group of patients, the use of apixaban vs. that of warfarin [45].
In the second prospective study, a subanalysis of ENGANGE AF, TIMI 48 where patients were treated with edoxaban or warfarin, patients who had falls and those who did not have it were analyzed.
This observed population group (n = 900), older (average 77 years), with more comorbidities (Charlson Comorbidities Index > 5, CHA2DS2VASC > 5, HAS-BLED > 3, 50% permanent AF), had a reduction in mortality and significant severe bleeding, with a considerable decrease in the dreaded intracerebral hemorrhage (ICH) [46].
In the analysis of a subgroup of ARISTOPHANES, considered the largest retrospective observational study using a US database, from 2013 to 2015, they were a population group of fragile elderly people with NVAF with an average age of 83–84 years. Comparing cohorts of patients medicated with DOACS (apixaban, dabigatran, and rivaroxaban) or warfarin, significant weights were established referring to stroke/ES and MB risks [47].
All patients with AF were 150,487, 34% of these were fragile, 90% had a CHA2DS2VASc score ≥ 4, taken as a high risk of stroke, and in more than 80% a HAS-BLED ≥ 3, was considered a threat to bleeding.
Better response with respect to SEE and stroke risk was found with patients who received apixaban (49%) and rivaroxaban (21%), compared to those treated with warfarin.
In relation to MB, apixaban (38%) and dabigatran (21%) had less bleeding and with regard to rivaroxaban vs. warfarin, in the former, there was a small increase in bleeding.
In the SAFIR Cohort study, 995 fragile elderly people were admitted to 33 centers and then followed for a year, it was sought to compare the use of rivaroxaban vs. warfarin.
This group of elderly people with many comorbidities was made up of 23% of nonagenarian people, almost half suffered from a decrease in kidney function, 77% high blood pressure, 50% malnourished, 41% anemia, 39% dementia, and 27% falls (an average of the different scores: CHA2DS2VASc = 4.8, HAS-BLED = 2.3, mini-mental test = 21.5, activities of daily life 4.4, CCI = 6.7).
When comparing the two Cohorts (rivaroxaban vs. warfarin), adjusted to comorbidities, age, and previous treatment, fragile elderly patients who used rivaroxaban had a significant reduction in MB of 33%, a lower percentage of ICH of 48%, with no differences in mortality decrease and stroke [48].
So, the use of DOACs in fragile patients is a good therapeutic alternative, due to the wide use in the treatment of these patients, wide therapeutic range, predictable pharmacokinetics, easy administration, and little drug interaction; without the need for frequent monitoring and dose adjustment, what is very important in this age group.
The fragile patient is significantly vulnerable due to the polypharmacy by which the use of DOACs in AF dispenses with therapeutic bridge with low molecular weight heparin and helps expand the range of a better diet, being able to incorporate leafy vegetables, contained with the use of vitamin K antagonist [49].
4. Nonagenarian patient with AF
4.1 Epidemiology
Improvements in health systems and education in human care progressively lead to an increase in life expectancy, especially in developed countries.
The population census of Spain 2021 had a total of 47,394,223 inhabitants, with a record of 491,369 (1.03%) individuals ≥90 years old [50]. In Argentina, 45,808,747 people were projected for 2021, of whom 242,409 (0.53%) would be ultra-elderly people [51].
In Germany, according to population growth projection data in 2021, the total population of 83,450,000 and is expected by 2030 to be 82,857,000, with a slight population decrease of 593,000 people (0.71%). Paradoxically, the numerical count of residents will increase in the age group ≥90 years, from 878,000 to 1.40,300 (1.69%); and in this way, it is speculated that the number of very long-lived individuals will grow by 59.79% [52].
In the prospective longitudinal study in Gothenburg, Sweden, which initiated the enrolment of patients at 70 years and was then followed for 30 years; an AF prevalence of 16.8% at 90 years was recorded, with an incidence of approximately 47/1000/year in both sexes; and in the 95–99-year group (n = 189) it had an almost double incidence of 93/1000/year; with an increase in men [53].
4.2 Anticoagulated nonagenarian patient
In the subanalysis of very elderly patients with NVAF, J-RHYTHM registry, 7406 consecutive individuals were enrolled who were divided into three age groups (<70 years; 70–84 years, and >85 years).
This elderly population of the third age group with the highest preponderance to polypathologies (n = 330) had an average age of 87.4 ± 2.8 (4.4%), with 58.8% permanent AF. The combination of thrombus embolism and major bleeding was lower in those who used warfarin at an International Normalized Ratio (INR) between 1.6 and 2.59 with a p < 0.001.
The registry compared the ultra-elders the use of warfarin with a TTR of 67.1 vs. the other group, those who did not use warfarin. It was postulated that it could be used in very long-lived, with a lower INR range than that used in large anticoagulation works [54].
Based on the National Registry of Taiwan 2012, T.-F. Chao et al. [55] investigated patients >90 years with NVAF in a total of n = 16,798 with an average age of 92.5 years.
N = 7362 were observed with different pre-existing diseases, such as chronic kidney disease, n = 3151 (CKD); intracerebral bleeding, n = 950 (ICH); and gastrointestinal bleeding, n = 5370 (GI).
About 67.3% of the patients studied, n = 4955, were not treated with anticoagulants (N-OACs), and 32.7%, n = 2407 were anticoagulated (OACs).
Of the OAC, DOACs was used in 23.6%; apixaban (n = 190), 2.6%; rivaroxaban (n = 927), 12.6%; dabigatran (n = 620), 8.4%; as a vitamin K antagonist, warfarin (n = 670), 9.1%.
Rivaroxaban was the most used DOACs in doses of 10 mg, 15 mg, and 20 mg once a day, with a preference of treating physicians with doses of rivaroxaban 15 mg/day at 41%. Regarding apixaban, the doses of 2.5 mg every 12 hours and dabigatran 110 mg twice a day were the most frequently chosen drug presentations (Figure 6) [55].
Figure 6.
Patients >90 with AF and history of previous illnesses.
A total of 1750 patients with AF >90 years of age were identified from three regions of Spain, these enrolled individuals were divided into three groups; the nonanticoagulated n = 534; those anticoagulated with vitamin K antagonist (VKA), n = 500 with INR = 2–3. Those who were treated with DOACs, n = 716. Patients had a creatinine clearance close to 50 ml/min [56].
In a subanalysis of the FREFER-AF study, 6412 adult patients with AF were enrolled and followed for 12 months. In this European registry, they were divided into three age groups (<85 years old; >85 years old; and >90 years old), 505 patients were very old >85 years old and referred to the third group (16.6%), 84 of them were extremely elderly.
This segment of ultra-elderly people suffered a net clinical benefit when they were anticoagulated with DOACs, a balance given by a reduction in thromboembolic events of 43%, which is evident when treating 50 individuals to avoid an event.
A significant difference was established in favor of anticoagulantes of 4.6%; p < 0.48, with an increase in major bleeding similar to patients >75 years (younger), the comparison was made by age groups who took only anticoagulants, only anti-platelets, or the sum of the two, p < 0.025.
Regarding MB, it had only a 10% increase compared to the extremely elderly (>90) who were not anticoagulated.
The net clinical benefit is observed in the three groups, with greater intensity in those over 90 years of age, being 8.02% with a p < 0036 (Figure 7) [57].
Figure 7.
Net clinical benefit adjusted for the mortality risk, of OAC vs. no OAC (adapted).
It was found among the best net benefit of reducing embolic phenomena and bleeding to anticoagulated patients >90 years old (6.1% use of DOACs).
Nonagenarian patients aged 90–100.1 years (n = 300) with an age average of 91 years who suffered from AF and were medicated with OACs were studied.
Extremely elderly individuals were divided into three groups; those who took DOACs (n = 93), those who took warfarin (n = 147), and a third group (N-OACs) n = 80 who were not medicated with anticoagulants.
Regarding the stroke/TIA/SEE the DOACs were statistically significant reduction (Figure 8) and it was observed on the bleeding events the DOACs had twice the percentage of bleeding—5%/year vs. 2.5% from warfarin use (p < 0.o48) (Figure 9) [58].
Figure 8.
Annual STROKE and TIA events.
Figure 9.
Annual major bleeding events.
As already observed, in the subanalysis of the START-T Register, done in Italy, patients enrolled from 2012 to 2013, elderly people with NVAF, who were mostly treated with warfarin as an anticoagulant since the spread of the use of DOACs was beginning in this country. Two-thirds of the elderly were observed to have moderate or severe kidney disease [20].
In the START-T Registry 2 subanalysis, elderly people enrolled with VNAF, with average age 88.4 ± 2.8, compared DOACs (41.3%) vs. warfarin in the range 2–3 (58.7%).
The study was divided into two groups, <85 years and >85 years (n = 3209), in the second group, >90 years out of age 55 patients (1.7%).
In very elderly patients it was obtained; a mortality rate and a lower risk of sacred with a small thromboembolic increase [59].
In the Swedish design of 30 years of follow-up of patients with and without AF, separated by sex, it was observed that among survivors, the cumulative incidence of AF was more than 50%. Patients with AF had twice the chance of death [60].
In a geriatric institute, 77 geriatric patients with an average age of 80 ± 7 years, anticoagulated with warfarin and DOACs, were retrospectively enrolled after a fall from their own height or less. After admission to the hospital, he/she had a brain CT scan where the tomography image was accepted as positive if an ICH was observed.
The first brain CT had 20.8% positivity, then in an average control of 8 hours, in those patients with images that were negative, 9.8% HIC was found not detected previously.
In the group of patients who took warfarin, there was 30% HIC vs. 14% of those who took DOACs. Patients who used DOACs had a higher rate of use of aspirin and clopidogrel [61].
In the Japanese study on anticoagulated elderly people, SAKURA-AF Registry, three groups of elderly people were enrolled, the third group, of very elderly with an average age of 87.3 years ± 2.5 (>85 years of age and under <97 years of age) where the use of DOACs and warfarin were compared.
About 45.8% DOACs were used and of these, 79% were in low doses. The study described those embolic events increase, in proportion, more than hemorrhagic events, and suggested the effective use of DOACs in very old people [62].
In a larger prevalence study of nonagenarian patients with anticoagulated AF made in the city of Madrid, published 2019, 10,077 nonagenarians (17%) had a high prevalence of comorbidities, 67.2% were anticoagulated; they used 11.6% DOACs [63].
The Berlin Registry ≥89 years studied by Wutzler et al., with an average age of 92-year-old patients who received anticoagulants by 26.5%; they used 21.1% vitamin K antagonist, and 5.4% used DOACs [64].
Regarding the falls, very frequently in nonagenarian, with the classic analysis of the Markov model, it was shown that to suffer from a dreaded subdural hematoma in anticoagulated patients with warfarin over 1 year, a hypothetical number of 295 falls is needed, to overcome the benefit of said anticoagulation [65].
When studied in patients aged 90 years old vs. <60 years old, fall mortality increases considerably (5.5% vs. 0.9%).
In a 10-year retrospective cohort study, which included 5088 traumatized patients, young and nonagenarian patients were compared.
It was observed that the <60 years had an early home discharge of 73.7% vs. 18.2% (p < 0.001). Patients who used aspirin had greater intracerebral bleeding (p = 0.001). As for mortality caused by all injuries caused by trauma, added to death from cerebral hemorrhage, aspirin (p = 0.046) and warfarin (p = <0.001) show worse rates [66].
In the population analyzed in Spain in patients over 90 years of age in acute renal failure, the functional decline was the most frequent cause, presenting with 71% of hypertensive patients, 43% chronic kidney disease, 26% with AF among others [67].
A Korean database under review (n = 20,575) was used, where the use of DOACs and warfarin in elderly people with AF was compared.
In the total group of patients over 80 years of age, a positive benefit was observed on the outcomes of the clinical combination (ischemia, stroke and major bleeding), but there were no significant differences in people over 90 years of age; however, the largest East Asian study showed that extremely elderly patients (≥ 90 years (n=2142)), who were anticoagulated with NOACs, had benefits over the use of Warfarin.
Treatment with NOACs was preferred (83.3%), and warfarin was also used (almost 16%); of the total number of patients taking NOACs, 80% used low doses of anticoagulants [68].
GFR is extremely important in nonagenarians and we must keep in mind the Crockroft-Gaul formula for anticoagulation, it is of the simple and practical equation that contemplates a wide age range (25–100 years) [11].
Taking into account that renal function declines in elderly people, especially GFR and effective glomerular flow, with a 10% drop in the latter per milliliter/minute/body surface [69].
5. Conclusions
Over the years, patients with AF, the elderly, the very elderly, and the fragile increase the likelihood of thromboembolic diseases, as well as having bleeding with gastrointestinal predominance, after a stroke or after falls.
Since the appearance of DOACs, an optimal, versatile, and easy-to-use treatment has been found to maintain the thin balance between patients who most need to be prevented from SE and Stroke, and bleeding.
A reduction given by the drug group was obtained, an average of about 50% of HICs with a decrease in major bleeding, including GI.
The decision of the type of DOACs must be made to the measure of each patient and taking into account the precautions of a prior comprehensive assessment of the long-lived person.
Acknowledgments
To the University Professor Llopis Maria Elizabeth, Ortigoza Facundo Daniel, Ortigoza Lorenzo Tomas, and the Language Teacher E. Giaccone Diana.
Conflict of interest
The author declares no conflict of interest.
\n',keywords:"elderly, direct oral anticoagulants, fragility, nonagenarian, non-vitamin K antagonist oral anticoagulants, atrial fibrillation, anticoagulation",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/81192.pdf",chapterXML:"https://mts.intechopen.com/source/xml/81192.xml",downloadPdfUrl:"/chapter/pdf-download/81192",previewPdfUrl:"/chapter/pdf-preview/81192",totalDownloads:50,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:0,impactScoreQuartile:0,hasAltmetrics:0,dateSubmitted:"January 29th 2022",dateReviewed:"February 3rd 2022",datePrePublished:"April 10th 2022",datePublished:"June 15th 2022",dateFinished:"April 10th 2022",readingETA:"0",abstract:"Atrial fibrillation is a frequently observed entity in medical practice, with cases on the rise if we focus on age groups of frail elderly patients. It is important to identify them since advanced age and comorbidities suppose greater numbers of cases of thromboembolic diseases and strokes, entities that can be prevented with the non-vitamin K antagonist oral anticoagulants (NOACs), managing a balance between prevention and safety and thus avoiding complications, for this, a correct search and screening must be made to reach the largest number of patients who could benefit from this therapy. Old age is not a synonym of frailty, so, we must be cautious with the loss of autonomy of our patients and we must have a multidisciplinary approach to accompany this increasingly frequent and extended period, being very alert to drug interactions and decreased daily life skills.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81192",risUrl:"/chapter/ris/81192",book:{id:"11321",slug:"anticoagulation-current-perspectives"},signatures:"Ortigoza Daniel Víctor",authors:[{id:"446232",title:"Dr.",name:"Daniel Victor",middleName:null,surname:"Ortigoza",fullName:"Daniel Victor Ortigoza",slug:"daniel-victor-ortigoza",email:"dortigoza@yahoo.com.ar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/446232/images/22644_n.png",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. An elderly patient with AF",level:"1"},{id:"sec_2_2",title:"2.1 Epidemiology",level:"2"},{id:"sec_3_2",title:"2.2 Diagnosis of AF in the elderly",level:"2"},{id:"sec_4_2",title:"2.3 Elderly anticoagulated patient",level:"2"},{id:"sec_6",title:"3. Frail patient with AF",level:"1"},{id:"sec_6_2",title:"3.1 Epidemiology",level:"2"},{id:"sec_7_2",title:"3.2 Definition",level:"2"},{id:"sec_8_2",title:"3.3 Fragile patient assessment tools",level:"2"},{id:"sec_9_2",title:"3.4 Fragility and anticoagulation",level:"2"},{id:"sec_11",title:"4. Nonagenarian patient with AF",level:"1"},{id:"sec_11_2",title:"4.1 Epidemiology",level:"2"},{id:"sec_12_2",title:"4.2 Anticoagulated nonagenarian patient",level:"2"},{id:"sec_14",title:"5. Conclusions",level:"1"},{id:"sec_15",title:"Acknowledgments",level:"1"},{id:"sec_18",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Connolly SJ, Ezekowitz MD, Yusuf F, et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2009;361(12):1139-1151. DOI: 10.1056/NEJMoa0905561'},{id:"B2",body:'Patel M, Mahaffey K, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillations. The New England Journal of Medicine. 2011;365(10):883-889. DOI: 10.1056/NEJMoa1009638'},{id:"B3",body:'Granger C, Alexander J, McMurray J, et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2011;365:981-992. DOI: 10.1056/NEJMoa1107039'},{id:"B4",body:'Giugliano R, Ruff CT, Braunwald E, et al. Edoxaban versus warfarina in patients with atrial fibrillation. The New England Journal of Medicine. 2013;369(22):2093-2104. DOI: 10.1056/NEJMoa1310907'},{id:"B5",body:'Europece PMC Funders Group Author Manuscript. Frailty and the older people. Lancet. 2013;381(9868):752-756. DOI: 10.1016/S0140-6736(12)62167-9'},{id:"B6",body:'Hindricks G, Potpara T, Dagres N, et al. Sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la. European Association of Cardio-Thoracic Surgery (EACTS) 2021. 2020;74(5):378-8310. DOI: 10.1093/eurheartj/ehaa612'},{id:"B7",body:'Fauchier L, Philippart R, Clementy N, et al. How to define valvular atrial fibrillation? Archives of Cardiovascular Diseases. 2015;108(10):530-539. DOI: 10.1016/j.acvd.2015.06.002'},{id:"B8",body:'Deirdre A, Lip G. Use of the CHA2DS2-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012;126(7):860-865. DOI: 10.1161/CIRCULACIÓN AHA.111.060061'},{id:"B9",body:'Stefell J, Collins R, Antz M, et al. European heart rhythm association practical guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation. EP Europace. 2021;23(10):1612-1676. DOI: 10.1093/europace/euab065'},{id:"B10",body:'Lip GYH, Frison L, Halperin JL, Lane CD. Comparative validation of a Novel risk score for predicting bleeding risk min anticoagulated patients with atrial fibrillation. The HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly) Score. Journal of the American College of Cardiology. 2011;57:173-180. DOI: 10.1016/j.jacc.2010.09.024'},{id:"B11",body:'Cockroft DW, Gault MH. Prediction of creatinine clearance fronserun creatinine. Nephron. 1976;16(1):31-41. DOI: 10.1159/000180580'},{id:"B12",body:'Fehrman-Ekholm I, Skeppholm L. Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scandinavian Journal of Urology and Nephrology. 2004;38(1):73-77. DOI: 10.1080/00365590310015750'},{id:"B13",body:'Sukumar S, Gulilat M, Lintm B, et al. Apixabán concentrations with lower than recommended dosing in older adults with atrial fibrillation. Journal of the American Geriatrics Society. 