Pacemaker Troubleshooting and early complications of pacemaker insertions
\r\n\tThus, we call for research and review papers on the chemistry and physics of dyes, pigments, and their intermediates, including chemical constituents, spectroscopic aspects, surface, solution, crystal formation, photochemical, and ecological or biological properties. The book will be of interest to a wide variety of researchers worldwide whose work involves various fields of activity such as dyes and pigment synthesis, imaging, sensor, energy, medicine, polymers, food product, toxicological properties, etc.
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Millions of pacemakers have been implanted worldwide and, as a result the quality of life for these patients has been drastically improved, not forgetting the reduced morbidity and mortality. The first stimulations through transthoracic electrodes were pioneered by Zoll in the early fifties (Zoll, 1952)), then came percutaneous endocardial pacing in 1959 (Furman & Schwedel. (1959).. A “permanent” pacemaker using epicardial electrodes was first described in 1960 (Chardack, 1960). Pacemakers and implantation techniques have progressed rapidly since the then; Generators are more reliable, more compact, filled with micro-electronic components, can be controlled automatically and remotely and thus providing more options for programmation and monitoring and a longer pacemaker life span (Kusomoto & Goldschlager, 1996; Trohman, et al, 2004). Leads are thinner and more resistant to damage and thus equally longer-lasting.
The latest European guidelines published in 2007 confirmed the classic indications; symptomatic bradyarrhythmias including sinus node dysfunction and atrioventricular or intraventricular conduction disturbances (Vardas et al., 2007). The guidelines also recommended cardiac pacing for specific conditions (vasovagal syncope, hypertrophic cardiomyopathy, heart failure with prolonged QRS duration, etc). Since over 10 years, left ventricular resynchronisation therapy has proved to be beneficial to patients presenting heart failure with complete left bundle block in association with optimal medical treatment; the European guidelines were updated for this indication in 2010 (Dickstein,2010)
The correct implantation of a pacemaker is capital for optimal function. A recent trend shows pacemaker implantation can be performed as successfully in the electrophysiology study environment as in the operating room (Garcia-Bolao & Alegria, 1999). This requires a centre with a qualified team of cardiologists as well as experienced nursing and technical staff. Continued education for the team and follow-up of complications is essential. The cardiologists’ or surgeons’ experience, and the volume of pacemakers implanted in the centre, plays a role in reducing post-implantation complications; thus, guidelines discourage this procedure in centres with a low volume of implantation.
Despite these precautions, some early complications, occurring within the first 6 weeks after implantation, may be observed. Their incidence is probably underestimated (approximately 7%), as is their severity (Kiviniemi et al., 1999; Klug et al., 2003). Less than 5% have to incur reintervention. Per-procedure mortality is extremely rare; only one case was observed in the cohort of 650 patients implanted at Columbia-Presbyterian Medical Centre. The dutch database FLOOWPACE PM has indexed/listed six variables associated with at least one complication prior to hospital discharge; a low body mass index, history of heart failure (one of the principal indications for implantation), a subclavian venous access, an active fixation auricular pacing lead, and double lead implantation. These patients should be considered at risk for complications (van Eck et al., 2007).
Early complications of pacemaker implantation are not uncommon, even in an experienced team of cardiologists or surgeons. Before discharge, careful evaluation of the pacing system is required. Diagnosis of malfunction is not always evident. Most of the patients needed an invasive procedure or medical intervention to prevent further morbidity.
Through practical clinical examples, we aim to elaborate the principal complications of electronic implanted cardiac devices, as well as discuss situations in which the presence of such a device needs to be kept in mind for the work-up of disorders that may or may not seem pacemaker-related.
