Modified classification of infected aortic aneurysms according to Wilson et al. [14].
\r\n\t
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Despite the digital divide, the underdeveloped and developing countries have also been transformed by ICT and the evolution of it. In the age of the internet and micro-screens, a whole generation of new communication professionals and young people marked by the use of these technologies has grown up. Specifically, the ways of consuming cultural products and the media have undergone a major renovation following the substantial rise in the use of personal computers, Internet and smartphones. At the start of the new millennium, Castells [1] called attention to the structural changes caused by ICT and the emergence of a new global society based on the establishment of networks: “The convergence of social evolution and technology has created a new base for carrying out activities throughout the social structure. This material base, composed of networks, marks the dominant social processes” (p. 3).
Even today, and supported by ICT and their high inclusion power, in Latin America, an “imperialist culture” is maintained, defined by Petras ([2], p. 145) as “the systematic penetration of the rules of the dominant classes of the West” and based on “the significant construction of social acts and the historical particularity of human culture” ([3], p. 22). McLuhan suggests the complete ecological unity that exists in the interaction between the physics of the media and the metaphysics of culture [4].
In Cuba, not only journalists, but all of Cuban society, are inserted into a national context where there are major technological limitations, caused by the economic problems of the nation and, to a large extent, due to the isolation caused by the US embargo, tightened at the beginning of 2019 by US policies towards Cuba through the activation of Title III of the Helms-Burton Act by the Trump administration.
As a result of the dissolution of the USSR in 1991, Cuba lost its main market and underwent a deep economic crisis, which caused irreparable damage to the functioning of much of the media and all social spheres. During this period of time, called the “Special Period”, old evils overcome by the 1959 Revolution returned to life on the Island: poverty, loss of moral values and development of the black market, among other adversities. These events marked “the beginning of a process that would shake the relative social homogeneity of life opportunities achieved” [5]. In this environment, the new technologies began to determine journalistic practice, the relationship between journalists and the Government, and the cultural and media consumption—as well as the “informal” consumption of contents.
In these circumstances, the “black market” became a consolidated space where distributors of audiovisual content in Cuba bypassed the media and the official cultural industry. In this way, the “banks”1 started to rent out movies in VHS format and the commercialization of the so-called “cables”, which connected different houses to provide access to the same satellite antenna, then began the process of replacing VHS with DVDs as audiovisual support and “burners/sellers” of discs appeared. With this background, the so-called
As part of this alternative consumption of cultural, informative and entertainment products, the
Since the British Cultural studies placed context as a fundamental determinant to take into account in communication studies, it has become a fundamental element in the investigations that seek to establish the correlations between the different structural systems of a country. The Latin American perspective of cultural studies emphasizes the relationship between communication and culture because at the beginning of its implementation in the region, according to Mattelart and Neuveu [7], Latin America was still suffering the years of authoritarian regimes, or coming out of them to enter into the years of democratic transitions, between the failure of the progressive forces, not to mention the bloodshed that for the academic community lead to the tragic disappearance and exile of numerous researchers. As a consequence, Latin American thinkers were challenged to amalgamate their theories from the logic of the intersections: history had to be understood at the same time as economy, the dependence of the time and the collaboration of local elites with the dominators; it was necessary to understand the popular and residual at its intersection with the processes of codification of the dominant culture [8]. In this way, the paradigm of active reception was transcended, in order to experiment with the educational, commercial, informative and, above all, political content of the mass media, not because of the content itself, but because of the influence it has on the audience and the use that the sources of power—both democratic and factual—can make of them.
From the 1980s, the new political winds of the continent led to major breakdowns and theoretical shifts, shaping the main contributions in the field of cultural studies in the region. Previously, the Cuban Revolution had triumphed in 1959, decades later progressive governments emerged in several Latin American countries. In this context, the media are considered as a real part of the processes of social reproduction and a critical activity begins to confront the theoretical and methodological heritage that generated profound epistemological changes and gave life to a new conception of communication in which the role of government was fundamental. The theory of dependence appears, to bring to coalition issues such as the cultural penetration of imperialism in the continent, the cultural dominance that the American way of life entailed, and the subordination and domination of native cultures, among others. This movement advocated by a New World Order of Information and Communication, in which underdeveloped countries should establish national communication policies to protect cultural heritage.
The media were considered important diffusion instruments, by some, of the values and the dominant ideology; by others, of the modernization necessary to get out of underdevelopment [9]. In turn, evidence of the dominance of the “cultural industry” of the United States in Latin America accumulated. Despite any criticism for the Theory of Dependency, Gámez [9] points out how community radios, alternative newspapers and, in general, betting on popular communication appear as a means of stimulating the participation of the most exploited sectors. By understanding the cultural nature of mass communication, and legitimating it as a space for the production of meanings, the transmissive models are overcome and the active character of the individual is emphasized, whose consumption practices and meaning production will be conditioned by the sociohistorical environment in which it develops:
In this new scenario, and after the fall of the utopias that signified the collapse of the socialist experiences, disbelief is generated in the rigid/absolute schemas/conceptions. For this reason, the previous paradigms were questioned and the communication sciences, which had not managed to solve their methodological and epistemological challenges, began to reverse what they had held to be true. In this context, Jesús Martín-Barbero places “mediation” as one of the central and most systematic analytical categories within his studies. The theoretical proposal of this author opened the way to think about communication from two essential displacements: from media to mediations and from communication to culture.
Martín-Barbero [11] offers a broad conception of communication, which goes far beyond what concerns the media itself to the proposal that mediation becomes an essential category for analysis. This entails studying how culture is negotiated and how it is subject to transactions in a series of contexts, including cinema, popular press, television, radio, circus, musical performances and many others. Martín-Barbero suggests that the syncretic nature of popular practices is of great importance in Latin America. Such practices contribute both to preserve cultural identities and to adapt them to modern demands. Essentially, according to Schlesinger and Morris ([12], p. 8), “interest in mediations is a discourse on the formation of identities”.
Some thinkers consider that the contribution of Martín-Barbero [11, 13, 14, 15] and García Canclini [16, 17, 18, 19, 20, 21] has been fundamental in detecting the importance of the topic of “cultural consumption” at a time when the dominant preoccupation in the studies on culture and communication in Latin America was still the analysis of the messages in the mass media as a support of the “ideology of domination”.
According to Olivera and Salas [22], the psychological and sociological perspectives of the revolutionary communicative maneuvers self-endorsed through “the mimetic contamination of the Cuban Social Sciences with the Marxist-Leninist theoretical currents arrived from the socialist field” (p. 5). The area of communication was doubly affected, because in the USSR this scientific field was not as developed as other fields. As a consequence of the importation of foreign models, these authors claim that “the autochthonous theoretical development, the critical examination of the different objects of study and the theoretical updating of the researchers was limited, and the existence of a left functionalism was generated” (p. 6); to the point where all scientific fields suffered from too strong a dependence on state guidelines: “The research practices were very permeated by the ideology assumed from the political power and less influenced by an epistemological vision” (p. 7). An affirmation that agrees with the criterion of Linares and Rivero ([23], p. 7): “The state played the role of regulator par excellence in the construction of spaces of equality in all the fundamental areas of life, including recreational—cultural”.
This is a logic that, to this day in Cuba, continues to develop from more complex tactics and the increase of the new technological devices and the new discursive, relational and structural mediations between journalists, citizens and the government. For Castells [24], we live in a time that is expressed in a new information and communication system of global reach, of convergence of means and languages, and interactive, generated through the expansion of the internet and the new technologies of the information and communication, differentiated from the traditional media in regards to their reticular structure and digitalization. A context in which Canclini [20] especially emphasizes cyberspace as a sphere in which all types of language coexist and which has caused a readjustment in the ways of understanding communication and interpreting the sociocultural practices of the subjects: “This contamination between audience behaviors is even more versatile on the Internet, where the boundaries between eras and educational levels blur” (p. 30).