2019;67(9):1902-1906. DOI: 10.1111/jgs.15982'},{id:"B14",body:'Durand M, Schnitzer M, Pang M, et al. Effectiveness and safety among direct oral anticoagulants in nonvalvular atrial fibrillation: A multi-database cohort study with meta-analysis. British Journal of Clinical Pharmacology. 2021;87(6):2589-2601. DOI: 10.1111/bcp.14669'},{id:"B15",body:'Lauw MN, Eikelboom JW, Coppens M, et al. Effects of dabigatran according to age in atrial fibrillation. Heart. 2017;103(13):1015-1023'},{id:"B16",body:'Yavelov IS. Rivaroxaban in prevention of stroke in elderly patients with non-valvular atrial fibrillation. Kardiologiia. 2019;59(12S):4-11. DOI: 10.18087/cardio.n892'},{id:"B17",body:'Sadlon AH, Tsakiris DA. Direct oral anticoagulants in the elderly: Systematic review and meta-analysis of evidence, current and future directions. Swiss Medical Weekly. 2016;146:w14356. DOI: 10.4414/smw.2016.14356'},{id:"B18",body:'Rutherford O-CW, Jonasson C, Ghanima W, et al. Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation. Heart. 2021;0:1-8. DOI: 10.1136/heartjnl-2020-318753'},{id:"B19",body:'Kato ET, Guigliano R, Ruff C, et al. Efficacy and safety of edoxaban in elderly patients with atrial fibrillation in the ENGAGE AF–TIMI 48 trial. Journal of the American Heart Association. 2016;5(5):e003432. DOI: 10.1161/JAHA.116.003432'},{id:"B20",body:'Antonucci E, Poli D, Tossetto A, et al. The Italian START-register on anticoagulation with focus on atrial fibrillation. PLoS One. 2015;10(5):e0124719. DOI: 10.1371/ journal.pone.0124719'},{id:"B21",body:'Valdiviso JM. Calcificacionvascular: Tipos y mecanismos. Nefrología (Madr.). 2011;31(2):1-9. Available from: http://scielo.isciii.es/scielo.php? script=sci_arttext&pid=S0211-69952011000200005'},{id:"B22",body:'Higdon J. Linus Pauling Institute. Oregon State University. Vitamin K. Available from: https://lpi.oregonstate.edu/es/mic/vitaminas/vitamina-K'},{id:"B23",body:'Huang H, Liu P, Hsu J, et al. Risk of osteoporosis in patients with atrial fibrillation using non-vitamin K antagonist oral anticoagulants or warfarin. JAHA. 2020;9:e013845. DOI: 10.1161/JAHA.119.013845'},{id:"B24",body:'Conen D. Epidemiology of atrial fibrillation. European Heart Journal. 2018;39(16):1323-1324. DOI: 10.1093/eurheartj/ehy171'},{id:"B25",body:'Figueiredo Da Mata F, Pérez Da Silva Pereira P, Cordeiro de Andrade K, et al. Prevalence of frailty in American and the Caribbean: A systematic review and meta-analysis. 2016;11(8):(1-8). DOI: 10.1371/journal.pone.0160019'},{id:"B26",body:'Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of chronic atrial fibrillation: The Framingham study. The New England Journal of Medicine. 1982;306(17):1018-1022. DOI: 10.1056/NEJM198204293061703'},{id:"B27",body:'Carlson M, Waldo A. Fibrilación y Aleteo Auricular. In: González Zuelgaray J, editor. Arritmias Cardíacas. Buenos Aires: Inter-Médica; 1996. pp. 101-111. Chapter 6'},{id:"B28",body:'Go S, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA. 2001;285(18):2370-2375. DOI: 10.1001/jama.285.18.2370'},{id:"B29",body:'Gou Q et al. Atrial fibrillation and frailty. Journal of Geriatric Cardiology. 2020;17(29):105-109. DOI: 1011909/j.issn.1671-5411.202002.007'},{id:"B30",body:'Collard RM, Boter H, Scoevers R, et al. Prevalence of frailty in community-dwelling older persons: A systematic review. Journal of the American Geriatrics Society. 2012;60(8):1487-1492. DOI: 10.1111/j.1532-5415.2012.04054.x'},{id:"B31",body:'Staek L, Wang B, Preys S, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: Cohort study based on longitudinal data from the Framingham Heart Study. BMJ Clinical Research. 2018;361:k1453. DOI: 10.1136/bmj.k1453'},{id:"B32",body:'Hindricks G, Potpara T, Dares N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal. 2021;42(5):373-498. DOI: 10.1093/eurheartj/ehaa612'},{id:"B33",body:'Fried L, Ferrucci L, Derer J, et al. Untangling the concepts of disability, frailty and comorbidity: Implications for improved targeting and care. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2004;59(3):255-263. DOI: 10.1093/gerona/59.3.m255'},{id:"B34",body:'Ortigoza D, Valentino M. Uso non-vitamin K Antagonists in frail patients with atrial fibrillation. Revista de la Federacion Argentina de Cardiologia. 2021;50(2):43-48. Available from: https://revistafac.org.ar/ojs/index.php/revistafac/issue/view/11'},{id:"B35",body:'Tiedemann A, Lord S, Sherrington C. The development and validation of a brief performance-based fall risk assessment tool for use in primary care. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2010;65(8):896-903. DOI: 10.1093/gerona/glq067'},{id:"B36",body:'El Anciano frágil y riesgo nutricional. Available from: https://www.nutricionemocional.es/sites/default/files/infogeriatria_n16_final_1.pdf'},{id:"B37",body:'Oliveras Santos P, Soares da Siva I, Araújo S. Functional capacity of elderly people attending the family health program at Viveiros, Feira de Santana, Bahia, Brazil. Acta Fisiatrica. 2012;19(4):233-236. DOI: 10.5935/0104-7795.20120037D'},{id:"B38",body:'Chalson M, Pompei P, Ales K, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases. 1987;40(5):373-383. DOI: 10.1016/0021-9681(87)90171-8'},{id:"B39",body:'Peterson JC, Paget SA, Lachs MS, et al. The risk of comorbility. Annals of the Rheumatic Diseases. 2012;71:635-637. DOI: 10.1136/annrheumdis-2011-200473'},{id:"B40",body:'Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology, Series A: Biological Sciences. 2001;56(3):M146-M156. DOI: 10.1093/gerona/56.3.m146'},{id:"B41",body:'Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and 40-frailty in elderly people. CMAJ. 2005;173(5):489-495. DOI: 10.1503/cmaj.050051'},{id:"B42",body:'Ortigoza D, Taranto L. The attention system in a hospital\'s emergency medical service. Salud(i)Ciencia. 2019;23(6):519-523. DOI: 10.21840/siic/160015. Available from: https://www.siicsalud.com/dato/sic/236/160015.pdf'},{id:"B43",body:'Fumagalli S, Potpara TS, Bjerregaard Larsen T, et al. Frailty syndrome: An emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey. EP Europace. 2017;19(11):1896-1902. DOI: 10.1093/europace/eux288'},{id:"B44",body:'Patti G, Mantione L, Bressi E, et al. Efficacy and safety of oral anticoagulant therapy in frail patients with atrial fibrillation. Monaldi Archives for Chest Disease. 2018;88(2):10-12. DOI: 10.4081/monaldi.2018.958'},{id:"B45",body:'Rao M, Vinereanu D, Wojdyla D, et al. Clinical outcomes and history of fall in patients with atrial fibrillations treated with oral anticoagulation: Insights from the ARISTOTLE trial. The American Journal of Medicine. 2018;131(3):269-275. DOI: 10.1016/j.amjmed.2017.10.036'},{id:"B46",body:'Steffel J, Gugliano RP, Braunwald E, Murphy S, et al. Edoxaban versus warfarina; in atrial fibrillation patients at risk of falling. ENANGE AF-TIM 48 analysis. Journal of the American College of Cardiology. 2016;68:1169-1178. DOI: 10.1016/j.jacc.2016.06.034'},{id:"B47",body:'Lip G, Keshishian A, Kang A, Damane A, et al. Oral anticoagulants for nonvalvular atrial fibrillation in frail elderly patients: Insights from the ARISTOPHANES study. Journal of Internal Medicine. 2021;289(1):42-52. DOI: 10.1111/joim.13140'},{id:"B48",body:'Hanon O, Chaussade E, David JP, et al. SAFIR cohort: One-year prospective follow-up of very old and frail patients treated with direct oral anticoagulant, rivaroxaban. Archives of Cardiovascular Diseases Supplements. 2020;12(1):115. DOI: 10.1016/j.acvdsp.2019.09.250'},{id:"B49",body:'Bauersachs RM, Herold J. Oral anticoagulation in the elderly and frail. Hämostaseologie. 2020;40:74-83. DOI: 10.1055/s-0040-1701476'},{id:"B50",body:'Población residente por fecha, sexo y edad. Total Nacional (90 años y más). Instituto nacional de estadística INE; 2021. Available from: https://www.ine.es/jaxiT3/Tabla.htm?t=31304'},{id:"B51",body:'Instituto Nacional de Estadística y Censos de la República Argentina. Población y estimaciones (90 años y más). Available from: https://www.indec.gob.ar/indec/web/Nivel4-Tema-2-24-84'},{id:"B52",body:'Bevölkerung in absolutenZahlen, Anteile der Altersgruppen in Prozent, 1960 bis 2050 StatistischesBundesamt: Lange Reihen: BevölkerungnachAltersgruppen, 13. koordinierteBevölkerungsvorausberechnung: BevölkerungDeutschlandsbis 2060: BundeszentralefürPolitischeBildung. Available from: https://www.bpb.de/nachschlagen/zahlen-und-fakten/soziale-situation-in-deutschland/61541/altersstruktur'},{id:"B53",body:'Lernfelt G, Mandalenakis Z, Hornestam B, et al. Atrial fibrillation in the ederly general population: A 30-years follow-up from 70 to 100 years of age. Scandinavian Cardiovascular Journal. 2020;54(4):232-238. DOI: 10.1080/14017431.2020.1729399'},{id:"B54",body:'Kodani E, Atarashi H, Inoue H, Okumura K, Yamashita T, Origasa H. Use of warfarin in elderly patients with non-valvular atrial fibrillation—subanalysis of the J-RHYTHM registry. Circulation Journal. 2015;79(11):2345-2352. DOI: 10.1253/circj.cj-15-0621'},{id:"B55",body:'Chao T-F, Chiang C-E, Chan Y-H, et al. Oral anticoagulants in extremely-high-risk, very elderly (>90 years) patients with atrial fibrillation. Heart Rhythm. 2021;18(6):871-877. DOI: 10.1016/j.hrthm.2021.02.018'},{id:"B56",body:'Raposeiras-Roubín S, Rodríguez DA, Freire SJC. Vitamin K antagonists and direct oral anticoagulants in nonagenarian patients with atrial fibrillation. DOI: 10.1016/j.jamda.2019.08.033. Epub 2019 Nov 19, 1-7'},{id:"B57",body:'Patti G, Lucerna M, Pecen L, Siller-Matula JM, Cavallari I, Kirchhof P, et al. Thromboembolic risk, bleeding outcomes and efect of diferent antithrombotic strategies in very elderly patients with atrial fibrillation: A sub-analysis from the PREFER in AF (PREvention oF thromboembolic events-european registry in atrial fbrillation). Journal of the American Heart Association. 2017;6:e005657. DOI: 10.1161/JAHA.117.005657'},{id:"B58",body:'Yamaji H, Higashiya S, Murakami T. Effects of oral anticoagulants on patients with atrial fibrillation aged 90 years and older: Comparison among direct oral anticoagulant, warfarin anticoagulant, and nonanticoagulation. Journal of Cardiovascular Pharmacology. 2019;74:246-245. DOI: 10.1097/FJC.0000000000000703'},{id:"B59",body:'Poli D, Antonucci E, Ageno W, Bertù L, Migliaccio L, Martinese L, et al. Oral anticoagulation in very elderly patients with atrial fibrillation: Results from the prospective multicenter START2-REGISTER study. PLoS One. 2019;14(5):e0216831. DOI: 10.1371/journal.pone.0216831'},{id:"B60",body:'Lernfelt G, Mandalenakis Z, Hornestam B, et al. Atrial fibrillation in the elderly general population: A 30-year follow-up from 70 to 100 years of age. Scandinavian Cardiovascular Journal. 2020;54(4):232-238. DOI: 10.1080/14017431.2020.1729399'},{id:"B61",body:'Cocca A, Privette A, Leon S, et al. Delayed intracranial hemorrhage in anticoagulated geriatric patients after ground level falls. The Journal of Emergency Medicine. 2019;57(6):812-816. DOI: 10.1016/j.jemermed.2019.09.011'},{id:"B62",body:'Nishida T, Okumura Y, Yokoyama K, et al. Oral anticoagulant use and clinical outcomes in elderly Japanese patients: Findings from the SAKURA AF registry. Heart and Vessels. 2019;34(12):2021-2030. DOI: 10.1007/s00380-019-01446-6'},{id:"B63",body:'Lahoz C, Cárdenas J, Salinero-Ford M, et al. Prevalence of atrial fibrillation and associated anticoagulant therapy in the nonagenarian population of the Community of Madrid, Spain. Geriatrics & Gerontology International. 2019;19(3):203-207. DOI: 10.1111/ggi.13587'},{id:"B64",body:'Wutzler A, von Ulmenstein S, Attanasio P, et al. Treatment of nonagenarians with atrial fibrillation: Insights from the Berlin atrial fibrillation (BAF) registry. Journal of the American Medical Directors Association;16(11):969-972. DOI: 10.1016/j.jamda.2015.05.012'},{id:"B65",body:'Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. 1999;159(7):677-685. DOI: 10.1001/archinte.159.7.677'},{id:"B66",body:'Bhattacharya B, Maung A, Schuster K, Kimberly A, et al. The older they are the harder they fall: Injury patterns and outcomes by age after ground level falls. Injury. 2016;47(9):1955-1959. DOI: 10.1016/j.injury.2016.06.019'},{id:"B67",body:'Begoña S, Sanz M, Muños Ramos P, et al. Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups. Revista Española de Geriatría y Gerontología. 2020;55(6):326-331. DOI: 10.1016/j.regg.2020.06.004'},{id:"B68",body:'Kwon S, So-R L, Choi EK, et al. Non-vitamin K antagonist oral anticoaulantsinveryederly east Asians with atrial fibrillation: A nationwide population-based Study. American Heart Journal. 2020;229:81-91. DOI: 10.1016/j.ahj.2020.08.006'},{id:"B69",body:'Musso C, Oreopoulos D. Aging and physiological changes of the kidneys including changes in glomerular filtration rate. Nephron. Physiology. 2011;119(Suppl. 1):1-p5. DOI: 10.1159/000328010'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Ortigoza Daniel Víctor",address:"dortigoza@yahoo.com.ar",affiliation:'
Committee on Arrhythmias and Electrophysiology of the Argentine Federation of Cardiology (AFC), Argentina
Medical Emergencies of the Lebanese Syrian Hospital, Argentina
'}],corrections:null},book:{id:"11321",type:"book",title:"Anticoagulation",subtitle:"Current Perspectives",fullTitle:"Anticoagulation - Current Perspectives",slug:"anticoagulation-current-perspectives",publishedDate:"June 15th 2022",bookSignature:"Xingshun Qi and Xiaozhong Guo",coverURL:"https://cdn.intechopen.com/books/images_new/11321.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-80355-892-9",printIsbn:"978-1-80355-891-2",pdfIsbn:"978-1-80355-893-6",reviewType:"peer-reviewed",numberOfWosCitations:0,isAvailableForWebshopOrdering:!0,editors:[{id:"197501",title:"Dr.",name:"Xingshun",middleName:null,surname:"Qi",slug:"xingshun-qi",fullName:"Xingshun Qi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"321045",title:"Prof.",name:"Xiaozhong",middleName:null,surname:"Guo",slug:"xiaozhong-guo",fullName:"Xiaozhong Guo"},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"183"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"81048",type:"chapter",title:"Anticoagulants and Hypercoagulability",slug:"anticoagulants-and-hypercoagulability",totalDownloads:52,totalCrossrefCites:0,signatures:"Ibrahim Kalle Kwaifa",reviewType:"peer-reviewed",authors:[{id:"445891",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kalle Kwaifa",fullName:"Ibrahim Kalle Kwaifa",slug:"ibrahim-kalle-kwaifa"}]},{id:"81022",type:"chapter",title:"Anticoagulation in Thrombophilia",slug:"anticoagulation-in-thrombophilia",totalDownloads:48,totalCrossrefCites:0,signatures:"Iris Bararu Bojan, Stefan Dobreanu, Oana Viola Badulescu, Maria Cristina Vladeanu, Andrei Bojan, Carmen Elena Plesoianu and Manuela Ciocoiu",reviewType:"peer-reviewed",authors:[{id:"193903",title:"Prof.",name:"Manuela",middleName:null,surname:"Ciocoiu",fullName:"Manuela Ciocoiu",slug:"manuela-ciocoiu"},{id:"304872",title:"Dr.",name:"Iris",middleName:null,surname:"Bararu Bojan",fullName:"Iris Bararu Bojan",slug:"iris-bararu-bojan"},{id:"311350",title:"Dr.",name:"Oana-Viola",middleName:null,surname:"Badulescu",fullName:"Oana-Viola Badulescu",slug:"oana-viola-badulescu"},{id:"311408",title:"Dr.",name:"Andrei",middleName:null,surname:"Bojan",fullName:"Andrei Bojan",slug:"andrei-bojan"},{id:"452545",title:"Dr.",name:"Stefan",middleName:null,surname:"Dobreanu",fullName:"Stefan Dobreanu",slug:"stefan-dobreanu"},{id:"452714",title:"Dr.",name:"Maria Cristina",middleName:null,surname:"Vladeanu",fullName:"Maria Cristina Vladeanu",slug:"maria-cristina-vladeanu"},{id:"452715",title:"Dr.",name:"Carmen",middleName:"Elena",surname:"Plesoianu",fullName:"Carmen Plesoianu",slug:"carmen-plesoianu"}]},{id:"81192",type:"chapter",title:"Use of Non-Vitamin K-Dependent Oral Anticoagulants in Elderly and Fragile Patients with Atrial Fibrillation",slug:"use-of-non-vitamin-k-dependent-oral-anticoagulants-in-elderly-and-fragile-patients-with-atrial-fibri",totalDownloads:50,totalCrossrefCites:0,signatures:"Ortigoza Daniel Víctor",reviewType:"peer-reviewed",authors:[{id:"446232",title:"Dr.",name:"Daniel Victor",middleName:null,surname:"Ortigoza",fullName:"Daniel Victor Ortigoza",slug:"daniel-victor-ortigoza"}]},{id:"81507",type:"chapter",title:"Danaparoid Sodium: A Review of Its Use in Hepatic Thrombotic Disorders",slug:"danaparoid-sodium-a-review-of-its-use-in-hepatic-thrombotic-disorders",totalDownloads:29,totalCrossrefCites:0,signatures:"Harry N. Magnani",reviewType:"peer-reviewed",authors:[{id:"448016",title:"Dr.",name:"Harry N.",middleName:null,surname:"Magnani",fullName:"Harry N. Magnani",slug:"harry-n.-magnani"}]},{id:"81047",type:"chapter",title:"COVID-19 and Thrombosis: Pathophysiological Mechanisms and Therapeutic Update",slug:"covid-19-and-thrombosis-pathophysiological-mechanisms-and-therapeutic-update",totalDownloads:22,totalCrossrefCites:0,signatures:"Isabel Izuzquiza-Avanzini, Raquel Gutiérrez-López, Manuel Lorenzo López-Reboiro, Clara Martínez-Vivero and José López-Castro",reviewType:"peer-reviewed",authors:[{id:"171329",title:"Dr.",name:"José",middleName:null,surname:"López-Castro",fullName:"José López-Castro",slug:"jose-lopez-castro"},{id:"451568",title:"Dr.",name:"Isabel",middleName:null,surname:"Izuzquiza Avanzini",fullName:"Isabel Izuzquiza Avanzini",slug:"isabel-izuzquiza-avanzini"},{id:"451906",title:"Dr.",name:"Raquel",middleName:null,surname:"Gutiérrez-López",fullName:"Raquel Gutiérrez-López",slug:"raquel-gutierrez-lopez"},{id:"451907",title:"Dr.",name:"Manuel Lorenzo",middleName:null,surname:"López Reboiro",fullName:"Manuel Lorenzo López Reboiro",slug:"manuel-lorenzo-lopez-reboiro"},{id:"451908",title:"Ms.",name:"Clara",middleName:null,surname:"Martínez Vivero",fullName:"Clara Martínez Vivero",slug:"clara-martinez-vivero"}]},{id:"81239",type:"chapter",title:"Methodological Quality of Clinical Practice Guidelines for Pharmacological Prophylaxis of Venous Thromboembolism in Hospitalized Adult Medical and Surgical Patients and Summary of the Main Categories of Recommendations Included in High-Quality CPGs: A Sys",slug:"methodological-quality-of-clinical-practice-guidelines-for-pharmacological-prophylaxis-of-venous-thr",totalDownloads:43,totalCrossrefCites:0,signatures:"Ana Paula Callejo de Souza, Franciele Cordeiro Gabriel, Géssica Caroline Henrique Fontes-Mota, Mariana de Siqueira Siva and Eliane Ribeiro",reviewType:"peer-reviewed",authors:[{id:"447267",title:"B.Sc.",name:"Ana Paula",middleName:null,surname:"Callejo de Souza",fullName:"Ana Paula Callejo de Souza",slug:"ana-paula-callejo-de-souza"},{id:"452838",title:"MSc.",name:"Franciele",middleName:null,surname:"Cordeiro Gabriel",fullName:"Franciele Cordeiro Gabriel",slug:"franciele-cordeiro-gabriel"},{id:"452839",title:"MSc.",name:"Géssica",middleName:null,surname:"Caroline Henrique Fontes-Mota",fullName:"Géssica Caroline Henrique Fontes-Mota",slug:"gessica-caroline-henrique-fontes-mota"},{id:"452840",title:"Mrs.",name:"Mariana",middleName:null,surname:"de Siqueira Siva",fullName:"Mariana de Siqueira Siva",slug:"mariana-de-siqueira-siva"},{id:"452841",title:"Dr.",name:"Eliane",middleName:null,surname:"Ribeiro",fullName:"Eliane Ribeiro",slug:"eliane-ribeiro"}]}]},relatedBooks:[{type:"book",id:"7959",title:"Digestive System",subtitle:"Recent Advances",isOpenForSubmission:!1,hash:"13733cf2ed3652affb7832d133815bcd",slug:"digestive-system-recent-advances",bookSignature:"Xingshun Qi and Sam Koruth",coverURL:"https://cdn.intechopen.com/books/images_new/7959.jpg",editedByType:"Edited by",editors:[{id:"197501",title:"Dr.",name:"Xingshun",surname:"Qi",slug:"xingshun-qi",fullName:"Xingshun Qi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"67428",title:"Peptic Ulcer Disease",slug:"peptic-ulcer-disease",signatures:"Monjur Ahmed",authors:[{id:"206355",title:"Associate Prof.",name:"Monjur",middleName:null,surname:"Ahmed",fullName:"Monjur Ahmed",slug:"monjur-ahmed"}]},{id:"69303",title:"Mid-Gastrointestinal