A 61 year old man presents to his general practitioner with right thoracic pain and dyspnoea, progressively worsening since three days. He was discharged from cardiology a week before, for implantation of a double chamber pacemaker for sick sinus syndrome with symptomatic atrial fibrillation and bradycardia. Clinical examination revealed good cicatrisation of the implantation site, normal cardiac sounds with no murmur, but abolished respiratory sounds in the right lung. Twelve-lead electrocardiogram (EKG) showed a sinus rhythm with paced ventricular response (typical left bundle block pattern). Chest X-ray confirmed the presence of a complete right pneumothorax (Figure 1). The patient was therefore treated with a chest tube and his recovery was uneventful. The additional hospital stay was three days.
Chest X-ray showing complete right pneumothorax, which was treated with a chest tube.
An 80 year old male needed pacing for complete atrioventricular block is re-admitted three months after implantation. Despite daily wound care by a home-based nurse, the suture line at the site of implantation would not cicatrize. Patient history included myocardial infarction for which percutaneous cardiac intervention (PCI) with a bare metal stent was performed, as well as receiving classical medical treatment that included clopidogrel and aspirin on a daily basis. After implantation, a large hematoma formed in the generator pocket. A conservative treatment was initially proposed. On re-admission, the hematoma had almost completely disappeared, but severe skin necrosis was impeding site closure to the extent that the leads were visible with the naked eye. The absence of infection, as proved by numerous negative swab cultures, allowed for the pacemaker generator to be re-implanted under the pectoralis muscle.
Hematoma. Lack of suture line healing, pacemaker leads visible.
A 60 year old female patient with no medical history and under no current treatment was admitted for complete atrioventricular block causing shortness of breath and dizziness. Implantation of a double chamber pacemaker was performed with ease. P/R sensings were measured at 3.1 mV and 7.8 mV respectively, and both thresholds for stimulation are 0.5 volt/0.4 msec. The next day, the patient represented with dizziness and faints. Lead displacement was suspected. EKG no longer showed physiological stimulation and chest X-ray confirmed lead displacement (Figure 3). Lead repositioning and active fixation was performed successfully.
Chest X-ray showing migration of both atrial and ventricular leads.
• Failure to OUTPUT: no pacemaker activity. NO SPIKE • battery failure or EOL (end of life), battery trauma lead problems : lead fracture, lead dislodgement, fractured lead insulation, poor lead connection • oversensing causes (myopotentials, electromagnetic interference, cross-talk phenomenon) • "cross-talk” phenomenon • extreme electromagnetic interference • pseudo-malfonction : hystérésis, normal algorithmes (AV conduction) |
• Failure to CAPTURE: no depolarisation of the cavity. SPIKE without P/QRS complexes • normal situation : Functional non-capture—output delivered during refractory period • inappropriate programming of the pacemaker (too low safe margin) • lead problems : lead fracture, lead dislodgement, fractured lead insulation, poor lead connection • myocardial perforation • elevated pacing threshold : ○ myocardial infarction (necrosis) at the lead tip ○ drugs (eg, flecainide) ○ dyskaliemia ○ metabolic abnormalities (eg, acidosis, alkalosis) |
• Oversensing (Oversensing occurs when a pacemaker incorrectly senses cardiac/noncardiac electrical activity and is inhibited from pacing): • Myopotentials or muscular activity (particularly the diaphragm or pectoralis muscles) • cross-talk phenomenon • electromagnetic interference (eg, Magnetic Resonance Imaging (MRI) • lead fracture and fractured lead insulation |
• Undersensing (Undersensing occurs when a pacemaker incorrectly misses intrinsic depolarization and paces despite intrinsic activity) • Normal device function—misinterpretation : triggered mode, fusion and pseudo-fusion beats, functional undersensing (long refractory periods, blanking period, safety pacing, oversensing) • poor lead positioning (poor intrinsic signal amplitude), lead dislodgment, lead fibrosis or thrombosis • magnet application • battery depletion • drugs (eg, flecainide, amiodarone) • metabolic abnormalities (eg, acidosis, alkalosis) • dyskaliemia (eg, hyperkaliemia) • hypothyroidism • ischemia and myocardial infarction • or electrical shock (transient) |
Pacemaker Troubleshooting and early complications of pacemaker insertions
A 77 year-old patient had a physiological pacemaker implanted for symptomatic sinus bradycardia, with sinus arrest. A few days after the intervention, she presented with continuous chest pain. Upon clinical examination, blood pressure was 130/80 mmHg, heart sounds were regular but a pericardial friction rub was audible. EKG showed a sinus rhythm with ventricular capture. Chest X-ray revealed a ventricular lead projecting further than the apex (Figure 4). Cardiac ultrasounds confirmed myocardial perforation by the lead and a minimal pericardial effusion. We decided to abstain from removing the lead, which would have been to some extent invasive in this elderly patient. Treatment by anti-inflammatory drug was installed and was sufficient for pain relief.