At this point, it is important to clarify that, despite there being cultural policies directed from the state to expand the links between Cuban population, education, culture and revolutionary ideology, “there is no direct and unilateral relationship between institutional efforts and behavior of the subjects” ([20], p. 63). Cuba, like every country with scarce financial resources, is late to most of the technological advances. Hence, the well-known “digital gap”, which separates the technological context of the developed world from territories with little monetary capital, has widened in the Island due to the policy of isolation of the revolutionary government itself and the economic embargo imposed on Cuba by the United States. Specifically, there is an external digital gap when compared with other nations, and an internal one due to differences in access between citizens themselves.
However, the relative absence of internet and other ICTs in Cuba does not have a high impact due to the high standard training of citizens in mathematical knowledge and reading and writing. A very important aspect to take into account is that the digital gap should not be measured only in terms of availability of technological resources, but also human resources and, in this sense, the Cuban population does not deviate far from the First World. According to Pedro Urra (2015, personal interview), it is not enough to own the equipment, it must also be known how to make the most of it. The most important issue does not lie in the possession of devices, because this is not as serious as the ignorance of languages. In addition, the first could be solved if the political strategy for the distribution of ICTs in Cuba were changed. If there were a national policy that promoted social, community, family and individual access to new technologies, with a less instrumental and political vision, they could be used in a more active and innovative way. Therefore, while it is relevant to highlight Cuba’s achievements in digital literacy, it is also important to recognize that, as long as ICTs are not overcrowded, the potential skill of the population will not be fully manifested.
One of the main limitations of official media was and is the excessive control exerted by the state’s management over it. Gustavo Arcos (2015, personal interview) highlight that this could provoke a certain priority for the transmission of materials with a high political content during audience’s preferred periods of relaxation: “Media are excessively controlled by the Ideological Department [of the Communist Party of Cuba], which governs, determines and conditions contents. It has as a consequence that many topics provided by official media do not take into account the needs of the public. That’s when alternative businesses thank those responsible for programming, as the public come to them to satisfy their moments of leisure and relaxation”.
The “corseted” programming, technical deficiencies, and the lack of adaptation to the needs and tastes of the audience, favored the proliferation of “alternative” platforms. Although “there was a time when the importation of VHS players was prohibited, with a very simple idea based on restricting the entry of this equipment into the country” (Pedro Urra, 2015, personal interview).
However, as Pedro Urra continues affirming, “this was a failed attempt to control the use of media linked to the mass consumption of information […]. Parts of the new technologies were massified through the alternative market, because there was no state means of acquiring them. This was due to the absence of a policy for the use of ICTs at the population level”.
From the 1990s, with the popularization of Betamax lecto-recording equipment and Video Home System (VHS), the so called “film libraries” (
Barrera [25] points out that
In the first decade of this century, large external storage disks with USB connection reached the IT market. This technology still coexists with the DVD in the Cuban market of informal distribution, however, large hard drives will end up replacing DVDs due to their greater capacity for storing information. The displacement of one technology by another is a gradual and inexorable process, therefore, although in the alternative distribution both forms still coexist, it is a question of time until the most advanced relegate those with less capacity.
The alternative consumption of cultural, informative and entertainment products is a phenomenon rooted in Cuban society almost 20 years before the existence of the
“The
Although the scope of the
A pertinent example of the complexity of the production and distribution system of cultural material and leisure in Cuba was the controversy sparked by the film
The
The great unknown about this product is its realization. With the aforementioned technological limitations, the ways used to download a Terabyte of information every week are a mystery: “How can hundreds of gigabytes of video information be obtained, often within a few hours of the original transmission?” Asks Dean Luis Reyes [28] in his article
The variety and quantity of materials is not the only outstanding feature, Vladia Rubio [29], on the
In the press, the
We need to specify exactly what the
So wide has been the scope of this product in Cuba in recent years, which, according to the Doctor of Communication Sciences and vice president of the Union of Journalists of Cuba (UPEC), Rosa Miriam Elizarde (2015, personal interview), has come to establish patterns in the consumption model of the Island that could determine the interaction with broadband internet: “Cultural consumption on that platform is marked and has to deal with the forms, tastes and interests of consumption that conform with the
This is a readjustment aimed at adjusting the territorial inequalities based on the distribution of natural resources, the strategic importance of the space, and the political-administrative decisions of the state [5].3
According to a study carried out in 2015 by the Social Research Center of the Radio and Television Institute (CIS) [31], the
The relevance achieved by the
On this lack and the absence of works on the consolidation of this “informal system”, which are transparent, rigorous and with impact on the spheres of power, the critic and researcher Juan Antonio García Borrero [33] delves deeper:
Due to the importance of this product, it is pertinent to carry out studies that characterize the informal consumption of contents included in the
One thing is certain, the
The
Intellectuals, directors of cultural institutions and researchers have publicly referred to this phenomenon, either through congresses, debates or press articles. A number stand out among these: Abel Prieto, Rafael Hernandez, Rebeca Chávez, Juan Antonio García Borrero, Cecilia Linares, Gustavo Arcos, Milena Recio, Mario Masvidal, Rolando Pérez Betancourt, Víctor Fowler, Dean Luis Reyes, Fernando Ravsberg and Omar Olazábal.
Above all, after the issue was addressed during April 2014, at the VIII Congress of the UNEAC, where the then advisor to the Council of state and former Minister of Culture, Abel Prieto (in
One of the main evidences of Cuba’s packaging is mentioned by the researcher and professor at the University of Havana, Laura Domínguez (2015, personal interview), who considers that the state offering is incapable of equaling the private one: “If we analyze Cuban TV, I do not think it is up to competing with the
The proposal of this chapter as a contribution to the cultural studies in Latin America is part of the idea that the decolonial turn in this region arises from the need of “changing the way of changing”, which entails an “epistemic declassification” (
Hence in Cuba, media, both official and private, and the academy [37, 38, 39] recognize the great ideological influence and the extent of consumption of the
This is a disjunctive that affects the country and citizens in general, but that directly concerns the group of journalists on the Island. The main friction between alternative platforms of cultural contents, like the
Similarly, the official media and journalists working on them are aware of their inability to face the information and entertainment offer of these alternative platforms that have the
It is a challenge for the new government, official institution and media, and journalists due to the diverse, dynamic and complex nature of this phenomenon; for the encompassing, deregulated and changing of this type of cultural practices, which include multiple social, economic, legal and, above all, political processes. Even more so in a country where the socialist values of the revolution, infused into society, have been based on collective and communal needs.
The current reality is that the social uses of the contents of the
The consumption of the
Infected aortic aneurysms, also known as “mycotic aortic aneurysms” (or microbial arteritis with aneurysms) are most commonly caused by bacterial infections. Around 1% of arterial aneurysms may be associated with an arterial infection. Although the prevalence of mycotic aortic aneurysms (MAAs) is low, its clinical impact may be severe and represents one of the most difficult arterial diseases to treat successfully.
\nIn the early nineteenth century, Jean Nicolas Corvisart coined the term “vegetation” as it resembled a cauliflower, describing organic lesions of the heart. In his monograph, presented in 1806, Corvisart wrote that he had observed six cases of valve disease with vegetations [1].
\nSome years later, in 1815, Joseph Hodgson performed some illustrations of ulcerating/perforating aortic valve endocarditis. He described the valve vegetations as “wart-like excrescences” using the term “fungus” in a patient who presented with an aortic root abscess. This report was probably the first to document peripheral embolization [2].
\nIn 1852, a British physician, William Kirkes, described that fibrinous fragments of valve vegetations were found in the kidneys, cerebral artery, and spleen in patients presenting with fever, heart murmur, purple skin spots, and skin nodules (later called “Osler nodules” by Emanuel Libman). He described how these fragments could be detached from the heart valves, passed into the blood, and may be arrested in the aorta or its branches [3, 4].