Bleeding",slug:"mid-gastrointestinal-bleeding",signatures:"Monjur Ahmed",authors:[{id:"206355",title:"Associate Prof.",name:"Monjur",middleName:null,surname:"Ahmed",fullName:"Monjur Ahmed",slug:"monjur-ahmed"}]},{id:"67812",title:"Gastrointestinal Manifestations of IgA Vasculitis-Henoch-Schönlein Purpura",slug:"gastrointestinal-manifestations-of-iga-vasculitis-henoch-sch-nlein-purpura",signatures:"Camelia Cojocariu, Ana Maria Singeap, Stefan Chiriac, Catalin Sfarti, Irina Girleanu, Oana Petrea, Anca Trifan and Carol Stanciu",authors:[{id:"45442",title:"Dr.",name:"Anca",middleName:null,surname:"Trifan",fullName:"Anca Trifan",slug:"anca-trifan"},{id:"58426",title:"Prof.",name:"Carol",middleName:null,surname:"Stanciu",fullName:"Carol Stanciu",slug:"carol-stanciu"},{id:"202666",title:"Dr.",name:"Irina",middleName:null,surname:"Girleanu",fullName:"Irina Girleanu",slug:"irina-girleanu"},{id:"288391",title:"Associate Prof.",name:"Camelia",middleName:null,surname:"Cojocariu",fullName:"Camelia Cojocariu",slug:"camelia-cojocariu"},{id:"306764",title:"Dr.",name:"Ana Maria",middleName:null,surname:"Singeap",fullName:"Ana Maria Singeap",slug:"ana-maria-singeap"},{id:"306765",title:"Dr.",name:"Stefan",middleName:null,surname:"Chiriac",fullName:"Stefan Chiriac",slug:"stefan-chiriac"},{id:"306766",title:"Dr.",name:"Catalin",middleName:null,surname:"Sfarti",fullName:"Catalin Sfarti",slug:"catalin-sfarti"},{id:"306768",title:"Dr.",name:"Oana",middleName:null,surname:"Petrea",fullName:"Oana Petrea",slug:"oana-petrea"}]},{id:"67678",title:"Biomechanics of the Small Intestinal Contractions",slug:"biomechanics-of-the-small-intestinal-contractions",signatures:"Ravi Kant Avvari",authors:[{id:"296837",title:"Dr.",name:"Ravi Kant",middleName:null,surname:"Avvari",fullName:"Ravi Kant Avvari",slug:"ravi-kant-avvari"}]},{id:"69768",title:"Serum Sodium Concentration in Patients with Portal Hypertension and Acute Gastrointestinal Bleeding Treated with Terlipressin: A Retrospective Observational Study",slug:"serum-sodium-concentration-in-patients-with-portal-hypertension-and-acute-gastrointestinal-bleeding-",signatures:"Xinmiao Zhou, Lichun Shao, Tingxue Song, Wenchun Bao, Xiaozhong Guo and Xingshun Qi",authors:[{id:"197501",title:"Dr.",name:"Xingshun",middleName:null,surname:"Qi",fullName:"Xingshun Qi",slug:"xingshun-qi"}]},{id:"68799",title:"Prologue: Biliary System - History and Background",slug:"prologue-biliary-system-history-and-background",signatures:"Sam Koruth and Sooraj Sankar",authors:[{id:"237315",title:"Dr.",name:"Sam",middleName:null,surname:"Koruth",fullName:"Sam Koruth",slug:"sam-koruth"}]},{id:"63683",title:"Gall Bladder Carcinoma: Clinical Presentations and Different Modalities of Treatment",slug:"gall-bladder-carcinoma-clinical-presentations-and-different-modalities-of-treatment",signatures:"Wala Ben Kridis, Nabil Toumi, Jamel Daoud, Afef Khanfir and Mounir Frikha",authors:[{id:"241067",title:"Dr.",name:"Wala",middleName:null,surname:"Ben Kridis",fullName:"Wala Ben Kridis",slug:"wala-ben-kridis"},{id:"267757",title:"Prof.",name:"Nabil",middleName:null,surname:"Toumi",fullName:"Nabil Toumi",slug:"nabil-toumi"},{id:"267758",title:"Prof.",name:"Afef",middleName:null,surname:"Khanfir",fullName:"Afef Khanfir",slug:"afef-khanfir"},{id:"267759",title:"Prof.",name:"Mounir",middleName:null,surname:"Frikha",fullName:"Mounir Frikha",slug:"mounir-frikha"},{id:"270321",title:"Prof.",name:"Jamel",middleName:null,surname:"Daoud",fullName:"Jamel Daoud",slug:"jamel-daoud"}]},{id:"65788",title:"Intraoperative ERCP for Management of Gallbladder and Common Bile Duct Stones",slug:"intraoperative-ercp-for-management-of-gallbladder-and-common-bile-duct-stones",signatures:"Ahmed Abdelraouf Elgeidie",authors:[{id:"262855",title:"Prof.",name:"Ahmed",middleName:null,surname:"Elgeidie",fullName:"Ahmed Elgeidie",slug:"ahmed-elgeidie"}]},{id:"63779",title:"Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy",slug:"cystic-artery-variations-and-associated-vascular-complications-in-laparoscopic-cholecystectomy",signatures:"Pankaj Prasoon, Tomohiro Katada, Kohei Miura, Yuki Hirose, Jun Sakata and Toshifumi Wakai",authors:[{id:"79381",title:"Dr.",name:"Toshifumi",middleName:null,surname:"Wakai",fullName:"Toshifumi Wakai",slug:"toshifumi-wakai"},{id:"266766",title:"Dr.",name:"Pankaj",middleName:null,surname:"Prasoon",fullName:"Pankaj Prasoon",slug:"pankaj-prasoon"},{id:"266768",title:"Dr.",name:"Tomohiro",middleName:null,surname:"Katada",fullName:"Tomohiro Katada",slug:"tomohiro-katada"},{id:"266770",title:"Dr.",name:"Yuki",middleName:null,surname:"Hirose",fullName:"Yuki Hirose",slug:"yuki-hirose"},{id:"266772",title:"Prof.",name:"Jun",middleName:null,surname:"Sakata",fullName:"Jun Sakata",slug:"jun-sakata"}]}]}],publishedBooks:[{type:"book",id:"6634",title:"Homeostasis",subtitle:"An Integrated Vision",isOpenForSubmission:!1,hash:"3731dfa513781db054545963a4394938",slug:"homeostasis-an-integrated-vision",bookSignature:"Fernanda Lasakosvitsch and Sergio Dos Anjos Garnes",coverURL:"https://cdn.intechopen.com/books/images_new/6634.jpg",editedByType:"Edited by",editors:[{id:"117630",title:"Dr.",name:"Fernanda",surname:"Lasakosvitsch Castanho",slug:"fernanda-lasakosvitsch-castanho",fullName:"Fernanda Lasakosvitsch Castanho"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6905",title:"Blood Groups",subtitle:null,isOpenForSubmission:!1,hash:"545ab2a5b402edec6332c7d632eba398",slug:"blood-groups",bookSignature:"Anil Tombak",coverURL:"https://cdn.intechopen.com/books/images_new/6905.jpg",editedByType:"Edited by",editors:[{id:"202814",title:"Associate Prof.",name:"Anil",surname:"Tombak",slug:"anil-tombak",fullName:"Anil Tombak"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7125",title:"Iron Deficiency Anemia",subtitle:null,isOpenForSubmission:!1,hash:"25d82a6ea6c9d80b195bb40aad06be49",slug:"iron-deficiency-anemia",bookSignature:"Luis Rodrigo",coverURL:"https://cdn.intechopen.com/books/images_new/7125.jpg",editedByType:"Edited by",editors:[{id:"73208",title:"Prof.",name:"Luis",surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7181",title:"Erythrocyte",subtitle:null,isOpenForSubmission:!1,hash:"267d215004c995048557176978208b15",slug:"erythrocyte",bookSignature:"Anil Tombak",coverURL:"https://cdn.intechopen.com/books/images_new/7181.jpg",editedByType:"Edited by",editors:[{id:"202814",title:"Associate Prof.",name:"Anil",surname:"Tombak",slug:"anil-tombak",fullName:"Anil Tombak"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7845",title:"Platelets",subtitle:null,isOpenForSubmission:!1,hash:"d33b20516d6ff3a5b7446a882109ba26",slug:"platelets",bookSignature:"Steve W. Kerrigan",coverURL:"https://cdn.intechopen.com/books/images_new/7845.jpg",editedByType:"Edited by",editors:[{id:"73961",title:"Dr.",name:"Steve W.",surname:"Kerrigan",slug:"steve-w.-kerrigan",fullName:"Steve W. Kerrigan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[]},onlineFirst:{chapter:{type:"chapter",id:"81688",title:"Prolapsing Hemorrhoids",doi:"10.5772/intechopen.104554",slug:"prolapsing-hemorrhoids",body:'
1. Introduction
Hemorrhoids are a disease of the anorectal area, that is often found in clinical practice, it is an enlargement and prolapsing (shift to the distal) of the anal cushion that gives clinical signs and symptoms [1]. Dilation and deformity of the blood vessels in the anal cushions, accompanied by destruction of the supporting tissues are the main pathological conditions of hemorrhoids. Inflammatory reactions and hyperplasia of blood vessels can also be found in hemorrhoids [2, 3].
Patients with complaints of bloody stools or anal discomfort are often caused by hemorrhoids, but the exact prevalence is unknown and will be lower than reality because many are under-reported and patients are self-medicating. The prevalence varies greatly from country to country, depending on the recording system. Data in the United States in 1990 showed that more than 10 million people suffered from hemorrhoids, or about 4.4% of the total population, while in the UK it was reported to be 13–36% of the general population [3]. The prevalence of men and women is comparable, and mostly occurs at the age of 45–65 years. White and high socioeconomic populations are more frequently affected than blacks and low socioeconomic populations [2].
Considering that hemorrhoids are the most common anal canal abnormalities and also the reason for patients’ visits to the doctor or physician, a deep understanding of the anatomy, physiology, pathogenesis, risk factors, diagnosis, and rational management is needed for doctors, to be able to treat hemorrhoids correctly and effectively, so that the patient is protected from irresponsible hemorrhoid management practices.
2. Anatomy and physiology
The anal canal is a continuation of the distal rectum. The surgical anal canal is formed by the hindgut in the proximal part and the anoderm in the distal part, and the border between both is dentate lines. The proximal part of the anus is covered by a mucous line. The superior rectal artery that flows through the anal canal will branch into two, to the left and right. The right branch of the superior rectal artery branches into anterior and posterior branches. This artery will form an arteriovenous plexus located in the right anterior, right posterior, and left lateral regions, which will be covered by mucosa that produces an anal cushion. For practical purposes, from a perineal view, we call it 11.00 o’clock the right anterior, 07.00 o’clock the right posterior, and 03.00 o’clock the left lateral anal cushion [4].
There are two anal canal sphincters, the internal anal canal sphincter (IAS) as a continuation and thickening of the circular layer of rectal muscle and the external anal sphincter (EAS). The IAS is made of smooth muscle. It is an involutory muscle, while the external sphincter muscle is a voluntary muscle consisting of three layers—deep, superficial, and subcutaneous [1]. Anal incontinence during rest is caused by the contraction of the IAS and anal cushion, which participate 70–80% and 20–30%, respectively. During defecation, the anal cushion will prolapse downward to protect the anal crypt, estuary of the anal gland, and anal canal skin, and return after defecation. The ability of the anal cushion to return is due to the function of the muscle of Treitz, the continuation of muscle fiber from the longitudinal muscle fiber of the rectum. The Treitz muscle consists of two parts—the submucous muscle and the Park ligament, where the last part of it is located at the bottom of the anal cushion [4].
According to Aigner, et al., (2009), there are sphincter-like structures in the vascular plexus, formed by thickened tunica media that contain 5–15 layers of smooth muscle cells located between the vascular plexus and the subepithelial space of the anal cushions in normal anorectal specimens. The role of these sphincter-like structures is to coordinate the filling and drainage of the anorectal vascular plexus. This vascular plexus is without tunica media and larger than usual, like a lacuna [5].
3. Pathogenesis and risk factors
The pathogenesis of hemorrhoids is still largely unknown. Hemorrhoids occur based on the theory of varicose veins, as in the case of leg varicose veins, but in the case of hemorrhoids, they occur in the anus. This theory has been abandoned because various studies have shown that varicose veins and hemorrhoids are different entities. There was no increase in the incidence of hemorrhoids in patients with portal hypertension. The theories of vascular hyperplasia and hypertrophy of the anal sphincter are not supported by the evidence. Today, the theory of the sliding of the anal cushions is widely accepted [2, 4].
As it has been stated in the physiology of the anus and rectum, the anal cushion plays a role in protecting the anal canal during defecation. After the stool comes out, the anus cushions will return to their place due to the work of the Treitz muscles. In constipation, there will be difficulty in defecating. The patient will push a lot so that the anal cushions are often forced to shift distally. Over time, it will be followed by damage to the supporting tissue, so that the anal cushions cannot return to their own position. Prolapsing anal cushions will be followed by venous dilatation, vascular thrombosis, degeneration of fibroelastic tissue, and damage to the Treitz muscles. Inflammatory reactions are also seen in the vascular wall and the surrounding supporting tissues, ulceration, ischemia, and thrombosis [4].
Several enzymes play a role in the degradation of the supporting tissues of the anal pads. Matrix metalloproteinase (MMP), a zinc-dependent proteinase, is the most potent enzyme and is capable of degrading elastin, fibronectin, and collagen. MMP-9 is overexpressed in hemorrhoids and degrades elastin fibers. Activation of MMP-2 and MMP-9 by thrombin, plasmin or other proteinases results in damage to the capillary bed and stimulates the vascular proliferative activity of TGF (transforming growth factor). This also explains the thinning of the tunica media in the sphincter-like structures that control blood flow from the arteries to the venous plexus. Hemorrhoids have an overexpressed endoglin attachment site with TGF. Microvascular density also increases, influenced by Vascular Endothelial Growth Factors (VEGF), which increases, especially when there is thrombosis [4].
Morphological and hemodynamic studies showed that in hemorrhoids there was an increase in the diameter of the branches of the superior rectal artery, the amount of blood flowing and its flow rate increased significantly. There is a correlation between the diameter of the arterial branches and the degree of hemorrhoids [6]. Physiological changes in the anal canal in hemorrhoids have also been reported. Anal canal pressure at rest in patients with prolapsed and unprolapsed hemorrhoids was higher than in normal people, without internal anal sphincter hypertrophy. This pressure will decrease after hemorrhoidectomy is performed, so it can be said that this increase in pressure is due to the effect of hemorrhoids, not the cause [7].
Constipation is widely believed to be a risk factor for the occurrence of hemorrhoids, through the sliding mechanism of the anal cushion, as previously stated, but diarrhea has also been reported to increase the risk of hemorrhoids, through an unclear mechanism. Pregnancy is also a predisposing factor for hemorrhoids due to increased intra-abdominal pressure causing congestion of the anal cushion, and the patient can recover after delivery. Many other risk factors have been reported for the occurrence of hemorrhoids, such as a low-fiber diet, spicy foods, and drinking alcohol [2, 4, 7].
4. Pathology and grading
Hemorrhoids due to prolapse of the anal cushions are called internal hemorrhoids. The lump is covered with mucosa and is often accompanied by the skin of the anal canal, thus forming mixed hemorrhoids, but the predominance is internal hemorrhoids. If only the external hemorrhoidal plexus is dilated, it is called external hemorrhoids. On histological examination of the surgical specimen for internal hemorrhoids, a very marked widening of the vascular plexus and fragmentation of the Treitz muscles will be found. When examined deeply, an increase in leukocytes both inside and outside the blood vessels (inflammatory component) and, with special staining, thinning of the blood vessel walls due to thinning of the tunica media (sphincter-forming muscles) will be seen. External hemorrhoids are mainly dilated subcutaneous veins accompanied by an inflammatory reaction, but patients often present with pain due to a thrombus [2, 3, 4].
Stages of internal hemorrhoids need to be determined before starting therapy because the stage will greatly determine the choice of therapy. Goligher was the expert who first proposed the degree of hemorrhoids, so the Goligher classification is known, and is still used today (Figure 1) [8].
Figure 1.
Internal Hemorrhoid grade. Grade I: no prolapse seen from outside, but can be seen by u-turn colonoscopy, Grade II: the lump can be seen during straining and spontaneously return after straining is completed. Grade III: the lump can be seen during and after straining and only by manual help can be reduced to its positions. Grade IV: The lump is already outside the anus, and cannot or fail to be reduced.
Grade I: anal cushion bleeding but no prolapse. Grade II: anal cushions prolapse out of the anus during defecation, but can spontaneously return. Grade III: prolapsed anal cushions that protrude from the anus during defecation but require manual assistance to return to their original position. Grade IV: prolapsed anal cushions out the anus and cannot be reposed manually.
The American Society of Colorectal Surgery (ASCS) made a modification to Goligher grading because in Goligher the classification is based on what the patient says, but in ASCS it is based more on examination. In grades II and III, a Valsalva test should be performed, while in grade IV, this includes being able to manually reposition the prolapsed anal cushions, which will soon come back out. In grade IV, due to obstruction of venous return by the anal sphincter, often accompanied by incarceration and thrombosis under the anal mucosa or skin (Figure 2).
Figure 2.
Grade IV mixed hemorrhoids with thrombus in external (orange arrow) and internal (yellow arrow) components.
5. Diagnosis
5.1 Differential diagnosis
Because patients often present with fresh bloody stools and lumps in the anus, the following diseases should be considered: Anorectal malignancy (adenocarcinoma, squamous cell carcinoma, and malignant melanoma), rectal prolapse, prolapsed rectal polyp, anal fistula, anal fissure, Crohn’s disease, and condyloma acuminata [2]. Each has different signs and symptoms, so recognizing the signs and symptoms of each will lead to a good diagnosis.
5.2 Signs and symptoms
Bleeding in hemorrhoids is often fresh red blood without pain. This is different from an acute anal fissure, which causes fresh bloody stools accompanied by intense pain because there is an injury in the anal canal skin, which is rich in pain receptor nerves (somatic nerves). The color of the blood in hemorrhoidal bleeding is fresh because the source of the blood is the arteriovenous shunt. Rectal bleeding in rectal carcinoma is often reddish, along with the mucus. Left colon carcinoma is often accompanied by small stools with blood on their surface, while bleeding in the right colon carcinoma is often brown in color with diarrhea. A positive occult blood test should be considered more proximal to the source of bleeding, so a colonoscopy is recommended to detect the source of bleeding [1]. The prolapsed mucosa will secrete mucus which can irritate the anal skin, causing itching. In large hemorrhoids, the patient may feel incomplete defecation or feeling of fullness in the rectum. Pain in hemorrhoids only occurs when a thrombus occurs, especially in the blood vessels under the skin or at grade IV, which is constricted by a strong anal sphincter, causing strangulation [3].
5.3 Physical examination
With the patient in the lithotomy or Sim\'s position, laying on the left side with maximum flexion in the hip and knee joints, inspections are carried out in the perineal and anal areas to detect possible skin tags, external hemorrhoids, skin inflammation due to irritation by mucus and feces, the presence of fissures or anal fistula. (Figure 3). When the prolapsed anal cushion is visible, it is necessary to identify the position and number of the main lumps, the presence or absence of the prolapsed anal canal skin, and the presence of thrombus or ulceration [3].
Figure 3.
In Sim’s position, spreading the anus by the left and right finger and asking the patient to strain, two nodules can be seen at 03.00, and 07.00 o’clock, in this case, anal fissure can also be seen at 06.00 o;clock (black arrow). (Personal collection).