Chest X-ray showing atrial and ventricular leads, with the ventricular lead clearly beyond the cardiac shadow
Chest scan showing significant pericardial effusion, responsible for pre-tamponnade and shock.
An 85 year old female patient is admitted for malaise and confusion. Medical history is positive for asthma treated regularly by corticoids and B2 mimetic aerosols. EKG shows a complete atrioventricular block and, after excluding all reversible causes, a physiological pacemaker is implanted. No complications are noted during her hospital stay. Having regained her autonomy and the confusional episode resolved, the patient returns to her old age home with instructions for routine care for the following weeks. A follow-up is programmed at six weeks and the cardiologist is confronted with a case of skin erosion and exteriorisation of the pacemaker generator (Figure 6). Due to the high risk of infection in this case, the device is removed and a new device is implanted on the contra-lateral side after six weeks of antibiotherapy and with negative hemocultures.
Erosion and exteriorisation of pacemaker generator in our elderly patient.
A 55 year old patient with history of hypertension, obesity, diabetes, anterior myocardial infarction and severe left ventricular dysfunction has a defibrillator implanted in primary prevention of sudden death. The follow-up is satisfactory with acceptable sensing, impedance and threshold stimulation values on the device programmer. EKG shoes a sinus rhythm with evident old anterior infarction. Chest X-ray, performed in a recumbent position and under non-optimal condition seems satisfactory and the patient is discharged. Upon follow-up one month later, the parameters of the defibrillator are still satisfactory, but the ventricular stimulation shows atypical right bundle block. Chest X-ray confirms the suspected left ventricular stimulation, via a permeable foramen ovale (Figure 7). Lead replacement is indicated seeing the high risk of thrombo-embolic complications in this young patient.
Chest X-ray showing a ventricular lead that is located higher than usual; this lead is in the left ventricle, having gone through a patent foramen ovale.
erroneous left ventricular lead placement in patient with an atrial septal defect
biventricular stimulation or cardiac resynchronisation therapy (CRT) (Figure 8)
epicardial lead placement.
some cases of “normal” right ventricular apical stimulation
Chest X-ray showing implantation of 3 leads including a left ventricular lead placed in a branch of the coronary sinus (cardiac resynchronisation therapy).
A 68 year old patient, with a history of chronic obstructive pulmonary disease and psychosis, underwent pacemaker implantation for repeated loss of consciousness due to sinus hypersensitivity. Carotid sinus massage resulted in 10 second pauses. The pacemaker was set in double chamber mode and after satisfactory programmation control (P-R sensing 2.5 mV and 12.5 mV, impedance at 564 ohms and 496 ohms respectively, stimulation thresholds at 0.5 volts/0.4 msec), the patient was discharged to his psychiatric institution. At one month follow-up, the patient has no complaints, though anamnesis is laborious. Check-up of the stimulator shows absence of detection of both P and R waves, and absence of atrioventricular capture despite maximal stimulation. Displaced leads are suspected and confirmed by chest x-ray (Figure 9). The patient later admits to having manipulated the pace generator by repeatedly twisting it around. Correct repositioning and fixation of the leads were conducted.