\nThe suggestion of an infection point of entry and transportation by blood flow was reinforced by a pioneering microbiologist, Edwin Klebs. In 1878, he suggested that cases of endocarditis were always due to an infectious organism [5].
\nThe first complete description of an infected aneurysm was presented in 1885 by Osler. He presented the first broad report of this entity with a complete description of clinical and anatomical features of infective endocarditis as the cause of these arterial infections. The report included clinical features, anatomical location in the aorta, and cases of “ulcer formation and perforation of the aorta with production of multiple aneurysms” [6].
\nThere were some other early reports that explained how infected aortitis was nearly always secondary to endocarditis [3, 5, 7, 8]. In another report published in 1923, a series of 217 patients with mycotic aneurysms was presented, showing that 86% of mycotic aneurysms were associated with infective endocarditis [9]. Although most infected aneurysms are due to bacterial infections, the term “mycotic,” which is still misleading, is used to describe these aneurysms that arise after an inflammatory destruction of the arterial wall happens associated to arterial embolization. A wide variety of terminologies have been used to describe infected aortic aneurysms, although most of them have not received a great acceptance. Some of these include mycotic aortic aneurysms (MAAs), suppurative arteritis, septic aortic pseudoaneurysm (SAP), cryptogenic mycotic aneurysm, and microbial arteritis with aneurysms [10, 11, 12, 13].
\n\nTable 1 includes a previous classification of infected aneurysms (Table 1) [14]. The main etiology of MAAs is considered to be similar to that of arterial aneurysms and includes the following:
\n
\n
\n
\n
\n
\n | Mycotic aneurysm | \nInfected aneurysm | \nMicrobial arteritis | \nTraumatic infected pseudoaneurysm | \nContiguous septicemia | \n
---|---|---|---|---|---|
Etiology | \nEndocarditis | \nBacteremia | \nBacteremia | \nTraumatic | \nBacteremia | \n
Location | \nAny vessel | \nDistal aorta | \nAortoiliac | \nFemoral, carotid | \nAortoiliac | \n
Age | \n30–50 | \n>50 | \n>50 | \n<30 | \n>50 | \n
Sex | \nF > M | \nM | \nM | \nM/F | \nM/F | \n
Incidence | \nRare | \nUnusual | \nCommon | \nCommon | \nUnusual | \n
Number | \nMultiple | \nSingle | \nSingle | \nMultiple | \nMultiple | \n
Bacteriology | \n\n | \n\n | \n\n | \n\n | \n\n |
Modified classification of infected aortic aneurysms according to Wilson et al. [14].
\n
Some important risk factors for development of MAAs include some of the following:
\n
\n
\n
Infected arterial aneurysms are relatively uncommon and can affect very different anatomical location and practically any artery. Depending on different studies presented in the literature, the most common sites for mycotic arterial aneurysms are the aorta and the intracranial cerebral arteries. Following Baddour publication in 2015, regarding an American Heart Association (AHA) statement report on infective endocarditis (IE) in adults, the most common site of mycotic aneurysms was the intracranial arteries, with an incidence of 1.5–5% of cases, and an overall mortality among those with IE of 60% [17]. Some other series have reported similar findings, with intracranial arteries being the most common site for mycotic aneurysms (especially the middle cerebral artery), with and incidence of symptomatic peripheral mycotic aneurysms of 1–5% [19].
\nSome other reports have published that the higher incidence sites of infected aneurysms are the abdominal aorta, followed by peripheral arteries (typically occurring at bifurcation sites), cerebral arteries, and visceral arteries, in descending order of frequency [20]. On the other hand, previous historical series have reported that the abdominal aorta was the second most common site of aneurysm infection, with the common femoral artery being the most common site [21].
\nMycotic aneurysms of coronary arteries are rare, but have also been described. González et al. performed a review including 922 cases of definite infective endocarditis (IE), and reported a 2% rate of symptomatic peripheral mycotic aneurysms. In their review, 66% of mycotic aneurysms were intracranial (in the region of the middle cerebral artery) and 34% were extracranial [19].
\nWith regard to infected aneurysms of the aorta, most reported series have less than 50 patients. Most series concur that the most common aortic location for infected aneurysms of the aorta is the infrarenal aorta, with a similar distribution of cases between the aortic arch and descending aorta.
\nOne of the largest series involving MAAs presented 36 cases of aortic infection, with the following epidemiology data: infrarenal aortic aneurysm in 15 patients (42%), a suprarenal aneurysm in 3 (8%), a thoracic aneurysm in 5 (14%), and a thoracoabdominal (TAAA) in 13 (36%) [22].
\nA large multicenter European study was published in 2014, where data from 123 patients with 130 identified MAAs were analyzed. Similar epidemiologic findings were found, with infrarenal location being the most common (51%), followed by descending MAAs (28%), paravisceral (12%), multiple MAAs (6%), and arch MAAs (3%) [23].
\nPrimary MAAs are a challenging and very complex vascular pathology. Although they represent a small proportion of patients within all aortic aneurysms, when left untreated, they almost always develop into rupture or lethal complications. Without treatment, there is a very high level of lethal complications, including aortic rupture, abscess formation, and sepsis [17].
\nWith regard to bacteriological patterns in infected aortic aneurysms, there have been some changes in bacterial patterns depending on the published series decade. Some initial studies on aortic infection have presented their results confirming
This change in bacteriologic patterns was already observed in the early 1980s, when comparing those series from before 1965 and those from after 1965. Collected series from English language reported before 1984 (178 patients with 243 MAAs) showed that
Some current series have presented a much higher incidence of Gram-negative organisms compared with older series, with Gram-negative microorganisms seen in up to 35% of cases. Different groups have described a higher incidence of aneurysm rupture and mortality in those patients with Gram-negative infections compared with Gram-positive organisms. Aortic aneurysms with
Although bacteriologic patterns continue to evolve,
Depending on the different series, anatomical location, and geographic area, blood cultures have been found to be positive in 50–85% of patients, with organisms being able to be isolated from the aneurysmal tissue in 62–76% of patients [23, 24, 25, 26].
\nSome reviews have related mortality with the type of microorganism involved in aortic infections. In a series of 22 patients who presented with aortic aneurysmal infection, mortality was 36% in those with
Symptoms of mycotic aortic aneurysms are very commonly nonspecific in the initial development of the disease. Patients with MAAs often present with fever of unknown cause. Many series have reported fever as the most common presenting sign of MAAs. These patients with febrile illness frequently present with insidious onset, apathy, weight loss, and general malaise [24].
\nA high index of suspicion is of great importance in order to avoid delay in diagnosis, as the natural history of most of these untreated mycotic aortic aneurysms is fatality. The most common causes of death in these patients are lethal sepsis or massive hemorrhage due to rupture [24, 31].
\nA vast majority of patients are symptomatic at the time of diagnosis. Most groups have outlined rates of MAAs as symptomatic on diagnosis involving 93–100% of cases [28, 31]. One of the most common symptoms at the time of initial evaluation is localized pain. When present, pain is most commonly localized in the abdomen, chest, or back. Some groups have reported pain as the most common initial clinical symptom of MAAs, in up to 88% of patients [28, 32]. It has been previously reported that the classic triad of mycotic aortic aneurysms includes fever, pulsatile mass, and back pain. This triad has been described in around 40% of patients [31].
\nOther manifestations have been described associated to MAAs, including the following:
Rupture
Expanding hematoma
Intraabdominal retroperitoneal hematomas usually produce hypovolemic shock. In cases of infected aortoiliac or associated mycotic femoral aneurysms, superficial expanding hematomas might be seen.
Acute ischemia of the lower limbs
Embolization is a common clinical sign that increases limb loss and mortality rates.