Keep in mind that, other than hemorrhoids, other prolapses are rectal prolapse and rectal polyps. In a prolapsed rectal polyp, it will appear as a round lump covered with mucosa and have a stalk (Figure 4a and b). The rectal prolapse is concentric or circular in shape (not lumpy or no radial indentation), not followed by prolapse of the anal skin, and the finger can enter between the prolapse and the anal canal wall [9]. If during the initial examination there is no prolapsed lump, the patient is asked to strain so that prolapse can occur, or more effectively, the patient is asked to squat and be asked to push into the toilet. In addition to the prolapse examination as mentioned above, wait a while to observe the ability of the prolapsing anal cushion to spontaneously disappear, due to self repositioning, or must be pushed with your fingers [8].
Figure 4.
a. Prolapse of rectal polyps, b. the polyps stalk can be seen after retracted outside. (Personal collection).
Anal melanoma can affect the anal canal and distal rectum, and the majority of tumors are located within 6 cm proximal to the anal verge. There are two types, melanotic, which consists 70% of cases and amelanotic 30%. Amelanotic melanoma is mostly located in the mucosa. Anal melanoma is a rare anal neoplasm. It accounts for approximately 1–4% of anal neoplasms and is female predominant. The signs are an anal lump, pain, and bleeding [10].
Melanotic anal melanoma can be confused with hemorrhoids with thrombosis, as both cause black discoloration. Hemorrhoid thrombus is usually more painful, and the pain will subside after day 3 due to the shrinkage of the lump. This phenomenon is not found in melanotic anal melanoma. The presence of a satellite nodule is also specific to melanoma (Figure 5a). The diagnosis is based on the histological picture of the biopsy specimen. A CT scan is needed to confirm the degree of infiltration, lymph node involvement, and distant metastasis. In Figure 5b, the tumor has already infiltrated the anal sphincter. The abdominal perineal ano-recto-sigmoidectomy (Mile’s procedure) with permanent sigmoidostomy is the surgery of choice [1, 10].
Figure 5.
Anal melanoma, melanotic type. a. with satellite nodule (arrow), b. infiltration to anal sphincter on CT scan (Personal collection).
The patient should also have a digital rectal examination (DRE). Uncomplicated internal hemorrhoids are often vaguely palpable as a soft anorectal mass that is absent in normal people, but when a thrombus or scar tissue has occurred, something harder or a narrowing due to a stricture may be felt. During DRE, anal sphincter tone, prostate enlargement, and the presence of other abnormalities in the rectum, as well as outside the rectum in women, such as the uterus and adnexa, should also be evaluated. To palpate rectal cancer that cannot be reached by fingers, it can be done bimanually (one hand on the lower abdomen and pressing down) or the patient is asked to push (Valsalva test). When there is a rectal tumor in a high position and mobile, it is often palpable with the maximal position of the finger during a digital rectal examination. Patients with complaints of pain in the rectal area have the possibility of fissures, but there is also the possibility of arthritis of the sacro-coccigeal joint. For this reason, during a digital rectal examination, it should not be forgotten to move the coccyx from the sacrum bone. The presence of arthritis will cause pain with movement [1, 3].
5.4 Endoscopy
During anuscopy, the size of the hemorrhoidal nodule, position, level of inflammation, and the possibility of bleeding should be assessed. When a colonoscopy is performed, the retroflexed position of the scope can see hemorrhoids in the rectum. Likewise, a transparent anoscope can clearly see the anal canal and hemorrhoids. Photo documentation can be made during endoscopy [1, 2, 3].
As rectal bleeding is the main complaint of internal hemorrhoid, should a routine complete colon examination be done to rule out other causes of bleeding? American Society of Colon and Rectal Surgeons (ASRC) recommends patients with—a) rectal bleeding, b) positive fecal immunochemical testing (FTT), c) positive FTT-fecal DNA test, d) patients with high risk for colorectal malignancy such as d.1) age 50 years or more if no complete examination within 10 years, d.2) age 40 years or more or 10 years younger with history of first degree relative of colorectal cancer or advanced adenoma diagnosed at age less than 60 years, and d.3) age 40 years or more or 10 years younger with history positive for two first degree relatives with advance adenomas or colorectal carcinomas [8].
5.5 Complications
The most common complication for hemorrhoid patients is bleeding. Bleeding varies, from just spots that drip after defecation to heavy bleeding chronic. Slight bleeding may result in microcytic hypochromic anemia, while if the bleeding is profuse, patients may come down with hypovolemic shock. The profuse bleeding is an emergency, so it must be managed immediately [1, 2, 3]. Another complication is thrombosis of the veins, which can be located under the mucosa or the skin. Thrombosis of the skin or mucosa near the skin will be very painful, prompting the patient to seek treatment immediately. Prolapsed hemorrhoids accompanied by a strong anal sphincter can result in compression of the blood flow, resulting in strangulation and even necrosis [1].
5.6 Management
Management of hemorrhoids depends on the stage. Management includes dietetic management and lifestyle changes (controlling risk factors), administration of drugs, and nonsurgical and surgical interventions. In grade I, II, and small III hemorrhoids, management starts with dietetic management, changing lifestyle, and administration of drugs, if those fail then nonsurgical intervention is considered. In major stages III and IV, the main choice is surgery plus dietetic management and lifestyle changes. In cases of acute thrombosis or strangulation, emergency surgery is required [8].
5.7 Dietetic management and lifestyle modifications
Patients with hemorrhoids are very prone to bleeding, and the lumps may become more swollen when the stool is hard because the defecation must be strained hard. To avoid this, the stool must be soft so that it does not cause trauma. This could be achieved by increasing a high-fiber diet or adding a bulking laxative to the diet, such as bran or methylcellulose, to facilitate defecation. A meta-analysis study showed that a high-fiber diet reduced the risk of complaints and bleeding in up to 50% of cases, although it did not improve complaints of prolapse, pain, and itching [11]. A high-fiber diet is very effective for hemorrhoids that do not prolapse [1, 3].
Controlling the manageable risk factors by modification of lifestyle plays a role in the healing process of hemorrhoids [3]. Patients who initially do not like fiber foods should be advised to consume high fiber, drink enough water, and do regular physical activity to facilitate defecation. The recommended amount of fiber per day is 35 gr [1]. Foods that contain high fat should be avoided because they do not support the formation of large and loose stools, as well as drugs that cause constipation or even diarrhea, should also be avoided. The wrong way of defecating must be corrected. Avoid defecating by pushing too hard and sitting on the toilet for too long (smoking, reading newspapers, playing with cell phones, etc.) [2]. By squatting, it is easier to pass stool, because the puborectal muscle is more relaxed. One study shows that defecating in a squatting position only takes 1 minute, as opposed to a sitting position that needs 4–15 minutes [12]. When you are used to defecating by sitting on the toilet, by propping your feet higher, the position would be more like squatting. After defecation, the anoperineal must be clean. Remaining feces in the anal canal, for example in the anal crypts, can stimulate inflammation.
6. Medicamentous treatment
6.1 Flavonoids
Flavonoids are herbal medicines that are given orally. This drug was originally indicated as a blood vessel strengthening agent (venotonic) and an anti-edema agent in the treatment of varicose veins in the legs. These flavonoids have been studied in varicose veins. They have the ability to increase vascular tone, decrease venous capacity, decrease capillary permeability, increase lymphatic drainage, and have anti-inflammatory effects. Although the mechanism of healing in hemorrhoids is not clear, this drug has been widely used in Europe and Asia. The micronized purified flavonoid fraction (MPFF) consisting of 90% diosmin and 10% hesperidin is the most commonly used flavonoid in clinical practice. This fine shape (less than 2 microns in size), allows absorption to be easier so that it works faster [13].
A recent meta-analysis showed that MPFF treatment provided significant benefits for bleeding (odds ratio [OR] 0.082, p < 0.001), discharge/leakage (OR 0.12, p < 0.001), and overall improvement according to patients (OR 5.25, p < 0.001) and investigators (OR 5.51, p < 0.001). MPFF also reduces pain (OR 0.11, P = 0.06) [14]. The recommended dose in the acute phase is 3x1 gr in the first 3–4 days and then decreases to 2x1 gr. The medication can be stopped gradually, according to the patient\'s response. Long-term use of this medication is reported to be safe. The medication is also reported to be safe to be used in pregnant women [13].
Purple leaf (Grapthopylum pictum extract/GPE), which also contains flavonoids, has been shown to be useful in improving the complaints of hemorrhoids in developing countries. In a study for patients with hemorrhoids, with a pre and post-test-only group design, it was reported that GPE reduces the signs and symptoms [15]. In animal studies, inducing anal Wistar rats with croton oil, showed that GPE, reduces inflammatory markers [16], accelerates ulcer healing [17], and reduces edema [18]. Currently, in Indonesia, GPE can be considered a standardized herb. To be recognized as a phytopharmaca, it needs to be continued with better clinical trials.
6.2 Calcium dobesilate
It is an oral drug that has a venotonic effect (strengthens veins), reduces capillary permeability, inhibits thrombotic aggregation, and increases blood viscosity, which results in reducing edema. Calcium dobesilates are often used for leg varicose veins and diabetic retinopathy. Research on hemorrhoids using calcium dobesilate combined with fiber supplementation has also shown good clinical effects, namely reducing bleeding and inflammation [2].
6.3 Topical treatment
Forms of topical treatment of hemorrhoids are zalf, cream, or rectal suppositories. The purpose of topical treatment is to reduce the symptoms, so most of the ingredients are local anesthetics, corticosteroids, antibiotics, and anti-inflammatory drugs. There is not yet sufficient scientific evidence to support the use of topical treatment [8]. This drug can be purchased without a prescription. It is important to remember that topical treatments are only used in the acute stage. Long-term use of topical treatment can result in thinning the mucosa so that it bleeds easily or the possibility of fungal growth. It is highly recommended that after the acute stage has passed, the drug should be stopped and other drugs given orally, such as the flavonoids described above, should be continued zalf containing 0.2% glyceryl trinitrate or nifedipine, a calcium channel blocker, has been reported to reduce pain due to relaxation of the internal anal sphincter. There is also a topical vasoconstrictor, namely zalf, which contains 0.25% phenylephrine and is reported to reduce the complaints of hemorrhoid patients [19].
6.4 Instrumentation
In the early stages of hemorrhoids, instrumentation can be performed in the private practice room, so it is called an “office-based procedure.” External hemorrhoids with thrombus—the thrombus can be removed under local anesthesia, while internal hemorrhoids can be performed with instrumentation. There are various types of instrumentation therapy, but the principle of action is the same. By performing fibrotization at the base of hemorrhoid, it is expected that the blood flow to the anal cushion will decrease and the prolapsed anal cushion will be shrunk and attracted cranially [2, 3].
6.5 Thrombectomy
Thrombectomy is the procedure of removing a thrombus (blood clot) from external hemorrhoid with a thrombus, performed under local anesthesia (Figure 6a). The pain of external hemorrhoids with thrombus occurs on the first day, and after the third day, the pain will decrease. Removing the thrombus will quickly relieve the pain. After the 3rd day, because the pain has subsided, there is no indication of thrombectomy. External hemorrhoid will heal through fibrotization of the thrombus into a skin tag [20].
Figure 6.
Office-based procedure a. External hemorrhoid with thrombus, before and after excision b. Sclerotherapy c. Rubber Band Ligation. (illustrated by Kanaya).
6.6 Sclerotherapy
Submucosal injection at the base of hemorrhoid (Figure 6b) with sclerosing agents, such as 5% phenol in oil, vegetable oil, quinine, urea hydrochloride, and hypertonic saline, will result in fibrotization at the base of hemorrhoid so that the anal cushion will be retracted cranially. Injections are often needed several times until the anal cushion is in a normal position. Sclerotherapy is indicated in grade I, and II hemorrhoids [3]. The correct injection should be perivasal. Injection errors may cause problems. Too superficially, they may cause ulceration. Too deep into the muscle causes pain and possibly strictures. Injections into the plexus venosus can cause upper abdominal or precordial pain. Too deep into the prostate can result in an abscess and damage the periprostatic nerves, which can cause erectile dysfunction. Or it can be as serious as retroperitoneal sepsis, as reported by Barwell et al. (1999) [21]. Prophylactic antibiotics are not needed for sclerotherapy, except for cases with immunodeficiency [1, 2, 3].
6.7 Rubber band ligation (RBL)
Binding of hemorrhoids with rubber rings (Figure 6c) will result in ischemia, necrosis, and healing by the formation of scar tissue that will fix the remaining connective tissue to the rectal wall. RBL is indicated for grade I, II, or small grade III hemorrhoids that do not improve with non-interventional treatment. It is important to keep in mind not to do the ligation too close to the dentate line because it will cause severe pain. Research shows ligation at 2 or 3 places at once or sequentially gives the same results, but post-procedural pain is higher in multiple banding [3]. Discomfort or pain in the rectum can be reduced by taking warm baths and avoiding hard stools by consuming high-fiber foods and drinking enough water, or, if necessary, laxatives. Other than pain, complications after RBL include the possibility of bleeding, mucosal ulceration, thrombosis of external hemorrhoids, and, very rarely, pelvic abscess [1, 2].
6.8 Infrared coagulation
An infrared light probe affixed to the base of hemorrhoid through the anoscope for 1.0–1.5 seconds will have an impact on tissue coagulation and evaporation of fluid in the cells so that hemorrhoid will shrink. The necrotic tissue will appear as white spots, which will heal as fibrotic tissue. This technique is safer than sclerotherapy [1].
6.9 Radiofrequency ablation (RFA)
This technique is relatively new, with an RFA spherical electrode anoscope connected to a radiofrequency generator, attached to the hemorrhoid tissue, which causes evaporation and coagulation of the tissue. In this way, the vascular component will be reduced and fixed to the underlying tissue through fibrotic tissue. Complications that have been reported are thrombosis, wound infection, and urinary retention. From the evaluation of this method, the risk of rebleeding and prolapse is still quite high [2].
6.10 Cryotherapy
Freezing hemorrhoid tissue with a cryotherapy probe is claimed to provide low pain because it is carried out at a low temperature, but in fact, several clinical trials have shown prolonged pain, prolapse, and foul-smelling discharge, so this method is now rarely used [2].
6.11 Laser hemorrhoidoplasty
Laser energy can coagulate the venous plexus tissue. The patient is set in the lithotomy position. Local anesthetic infiltration is performed with xylocaine 20 mL 1% around the anal and perianal skin. A C-shape anoscope is used. A small cut is made in the skin of the anal canal close to hemorrhoid to be targeted for the laser shot. Then a small tube is inserted through which the laser probe will pass, followed by laser shots in several places, generally 5-6 shots, but it can be more, depending on the size of hemorrhoid. The direction of the probe and laser beam can be seen in Figure 7. After finishing one point, you can move to another point. The results and the complications were not significantly different from Milligan-Morgan hemorrhoidectomy, or stapler, but less painful [22].
Figure 7.
Laser hemorrhoidoplasty. a. Dentate line, b. Schematic direction of laser shot. (Illustrated by Kanaya).
Are there any different indications between sclerotherapy and RBL? There is no difference in terms of indication, but RBL can be done for small IIIrd-degree internal hemorrhoids. If there are no different indications, which one is the best? Research comparing sclerotherapy and RBL concluded that RBL is superior in the resolution of anal protrusion but with higher pain [23]. A survey in the Netherlands reported that most surgeons who treat hemorrhoids choose RBL for the first treatment of Grade II or III internal hemorrhoids [24]. A combination of sclerotherapy and RBL can be done and may improve the result. Research by Kanellos et al. (2003) reported that for the treatment of IInd degree hemorrhoids, the combination of sclerotherapy and RBL is significantly more efficient than sclerotherapy or RBL alone, and RBL is better than sclerotherapy [25]. The results of laser hemorrhoidoplasty are promising [22]. But we are still waiting for long-term results in many cases, and the other problem is that the cost is very expensive.
6.12 Surgical management
Surgical treatment is indicated when nonsurgical treatment is unsuccessful or in hemorrhoids with complications. The presence of strangulation, bleeding that does not stop nonsurgically, and thrombosis indicates emergency surgery. If the presence of other anal canal diseases associated with hemorrhoids, such as fissures and fistulas that require surgery, can be considered for hemorrhoid surgery at once if hemorrhoids are also a complaint [3]. However, surgery is indicated for hemorrhoids in grades III and IV. In general, there are two kinds of surgery—the first is excision of the enlarged and prolapsed anal cushion, and the second is surgery to spare and fix the anal cushion (“anal cushion preserving surgery”).
Based on the understanding of the pathogenesis of hemorrhoids as varicose veins, an excision is an option, but based on the theory of sliding or prolapsing of the anal cushion, surgery by fixing the anal cushion toward the cranially is the superior choice. The discovery of increasing caliber and flow of the rectal artery in hemorrhoids and the presence of a sphincter-like structure, in the form of thickening of the tunica media, at the arteriovenous connection, that is thinning or missing in hemorrhoids, [5, 6] superior rectal artery ligation is more rational.
6.13 Excisional hemorrhoidectomy (EH)
EH is a hemorrhoid surgery by removing the hemorrhoids, where nowadays the gold standard is radially removing the three largest lumps (11, 3, and 7 o’clock). Tissues are removed, including the mucosa and the venous plexus below it, without damaging the internal anal sphincter, and maintaining a normal mucosal bridge in between them. After excision, the lump can be left unstitched (Morgan Milligan technique Figure 8a) or sutured (Fergusson technique, Figure 8b) [1].
Figure 8.
a. After removing three piles and leaving no suture (Milligan-Morgan) (Personal collection). b. After removing 3 piles and suturing is performed (Ferguson technique) (Illustrated by Kanaya).
It is still debatable which one is better, left open or sewn, because, from various studies, the results are inconsistent. Rationally, in sutured cases, it is very often that the wound will also open in the next couple of days, either because the thread is broken or the tissue is cut. For those reasons, many surgeons choose the open technique. However, a meta-analysis done by Batti et al. (2016) showed the superiority of closed hemorrhoidectomy (Ferguson) over open hemorrhoidectomy (Morgan Milligan) in reducing postoperative pain, risk of postoperative bleeding, and faster wound healing. The only advantage of Morgan Milligan is shorter operative time, while the other aspects, such as length of hospital stay, postoperative complications, recurrence, and risk of surgical site infection, were similar in both groups [26].
There is a circular hemorrhoid excision technique that involves removing the entire lump, including the skin, mucosa, and the underlying venous plexus while maintaining the internal anal sphincter, followed by circular suturing of the skin with the mucosa as well. This technique, known as the Whitehead technique, has been abandoned because of the severe postoperative pain and complications that often arise, namely the risk of injury to the internal anal sphincter, which will cause incontinence, strictures that will cause difficulty passing stools, and exposing the mucosa, which will cause frequent anal canals to be wet (wet anal syndrome/whipping anus) [27]. Because the anal mucosa is rich in nerves and is able to feel and distinguish the desire to defecate solid, liquid, or fart, there are two cases, which I noticed from my personal cases, of patients complaining of the urge to fart but passing stool after Whitehead hemorrhoid surgery. The other method of hemorrhoidectomy technique is submucosal hemorrhoidectomy, which involves removing the venous plexus only (Park’s technique). It is currently being discontinued because the technique is more difficult and the risk of bleeding is high [2].
As excisional hemorrhoidectomy is done by removing the anal cushion, the possibility of reducing anal resting pressure after surgery is possible. According to the findings of a study conducted by Li et al. (2012), patients with preoperative compromised continence may have further deterioration of their continence, and thus Milligan-Morgan hemorrhoidectomy should be avoided in such patients [28].
Although the long-term recurrence rate is significantly lower than other methods, the main problem with excisional hemorrhoidectomy is the excruciating postoperative pain. The pain is thought to be caused by a side-burning wound caused by the use of electrocautery. Research shows that the use of lower-temperature cutting energies, such as ligasures or ultrasonic blades (Harmonic scalpel) provides significantly less pain than electrocautery [29].
6.14 Repositioning the anal cushions
The pathology of grade III and IV internal hemorrhoids shows damage to the structure of the supporting tissue of the anal cushions, namely the Treitz muscle and the muscularis mucosae so that if it prolapses, it cannot be repositioned spontaneously but must be repositioned with fingers or cannot be reposed manually. In the beginning, the first effort to treat prolapse is made by performing sutures to fix anal cushions to the base of the hemorrhoids. However, this method still causes problems, namely bleeding and annoying pain, so this method is less attractive [2].
6.14.1 The stapled hemorrhoidopexy (SH)
SH, which was introduced in 1988, is the most widely used method of repositioning the anal cushion [1]. A circular stapler is used to perform a circular excision of the mucosa of the distal rectum and reattach the cut with the stapler, repositioning the prolapsed anal cushions (Figure 9).
Figure 9.
Stapler hemorrhoidopexy. a. purse-string suture on Morgani column in upper margin of internal hemorrhoids, b. thread knotted between anvil and stapler head, approximate both until save the position and then fire. c.After removing the stapler, the rest of the anal cushion retracted upside, (Illustrated by Kanaya) d. Accurate stapling if we have complete circular rectal tissue like donuts. (personal collection).
With circular rectal excision, it is expected that the branch of the superior rectal artery could be cut, and this would result in decreased anal cushion bleeding and the lump would shrink. However, the cutting of the rectal artery cannot be fully realized, because it will depend on the depth of the suture and the location of the artery at the suture level. The research showed that the superior rectal artery was located in the submucosa at 100% at 1 cm above the anorectal ring and 96.6% at 2 cm and 67.1% at 3 cm above the anorectal ring [30]. A study is needed to confirm rectal branch artery cutting in the rectal specimen of stapler hemorrhoidopexy.
A meta-analysis of a randomized controlled trial showed that compared to excisional hemorrhoidectomy, SH provides less pain, a shorter length of stay, and a quicker return to work, but higher long-term recurrence [31, 32]. If the purse-string suture is too deep, it can get into the rectal muscle, which can lead to serious complications. There have been reports of rectovaginal fistulas, pelvic abscesses, and even peritonitis and strictures [2].
DG-HAL, developed by Morinaga (Japan) in 1995, is to perform ligation of the distal branch of the superior rectal artery with the help of Doppler to detect the location of the artery so that the ligation will be accurate. From empirical experience, the hemorrhoids will shrink at 6 weeks’ follow-up.
Initial experience showed that for grade III and IV hemorrhoids, this procedure did not give satisfactory results, the recurrent rate was still high, so in 2005, the DG-HAL procedure was added with rectoanal repair (RAR), (Figure 10), namely, performing continuous sutures to fix the anal cushion proximally. To make sure that the anal cushion can move and be fixed proximally, the first stitch in the proximal part should include the rectal muscle and then submucosally. To avoid severe pain, the last suture to fix the anal cushions should be placed above 1 cm from the dentate line [33]. Figure 11a and b show hemorrhoids before and after DG-HAL-RAR.
Figure 10.
DG-HAL-RAR a. Position of the probe to detect a branch of the superior rectal artery b. The number of arterial sutures varies from 5 to 8 and is not at the same level. c-d. Continues suturing for rectoanal repair. e. After the suture has been knotted, the final position. (Illustrated) by Kanaya).
Figure 11.
a. Prior to surgery, Grade III Internal Hemorrhoid, and b. After DG-HAL-RAR. (personal collection).
The small meta-analysis of 3 RCT, by comparing 70 SH with 80 DG-HAL-RAR, the baseline homogenous (P = 0.40), showed no difference regarding success rate (p = 0.19), operation time (P = 0.55), postoperative complications (p = 0.11), and recurrence rate (P = 0.46), and the only difference is postoperative pain. DG-HAL causes less postoperative pain (P < 0.00001) [34]. A 705-patient multicenter study in Brazil found that a one-year follow-up after DG-HAL-RAR was significantly better in grades II and III compared to grade IV. Recurrence of prolapse, recurrence of bleeding, and thrombosis of grade II-III versus grade IV were 2.36% vs 26.54%, 1.01% vs 7.96%, and 1.35% vs 10.61%, respectively [35].
It should be noted that several conditions can contribute to increased pain after DG-HAL-RAR, namely the additional excision of thrombus of internal and external hemorrhoids, the presence of anal fissures, or laceration of the anal canal of the skin. This encourages caution during probe insertion. Additional local anesthetic infiltration will help to reduce postoperative pain [36]. In the case of large grade III and IV internal hemorrhoids, additional minimucosal excision is advised if any nodule remains after DG-HAL-RAR [37].
In developing countries, cases of large circular Grade IV internal hemorrhoids occur very often (Figure 12a). Since the Whitehead procedure has already been abandoned due to its complications, the Morgan Milligan procedure is the only choice. However, after removing 3 main piles, the normal mucosal bridges are still prominent (Figure 12b). The addition of DG-HAL-RAR to prominent mucosal bridges gives a good result (Figure 12c). Followed up for 17 months, with a good appearance and no complaints (Figure 12d) [38].
Figure 12.
a. large circular Grade IV internal hemorrhoid, b. normal mucosal bridges are still visible after removal of three main piles (Milligan-Morgan Procedure). c. After DG-HAL-RAR of prominent visible mucosal bridges. d. 17 months postoperatively. (Personal collection).
6.15 Post-surgical care
For patients with instrumentation or surgery that only repositions the anal cushion, no special treatment is needed. Consuming high fiber and drinking lots of water will facilitate defecation, which is the standard for managing hemorrhoids, either conservatively or operatively, and also must be carried out postoperatively. The administration of analgesia is more tailored to the patient\'s needs because excision hemorrhoidectomy causes greater pain, so the need for analgesics is extra [2, 3]. Flavonoids, in this case, MPFF given post-surgery, have been proven by a meta-analysis of RCTs to reduce the risk of bleeding and post-surgical pain [14].
For excision hemorrhoidectomy, because the wound in the anal area, it requires special care. The anal area is a dirty area due to contamination with feces. Because of the pain, the patient will prefer not to wipe cleanly after defecation. Soaking in warm water with disinfectant will greatly help to clean the wound from contaminants, thereby helping reduce infection and speed healing. Soaking in warm water is also beneficial for reducing pain [8].
Changes in diet, method of defecation, and control of identified risk factors for the patients (chronic cough, shortness of breath, constipation, urinary difficulties, weight lifting, etc.) are important factors in preventing recurrence [8].
7. Summary
Hemorrhoids are frequently encountered in clinical practice, and physicians must be well-versed in the pathogenesis, risk factors, correct diagnosis, and correct management for patients to receive the best care and recover. The anal cushion sliding theory is now well accepted in the pathogenesis of hemorrhoids and is mostly related to constipation. Therefore, in the management of hemorrhoids, prevention or treatment of constipation has an important place. The first choice for preventing or treating constipation is to eat a high-fiber diet and drink plenty of water. Flavanoids, as oral medication, can be added since they have already been demonstrated to reduce hemorrhoid signs and symptoms. In the case of grades I, II, or small grades III, which fail in medicamentous treatment, instrumentation can be offered, and rubber band ligation is the best choice due to its effectiveness and low price. Surgery is the treatment of choice in emergency cases (thrombosis, strangulation, or bleeding that fails with other treatments) and in cases of grade III and IV that fail nonsurgical management. The gold standard of hemorrhoid surgery is excisional surgery, namely Morgan Milligan and Ferguson. Ferguson is slightly superior to Morgan Milligan regarding postoperative pain, bleeding, and speed of healing. Since excisional surgery is painful, nowadays it offers anal cushion preserving surgery. They are stapler hemorrhoidopexy (SH), hemorrhoidal artery ligation, and rectoanal repair under the guidance of Doppler (DG HAL-RAR). Both methods were comparable regarding the length of operative time, bleeding complications, and recurrence. But only regarding postoperative pain, DG HAL-RAR was superior to SH. DG HAL-RAR and SH also had less postoperative pain but higher recurrence compared to excisional surgery. Based on its advantages and disadvantages, let the patient choose the method of surgery.
\n',keywords:"hemorrhoids prolapse, hemorrhoidectomy, hemorrhoidopexy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/81688.pdf",chapterXML:"https://mts.intechopen.com/source/xml/81688.xml",downloadPdfUrl:"/chapter/pdf-download/81688",previewPdfUrl:"/chapter/pdf-preview/81688",totalDownloads:33,totalViews:0,totalCrossrefCites:0,dateSubmitted:"February 18th 2022",dateReviewed:"March 18th 2022",datePrePublished:"May 7th 2022",datePublished:null,dateFinished:"May 7th 2022",readingETA:"0",abstract:"Hemorrhoids are a common anorectal disease and are often found in clinical practice. Patients mostly come with a complaint of anal bleeding or prolapsing mass. Grade III and IV prolapsing hemorrhoids are distinguished from grade II by the fact that grade II prolapse only during defecation and returns simultaneously after defecation and usually does not cause complaint. Prolapsing hemorrhoids should be differentiated from prolapsing rectal polyps, small rectal prolapse, anorectal tumors, hypertrophy of the anal papilla, and condylomas. Nowadays, the management of prolapsing hemorrhoids varies. Medical therapy is rarely used alone, it is used to improve the effect of surgical therapy. The surgical gold standard for prolapsing hemorrhoids is excision surgery (hemorrhoidectomy) with or without suturing. However, since it comes with pain complaints, non-excision surgery is now offered. Non-excision surgery is divided into two types—stapled hemorrhoidopexy and hemorrhoidal artery ligation and rectoanal repair. Each method of surgery has its own advantages and disadvantages. This chapter review discusses the anatomy, pathophysiology, diagnosis, and management of prolapsing hemorrhoids.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81688",risUrl:"/chapter/ris/81688",signatures:"Sigit Adi Prasetyo, Parish Budiono and Ignatius Riwanto",book:{id:"11272",type:"book",title:"Benign Anorectal Disorders - An Update",subtitle:null,fullTitle:"Benign Anorectal Disorders - An Update",slug:null,publishedDate:null,bookSignature:"Dr. Alberto Vannelli and Dr. Daniela Cornelia Lazar",coverURL:"https://cdn.intechopen.com/books/images_new/11272.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-706-9",printIsbn:"978-1-80355-705-2",pdfIsbn:"978-1-80355-707-6",isAvailableForWebshopOrdering:!0,editors:[{id:"34524",title:"Dr.",name:"Alberto",middleName:null,surname:"Vannelli",slug:"alberto-vannelli",fullName:"Alberto Vannelli"}],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. Anatomy and physiology",level:"1"},{id:"sec_3",title:"3. Pathogenesis and risk factors",level:"1"},{id:"sec_4",title:"4. Pathology and grading",level:"1"},{id:"sec_5",title:"5. Diagnosis",level:"1"},{id:"sec_5_2",title:"5.1 Differential diagnosis",level:"2"},{id:"sec_6_2",title:"5.2 Signs and symptoms",level:"2"},{id:"sec_7_2",title:"5.3 Physical examination",level:"2"},{id:"sec_8_2",title:"5.4 Endoscopy",level:"2"},{id:"sec_9_2",title:"5.5 Complications",level:"2"},{id:"sec_10_2",title:"5.6 Management",level:"2"},{id:"sec_11_2",title:"5.7 Dietetic management and lifestyle modifications",level:"2"},{id:"sec_13",title:"6. Medicamentous treatment",level:"1"},{id:"sec_13_2",title:"6.1 Flavonoids",level:"2"},{id:"sec_14_2",title:"6.2 Calcium dobesilate",level:"2"},{id:"sec_15_2",title:"6.3 Topical treatment",level:"2"},{id:"sec_16_2",title:"6.4 Instrumentation",level:"2"},{id:"sec_17_2",title:"6.5 Thrombectomy",level:"2"},{id:"sec_18_2",title:"6.6 Sclerotherapy",level:"2"},{id:"sec_19_2",title:"6.7 Rubber band ligation (RBL)",level:"2"},{id:"sec_20_2",title:"6.8 Infrared coagulation",level:"2"},{id:"sec_21_2",title:"6.9 Radiofrequency ablation (RFA)",level:"2"},{id:"sec_22_2",title:"6.10 Cryotherapy",level:"2"},{id:"sec_23_2",title:"6.11 Laser hemorrhoidoplasty",level:"2"},{id:"sec_24_2",title:"6.12 Surgical management",level:"2"},{id:"sec_25_2",title:"6.13 Excisional hemorrhoidectomy (EH)",level:"2"},{id:"sec_26_2",title:"6.14 Repositioning the anal cushions",level:"2"},{id:"sec_26_3",title:"6.14.1 The stapled hemorrhoidopexy (SH)",level:"3"},{id:"sec_27_3",title:"6.14.2 Doppler-Guided Hemorrhoid Artery Ligation (DG-HAL)",level:"3"},{id:"sec_29_2",title:"6.15 Post-surgical care",level:"2"},{id:"sec_31",title:"7. Summary",level:"1"}],chapterReferences:[{id:"B1",body:'Beck, DE, Steele, SR, & Wexner, SD. Fundamentals of Anorectal Surgery. 3rd ed. Philadelphia: Springer; 2019'},{id:"B2",body:'Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management World. Journal of Gastroenterology. 2012;18:2009-2017'},{id:"B3",body:'Ganz RA. The evaluation and treatment of hemorrhoids: A guide for the gastroenterologist. Clinical Gastroenterology and Hepatology. 2013;11:593-603'},{id:"B4",body:'Margetis N. Pathophysiology of internal hemorrhoids. Annals of Gastroenterology. 2019;32:264-272'},{id:"B5",body:'Aigner F, Gruber H, Conrad F, Eder J, Wedel T, Zelger B, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: Impact on the course of hemorrhoidal disease. International Journal of Colorectal Disease. 2009;24(1):105-113'},{id:"B6",body:'Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, et al. The vascular nature of hemorrhoids. Journal of Gastrointestinal Surgery. 2006;10(7):1044-1050'},{id:"B7",body:'Loder PB, Kamm MA, Nicholls RJ, Phillips KS. Haemorrhoids: Pathology, pathophysiology and aetiology. Brithish Journal of Surgery. 1994;81:946-954'},{id:"B8",body:'Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of colon and rectal surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon and Rectum. 2018;61:284-292'},{id:"B9",body:'Ratto C, Parello A, Donisi L. In: Litta F, editor. Colon, Rectum and Anus: Anatomic, Physiologic and Diagnostic Bases for Disease Management. Switzerland: Springer; 2017'},{id:"B10",body:'Malaguarnera G, Madeddu R, Catania VE, Bertino G, Morelli L, Perrotta RE, et al. Anorectal mucosal melanoma. Oncotarget. 2018;9(9):8785-8800'},{id:"B11",body:'Alonso-Coello P, Mills E, Heels-Ansdell L-Y, Zhou Q , Johanson JF, et al. Fiber for the treatment of hemorrhoids complications: A systematic review and meta-analysis. The American Journal of Gastroenterology. 2006;101(1):181-188'},{id:"B12",body:'Lam TCF, Islam N, Lubowski DZ, King DW. Does squatting reduce pelvic floor descent during defecation? The Australian and New Zealand Journal of Surgery. 1993;63:172-174'},{id:"B13",body:'Periera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, et al. Phlebotonics for haemorrhoids (Review). The Cochrane Library. 2012;(8):1-59'},{id:"B14",body:'Sheikh P, Lohsiriwat V, Shelygin Y. Micronized purified flavonoid fraction in hemorrhoid disease: A systematic review and meta-analysis. Advances in Therapy. 2020;37:2792-2812'},{id:"B15",body:'Puspitasari. Pengaruh pemberian ekstrak daun wungu (Graptophyllum pictum GRIFT) dan Pegagan (Centella asiatica L) pada penderita hemoroid di desa Payaman Solokuro Lamongan. Airlangga University. 2016. Downloaded from: http://repository.unair.ac.id/30804/'},{id:"B16",body:'Prasetyo SA, Riwanto I, Dharmana E, Susilaningsih N, Prajoko YW, Nugroho EA. Gratophyllum pictum (L.) griff extract as anti-inflammatory on wistar rat with experimental hemorrhoids. study on serum IL-6, COX-2, TNF-alpha and total leucocytes in anal tissue. International Surgery. 2020. DOI: 10.9738/INTSURG-D-18-00039.1'},{id:"B17",body:'Prasetyo SA, Wisnu Y, Nugroho EA, Dharmana E, Susilaningsih N, Riwanto I. Role of micronize purified flavonoid fraction and ethanol Graptophyllum pictum extract on experimental anal ulcer healing. Study on Wistar rat. Journal of Coloproctology. 2020;4:105-111'},{id:"B18",body:'Budiono BP, Prasetyo SA, Riwanto I, Susilaningsih N, Nugroho EA. Graptophyllum pictum extract in the treatment of experimental hemorrhoids: Effects on vascular leakage and matrix metalloproteinase-9 levels. Journal of Medical Sciences. 2021;9:1785-1789. DOI: 10.3889/oamjms.2021.7763'},{id:"B19",body:'Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. Journal of the American College of Surgeons. 2006;204(1):102-117. DOI: 10.1016/j.jamcollsurg. 2006.08.022. Epub 2006 Oct 25'},{id:"B20",body:'Johnson M. Trombosed Hemorrhoids 101: A Guide to Thrombosed Hemorrhoids Relief. 2017; Downlouded May 2021 from: https://senvie.com/blogs/senvie/thrombosed-hemorrhoids-guide-101'},{id:"B21",body:'Barwell J, Watkins RM, Lloyd-Davies E, Wilkins DC. Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: Report of a case. Diseases of the Colon and Rectum. 1999;42(3):421-423. DOI: 10.1007/BF02236364'},{id:"B22",body:'Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-shkololli A. Laser hemorrhoidoplasty procedure vs open surgical hemorrhoidectomy: A trial comparing 2 treatments for hemorrhoids of third and fourth degree. Acta Informatica Medica. 2014 Dec;22(6):365-367'},{id:"B23",body:'Abiodun AA, Alatise OI, Okereke CE, Adesunkanmi ARK, Eletta EA, Gomna A. Comparative study of endoscopic band ligation versus injection sclerotherapy with 50% dextrose in water, in symptomatic internal haemorrhoids. The Nigerian Postgraduate Medical Journal. 2020;27:13-20'},{id:"B24",body:'van Tol RR, Bruijnen MPA, Melenhorst J, van Kuijk SMJ, Stassen LPS, Breukink SO. A national evaluation of the management practices of hemorrhoidal disease in the Netherlands. International Journal of Colorectal Disease. 2018;33:577-588'},{id:"B25",body:'Kanellos I, Goulimaris I, Christoforidis E, Kelpis T, Betsis DA. Comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: A prospective randomized trial. Colorectal Disease. 2003;5(2):133-138'},{id:"B26",body:'Bhatti MI, Sajid MS, Baig MK. Milligan–Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized Controlled Trials. World Journal of Surgery. 2016;40:1509-1519'},{id:"B27",body:'Devien CV. Death to Whitehead, hurray for Toupet or total circular Hemorrhoidectomy revisited. Its technique, their indications and their results. Annales de Chirurgie. 1994;48(6):565-571'},{id:"B28",body:'Li YD, Xu JH, Lin JJ, Zhu WF. Excisional hemorrhoidal surgery and its effect on anal continence. World Journal of Gastroenterology. 2012;18(30):4059-4063. DOI: 10.3748/wjg.v18.i30.4059'},{id:"B29",body:'Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic scalpel vs. electrocautery prospective evaluation hemorrhoidectomy. Diseases of the Colon and Rectum. 2001;4(44):558-563'},{id:"B30",body:'Ratto C, Parello A, Donisi L, Litta F, Zaccone G, Doglietto GB. Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications. British Journal of Surgery. 2012;99:112-118'},{id:"B31",body:'Shao WJ, Li GCH, Zhang ZHK, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. British Journal of Surgery. 2008;95:147-160'},{id:"B32",body:'Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. Stapled haemorrhoidopexy compared to Milligan–Morgan and Ferguson haemorrhoidectomy: A systematic review. International Journal of Colorectal Disease. 2009, 2009;24:335-344'},{id:"B33",body:'Ratto C. THD Doppler procedure for hemorrhoids: The surgical technique. Techniques in Coloproctology. 2014;18:291-298'},{id:"B34",body:'Sajid MS, Parampalli U, Whitehouse P, Sains P, McFall MR, Baig MKA. Systematic review comparing transanal haemorrhoidal de- arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Tech Coloproctology. 2012;16(1):1-8'},{id:"B35",body:'Sobrado CW, Klajner S, Hora JAB, Mello A, da Silva FML, Frugis MO, et al. Transanal haemorrhoidal dearterialization with mucopexy (Thd-M) for treatment of hemorrhoids: Is it applicable in all grades? Brazilian Multicenter Study. ABCD Arquivos Brasileros de Cirurgia Digestiva. 2020;33(2):e1504'},{id:"B36",body:'Prasetyo SA, Riwanto I. Factors affecting post-operative pain after doppler guided hemorrhoid artery ligation and recto-anal repair (DGHAL-RAR) of internal hemorrhoid. Media Medika Muda. 2016;1(3):145-150'},{id:"B37",body:'Theodoropoulos GE, Sevrisarianos N, Papaconstantinou J, Panoussopoulos SG, Dardamanis D, Stamapoulos P, et al. Doppler-guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III-IV haemorrhoids: A multicenter prospective study of safety and efficacy. Colorectal Diseases. 2010;12(2):125-134'},{id:"B38",body:'Riwanto I, Prasetyo SA. Challenge in management prominent Grade IV hemorrhoid. In: Presented at 2nd MASTERCLASS in venous Disease for Asian Countries. The Athenee Hotel Bangkok, 27-28 January. 2018'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Sigit Adi Prasetyo",address:null,affiliation:'
Faculty of Medicine, Division of Digestive Surgery, Department of Surgery, Diponegoro University, Dr Kariadi General Hospital, Semarang, Indonesia
Faculty of Medicine, Division of Digestive Surgery, Department of Surgery, Diponegoro University, Dr Kariadi General Hospital, Semarang, Indonesia