Mesenteric ischemia
Infected pararenal of thoracoabdominal aortic aneurysms (TAAA) involving the superior mesenteric artery (SMA) may cause acute thrombosis of the SMA or embolization into the distal mesenteric branches, leading to intestinal ischemia.
Osteomyelitis
Infection of the aorta may produce contiguous infection of the lumbar or thoracic vertebra. Interchangeably, a bone infection affecting the vertebra may provoke an infection of an aortic aneurysm.
Gastrointestinal bleeding
Although rare, primary aorto-duodenal fistula may occur due to an infected aortic aneurysm, when erosion of the vessel affects the third portion of the duodenum. Erosion and rupture of a MAA into a gastrointestinal structure, such as the esophagus or appendix, have also been described.
Intraabdominal abscess
Hemoptysis, dysphagia, and hoarseness
Rupture of a mycotic thoracic aortic aneurysm or pseudoaneurysm, or aortobronchial fistula formation may lead to hemoptysis [33].
Heart failure
Compression
Constriction or displacement of nearby structures may be present due to MAAs.
Although inflammation is frequently associated with aortic aneurysms, the classical appearance of an AAA needs to be differentiated from aortic aneurysms that are infected. Also mycotic aneurysms need to be addressed and distinguished from a clinical entity known as “inflammatory aneurysms.”
\nApproximately 3–10% of abdominal aortic aneurysms are characterized by increased inflammation surrounding the aneurysm. These inflammatory abdominal aortic aneurysms (IAAA) are typically differentiated from common AAAs by certain features. These include a classical description of periaortic inflammation as a white gleaming fibrotic surface with a thickened aneurysmal wall [34].
\nOther common features of IAAAs include major adhesions and fibrosis of close anatomical structures, such as the duodenum and ureters. This fibrosis commonly leads to indistinct retroperitoneal tissue planes on imaging studies.
\nThe classic triad of IAAAs includes abdominal pain, weight loss, and elevation of inflammatory markers (CRP, ESR). Inflammatory aortic aneurysms are not associated with periaortic air or fluid and are not infected (tissue samples and blood cultures are negative).
\nThe diagnosis of mycotic aortic aneurysms might be very challenging. In the presence of fever, general malaise, and a pulsatile abdominal mass or aortic aneurysm in imaging testing, a MAA should be suspected and investigated. An early diagnosis of MAAs is essential as it is associated with a high rate of hemorrhage due to rupture and high rate of early sepsis and mortality. Once a MAA is suspected, the patient should be investigated with laboratory testing and imaging studies.
\nVarious definitions have been proposed for the diagnosis of mycotic aneurysms, including clinical, laboratory and radiological features.
\nMost series agree that the definition of mycotic aortic aneurysm should include at least two of the following criteria:
Fever, sepsis, or localized pain.
Abnormal laboratory findings (elevated white cell count: WBC, C-reactive protein: CRP, or erythrocyte sedimentation rate: ESR).
Positive blood or aortic tissue cultures.
Specific radiologic findings, including: periaortic soft tissue air, fluid, or mass, saccular/multilobular aneurysm or pseudoaneurysm.
Some groups have used specific definitions to delineate mycotic aortic aneurysms, including all of the following: fever or sepsis, abnormal laboratory findings (elevated CRP or white cell count), positive blood cultures, and radiologic studies showing a false aneurysm (with or without stranding), periaortic fluid, or air around the aorta [35]. Common radiologic (CT and MRI) features of MAAs are an irregular aortic wall, a lobulated vascular periaortic mass, and peri-aneurysmal gas/soft-tissue mass/edema.
\nAlthough blood cultures may be negative in around 25–50% of patients, negative blood cultures alone are not enough to rule out infected aneurysms, and diagnostic testing should be completed.
\nUltrasound scanning may be useful in diagnosing the presence of an aortic aneurysm, but it is not reliable for specific diagnosis of aortic infection. Digital subtraction angiography (DSA), besides being an invasive procedure, is not reliable for specific identification of features that suggest and diagnose an infected aneurysm.
\nImaging studies for detection of MAAs include computed tomography scan (CT) and multislice CT angiography with 3D reconstruction, as well as magnetic resonance imaging (MRI). For many groups, MRI with gadolinium enhancement is becoming the noninvasive imaging modality of choice for the diagnosis of acute or chronic aortitis.
\nNuclear medicine studies, including fluorodeoxyglucose-positron emission tomography (FDG-PET) and nuclear gallium scanning, are alternative modalities for evaluating mycotic aortic aneurysms that are becoming increasingly useful. PET-CT testing has a very high sensitivity and both high positive and negative predictive values for aortic graft infection, and also provides important information in the diagnosis of mycotic aneurysms [35].
\nCurrent imaging studies have reported variable sensitivities regarding FDG-PET. Most series have published specificities of 88–100% for 18F-FDG PET and PET-CT for diagnosing active inflammation in arteritis (Figure 1) [35, 36, 37].
\nCT scan showing a reconstruction of a distal infrarenal MAA (A). Fused frontal imaging of the contrast CT and FDG-PET scan showing highly elevated FDG uptake in the distal aorta (B).
There are very few classifications regarding infected aortic aneurysms. The author would like to add a new modified classification of MAAs (Table 2).
\n\n | MAA grade I | \nMAA grade II | \nMAA grade III | \nMAA grade IV | \n
---|---|---|---|---|
Radiologic findings | \n\n
| \nGrade I and periaortic edema | \nGrade I and periaortic gas | \nGrade I and rupture (*) | \n
Inflammatory markers (CRP and ESR) | \n+ | \n+ | \n+++ | \n+++ | \n
Aortic tissue | \n— | \n+/− | \n+ | \n+ | \n
Incidence | \nRare | \nVery rare | \nVery rare | \nVery rare | \n
Bacteriology | \nAbsent | \nPresent | \nPresent | \nPresent | \n
Ribé’s proposal of new modified classification of MAAs.
\n
Various groups recommend vancomycin plus an anti-Gram-negative antibiotic (for coverage of
In general, at least 6 weeks of intravenous plus oral antibiotics should be implemented. However, there are no data to support specific duration of antibiotic therapy. Several authors have advocated long-term oral antibiotics after hospital discharge for all patients undergoing intervention, especially those who underwent endovascular repair. If positive cultures are obtained from tissue samples, life-long antibiotic therapy should be considered [31, 32, 38, 39].
\nThe aneurysm should be dissected back to normal aortic tissue. Once the aneurysm has been resected, the proximal aorta should be oversewn with a nonabsorbable suture, ligated 1–2 cm proximally, and possible omental coverage, to prevent blowout of the arterial stump.
\nIn those cases where it is likely that the patient may develop acute ischemia after arterial ligation, immediate revascularization should be considered. Extra-anatomical bypass (axillobifemoral bypass graft) after aneurysm resection and stump closure has been traditionally used. Autogenous vein, antibiotic, and silver impregnated grafts are also used. Other reported options are femoral-popliteal deep veins, cryopreserved arterial allografts, and Dacron prosthetic grafts [39, 40, 41].
\nSome groups have described this technique of retrograde visceral revascularization (1, 2, 3, or 4 visceral vessels might be revascularized), followed by TEVAR/EVAR. The technique is performed through a midline laparotomy incision. When using the infrarenal aorta as the inflow vessel, a bifurcated 14 × 7 mm Dacron graft is prepared. Two side grafts (usually 6 mm Dacron grafts) are anastomosed to the lateral aspect of the bifurcated graft, to create the 4-graft retrograde bypass. Correct routing and fashioning of the grafts are crucial to avoid early graft thrombosis. The right branch (6–7 mm) is anastomosed to the right renal artery (RA). The right 7 mm graft would be anastomosed side-to-end to the coeliac axis (tunneled in a retropancreatic position). To avoid graft kinking, the left 7 mm graft is anastomosed in an end-to-side fashion to the SMA in a “lazy C” configuration [42].