'}],corrections:null},book:{id:"11272",type:"book",title:"Benign Anorectal Disorders - An Update",subtitle:null,fullTitle:"Benign Anorectal Disorders - An Update",slug:null,publishedDate:null,bookSignature:"Dr. Alberto Vannelli and Dr. Daniela Cornelia Lazar",coverURL:"https://cdn.intechopen.com/books/images_new/11272.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-706-9",printIsbn:"978-1-80355-705-2",pdfIsbn:"978-1-80355-707-6",isAvailableForWebshopOrdering:!0,editors:[{id:"34524",title:"Dr.",name:"Alberto",middleName:null,surname:"Vannelli",slug:"alberto-vannelli",fullName:"Alberto Vannelli"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"212243",title:"Prof.",name:"Carlos",middleName:null,surname:"Bellot-Arcís",email:"bellot.arcis@gmail.com",fullName:"Carlos Bellot-Arcís",slug:"carlos-bellot-arcis",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{id:"57752",title:"A Comparative Study of the Validity and Reproducibility of Mesiodistal Tooth Size and Dental Arch with iTeroTM Intraoral Scanner and the Traditional Method",slug:"a-comparative-study-of-the-validity-and-reproducibility-of-mesiodistal-tooth-size-and-dental-arch-wi",abstract:"Introduction: The introduction of intraoral scanning offers an alternative for measuring mesiodistal tooth sizes.",signatures:"Ignacio Faus-Matoses, Ana Mora, Carlos Bellot-Arcís, Jose Luis\nGandia-Franco and Vanessa Paredes-Gallardo",authors:[{id:"150456",title:"Prof.",name:"Vanessa",surname:"Paredes",fullName:"Vanessa Paredes",slug:"vanessa-paredes",email:"vanessa.paredes@uv.es"},{id:"150458",title:"Prof.",name:"José-Luis",surname:"Gandia-Franco",fullName:"José-Luis Gandia-Franco",slug:"jose-luis-gandia-franco",email:"jose.l.gandia@uv.es"},{id:"212242",title:"Prof.",name:"Ignacio",surname:"Faus",fullName:"Ignacio Faus",slug:"ignacio-faus",email:"ignaciofaus@clinicafaus.com"},{id:"212243",title:"Prof.",name:"Carlos",surname:"Bellot-Arcís",fullName:"Carlos Bellot-Arcís",slug:"carlos-bellot-arcis",email:"bellot.arcis@gmail.com"},{id:"218390",title:"Prof.",name:"Ana",surname:"Mora",fullName:"Ana Mora",slug:"ana-mora",email:"amoracervera@gmail.com"}],book:{id:"5814",title:"Dental Anatomy",slug:"dental-anatomy",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"171777",title:"Prof.",name:"Abdolreza",surname:"Jamilian",slug:"abdolreza-jamilian",fullName:"Abdolreza Jamilian",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Islamic Azad University Dental Branch of Tehran",institutionURL:null,country:{name:"Iran"}}},{id:"171873",title:"Dr.",name:"Alireza",surname:"Darnahal",slug:"alireza-darnahal",fullName:"Alireza Darnahal",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"173044",title:"Prof.",name:"Letizia",surname:"Perillo",slug:"letizia-perillo",fullName:"Letizia Perillo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}},{id:"179565",title:"Dr.",name:"Nicola",surname:"Mobilio",slug:"nicola-mobilio",fullName:"Nicola Mobilio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ferrara",institutionURL:null,country:{name:"Italy"}}},{id:"198961",title:"MSc.",name:"Fabrizia",surname:"D'Apuzzo",slug:"fabrizia-d'apuzzo",fullName:"Fabrizia D'Apuzzo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}},{id:"199397",title:"Prof.",name:"Santo",surname:"Catapano",slug:"santo-catapano",fullName:"Santo Catapano",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ferrara",institutionURL:null,country:{name:"Italy"}}},{id:"199400",title:"Dr.",name:"Alex",surname:"Vargas",slug:"alex-vargas",fullName:"Alex Vargas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199400/images/5238_n.jpg",biography:"Professor Dr. Alex Vargas Diaz has been an academic at the Pontifical Catholic University of Chile (PUC) since 1995. After graduating from the University of Chile with title of Dentist, he specialized in Oral and Maxillofacial Surgery at the Hospital of the PUC. He later completed internships abroad and a Diploma in Business Administration in Health Organizations and a Diploma in Clinical Teaching. In his hospital training he has dedicated himself mainly to the subspecialties of oncologic pathology, trauma and implantology, in the maxillofacial area.\n\nCurrently is Associate Professor of the Department of Oncological and Maxillofacial Surgery, belonging to the Division of Surgery of the Faculty of Medicine of the PUC. Performs pre and postgraduate teaching for medical and dentistry careers, in addition to teaching-assistance in the UC-Christus Health Network. On the other hand, it conducts research in the area of bioengineering and tissue engineering, in conjunction with researchers from the Faculties of Engineering and Biological Sciences, in the areas of rapid prototyping, scaffolds, bone regeneration and stem cell culture. He has made numerous presentations in national and international congresses and has several publications in national and international magazines.\n\nHe is a member of the Society of Head and Neck Surgery and Maxillofacial Plastic Surgery, the Society of Oral Implantology of Chile, the American Academy of International Dentistry, the International Society of Cell Therapy, the International Dental Research Association and member of The Commission of National Education in Dentistry.\n\nHe is also a member of the Dentistry Education Commission of the Chilean Dentists College; Referee and Project Evaluator of the Research and Development Division of the Universidad Austral de Chile, the National Commission for Scientific and Technological Research (CONICYCT) and the National Council of Science and Technology of Paraguay (CONACYT); and Director in consultation of the Journal of Rapid Prototyping.\n\n\n\nAreas of interest:\nPre and post grade teaching and health-care activities in the areas of:\n-\tMaxillofacial Traumatology\n-\tOral Implantology\n-\tOral and Maxillofacial Pathology and Oncology\n\nResearch activities in the areas of:\n-\tBioengineering: 3D printing (biocompatible scaffolds and simulation models)\n-\tBiomedicine: Hard & Soft Tissue Regeneration and Biocompatibility",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"202023",title:"Dr.",name:"Paula",surname:"Astorga",slug:"paula-astorga",fullName:"Paula Astorga",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"205059",title:"Dr.",name:"Tomas",surname:"Rioseco",slug:"tomas-rioseco",fullName:"Tomas Rioseco",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"206137",title:"Mrs.",name:"Ludovica",surname:"Nucci",slug:"ludovica-nucci",fullName:"Ludovica Nucci",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"WIS-cost",title:"What Does It Cost?",intro:"
Open Access publishing helps remove barriers and allows everyone to access valuable information, but article and book processing charges also exclude talented authors and editors who can’t afford to pay. The goal of our Women in Science program is to charge zero APCs, so none of our authors or editors have to pay for publication.
",metaTitle:"What Does It Cost?",metaDescription:"Open Access publishing helps remove barriers and allows everyone to access valuable information, but article and book processing charges also exclude talented authors and editors who can’t afford to pay. The goal of our Women in Science program is to charge zero APCs, so none of our authors or editors have to pay for publication.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor this ambitious program, we’d love to hear from you. Contact us at info@intechopen.com.
\\n\\n
All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
\\n\\n
\\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
National Institute of Standards and Technology (NIST)
We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor this ambitious program, we’d love to hear from you. Contact us at info@intechopen.com.
\n\n
All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
\n\n
\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
National Institute of Standards and Technology (NIST)
\n\t
Research Councils United Kingdom (RCUK)
\n\t
Foundation for Science and Technology (FCT)
\n\t
Chinese Academy of Sciences
\n\t
Natural Science Foundation of China (NSFC)
\n\t
German Research Foundation (DFG)
\n\t
Max Planck Institute
\n\t
Austrian Science Fund (FWF)
\n\t
Australian Research Council (ARC)
\n
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"396",title:"Dr.",name:"Vedran",middleName:null,surname:"Kordic",slug:"vedran-kordic",fullName:"Vedran Kordic",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/396/images/7281_n.png",biography:"After obtaining his Master's degree in Mechanical Engineering he continued his education at the Vienna University of Technology where he obtained his PhD degree in 2004. He worked as a researcher at the Automation and Control Institute, Faculty of Electrical Engineering, Vienna University of Technology until 2008. His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. In the Engineering side, Digital Signal Processing, Computer Architecture, Electronics Devices, Digital Filtering and Engineering Management.\nApart from his Academic Interest and activities he loves sport especially, Cricket, Football, Snooker and Squash. He plays cricket for Esbjerg city in the second division team as an opener wicket keeper batsman. He is a very good player of squash but has not played squash since his arrival in Denmark.",institutionString:null,institution:null},{id:"611",title:"Prof.",name:"T",middleName:null,surname:"Nagarajan",slug:"t-nagarajan",fullName:"T Nagarajan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universiti Teknologi Petronas",country:{name:"Malaysia"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:13389},{group:"region",caption:"Middle and South America",value:2,count:11658},{group:"region",caption:"Africa",value:3,count:4168},{group:"region",caption:"Asia",value:4,count:22334},{group:"region",caption:"Australia and Oceania",value:5,count:2019},{group:"region",caption:"Europe",value:6,count:33642}],offset:12,limit:12,total:135272},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{sort:"dateEndThirdStepPublish"},books:[{type:"book",id:"11616",title:"Foraging",subtitle:null,isOpenForSubmission:!0,hash:"955b60bb658c8d1a09dd4efc9bf6674b",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11616.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11632",title:"Updated Research on Bacteriophages",subtitle:null,isOpenForSubmission:!0,hash:"d34dfa0d5d10511184f97ddaeef9936b",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11632.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11730",title:"Midwifery",subtitle:null,isOpenForSubmission:!0,hash:"95389fcd878d0e929234c441744ba398",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11730.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11697",title:"Scoliosis",subtitle:null,isOpenForSubmission:!0,hash:"fa052443744b8f6ba5a87091e373bafe",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11697.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11699",title:"Neonatal Surgery",subtitle:null,isOpenForSubmission:!0,hash:"e52adaee8e54f51c2ba4972daeb410f7",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11699.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11369",title:"RNA Viruses Infection",subtitle:null,isOpenForSubmission:!0,hash:"52f8a3a1486912beae40b34ac557fed3",slug:null,bookSignature:"Ph.D. Yogendra Shah",coverURL:"https://cdn.intechopen.com/books/images_new/11369.jpg",editedByType:null,editors:[{id:"278914",title:"Ph.D.",name:"Yogendra",surname:"Shah",slug:"yogendra-shah",fullName:"Yogendra Shah"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11809",title:"Lagomorpha",subtitle:null,isOpenForSubmission:!0,hash:"1e8fd5779205c16e5797b05455dc5be0",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11809.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11837",title:"Ecology and Geography of the Mediterranean",subtitle:null,isOpenForSubmission:!0,hash:"bbb25987a982d61da4f47fb13614ba3c",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11837.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11843",title:"Abortion Access",subtitle:null,isOpenForSubmission:!0,hash:"e07ed1706ed2bf6ad56aa7399d9edf1a",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11843.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11818",title:"Uveitis",subtitle:null,isOpenForSubmission:!0,hash:"f8c178e6f45ba7b500281005b5d5b67a",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11818.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11850",title:"Systemic Sclerosis",subtitle:null,isOpenForSubmission:!0,hash:"df3f380c5949c8d8c977631cac330f67",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11850.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11794",title:"Coconut Cultivation",subtitle:null,isOpenForSubmission:!0,hash:"48e1cb42a4162f64cae3a2e777472f21",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/11794.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:28},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:8},{group:"topic",caption:"Business, Management and Economics",value:7,count:4},{group:"topic",caption:"Chemistry",value:8,count:16},{group:"topic",caption:"Computer and Information Science",value:9,count:18},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:8},{group:"topic",caption:"Engineering",value:11,count:43},{group:"topic",caption:"Environmental Sciences",value:12,count:5},{group:"topic",caption:"Immunology and Microbiology",value:13,count:9},{group:"topic",caption:"Materials Science",value:14,count:17},{group:"topic",caption:"Mathematics",value:15,count:9},{group:"topic",caption:"Medicine",value:16,count:69},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:3},{group:"topic",caption:"Neuroscience",value:18,count:3},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:6},{group:"topic",caption:"Physics",value:20,count:6},{group:"topic",caption:"Psychology",value:21,count:5},{group:"topic",caption:"Robotics",value:22,count:2},{group:"topic",caption:"Social Sciences",value:23,count:7},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:12,limit:12,total:500},popularBooks:{featuredBooks:[{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10796",title:"Extracellular Vesicles",subtitle:"Role in Diseases, Pathogenesis and Therapy",isOpenForSubmission:!1,hash:"eb5407fcf93baff7bca3fae5640153a2",slug:"extracellular-vesicles-role-in-diseases-pathogenesis-and-therapy",bookSignature:"Manash K. Paul",coverURL:"https://cdn.intechopen.com/books/images_new/10796.jpg",editors:[{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11263",title:"Supply Chain",subtitle:"Recent Advances and New Perspectives in the Industry 4.0 Era",isOpenForSubmission:!1,hash:"aab634c9c1f9a692c1e9881d18e9c9b7",slug:"supply-chain-recent-advances-and-new-perspectives-in-the-industry-4-0-era",bookSignature:"Tamás Bányai, Ágota Bányai and Ireneusz Kaczmar",coverURL:"https://cdn.intechopen.com/books/images_new/11263.jpg",editors:[{id:"201248",title:"Dr.",name:"Tamás",middleName:null,surname:"Bányai",slug:"tamas-banyai",fullName:"Tamás Bányai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10739",title:"Global Decline of Insects",subtitle:null,isOpenForSubmission:!1,hash:"543783652b9092962a8fa4bed38eeb17",slug:"global-decline-of-insects",bookSignature:"Hamadttu Abdel Farag El-Shafie",coverURL:"https://cdn.intechopen.com/books/images_new/10739.jpg",editors:[{id:"192142",title:"Dr.",name:"Hamadttu",middleName:null,surname:"Abdel Farag El-Shafie",slug:"hamadttu-abdel-farag-el-shafie",fullName:"Hamadttu Abdel Farag El-Shafie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10911",title:"Higher Education",subtitle:"New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",isOpenForSubmission:!1,hash:"223a02337498e535e967174c1f648fbc",slug:"higher-education-new-approaches-to-accreditation-digitalization-and-globalization-in-the-age-of-covid",bookSignature:"Lee Waller and Sharon Waller",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg",editors:[{id:"263301",title:"Dr.",name:"Lee",middleName:null,surname:"Waller",slug:"lee-waller",fullName:"Lee Waller"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10669",title:"Corrosion",subtitle:"Fundamentals and Protection Mechanisms",isOpenForSubmission:!1,hash:"4a76d54f8a40fc2e7002a8d13fd617c1",slug:"corrosion-fundamentals-and-protection-mechanisms",bookSignature:"Fahmina Zafar, Anujit Ghosal and Eram Sharmin",coverURL:"https://cdn.intechopen.com/books/images_new/10669.jpg",editors:[{id:"89672",title:"Dr.",name:"Fahmina",middleName:null,surname:"Zafar",slug:"fahmina-zafar",fullName:"Fahmina Zafar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"95",title:"Applications and Experiences of Quality Control",subtitle:null,isOpenForSubmission:!1,hash:"4bcb22b1eee68210a977a97d5a0f363a",slug:"applications-and-experiences-of-quality-control",bookSignature:"Ognyan Ivanov",coverURL:"https://cdn.intechopen.com/books/images_new/95.jpg",editors:[{id:"22230",title:"Prof.",name:"Ognyan",middleName:null,surname:"Ivanov",slug:"ognyan-ivanov",fullName:"Ognyan Ivanov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"2160",title:"MATLAB",subtitle:"A Fundamental Tool for Scientific Computing and Engineering Applications - Volume 1",isOpenForSubmission:!1,hash:"dd9c658341fbd264ed4f8d9e6aa8ca29",slug:"matlab-a-fundamental-tool-for-scientific-computing-and-engineering-applications-volume-1",bookSignature:"Vasilios N. Katsikis",coverURL:"https://cdn.intechopen.com/books/images_new/2160.jpg",editors:[{id:"12289",title:"Prof.",name:"Vasilios",middleName:"N.",surname:"Katsikis",slug:"vasilios-katsikis",fullName:"Vasilios Katsikis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3560",title:"Advances in Landscape Architecture",subtitle:null,isOpenForSubmission:!1,hash:"a20614517ec5f7e91188fe8e42832138",slug:"advances-in-landscape-architecture",bookSignature:"Murat Özyavuz",coverURL:"https://cdn.intechopen.com/books/images_new/3560.jpg",editors:[{id:"93073",title:"Dr.",name:"Murat",middleName:null,surname:"Ozyavuz",slug:"murat-ozyavuz",fullName:"Murat Ozyavuz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"3568",title:"Recent Advances in Plant in vitro Culture",subtitle:null,isOpenForSubmission:!1,hash:"830bbb601742c85a3fb0eeafe1454c43",slug:"recent-advances-in-plant-in-vitro-culture",bookSignature:"Annarita Leva and Laura M. R. Rinaldi",coverURL:"https://cdn.intechopen.com/books/images_new/3568.jpg",editors:[{id:"142145",title:"Dr.",name:"Annarita",middleName:null,surname:"Leva",slug:"annarita-leva",fullName:"Annarita Leva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4805},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",publishedDate:"July 27th 2022",numberOfDownloads:7107,editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",publishedDate:"July 27th 2022",numberOfDownloads:1955,editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",publishedDate:"July 27th 2022",numberOfDownloads:1452,editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10796",title:"Extracellular Vesicles",subtitle:"Role in Diseases, Pathogenesis and Therapy",isOpenForSubmission:!1,hash:"eb5407fcf93baff7bca3fae5640153a2",slug:"extracellular-vesicles-role-in-diseases-pathogenesis-and-therapy",bookSignature:"Manash K. Paul",coverURL:"https://cdn.intechopen.com/books/images_new/10796.jpg",publishedDate:"July 20th 2022",numberOfDownloads:2289,editors:[{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"11263",title:"Supply Chain",subtitle:"Recent Advances and New Perspectives in the Industry 4.0 Era",isOpenForSubmission:!1,hash:"aab634c9c1f9a692c1e9881d18e9c9b7",slug:"supply-chain-recent-advances-and-new-perspectives-in-the-industry-4-0-era",bookSignature:"Tamás Bányai, Ágota Bányai and Ireneusz Kaczmar",coverURL:"https://cdn.intechopen.com/books/images_new/11263.jpg",publishedDate:"July 27th 2022",numberOfDownloads:888,editors:[{id:"201248",title:"Dr.",name:"Tamás",middleName:null,surname:"Bányai",slug:"tamas-banyai",fullName:"Tamás Bányai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10739",title:"Global Decline of Insects",subtitle:null,isOpenForSubmission:!1,hash:"543783652b9092962a8fa4bed38eeb17",slug:"global-decline-of-insects",bookSignature:"Hamadttu Abdel Farag El-Shafie",coverURL:"https://cdn.intechopen.com/books/images_new/10739.jpg",publishedDate:"July 20th 2022",numberOfDownloads:1566,editors:[{id:"192142",title:"Dr.",name:"Hamadttu",middleName:null,surname:"Abdel Farag El-Shafie",slug:"hamadttu-abdel-farag-el-shafie",fullName:"Hamadttu Abdel Farag El-Shafie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10911",title:"Higher Education",subtitle:"New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",isOpenForSubmission:!1,hash:"223a02337498e535e967174c1f648fbc",slug:"higher-education-new-approaches-to-accreditation-digitalization-and-globalization-in-the-age-of-covid",bookSignature:"Lee Waller and Sharon Waller",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg",publishedDate:"July 13th 2022",numberOfDownloads:2054,editors:[{id:"263301",title:"Dr.",name:"Lee",middleName:null,surname:"Waller",slug:"lee-waller",fullName:"Lee Waller"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10669",title:"Corrosion",subtitle:"Fundamentals and Protection Mechanisms",isOpenForSubmission:!1,hash:"4a76d54f8a40fc2e7002a8d13fd617c1",slug:"corrosion-fundamentals-and-protection-mechanisms",bookSignature:"Fahmina Zafar, Anujit Ghosal and Eram Sharmin",coverURL:"https://cdn.intechopen.com/books/images_new/10669.jpg",publishedDate:"July 27th 2022",numberOfDownloads:780,editors:[{id:"89672",title:"Dr.",name:"Fahmina",middleName:null,surname:"Zafar",slug:"fahmina-zafar",fullName:"Fahmina Zafar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"95",title:"Applications and Experiences of Quality Control",subtitle:null,isOpenForSubmission:!1,hash:"4bcb22b1eee68210a977a97d5a0f363a",slug:"applications-and-experiences-of-quality-control",bookSignature:"Ognyan Ivanov",coverURL:"https://cdn.intechopen.com/books/images_new/95.jpg",publishedDate:"April 26th 2011",numberOfDownloads:318480,editors:[{id:"22230",title:"Prof.",name:"Ognyan",middleName:null,surname:"Ivanov",slug:"ognyan-ivanov",fullName:"Ognyan Ivanov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"2160",title:"MATLAB",subtitle:"A Fundamental Tool for Scientific Computing and Engineering Applications - Volume 1",isOpenForSubmission:!1,hash:"dd9c658341fbd264ed4f8d9e6aa8ca29",slug:"matlab-a-fundamental-tool-for-scientific-computing-and-engineering-applications-volume-1",bookSignature:"Vasilios N. Katsikis",coverURL:"https://cdn.intechopen.com/books/images_new/2160.jpg",publishedDate:"September 26th 2012",numberOfDownloads:271760,editors:[{id:"12289",title:"Prof.",name:"Vasilios",middleName:"N.",surname:"Katsikis",slug:"vasilios-katsikis",fullName:"Vasilios Katsikis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",isOpenForSubmission:!1,hash:"4af8830e463f89c57515c2da2b9777b0",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",bookSignature:"Dragana Gabrić and Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11328",title:"Botulinum Toxin",subtitle:"Recent Topics and Applications",isOpenForSubmission:!1,hash:"7dd05a316001cef143e209eda51387a7",slug:"botulinum-toxin-recent-topics-and-applications",bookSignature:"Suna Sabuncuoglu",coverURL:"https://cdn.intechopen.com/books/images_new/11328.