\nEndovascular repair may be a suitable option for infected aortic aneurysms in high-risk patients, when open surgery mortality would be prohibitive. In cases of ruptured MAAs, endovascular repair may be an appropriate alternative, as a definitive treatment or until debridement and a final treatment may be performed. There is still ongoing controversy in the literature regarding the endovascular option as a main therapy or as an alternative [23, 30, 34, 39, 43].
\nProcedures are usually performed under epidural or general anesthesia, with open exposure of one or both common femoral arteries. In those undergoing TEVAR, cerebrospinal fluid (CSF) drainage should be considered in those patients with expected long thoracic segment coverage. Coverage of the left subclavian artery (LSA) is usually avoided unless completely necessary. Some authors have described aneurysm sac drainage after EVAR. The procedure is usually performed in a prone position. A 21-G needle is inserted into the aneurysm sac. Following dilation, a 14–16 Fr drainage catheter is used to aspirate and send the contents for microbiological analysis. Pryluck et al. consider that it might aid to decrease the infectious content of the aneurysm sac and effectively prevent late reinfection [44].
\nAlthough this chapter tries to focus on primary MAAs, infected aneurysms or pseudoaneurysms can also occur following prosthetic replacement of the aorta.
\nThe incidence of prosthetic aortic graft infection has been described in 0.5–2% of cases, including both early and delayed-onset complications [45]. All these prosthetic graft infections are associated with high morbidity and mortality rates. As previously described in the chapter, different surgical techniques have been described for repair of infected MAAs and aortic graft infection. Removal of all infected tissue and infected grafts are essential for a successful result.
\nPlastic surgery-reassembling procedures have also been described for coverage of arterial tissue after reconstruction, especially after infections involving the ascending aorta, aortic arch, and descending thoracic aorta. These procedures involve musculocutaneous pedicled flaps using various different muscles (including rectus abdominis, pectoralis major, latissimus dorsi, and vastus lateralis muscles) [46]. The application of these vascularized muscle and omental flaps by plastic surgeons, in conjunction with cardiothoracic and vascular surgeons, might be an important alternative for an adequate management of these prosthetic aortic infections. Omental flaps have been previously described as the most common applied type of autologous flap for coverage of ascending aorta, aortic arch, and descending thoracic aortic graft infections. Other options for wound closure in cases of infected prosthetic aortic grafts with associated wound infection include different types of vacuum-assisted closure (VAC) devices [46].
\nWe present here a report of 3 cases of MAAs treated in our center, with a description of the procedural techniques and outcomes.
\nThe first patient (JGR) was a 72-year-old male with a medical background of smoking, who was evaluated for fever and general malaise. Physical examination revealed an expansive abdominal pulsatile mass, with pain on palpation. Laboratory testing showed elevation of elevated WBC (22 × 103/μL), and inflammatory markers (CRP, ESR, and procalcitonin). CT angiogram revealed an infected infrarenal AAA, measuring 9.2 cm in diameter, with periaortic edema and gas (Figure 2). After cardiac, pulmonary, and renal evaluation, the patient was treated with an aorto-aortic silver-coated Dacron bypass graft. Blood cultures were positive for Staphylococcus aureus. After an uneventful recovery, he was discharged from hospital 10 days after surgery on long-term antibiotics.
\nPatient 1. Chest computed tomography (CT) scan presenting a 9-cm MAA in the infrarenal aorta. MAA compressing (white arrow) the duodenum (A). Sagittal, frontal, and sagittal planes (B).
The second patient (ABM) was a 66-year-old male with a medical history of chronic obstructive pulmonary disease (COPD), hypertension, and smoking. He was initially evaluated in the emergency department for hematochezia, fever, and abdominal pain. Physical examination showed a distended abdomen with an abdominal pulsatile mass. Laboratory testing showed markedly elevated inflammatory markers, including CRP and ESR. The patient presented sudden rectal bleeding and hypotension. Emergent CT angiography scan demonstrated a MAA at the level of the infrarenal aorta, with an associated primary aorto-enteric fistula (AEF) Figure 3.
\nPatient 2. Abdomen angiography CT scan showing an infrarenal MAA. Multilobular mass seen in axial (A) and sagittal (B) planes. Presence of an aortoenteric fistula (AEF) at the site (yellow arrow) of this MAA (C).
He was taken to the operating room and had an urgent open aortic and small bowel repair. An aorto-aortic straight bypass graft, using a silver-coated-Dacron graft, was performed. Repair of the fistula into the jejunum was carried out with resection of the perforated bowel, and end-to-end anastomosis of a non-affected segment of jejunum. A Jackson-Pratt drain was left for 6 postoperative days. Blood cultures and aortic tissue sample were both positive for
He had a follow-up at 1, 6, and 12 months. His last CT scan showed no signs of aortic infection, without elevation of inflammatory markers on laboratory testing. His latest physical examination revealed no vascular abnormalities.
\nThe third patient (RMS) was a 74-year-old male who was admitted with persistent back pain and fever. CT scan revealed a juxtarenal infected aortic aneurysm with gas within the aneurysmal sac, measuring 9 cm in diameter (Figure 4). Further preoperative MRI-imaging revealed spondylodiscitis at the level of the lumbar vertebra L3-L4 (Figure 4).
\nPatient 3. CT scan revealing a juxtarenal MAA with gas within the aneurysmal sac (B), measuring 9 cm in diameter (A). Magnetic resonance imaging (MRI) showing vertebral osteomyelitis (spondylodiscitis) in a sagittal plane, with bone erosion (red arrow) at the level of vertebral bodies L3-L4 (C).
The patient was taken to the operating room and underwent an aorto-aortic straight rifampicin-bonded Dacron bypass-graft. Subsequent aortic wall tissue and blood cultures were found to be both positive for
Since 2011, we have performed in our center a novel hybrid repair in 2 cases of mycotic aortic aneurysms (MAAs), one of them a primary juxtarenal MAA, and the other one a suspected inflammatory infrarenal aortic aneurysm. This hybrid repair consisted in a two-stage procedure, performed within at least one-month difference, or once inflammatory markers and radiologic imaging studies had normalized.
\nThe first stage of the procedure consisted in performing an open repair of the MAA, with interposition of a cryopreserved arterial allograft. This was done in 2 patients who presented with abdominal pain and a pulsatile mass on physical examination, with a CT angiogram that showed a contained ruptured aortic aneurysm in both cases. An aorto-aortic bypass graft using a cryopreserved arterial allograft was performed in both cases (Figure 5).
\nIntraoperative images showing the surgical preparation of the arterial aortic cryopreserved allografts (A and B).
In the second stage, an endoprosthesis (Zenith® stent graft, Cook Medical Inc., Bloomington, Indiana, USA) was implanted just below the renal arteries, in the infrarenal aorta, 1 month after the procedure in the first patient. In the second case, an aortic endoprosthesis (Zenith Flex® stent graft, Cook Medical Inc., Bloomington, Indiana, USA) was deployed in the infrarenal aorta, sealing the inside of the cryopreserved allograft, 6 months after the initial procedure.
\nWe believe that this alternative option might decrease the risk of rupture of the cryopreserved allograft anastomosis, which is a devastating complication of open repair of MAAs [23, 41].
\nTreatment of aortic infection is still one of the most challenging situations for a vascular surgeon to confront.
\nOpen extra-anatomic bypass revascularization combined with extensive debridement of all infected aortic and peri-aortic tissues, with excision of the infected aorta and oversewing of the non-infected aortic stump has been considered the standard treatment for aortic infection [22, 26, 31].