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"270856",title:"Associate Prof.",name:"Suna",middleName:null,surname:"Sabuncuoglu",slug:"suna-sabuncuoglu",fullName:"Suna Sabuncuoglu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11085",title:"Polycystic Ovary Syndrome",subtitle:"Functional Investigation and Clinical Application",isOpenForSubmission:!1,hash:"3066dd3ff29e1fac072fd60b08d4d3e7",slug:"polycystic-ovary-syndrome-functional-investigation-and-clinical-application",bookSignature:"Zhengchao Wang",coverURL:"https://cdn.intechopen.com/books/images_new/11085.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"204883",title:"Dr.",name:"Zhengchao",middleName:null,surname:"Wang",slug:"zhengchao-wang",fullName:"Zhengchao Wang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10833",title:"Tumor Angiogenesis and Modulators",subtitle:null,isOpenForSubmission:!1,hash:"f29b575c46128b2da061ef7f9bd1070b",slug:"tumor-angiogenesis-and-modulators",bookSignature:"Ke Xu",coverURL:"https://cdn.intechopen.com/books/images_new/10833.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"59529",title:"Dr.",name:"Ke",middleName:null,surname:"Xu",slug:"ke-xu",fullName:"Ke Xu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11356",title:"Molecular Cloning",subtitle:null,isOpenForSubmission:!1,hash:"671c629dd86e97f0fb467b9e70e92296",slug:"molecular-cloning",bookSignature:"Sadık Dincer, Hatice Aysun Mercimek Takcı and Melis Sumengen Ozdenef",coverURL:"https://cdn.intechopen.com/books/images_new/11356.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"188141",title:"Prof.",name:"Sadik",middleName:null,surname:"Dincer",slug:"sadik-dincer",fullName:"Sadik Dincer"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7827",title:"Interpersonal Relationships",subtitle:null,isOpenForSubmission:!1,hash:"ebf41f4d17c75010eb3294cc8cac3d47",slug:"interpersonal-relationships",bookSignature:"Martha Peaslee Levine",coverURL:"https://cdn.intechopen.com/books/images_new/7827.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"186919",title:"Dr.",name:"Martha",middleName:null,surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10908",title:"Advances in Decision Making",subtitle:null,isOpenForSubmission:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",slug:"advances-in-decision-making",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10669",title:"Corrosion",subtitle:"Fundamentals and Protection Mechanisms",isOpenForSubmission:!1,hash:"4a76d54f8a40fc2e7002a8d13fd617c1",slug:"corrosion-fundamentals-and-protection-mechanisms",bookSignature:"Fahmina Zafar, Anujit Ghosal and Eram Sharmin",coverURL:"https://cdn.intechopen.com/books/images_new/10669.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"89672",title:"Dr.",name:"Fahmina",middleName:null,surname:"Zafar",slug:"fahmina-zafar",fullName:"Fahmina Zafar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10677",title:"Advanced Topics of Topology",subtitle:null,isOpenForSubmission:!1,hash:"bf964c52f9e653fac20a7fcab58070e5",slug:"advanced-topics-of-topology",bookSignature:"Francisco Bulnes",coverURL:"https://cdn.intechopen.com/books/images_new/10677.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"92918",title:"Dr.",name:"Francisco",middleName:null,surname:"Bulnes",slug:"francisco-bulnes",fullName:"Francisco Bulnes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"11195",title:"Recent Advances in Biometrics",subtitle:null,isOpenForSubmission:!1,hash:"2d32e33e0f499cb5241734bb75dd2a83",slug:"recent-advances-in-biometrics",bookSignature:"Muhammad Sarfraz",coverURL:"https://cdn.intechopen.com/books/images_new/11195.jpg",editedByType:"Edited by",publishedDate:"July 27th 2022",editors:[{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"101",title:"Cosmology",slug:"cosmology",parent:{id:"10",title:"Earth and Planetary Sciences",slug:"earth-and-planetary-sciences"},numberOfBooks:8,numberOfSeries:0,numberOfAuthorsAndEditors:94,numberOfWosCitations:82,numberOfCrossrefCitations:67,numberOfDimensionsCitations:118,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"101",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"10954",title:"Dark Matter",subtitle:"Recent Observations and Theoretical Advances",isOpenForSubmission:!1,hash:"b0fbd6ee0096e4c16e9513bf01273ab3",slug:"dark-matter-recent-observations-and-theoretical-advances",bookSignature:"Michael L. Smith",coverURL:"https://cdn.intechopen.com/books/images_new/10954.jpg",editedByType:"Edited by",editors:[{id:"59479",title:"Dr.",name:"Michael",middleName:"L.",surname:"Smith",slug:"michael-smith",fullName:"Michael Smith"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9982",title:"Cosmology 2020",subtitle:"The Current State",isOpenForSubmission:!1,hash:"35188e364272b0f50d145f33b01931fa",slug:"cosmology-2020-the-current-state",bookSignature:"Michael L. Smith",coverURL:"https://cdn.intechopen.com/books/images_new/9982.jpg",editedByType:"Edited by",editors:[{id:"59479",title:"Dr.",name:"Michael",middleName:"L.",surname:"Smith",slug:"michael-smith",fullName:"Michael Smith"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7389",title:"Redefining Standard Model Cosmology",subtitle:null,isOpenForSubmission:!1,hash:"25572d83043224835eabdf8632fc64ed",slug:"redefining-standard-model-cosmology",bookSignature:"Brian Albert Robson",coverURL:"https://cdn.intechopen.com/books/images_new/7389.jpg",editedByType:"Edited by",editors:[{id:"102886",title:"Prof.",name:"Brian Albert",middleName:null,surname:"Robson",slug:"brian-albert-robson",fullName:"Brian Albert Robson"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6693",title:"Essentials on Dark Matter",subtitle:null,isOpenForSubmission:!1,hash:"7b9819be21ab94f8d165da9b5531b6bc",slug:"essentials-on-dark-matter",bookSignature:"Abraão Jessé Capistrano de Souza",coverURL:"https://cdn.intechopen.com/books/images_new/6693.jpg",editedByType:"Edited by",editors:[{id:"52362",title:"Dr.",name:"Abraao",middleName:"Jesse",surname:"Capistrano",slug:"abraao-capistrano",fullName:"Abraao Capistrano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3211",title:"Open Questions in Cosmology",subtitle:null,isOpenForSubmission:!1,hash:"6e4e21582afb611a1552d8493d66f82c",slug:"open-questions-in-cosmology",bookSignature:"Gonzalo J. Olmo",coverURL:"https://cdn.intechopen.com/books/images_new/3211.jpg",editedByType:"Edited by",editors:[{id:"61779",title:"Dr.",name:"Gonzalo J.",middleName:null,surname:"Olmo",slug:"gonzalo-j.-olmo",fullName:"Gonzalo J. Olmo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1680",title:"Space Science",subtitle:null,isOpenForSubmission:!1,hash:"2429d8599f5c44daca7b0d12f3d70bb8",slug:"space-science",bookSignature:"Herman J. Mosquera Cuesta",coverURL:"https://cdn.intechopen.com/books/images_new/1680.jpg",editedByType:"Edited by",editors:[{id:"15074",title:"Dr.",name:"Herman J.",middleName:null,surname:"Mosquera Cuesta",slug:"herman-j.-mosquera-cuesta",fullName:"Herman J. Mosquera Cuesta"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1374",title:"Aspects of Today's Cosmology",subtitle:null,isOpenForSubmission:!1,hash:"6f152698fbe6139a2fe31a70ec8668d0",slug:"aspects-of-today-s-cosmology",bookSignature:"Antonio Alfonso-Faus",coverURL:"https://cdn.intechopen.com/books/images_new/1374.jpg",editedByType:"Edited by",editors:[{id:"62140",title:"Prof.",name:"Antonio",middleName:null,surname:"Alfonso-Faus",slug:"antonio-alfonso-faus",fullName:"Antonio Alfonso-Faus"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"400",title:"Advances in Modern Cosmology",subtitle:null,isOpenForSubmission:!1,hash:"042beba0021ef61f561bf65a1fb2b115",slug:"advances-in-modern-cosmology",bookSignature:"Adnan Ghribi",coverURL:"https://cdn.intechopen.com/books/images_new/400.jpg",editedByType:"Edited by",editors:[{id:"58295",title:"Dr.",name:"Adnan",middleName:null,surname:"Ghribi",slug:"adnan-ghribi",fullName:"Adnan Ghribi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:8,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"41690",doi:"10.5772/52455",title:"Where Is the PdV in the First Law of Black Hole Thermodynamics?",slug:"where-is-the-pdv-term-in-the-first-law-of-black-hole-thermodynamics-",totalDownloads:3445,totalCrossrefCites:16,totalDimensionsCites:29,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"Brian P. Dolan",authors:[{id:"155570",title:"Dr.",name:"Brian",middleName:"P.",surname:"Dolan",slug:"brian-dolan",fullName:"Brian Dolan"}]},{id:"33700",doi:"10.5772/29840",title:"Geomagnetically Induced Currents as Ground Effects of Space Weather",slug:"geomagnetically-induced-currents-as-ground-effects-of-space-weather",totalDownloads:2811,totalCrossrefCites:8,totalDimensionsCites:12,abstract:null,book:{id:"1680",slug:"space-science",title:"Space Science",fullTitle:"Space Science"},signatures:"Risto Pirjola",authors:[{id:"79589",title:"Dr.",name:"Risto",middleName:"Juhani",surname:"Pirjola",slug:"risto-pirjola",fullName:"Risto Pirjola"}]},{id:"41610",doi:"10.5772/52041",title:"Extended Theories of Gravitation and the Curvature of the Universe – Do We Really Need Dark Matter?",slug:"extended-theories-of-gravitation-and-the-curvature-of-the-universe-do-we-really-need-dark-matter-",totalDownloads:1712,totalCrossrefCites:11,totalDimensionsCites:11,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"L. Fatibene and M. Francaviglia",authors:[{id:"154114",title:"Prof.",name:"Mauro",middleName:null,surname:"Francaviglia",slug:"mauro-francaviglia",fullName:"Mauro Francaviglia"},{id:"154550",title:"Dr.",name:"Lorenzo",middleName:null,surname:"Fatibene",slug:"lorenzo-fatibene",fullName:"Lorenzo Fatibene"}]},{id:"18674",doi:"10.5772/23035",title:"Warm Inflationary Universe Models",slug:"warm-inflationary-universe-models",totalDownloads:2514,totalCrossrefCites:0,totalDimensionsCites:7,abstract:null,book:{id:"1374",slug:"aspects-of-today-s-cosmology",title:"Aspects of Today's Cosmology",fullTitle:"Aspects of Today's Cosmology"},signatures:"Sergio del Campo",authors:[{id:"50288",title:"Prof.",name:"Sergio",middleName:null,surname:"Del Campo",slug:"sergio-del-campo",fullName:"Sergio Del Campo"}]},{id:"41687",doi:"10.5772/52054",title:"Quintom Potential from Quantum Anisotropic Cosmological Models",slug:"quintom-potential-from-quantum-anisotropic-cosmological-models",totalDownloads:1434,totalCrossrefCites:1,totalDimensionsCites:3,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"J. Socorro, Paulo A. Rodríguez, O. Núñez-Soltero, Rafael Hernández and Abraham Espinoza-García",authors:[{id:"55439",title:"Dr.",name:"Jose",middleName:null,surname:"Socorro",slug:"jose-socorro",fullName:"Jose Socorro"},{id:"60971",title:"MSc.",name:"Abraham",middleName:null,surname:"Espinoza-García",slug:"abraham-espinoza-garcia",fullName:"Abraham Espinoza-García"},{id:"60972",title:"MSc.",name:"Paulo",middleName:null,surname:"Rodríguez",slug:"paulo-rodriguez",fullName:"Paulo Rodríguez"},{id:"165110",title:"MSc.",name:"Rafael",middleName:null,surname:"Hernández",slug:"rafael-hernandez",fullName:"Rafael Hernández"},{id:"165111",title:"MSc.",name:"Omar E.",middleName:null,surname:"Nuñez",slug:"omar-e.-nunez",fullName:"Omar E. Nuñez"}]}],mostDownloadedChaptersLast30Days:[{id:"66783",title:"Introductory Chapter: Standard Model of Cosmology",slug:"introductory-chapter-standard-model-of-cosmology",totalDownloads:1471,totalCrossrefCites:0,totalDimensionsCites:1,abstract:null,book:{id:"7389",slug:"redefining-standard-model-cosmology",title:"Redefining Standard Model Cosmology",fullTitle:"Redefining Standard Model Cosmology"},signatures:"Brian Albert Robson",authors:[{id:"102886",title:"Prof.",name:"Brian Albert",middleName:null,surname:"Robson",slug:"brian-albert-robson",fullName:"Brian Albert Robson"}]},{id:"41230",title:"Cosmological Constant and Dark Energy: Historical Insights",slug:"cosmological-constant-and-dark-energy-historial-insights",totalDownloads:3124,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"Emilio Elizalde",authors:[{id:"154905",title:"Prof.",name:"Emilio",middleName:null,surname:"Elizalde",slug:"emilio-elizalde",fullName:"Emilio Elizalde"}]},{id:"18676",title:"Introduction to Modified Gravity: From the Cosmic Speedup Problem to Quantum Gravity Phenomenology",slug:"introduction-to-modified-gravity-from-the-cosmic-speedup-problem-to-quantum-gravity-phenomenology",totalDownloads:2182,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"1374",slug:"aspects-of-today-s-cosmology",title:"Aspects of Today's Cosmology",fullTitle:"Aspects of Today's Cosmology"},signatures:"Gonzalo J. Olmo",authors:[{id:"61779",title:"Dr.",name:"Gonzalo J.",middleName:null,surname:"Olmo",slug:"gonzalo-j.-olmo",fullName:"Gonzalo J. Olmo"}]},{id:"41688",title:"Leptogenesis and Neutrino Masses in an Inflationary SUSY Pati-Salam Model",slug:"leptogenesis-and-neutrino-masses-in-an-inflationary-susy-pati-salam-model",totalDownloads:2042,totalCrossrefCites:2,totalDimensionsCites:5,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"C. Pallis and N. Toumbas",authors:[{id:"154011",title:"Dr.",name:"Constantinos",middleName:null,surname:"Pallis",slug:"constantinos-pallis",fullName:"Constantinos Pallis"},{id:"164280",title:"Dr.",name:"Nikolaos",middleName:null,surname:"Toumbas",slug:"nikolaos-toumbas",fullName:"Nikolaos Toumbas"}]},{id:"41282",title:"Plasma Vortices in Planetary Wakes",slug:"plasma-vortices-in-planetary-wakes",totalDownloads:1728,totalCrossrefCites:1,totalDimensionsCites:1,abstract:null,book:{id:"3211",slug:"open-questions-in-cosmology",title:"Open Questions in Cosmology",fullTitle:"Open Questions in Cosmology"},signatures:"H. Pérez-de-Tejada, Rickard Lundin and D. S. Intriligator",authors:[{id:"79235",title:"Dr.",name:"Hector",middleName:null,surname:"Perez-De-Tejada",slug:"hector-perez-de-tejada",fullName:"Hector Perez-De-Tejada"}]}],onlineFirstChaptersFilter:{topicId:"101",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"19",title:"Animal Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/19.jpg",isOpenForSubmission:!0,editor:{id:"259298",title:"Dr.",name:"Edward",middleName:null,surname:"Narayan",slug:"edward-narayan",fullName:"Edward Narayan",profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",biography:"Dr. Edward Narayan graduated with Ph.D. degree in Biology from the University of the South Pacific and pioneered non-invasive reproductive and stress endocrinology tools for amphibians - the novel development and validation of non-invasive enzyme immunoassays for the evaluation of reproductive hormonal cycle and stress hormone responses to environmental stressors. \nDr. Narayan leads the Stress Lab (Comparative Physiology and Endocrinology) at the University of Queensland. A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"28",title:"Animal Reproductive Biology and Technology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",isOpenForSubmission:!0,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). She is the head of the Reproduction and Embryology Laboratories and was lecturer of Reproduction and Reproductive Biotechnologies at Veterinary Medicine Faculty. She has over 25 years of experience working in reproductive biology and biotechnology areas with a special emphasis on embryo and gamete cryopreservation, for research and animal genetic resources conservation, leading research projects with several peer-reviewed papers. Rosa Pereira is member of the ERFP-FAO Ex situ Working Group and of the Management Commission of the Portuguese Animal Germplasm Bank.",institutionString:"The National Institute for Agricultural and Veterinary Research. Portugal",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"82991",title:"Diseases of the Canine Prostate Gland",doi:"10.5772/intechopen.105835",signatures:"Sabine Schäfer-Somi",slug:"diseases-of-the-canine-prostate-gland",totalDownloads:0,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"82956",title:"Potential Substitutes of Antibiotics for Swine and Poultry Production",doi:"10.5772/intechopen.106081",signatures:"Ho Trung Thong, Le Nu Anh Thu and Ho Viet Duc",slug:"potential-substitutes-of-antibiotics-for-swine-and-poultry-production",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Antibiotics and Probiotics in Animal Food - Impact and Regulation",coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg",subseries:{id:"20",title:"Animal Nutrition"}}},{id:"82905",title:"A Review of Application Strategies and Efficacy of Probiotics in Pet Food",doi:"10.5772/intechopen.105829",signatures:"Heather Acuff and Charles G. Aldrich",slug:"a-review-of-application-strategies-and-efficacy-of-probiotics-in-pet-food",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Antibiotics and Probiotics in Animal Food - Impact and Regulation",coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg",subseries:{id:"20",title:"Animal Nutrition"}}},{id:"82773",title:"Canine Transmissible Venereal Tumor: An Infectious Neoplasia in Dogs",doi:"10.5772/intechopen.106150",signatures:"Chanokchon Setthawongsin, Somporn Techangamsuwan and Anudep Rungsipipat",slug:"canine-transmissible-venereal-tumor-an-infectious-neoplasia-in-dogs",totalDownloads:14,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}}]},overviewPagePublishedBooks:{paginationCount:11,paginationItems:[{type:"book",id:"7233",title:"New Insights into Theriogenology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7233.jpg",slug:"new-insights-into-theriogenology",publishedDate:"December 5th 2018",editedByType:"Edited by",bookSignature:"Rita Payan-Carreira",hash:"74f4147e3fb214dd050e5edd3aaf53bc",volumeInSeries:1,fullTitle:"New Insights into Theriogenology",editors:[{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}}]},{type:"book",id:"7144",title:"Veterinary Anatomy and Physiology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7144.jpg",slug:"veterinary-anatomy-and-physiology",publishedDate:"March 13th 2019",editedByType:"Edited by",bookSignature:"Catrin Sian Rutland and Valentina Kubale",hash:"75cdacb570e0e6d15a5f6e69640d87c9",volumeInSeries:2,fullTitle:"Veterinary Anatomy and Physiology",editors:[{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}}]},{type:"book",id:"8524",title:"Lactation in Farm Animals",subtitle:"Biology, Physiological Basis, Nutritional Requirements, and Modelization",coverURL:"https://cdn.intechopen.com/books/images_new/8524.jpg",slug:"lactation-in-farm-animals-biology-physiological-basis-nutritional-requirements-and-modelization",publishedDate:"January 22nd 2020",editedByType:"Edited by",bookSignature:"Naceur M'Hamdi",hash:"2aa2a9a0ec13040bbf0455e34625504e",volumeInSeries:3,fullTitle:"Lactation in Farm Animals - Biology, Physiological Basis, Nutritional Requirements, and Modelization",editors:[{id:"73376",title:"Dr.",name:"Naceur",middleName:null,surname:"M'Hamdi",slug:"naceur-m'hamdi",fullName:"Naceur M'Hamdi",profilePictureURL:"https://mts.intechopen.com/storage/users/73376/images/system/73376.jpg",biography:"Naceur M’HAMDI is Associate Professor at the National Agronomic Institute of Tunisia, University of Carthage. He is also Member of the Laboratory of genetic, animal and feed resource and member of Animal science Department of INAT. He graduated from Higher School of Agriculture of Mateur, University of Carthage, in 2002 and completed his masters in 2006. Dr. M’HAMDI completed his PhD thesis in Genetic welfare indicators of dairy cattle at Higher Institute of Agronomy of Chott-Meriem, University of Sousse, in 2011. He worked as assistant Professor of Genetic, biostatistics and animal biotechnology at INAT since 2013.",institutionString:null,institution:null}]},{type:"book",id:"8460",title:"Reproductive Biology and Technology in Animals",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/8460.jpg",slug:"reproductive-biology-and-technology-in-animals",publishedDate:"April 15th 2020",editedByType:"Edited by",bookSignature:"Juan Carlos Gardón Poggi and Katy Satué Ambrojo",hash:"32ef5fe73998dd723d308225d756fa1e",volumeInSeries:4,fullTitle:"Reproductive Biology and Technology in Animals",editors:[{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",institutionURL:null,country:{name:"Spain"}}}]}]},openForSubmissionBooks:{paginationCount:5,paginationItems:[{id:"10845",title:"Marine Ecosystems - Biodiversity, Ecosystem Services and Human Impacts",coverURL:"https://cdn.intechopen.com/books/images_new/10845.jpg",hash:"727e7eb3d4ba529ec5eb4f150e078523",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"June 22nd 2022",isOpenForSubmission:!0,editors:[{id:"320124",title:"Dr.",name:"Ana M.M.",surname:"Gonçalves",slug:"ana-m.m.-goncalves",fullName:"Ana M.M. Gonçalves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"12222",title:"Advances and Challenges in Microplastics",coverURL:"https://cdn.intechopen.com/books/images_new/12222.jpg",hash:"a36734a551e0997d2255f6ce99eff818",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 1st 2022",isOpenForSubmission:!0,editors:[{id:"347657",title:"Prof.",name:"El-Sayed",surname:"Salama",slug:"el-sayed-salama",fullName:"El-Sayed Salama"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11650",title:"Aquifers - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11650.jpg",hash:"27c1a2a053cb1d83de903c5b969bc3a2",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 12th 2022",isOpenForSubmission:!0,editors:[{id:"271093",title:"Dr.",name:"Abhay",surname:"Soni",slug:"abhay-soni",fullName:"Abhay Soni"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"12223",title:"Sustainable Management of Natural Resources",coverURL:"https://cdn.intechopen.com/books/images_new/12223.jpg",hash:"1881a08bbd8f5dc1102c5cb7c635bc35",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 19th 2022",isOpenForSubmission:!0,editors:[{id:"144417",title:"Dr.",name:"Mohd Nazip",surname:"Suratman",slug:"mohd-nazip-suratman",fullName:"Mohd Nazip Suratman"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11668",title:"Mercury Pollution",coverURL:"https://cdn.intechopen.com/books/images_new/11668.jpg",hash:"0bd111f57835089cad4a9741326dbab7",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 22nd 2022",isOpenForSubmission:!0,editors:[{id:"196849",title:"Dr.",name:"Ahmed",surname:"Abdelhafez",slug:"ahmed-abdelhafez",fullName:"Ahmed Abdelhafez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}},{id:"82751",title:"Mitochondria-Endoplasmic Reticulum Interaction in Central Neurons",doi:"10.5772/intechopen.105738",signatures:"Liliya Kushnireva and Eduard Korkotian",slug:"mitochondria-endoplasmic-reticulum-interaction-in-central-neurons",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"82709",title:"Fatty Acid Metabolism as a Tumor Marker",doi:"10.5772/intechopen.106072",signatures:"Gatot Nyarumenteng Adhipurnawan Winarno",slug:"fatty-acid-metabolism-as-a-tumor-marker",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82716",title:"Advanced glycation end product induced endothelial dysfunction through ER stress: Unravelling the role of Paraoxonase 2",doi:"10.5772/intechopen.106018",signatures:"Ramya Ravi and Bharathidevi Subramaniam Rajesh",slug:"advanced-glycation-end-product-induced-endothelial-dysfunction-through-er-stress-unravelling-the-rol",totalDownloads:12,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"82388",title:"Epigenetics: Science of Changes without Change in DNA Sequences",doi:"10.5772/intechopen.105039",signatures:"Jayisha Dhargawe, Rita Lakkakul and Pradip Hirapure",slug:"epigenetics-science-of-changes-without-change-in-dna-sequences",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Modifications of Biomolecules",coverURL:"https://cdn.intechopen.com/books/images_new/11098.jpg",subseries:null}},{id:"82583",title:"Leukaemia: The Purinergic System and Small Extracellular Vesicles",doi:"10.5772/intechopen.104326",signatures:"Arinzechukwu Ude and Kelechi Okeke",slug:"leukaemia-the-purinergic-system-and-small-extracellular-vesicles",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82531",title:"Abnormal Iron Metabolism and Its Effect on Dentistry",doi:"10.5772/intechopen.104502",signatures:"Chinmayee Dahihandekar and Sweta Kale Pisulkar",slug:"abnormal-iron-metabolism-and-its-effect-on-dentistry",totalDownloads:12,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Iron Metabolism - A Double-Edged Sword",coverURL:"https://cdn.intechopen.com/books/images_new/10842.jpg",subseries:{id:"17",title:"Metabolism"}}}]},subseriesFiltersForOFChapters:[{caption:"Chemical Biology",value:15,count:2,group:"subseries"},{caption:"Proteomics",value:18,count:2,group:"subseries"},{caption:"Cell and Molecular Biology",value:14,count:17,group:"subseries"},{caption:"Metabolism",value:17,count:18,group:"subseries"}],publishedBooks:{paginationCount:9,paginationItems:[{type:"book",id:"10808",title:"Current Concepts in Dental Implantology",subtitle:"From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",slug:"current-concepts-in-dental-implantology-from-science-to-clinical-research",publishedDate:"July 27th 2022",editedByType:"Edited by",bookSignature:"Dragana Gabrić and Marko Vuletić",hash:"4af8830e463f89c57515c2da2b9777b0",volumeInSeries:11,fullTitle:"Current Concepts in Dental Implantology - From Science to Clinical Research",editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić",profilePictureURL:"https://mts.intechopen.com/storage/users/26946/images/system/26946.png",institutionString:"University of Zagreb",institution:{name:"University of Zagreb",institutionURL:null,country:{name:"Croatia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9493",title:"Periodontology",subtitle:"Fundamentals and Clinical Features",coverURL:"https://cdn.intechopen.com/books/images_new/9493.jpg",slug:"periodontology-fundamentals-and-clinical-features",publishedDate:"February 16th 2022",editedByType:"Edited by",bookSignature:"Petra Surlin",hash:"dfe986c764d6c82ae820c2df5843a866",volumeInSeries:8,fullTitle:"Periodontology - Fundamentals and Clinical Features",editors:[{id:"171921",title:"Prof.",name:"Petra",middleName:null,surname:"Surlin",slug:"petra-surlin",fullName:"Petra Surlin",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:"University of Medicine and Pharmacy of Craiova",institution:{name:"University of Medicine and Pharmacy of Craiova",institutionURL:null,country:{name:"Romania"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9588",title:"Clinical Concepts and Practical Management Techniques in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/9588.jpg",slug:"clinical-concepts-and-practical-management-techniques-in-dentistry",publishedDate:"February 9th 2022",editedByType:"Edited by",bookSignature:"Aneesa Moolla",hash:"42deab8d3bcf3edf64d1d9028d42efd1",volumeInSeries:7,fullTitle:"Clinical Concepts and Practical Management Techniques in Dentistry",editors:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",institutionURL:null,country:{name:"South Africa"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8202",title:"Periodontal Disease",subtitle:"Diagnostic and Adjunctive Non-surgical Considerations",coverURL:"https://cdn.intechopen.com/books/images_new/8202.jpg",slug:"periodontal-disease-diagnostic-and-adjunctive-non-surgical-considerations",publishedDate:"February 5th 2020",editedByType:"Edited by",bookSignature:"Nermin Mohammed Ahmed Yussif",hash:"0aee9799da7db2c732be44dd8fed16d8",volumeInSeries:6,fullTitle:"Periodontal Disease - Diagnostic and Adjunctive Non-surgical Considerations",editors:[{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",institutionString:"MSA University",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8837",title:"Human Teeth",subtitle:"Key Skills and Clinical Illustrations",coverURL:"https://cdn.intechopen.com/books/images_new/8837.jpg",slug:"human-teeth-key-skills-and-clinical-illustrations",publishedDate:"January 22nd 2020",editedByType:"Edited by",bookSignature:"Zühre Akarslan and Farid Bourzgui",hash:"ac055c5801032970123e0a196c2e1d32",volumeInSeries:5,fullTitle:"Human Teeth - Key Skills and Clinical Illustrations",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:{id:"52177",title:"Prof.",name:"Farid",middleName:null,surname:"Bourzgui",slug:"farid-bourzgui",fullName:"Farid Bourzgui",profilePictureURL:"https://mts.intechopen.com/storage/users/52177/images/system/52177.png",biography:"Prof. Farid Bourzgui obtained his DMD and his DNSO option in Orthodontics at the School of Dental Medicine, Casablanca Hassan II University, Morocco, in 1995 and 2000, respectively. Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Prosthodontics and Implant Dentistry",value:2,count:3},{group:"subseries",caption:"Oral Health",value:1,count:6}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:3},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:245,paginationItems:[{id:"196707",title:"Prof.",name:"Mustafa Numan",middleName:null,surname:"Bucak",slug:"mustafa-numan-bucak",fullName:"Mustafa Numan Bucak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196707/images/system/196707.png",biography:"Mustafa Numan Bucak received a bachelor’s degree from the Veterinary Faculty, Ankara University, Turkey, where he also obtained a Ph.D. in Sperm Cryobiology. He is an academic staff member of the Department of Reproduction and Artificial Insemination, Selçuk University, Turkey. He manages several studies on sperms and embryos and is an editorial board member for several international journals. His studies include sperm cryobiology, in vitro fertilization, and embryo production in animals.",institutionString:"Selçuk University, Faculty of Veterinary Medicine",institution:null},{id:"90846",title:"Prof.",name:"Yusuf",middleName:null,surname:"Bozkurt",slug:"yusuf-bozkurt",fullName:"Yusuf Bozkurt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/90846/images/system/90846.jpg",biography:"Yusuf Bozkurt has a BSc, MSc, and Ph.D. from Ankara University, Turkey. He is currently a Professor of Biotechnology of Reproduction in the field of Aquaculture, İskenderun Technical University, Turkey. His research interests include reproductive biology and biotechnology with an emphasis on cryo-conservation. He is on the editorial board of several international peer-reviewed journals and has published many papers. Additionally, he has participated in many international and national congresses, seminars, and workshops with oral and poster presentations. He is an active member of many local and international organizations.",institutionString:"İskenderun Technical University",institution:{name:"İskenderun Technical University",country:{name:"Turkey"}}},{id:"61139",title:"Dr.",name:"Sergey",middleName:null,surname:"Tkachev",slug:"sergey-tkachev",fullName:"Sergey Tkachev",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61139/images/system/61139.png",biography:"Dr. Sergey Tkachev is a senior research scientist at the Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia, and at the Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia. He received his Ph.D. in Molecular Biology with his thesis “Genetic variability of the tick-borne encephalitis virus in natural foci of Novosibirsk city and its suburbs.” His primary field is molecular virology with research emphasis on vector-borne viruses, especially tick-borne encephalitis virus, Kemerovo virus and Omsk hemorrhagic fever virus, rabies virus, molecular genetics, biology, and epidemiology of virus pathogens.",institutionString:"Russian Academy of Sciences",institution:{name:"Russian Academy of Sciences",country:{name:"Russia"}}},{id:"310962",title:"Dr.",name:"Amlan",middleName:"Kumar",surname:"Patra",slug:"amlan-patra",fullName:"Amlan Patra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/310962/images/system/310962.jpg",biography:"Amlan K. Patra, FRSB, obtained a Ph.D. in Animal Nutrition from Indian Veterinary Research Institute, India, in 2002. He is currently an associate professor at West Bengal University of Animal and Fishery Sciences. He has more than twenty years of research and teaching experience. He held previous positions at the American Institute for Goat Research, The Ohio State University, Columbus, USA, and Free University of Berlin, Germany. His research focuses on animal nutrition, particularly ruminants and poultry nutrition, gastrointestinal electrophysiology, meta-analysis and modeling in nutrition, and livestock–environment interaction. He has authored around 175 articles in journals, book chapters, and proceedings. Dr. Patra serves on the editorial boards of several reputed journals.",institutionString:null,institution:{name:"West Bengal University of Animal and Fishery Sciences",country:{name:"India"}}},{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.png",biography:"László Babinszky is Professor Emeritus, Department of Animal Nutrition Physiology, University of Debrecen, Hungary. He has also worked in the Department of Animal Nutrition, University of Wageningen, Netherlands; the Institute for Livestock Feeding and Nutrition (IVVO), Lelystad, Netherlands; the Agricultural University of Vienna (BOKU); the Institute for Animal Breeding and Nutrition, Austria; and the Oscar Kellner Research Institute for Animal Nutrition, Rostock, Germany. In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain.Dr. Satué is accredited as a Private University Doctor Professor, Doctor Assistant, and Contracted Doctor by AVAP (Agència Valenciana d'Avaluació i Prospectiva) and currently, as a full professor by ANECA (since January 2022). To date, Katy has taught 22 years in the Department of Animal Medicine and Surgery at the CEU-Cardenal Herrera University in undergraduate courses in Veterinary Medicine (General Pathology, integrated into the Applied Basis of Veterinary Medicine module of the 2nd year, Clinical Equine I of 3rd year, and Equine Clinic II of 4th year). Dr. Satué research activity is in the field of Endocrinology, Hematology, Biochemistry, and Immunology in the Spanish Purebred mare. She has directed 5 Doctoral Theses and 5 Diplomas of Advanced Studies, and participated in 11 research projects as a collaborating researcher. She has written 2 books and 14 book chapters in international publishers related to the area, and 68 scientific publications in international journals. Dr. Satué has attended 63 congresses, participating with 132 communications in international congresses and 19 in national congresses related to the area. Dr. Satué is a scientific reviewer for various prestigious international journals such as Animals, American Journal of Obstetrics and Gynecology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology, among others. Since 2014 she has been responsible for the Clinical Analysis Laboratory of the CEU-Cardenal Herrera University Veterinary Clinical Hospital.",institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"439435",title:"Dr.",name:"Feda S.",middleName:null,surname:"Aljaser",slug:"feda-s.-aljaser",fullName:"Feda S. Aljaser",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"423023",title:"Dr.",name:"Yosra",middleName:null,surname:"Soltan",slug:"yosra-soltan",fullName:"Yosra Soltan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"349788",title:"Dr.",name:"Florencia Nery",middleName:null,surname:"Sompie",slug:"florencia-nery-sompie",fullName:"Florencia Nery Sompie",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sam Ratulangi University",country:{name:"Indonesia"}}},{id:"428600",title:"MSc.",name:"Adriana",middleName:null,surname:"García-Alarcón",slug:"adriana-garcia-alarcon",fullName:"Adriana García-Alarcón",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428599",title:"MSc.",name:"Gabino",middleName:null,surname:"De La Rosa-Cruz",slug:"gabino-de-la-rosa-cruz",fullName:"Gabino De La Rosa-Cruz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428601",title:"MSc.",name:"Juan Carlos",middleName:null,surname:"Campuzano-Caballero",slug:"juan-carlos-campuzano-caballero",fullName:"Juan Carlos Campuzano-Caballero",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}}]}},subseries:{item:{id:"10",type:"subseries",title:"Animal Physiology",keywords:"Physiology, Comparative, Evolution, Biomolecules, Organ, Homeostasis, Anatomy, Pathology, Medical, Cell Division, Cell Signaling, Cell Growth, Cell Metabolism, Endocrine, Neuroscience, Cardiovascular, Development, Aging, Development",scope:"Physiology, the scientific study of functions and mechanisms of living systems, is an essential area of research in its own right, but also in relation to medicine and health sciences. The scope of this topic will range from molecular, biochemical, cellular, and physiological processes in all animal species. Work pertaining to the whole organism, organ systems, individual organs and tissues, cells, and biomolecules will be included. Medical, animal, cell, and comparative physiology and allied fields such as anatomy, histology, and pathology with physiology links will be covered in this topic. Physiology research may be linked to development, aging, environment, regular and pathological processes, adaptation and evolution, exercise, or several other factors affecting, or involved with, animal physiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11406,editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"306970",title:"Mr.",name:"Amin",middleName:null,surname:"Tamadon",slug:"amin-tamadon",fullName:"Amin Tamadon",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002oHR5wQAG/Profile_Picture_1623910304139",institutionString:null,institution:{name:"Bushehr University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",institutionURL:null,country:{name:"Spain"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",institutionString:null,institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",institutionString:null,institution:{name:"Alexandria University",institutionURL:null,country:{name:"Egypt"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",institutionString:"Kafkas University",institution:{name:"Kafkas University",institutionURL:null,country:{name:"Turkey"}}}]},onlineFirstChapters:{paginationCount:2,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:13,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}}]},publishedBooks:{paginationCount:2,paginationItems:[{type:"book",id:"9883",title:"Biosensors",subtitle:"Current and Novel Strategies for Biosensing",coverURL:"https://cdn.intechopen.com/books/images_new/9883.jpg",slug:"biosensors-current-and-novel-strategies-for-biosensing",publishedDate:"May 5th 2021",editedByType:"Edited by",bookSignature:"Luis Jesús Villarreal-Gómez and Ana Leticia Iglesias",hash:"028f3e5dbf9c32590183ac4b4f0a2825",volumeInSeries:11,fullTitle:"Biosensors - Current and Novel Strategies for Biosensing",editors:[{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6843",title:"Biomechanics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6843.jpg",slug:"biomechanics",publishedDate:"January 30th 2019",editedByType:"Edited by",bookSignature:"Hadi Mohammadi",hash:"85132976010be1d7f3dbd88662b785e5",volumeInSeries:4,fullTitle:"Biomechanics",editors:[{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",institutionURL:null,country:{name:"Canada"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},testimonialsList:[{id:"18",text:"It was great publishing with IntechOpen, the process was straightforward and I had support all along.",author:{id:"71579",name:"Berend",surname:"Olivier",institutionString:"Utrecht University",profilePictureURL:"https://mts.intechopen.com/storage/users/71579/images/system/71579.png",slug:"berend-olivier",institution:{id:"253",name:"Utrecht University",country:{id:null,name:"Netherlands"}}}},{id:"27",text:"The opportunity to work with a prestigious publisher allows for the possibility to collaborate with more research groups interested in animal nutrition, leading to the development of new feeding strategies and food valuation while being more sustainable with the environment, allowing more readers to learn about the subject.",author:{id:"175967",name:"Manuel",surname:"Gonzalez Ronquillo",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",slug:"manuel-gonzalez-ronquillo",institution:{id:"6221",name:"Universidad Autónoma del Estado de México",country:{id:null,name:"Mexico"}}}},{id:"8",text:"I work with IntechOpen for a number of reasons: their professionalism, their mission in support of Open Access publishing, and the quality of their peer-reviewed publications, but also because they believe in equality.",author:{id:"202192",name:"Catrin",surname:"Rutland",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",slug:"catrin-rutland",institution:{id:"134",name:"University of Nottingham",country:{id:null,name:"United Kingdom"}}}}]},submityourwork:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],subseriesList:[],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"August 3rd, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:107,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/212243",hash:"",query:{},params:{id:"212243"},fullPath:"/profiles/212243",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)}()