\nOpen surgical options include the use of antibiotic-soaked Dacron grafts, cryopreserved aortic allografts, and biological bovine pericardial materials. The use of the superficial femoral vein (SFV)and femoral or popliteal vein segments have also been used as an alternative to in situ reconstructions in aortic infections [26, 32]. Revascularizations using vein grafts have the advantage of a potential lower risk of infection/reinfection. SFV as an autologous material has shown excellent performance in terms of long-term infectious complications. The main disadvantage is that vein harvesting is time-consuming. Another possible disadvantage of using the SFV is its diameter discrepancy with the aorta, and the possible limitation of vein length. These vein reconstructions are also functional and durable on follow-up over time [47, 48, 49].
\nSome groups have presented lower rates of recurrent infection and lower morbidity and mortality rates associated with rifampicin-soaked Dacron grafts compared to those with untreated grafts [35, 45].
\nCryopreserved arterial allografts have the advantage of a higher resistance to infection, with low rates of reinfection. Techniques in cryopreservation have improved in the last decade, possibly contributing to better outcomes of revascularization using these allografts [35, 41, 50].
\nMAAs of the ascending aorta and aortic arch, without a past medical history of previous cardiac or cardiovascular surgery, are very rare. Macedo et al. reported an incidence of 2.6% of MAAs of the ascending aorta after a review of their more than 25-year experience with aortic mycotic aneurysms [51]. Descriptions of mycotic ascending aortic aneurysms or pseudoaneurysms in the literature are very scarce. MAAs of the thoracoabdominal aorta are also less common than those of the infrarenal aorta. Previous series have presented an incidence of primary infection of the thoracic and thoracoabdominal aorta affecting 0.7–4.5% of aortic aneurysms altogether [35]. Mycotic saccular, fusiform, and pseudoaneurysms of the ascending and descending thoracic aorta have been described in the literature. Repair of these aneurysms may be performed with different techniques, including cryopreserved arterial homografts, prosthetic antibiotic-soaked grafts, visceral debranching and endovascular stent-graft repairs, bovine pericardium patch grafts, and Dacron grafts with biological tissue coverage [35, 45, 52].
\nThe largest series of mycotic aortic aneurysms was presented by Heinola et al. in 2018. This international multicenter study included 187 patients. In their series, 51 patients (27%) were treated with open prosthetic repair, 56 (30%) with a biological material, and 80 were treated with EVAR (43%). Overall, open repairs were performed in 107 patients (57%) in this group, making this the largest series up to date on open aortic repair of MAAs [32]. In their analysis, blood and/or tissue culture were positive in 43 (77%) cases, 33 (59%) were positive for non-
The second largest study to date of open surgical treatment of mycotic aortic aneurysms (MAAs) was published in 2014 by Lin et al., including a group of 77 patients. In this study group, the in-hospital mortality rate was 10% (8/77) for patients who underwent open repair and 25% (2/8) for patients who underwent EVAR [27].
\nThe first report of endovascular aneurysm repair of a MAA was reported in 1998 by Semba et al. They reported no postoperative complications from persistent bacteraemia after a 24-month follow up, without postoperative mortality [53]. Since then, there have been various case reports and series of cases describing EVAR and TEVAR for the treatment of ruptured aortic aneurysms and MAAs and their outcomes [23, 30, 34, 38, 39, 53]. These series report favorable results for EVAR/TEVAR for MAAs, providing a less invasive procedure with low early mortality rates [23, 30, 33, 34, 39, 53].
\nKan et al. performed a systematic review of outcome after EVAR for the treatment of mycotic aortic aneurysms in 2007. They presented a life-time analysis, which reported a 30-day survival rate of 89% +/− 4% and a 2-year survival rate of 82% +/−5.8%. They performed a multivariate logistic regression analysis, which showed that only ruptured aneurysms and fever were significant predictors of persistent infection in EVAR after MAAs [38].
\nThe largest series to date on endovascular treatment of MAAs was reported in 2018 by Heinola et al. This multicenter-group reported 187 MAAs treated in 6 different European countries between 2006 and 2016 [32]. Another previous large series on endovascular treatment of MAAs was reported in 2012 by Sedivy et al. This series included 32 patients, treated during a 15-year period. In this series, 81% of patients survived the 30-day postoperative period. A total of 50% survived after 1-year follow-up and 40% survived after a 3-year follow-up [50]. Table 3 includes the most important series regarding MAAs (Table 3) [22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 35, 38, 39, 40, 41, 54].
\nSeries | \nYear | \nNumber patients | \nTechnique | \nMortality (30-day) | \n
---|---|---|---|---|
Moneta | \n1998 | \n17 | \nOpen | \n23% | \n
Soravia-Dunand | \n1999 | \n10 | \nOpen | \n57% | \n
Oderich | \n2001 | \n43 | \nOpen | \n21% | \n
Müller | \n2001 | \n33 | \nOpen | \n36% | \n
Fillmore | \n2003 | \n10 | \nOpen | \n40% | \n
Kyriakides | \n2004 | \n15 | \nOpen | \n26% | \n
Dubois | \n2010 | \n44 | \nOpen | \n18.2% | \n
Kan | \n2010 | \n41 | \nOpen (n = 21) | \n4.8% | \n
EVAR (n = 20) | \n5% | \n|||
Yu | \n2011 | \n53 | \nOpen | \n23% | \n
Weis-Müller | \n2011 | \n36 | \nOpen | \n33% | \n
Uchida | \n2012 | \n23 | \nOpen | \n5% | \n
Sedivy | \n2012 | \n32 | \nEVAR-TEVAR | \n18.8% | \n
Huang | \n2014 | \n43 | \nOpen (n = 29) | \n20% | \n
EVAR (n = 11) | \n9% | \n|||
Lin | \n2014 | \n109 | \nOpen (n = 77) | \n10% | \n
EVAR (n = 8) | \n25% | \n|||
Sörelius | \n2014 | \n123 | \nEVAR-TEVAR | \n9% | \n
Touma | \n2014 | \n16 | \nOpen-Allograft | \n28% | \n
Sörelius | \n2016 | \n132 | \nOpen (n = 62) | \n26% | \n
EVAR (n = 70) | \n14% | \n|||
Luo | \n2017 | \n40 | \nEVAR-TEVAR | \n10% | \n
Corvera | \n2018 | \n17 | \nOpen-Allograft | \n6% | \n
Heinola | \n2018 | \n187 | \nOpen (n = 51) EVAR (n = 80) Allograft (n = 56) | \n5% | \n
Largest modern series of mycotic aortic aneurysms (MAAs).
\n
Although some of these modern series present promising results, with lower 30-day mortality for endovascular treatments compared to open surgery, the risk of persistent infection and late complications might be higher. Some concerns are present in modern literature regarding endovascular repair, as there are still no long-term follow-up of these series and there is still an ongoing controversy and debate regarding placing a stent-graft in a tissue (aorta) that is still infected.
\nFor some complex thoracoabdominal aortic aneurysms (TAAAs), therapeutic options may be scarce. In those cases of symptomatic mycotic TAAAs, there may not be enough time to create fenestrated/branched custom-made endovascular stent-grafts. In order to avoid the high morbidity and mortality rates associated with total open surgical repair of these mycotic TAAAs, some groups have advocated for the performance of a hybrid aortic repair.
\nThis hybrid repair of type I, II, and III TAAAs consists in performing a visceral artery debranching with retrograde revascularization, followed by the implantations of a thoracoabdominal endovascular stent-graft [42, 55, 56].
\nContrary to what happens in the infrarenal abdominal aorta, extra-anatomic bypasses are very exceptionally used to repair primary MAAs of the thoracic and thoracoabdominal aorta, or graft infections on those sites. Patients with mycotic aneurysms of the ascending aorta or arch may present with different signs and symptoms, including persistent fever, fatigue, chest or back pain, dyspnea, pleural effusion, and hypovolemic shock in cases of mycotic aortic rupture [57].
\nMAAs have also reported following heart transplantation and different cardiac surgical procedures. Bacterial, viral, fungal, and protozoal infections have been described after cardiac transplantation, understanding that these patients under immunosuppressive medication are at risk of mycotic aneurysm formation [58]. In cases of ascending, arch, or descending thoracic mycotic aneurysms associated with severe mediastinitis, surgical techniques for aortic repair include cryopreserved arterial homografts, repair with deep or superficial femoral veins, coverage with the use of the greater omentum, creation of pedicled muscular flaps for arterial coverage, tissue debridement, and sternal re-closure [45, 57, 58].
\nWe described in this chapter 2 cases of a novel hybrid repair of MAAs, including a staged hybrid procedure, with a first stage including resection of the infected aneurysm and repair with an aortic cryopreserved arterial allograft, followed by a second procedure (once inflammatory markers have decreased and radiologic features have normalized) consisting of an aortic stent-graft. We believe that this option might minimize the risk of cryopreserved allograft rupture that has been previously described in the literature in cases of MAAs. Although there are no reports describing this technique, we consider that this might be a feasible alternative to prevent the risk of aortic rupture.
\nLong-term surveillance, including physical examination, laboratory assessment of inflammatory markers, and imaging studies (incorporating CT angiogram and FDG-PET or PET-CT) are critical for evaluation of possible complications and prompt decision in case of reinfections.
\nTreatment of mycotic aortic aneurysms (MAAs) remains a real challenge in modern vascular surgery. There are currently different treatment options, with an immense improvement in endovascular techniques and devices. Despite the fact of technological and endovascular improvements, this complex pathology is still associated with high morbidity and mortality rates. An early diagnosis and interventional procedure (open, hybrid, or endovascular repair) and aggressive antibiotic therapy are essential to improve outcomes.
\nAs an Open Access publisher, IntechOpen is dedicated to maintaining the highest ethical standards and principles in publishing. In addition, IntechOpen promotes the highest standards of integrity and ethical behavior in scientific research and peer-review. To maintain these principles IntechOpen has developed basic guidelines to facilitate the avoidance of Conflicts of Interest.
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\\n\\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\\n\\nEXAMPLES OF CONFLICTS OF INTEREST:
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\\n\\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
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\\n\\nPolicy last updated: 2016-06-09
\\n"}]'},components:[{type:"htmlEditorComponent",content:"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\nA Conflict of Interest can be identified at different phases of the publishing process.
\n\nIntechOpen requires:
\n\nCONFLICT OF INTEREST - AUTHOR
\n\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\n\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\n\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\nCONFLICT OF INTEREST - REVIEWER
\n\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\n\nEXAMPLES OF CONFLICTS OF INTEREST:
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\n\nNON-FINANCIAL
\n\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
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\n\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\nPolicy last updated: 2016-06-09
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The oxidative polymerization of catecholamines can be triggered by light, chemical and physical methods, thus representing one of the widely explored surface coating methods. The overall objectives of this chapter are to compile the various methods of accomplishing surface coatings and compare the structural diversity of catecholamines. The progress achieved so far on polydopamine (pDA) coatings on electrospun polymers will be discussed. Finally, we will summarize the research efforts on catecholamine coatings for biomedical applications as well as their potential as a high definition coating method.",book:{id:"7256",slug:"dopamine-health-and-disease",title:"Dopamine",fullTitle:"Dopamine - Health and Disease"},signatures:"Rajamani Lakshminarayanan, Srinivasan Madhavi and Christina Poh\nChoo Sim",authors:[{id:"256023",title:"Associate Prof.",name:"Lakshminarayanan",middleName:null,surname:"Rajamani",slug:"lakshminarayanan-rajamani",fullName:"Lakshminarayanan Rajamani"},{id:"270706",title:"Prof.",name:"Madhavi",middleName:null,surname:"Srinivasan",slug:"madhavi-srinivasan",fullName:"Madhavi Srinivasan"},{id:"270707",title:"Dr.",name:"Christina Poh Choo",middleName:null,surname:"Sim",slug:"christina-poh-choo-sim",fullName:"Christina Poh Choo Sim"}]},{id:"57303",doi:"10.5772/intechopen.70852",title:"Developmental Neurotoxicity of Fluoride: A Quantitative Risk Analysis Toward Establishing a Safe Dose for Children",slug:"developmental-neurotoxicity-of-fluoride-a-quantitative-risk-analysis-toward-establishing-a-safe-dose",totalDownloads:1063,totalCrossrefCites:1,totalDimensionsCites:5,abstract:"A meta-analysis showed that children with higher fluoride exposure have lower IQs than similar children with lower exposures. Circulating levels of fluoride in blood and urine in children have also been linked quantitatively to significantly lower IQ. Other human and animal studies indicate that fluoride is a developmental neurotoxicant and that it operates in utero. Economic impacts of IQ loss have been quantified. The objective was to use data from the meta-analysis and other studies to estimate a daily dose of fluoride that would protect all children from lowered IQ, and to estimate economic impacts. We used two methods: traditional lowest-observed-adverse-effect (LOAEL)/no-observed-adverse-effect level (NOAEL); and benchmark dose (BMD). We used 3 mg/L in drinking water as an “adverse effect concentration,” with reported fluoride intakes from food, in the LOAEL/NOAEL method. We used the available dose–response data for the BMD analysis. Arsenic, iodine, and lead levels were controlled for in studies we used. BMD analysis shows the possible safe dose to protect against a five-point IQ loss is between 0.0014 and 0.050 mg/day. The LOAEL/NOAEL safe dose range estimate is 0.0042–0.16 mg/day. The economic impact for IQ loss among US children is loss of tens of billions of dollars.",book:{id:"5894",slug:"neurotoxins",title:"Neurotoxins",fullTitle:"Neurotoxins"},signatures:"John William Hirzy, Paul Connett, Quanyong Xiang, Bruce Spittle\nand David Kennedy",authors:[{id:"215103",title:"Dr.",name:"J. William",middleName:null,surname:"Hirzy",slug:"j.-william-hirzy",fullName:"J. 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In recent years, its use has steadily increased in other neurological areas and new therapeutic areas and also in the aesthetic setting. Paradoxically, BoNT is also the causative agent of the disease botulism and a potential bioterrorism toxin. The BoNT family of toxins comprised more than 40 individual members, classified into 7 serotypes and are produced by Gram-positive obligate anaerobic bacteria. BoNTs are enzymatic multi-modular proteins with a complex multistep mechanism of action. Their target site is at peripheral neurons, particularly the neuromuscular junction, at which they inhibit acetylcholine neurotransmission. Despite intense activity in the BoNT field, today there are still gaps in knowledge both in clinical practice and in basic research. The discovery of the structure-function of BoNT and its domains has allowed rational design of new features using molecular engineering. The diversity of BoNT molecules, both natural and engineered, is an invaluable pool from which to design future new therapeutics with unique pharmacological properties for current and novel indications.",book:{id:"5894",slug:"neurotoxins",title:"Neurotoxins",fullTitle:"Neurotoxins"},signatures:"Elena Fonfria",authors:[{id:"199020",title:"Dr.",name:"Elena",middleName:null,surname:"Fonfria",slug:"elena-fonfria",fullName:"Elena Fonfria"}]},{id:"62697",doi:"10.5772/intechopen.79476",title:"Sleep and Health: Role of Dopamine",slug:"sleep-and-health-role-of-dopamine",totalDownloads:1015,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Introduction: Sleep is an important part of people’s lives and proper sleep is a prerequisite for good health.",book:{id:"7256",slug:"dopamine-health-and-disease",title:"Dopamine",fullTitle:"Dopamine - Health and Disease"},signatures:"Kourkouta Lambrini, Ouzounakis Petros, Papathanassiou Ioanna,\nKoukourikos Konstantinos, Tsaras Konstantinos, Iliadis Christos,\nMonios Alexandros and Tsaloglidou Areti",authors:[{id:"204594",title:"Ph.D.",name:"Lambrini",middleName:null,surname:"Kourkouta",slug:"lambrini-kourkouta",fullName:"Lambrini Kourkouta"},{id:"204595",title:"Mr.",name:"Petros",middleName:null,surname:"Ouzounakis",slug:"petros-ouzounakis",fullName:"Petros Ouzounakis"},{id:"204596",title:"Dr.",name:"Areti",middleName:null,surname:"Tsaloglidou",slug:"areti-tsaloglidou",fullName:"Areti Tsaloglidou"},{id:"204597",title:"MSc.",name:"Konstantinos",middleName:null,surname:"Koukourikos",slug:"konstantinos-koukourikos",fullName:"Konstantinos Koukourikos"},{id:"204598",title:"Dr.",name:"Konstantinos",middleName:null,surname:"Tsaras",slug:"konstantinos-tsaras",fullName:"Konstantinos Tsaras"},{id:"204599",title:"Mr.",name:"Christos",middleName:null,surname:"Iliadis",slug:"christos-iliadis",fullName:"Christos Iliadis"},{id:"204600",title:"Mr.",name:"Alexandros",middleName:null,surname:"Monios",slug:"alexandros-monios",fullName:"Alexandros Monios"},{id:"204602",title:"Dr.",name:"Ioanna",middleName:"V.",surname:"Papathanasiou",slug:"ioanna-papathanasiou",fullName:"Ioanna Papathanasiou"}]},{id:"63750",doi:"10.5772/intechopen.80711",title:"Serotonin Reuptake Inhibitors and Their Role in Chronic Pain Management",slug:"serotonin-reuptake-inhibitors-and-their-role-in-chronic-pain-management",totalDownloads:1245,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"Serotonin has a particular place in the modulation of pain. Experimental studies have described 5-HT1–7 receptors and their effects on facilitation or inhibition of nociceptive input. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors showed efficient and safer than tricyclic antidepressants in neuropathic pain. Although there is evidence regarding the beneficial impact of SSRIs in the multimodal acute pain management, studies are still searching for the potentially favorable effect of these drugs in the prevention of chronic postoperative pain. The scope of this chapter would be to update the knowledge regarding serotonin involving in pain pathways and to highlight the importance and contribution of serotonin reuptake inhibitors in the multimodal pain management schemes.",book:{id:"6679",slug:"serotonin",title:"Serotonin",fullTitle:"Serotonin"},signatures:"Adela Hilda Onuțu, Dan Sebastian Dîrzu and Cristina Petrișor",authors:null}],mostDownloadedChaptersLast30Days:[{id:"63723",title:"Oxidative Polymerization of Dopamine: A High-Definition Multifunctional Coatings for Electrospun Nanofibers - An Overview",slug:"oxidative-polymerization-of-dopamine-a-high-definition-multifunctional-coatings-for-electrospun-nano",totalDownloads:1953,totalCrossrefCites:5,totalDimensionsCites:10,abstract:"The invention that catecholamines undergo oxidative polymerization under alkaline conditions and form adhesive nanocoatings on wide variety of substrates has ushered their potential utility in engineering and biomedical applications. The oxidative polymerization of catecholamines can be triggered by light, chemical and physical methods, thus representing one of the widely explored surface coating methods. The overall objectives of this chapter are to compile the various methods of accomplishing surface coatings and compare the structural diversity of catecholamines. The progress achieved so far on polydopamine (pDA) coatings on electrospun polymers will be discussed. 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Multidisciplinary treatment teams may offer the most updated treatment and care. Pharmacotherapy is one standard treatment, effective in managing psychotic symptoms with supportive psychosocial interventions. As part of the health-care team, nurses deal with PDD on a 24-hour basis. Quality nursing care is essential for improving quality of life, health status, and continued abuse-free status of PDD.",book:{id:"6404",slug:"drug-addiction",title:"Drug Addiction",fullTitle:"Drug Addiction"},signatures:"Ek-uma Imkome",authors:[{id:"219235",title:"Associate Prof.",name:"Ek-Uma",middleName:null,surname:"Imkome",slug:"ek-uma-imkome",fullName:"Ek-Uma Imkome"}]},{id:"59317",title:"Effect of Alcohol on Brain Development",slug:"effect-of-alcohol-on-brain-development",totalDownloads:1208,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In the world, 3.3 million deaths occur every year due to harmful use of alcohol; this represents 5.9% of all deaths. Ethanol metabolites’ production and their post-translation modification are one of the proposed mechanisms that lead to neuronal toxicity. The projected neurochemical changes in chronic alcohol drinkers may be due to an imbalance between excitatory and inhibitory neurotransmitters. Interaction of alcohol with GABA and glutamate receptors (NMDA and AMPA) resulted in diverse adaptive changes in gene expression through neuronal pathways leading to alcohol toxicity. Alcohol consumption in an individual leads to biochemical changes that are correlated with complex inflammatory signaling pathways such as phosphorylation of proteins, synthesis of nitric oxide (NO), NF-kappaB and MAP kinase pathways in certain regions of the brain. Ethanol exposure activates neurons and microglial cells that lead to release of neuroimmune factors like high-mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4) and certain cytokines involved in immune responses leading to neuroimmune signaling in the brain. Epigenetic modification of DNA and histones may lead to neuronal gene expression, thus regulating ethanol toxicity. Researchers attempt to modulate therapies that can help to foil alcohol toxicity and support the development of original neuronal cells that have been injured or degenerated by alcohol exposure.",book:{id:"6404",slug:"drug-addiction",title:"Drug Addiction",fullTitle:"Drug Addiction"},signatures:"Farhin Patel and Palash Mandal",authors:[{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal"},{id:"219333",title:"Ms.",name:"Farhin",middleName:null,surname:"Patel",slug:"farhin-patel",fullName:"Farhin Patel"}]},{id:"61035",title:"Induced Pluripotent Stem Cell-Derived Human Glutamatergic Neurons as a Platform for Mechanistic Assessment of Inducible Excitotoxicity in Drug Discovery",slug:"induced-pluripotent-stem-cell-derived-human-glutamatergic-neurons-as-a-platform-for-mechanistic-asse",totalDownloads:1251,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Since the guiding principles of Replace, Reduce, and Refine were published, wider context-of-use for alternatives to animal testing have emerged. Induced pluripotent stem cell-derived human glutamatergic-enriched cortical neurons can be leveraged as 2- and 3-dimensional platforms to enable candidate drug screening. Uniquely so, 2-dimensional models are useful considering that they exhibit spontaneous firing, while, 3-dimensional models show spontaneous synchronized calcium transient oscillations. Here, the limitations of selected induced acute seizure models as well as the early utilization of fully differentiated glutamatergic neuron models for interrogation of inducible excitotoxicity following exposure to neuromodulators will be described. The context of use for candidate biomarkers of inducible seizure is also discussed.",book:{id:"5894",slug:"neurotoxins",title:"Neurotoxins",fullTitle:"Neurotoxins"},signatures:"Yafei Chen",authors:[{id:"201274",title:"M.Sc.",name:"Yafei",middleName:null,surname:"Chen",slug:"yafei-chen",fullName:"Yafei Chen"}]},{id:"65286",title:"Introductory Chapter: From Measuring Serotonin Neurotransmission to Evaluating Serotonin Post-Receptor Signaling Transduction",slug:"introductory-chapter-from-measuring-serotonin-neurotransmission-to-evaluating-serotonin-post-recepto",totalDownloads:1142,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"6679",slug:"serotonin",title:"Serotonin",fullTitle:"Serotonin"},signatures:"Ying Qu",authors:[{id:"94028",title:"Dr.",name:"Ying",middleName:null,surname:"Qu",slug:"ying-qu",fullName:"Ying Qu"}]}],onlineFirstChaptersFilter:{topicId:"1115",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:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"4",type:"subseries",title:"Fungal Infectious Diseases",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment",scope:"Fungi are ubiquitous and there are almost no non-pathogenic fungi. Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11400,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. 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