Chest X-ray showing displaced lead (ventricular lead tip indicated by the star).
Chest X-ray showing dual-coil ventricular lead displacement, causing pectoral permanent stimulation, in a case previously reported by our team (
Risk factors include obesity (adipose tissue being less firm in these patients), female sex, elderly patients, patients known as having stigmata for character disorders (obsessive compulsive tendencies, dementia). Treatment consists of repositioning the leads, and changing them in the event of fracture. Several surgical techniques have been proposed to avoid recurrence; implanting the pacemaker generator under the aponevrosis, active lead fixation (almost always the case with implantable cardioverter-defibrillators), Parsonet\'s dacron pouches. Patient education, and psychiatric treatment if indicated, should be proposed.
A 73 year old male has a defibrillator with resynchronisation implanted for ischemic cardiomyopathy after an anterior infarction left him with a left ventricular ejection fraction of 25%. He had presented an episode of ventricular tachycardia with syncope. Implantation of the device was by the subclavian route. There were no immediate post-operative complications and good parameters were recorded for all three leads. Three weeks later, the patient complains of discomfort in the left arm, followed by oedema of the whole arm, forearm and hand (Figure 11); ultrasound and vascular tomodensitometry confirmed complete thrombosis of the left subclavian vein, of the axillary vein, leading up until the convergence of the jugular vein. Anticoagulation therapy was commenced and evolution was slow but favourable in the following weeks.
Oedema of the left arm, forearm and hand caused by massive thrombosis of the subclavian vein after defibrillator with Cardiac Resynchronisation Therapy (CRT-D).
A 75 year old male is admitted for repeated fainting caused by major sinus dysfunction as shown by a 24 hour Holter monitor which revealed pauses of up to 8 seconds and paroxystic atrial fibrillation. Medical history was negative and patient was on no current treatment. EKG at rest showed a sinus rhythm with a frequency of 68 bpm and normal repolarisation. A physiological pacemaker is implanted in the operating room. After the intervention, the patient feels palpitations and an EKG recording shows probable pacemaker-mediated tachycardia (Figure 12). Programmation control shows a P-R sensing of 15.8 mV and 1.2 mV respectively, and threshold values for stimulation both inferior to 0.5 volts for 0.4 msec; a connection error is confirmed during threshold verification. Programming in AAI mode would result in VVI pacing, and programming in VVI mode would result in AAI pacing. Re-intervention allowed the correction of this connection error.
Tachycardia due to an error in the connection of the atrial and ventricular leads. We note the same QRS configuration as with VVI pacing from the apex.
Classical "endless loop" or pacemaker mediated tachycardia is rare with the double chamber generators of today.
it is usually initiated by an extra-systole with a retrograde p wave which is easily detected and sustains the circuit. Pacemaker mediated tachycardia can also be provoked by ventricular extra-systoles, by atrial over-detection (myopotentials, interferences) or underdetection and failure to capture
long post-ventricular atrial refractory period (PVARP), excluding retrograde P wave and retrograde conduction, may prevent pacemaker mediated tachycardia
Runaway Pacemaker is due to a malfunction of the pacemaker generator resulting in life-threatening rapid tachycardia (up to 200 bpm).
the generator may malfunction for various causes, including battery failure or external damage.
the use of a magnet can reduce the rate of the rhythm induced by the defiant pacemaker. Generator replacement is necessary.
Atrioventricular nodal reentrant tachycardia. In this case, the stimulator does not intervene in the circuit.
figure 13 shows the initiation of the common type (slow-fast) of atrioventricular nodal reentrant tachycardia ; this is a typical example where the arrhythmia is triggered by an atrial extrasystole which blocks the rapid pathway of the atrioventricular node and allows flow through the slow pathway and thus initiation of the supraventricular tachycardia circuit
radiofrequency ablation is the treatment of choice.
Other reentrant tachycardia includes
atrial flutter
orthodromic circus movement tachycardia using an accessory pathway in the retrograde direction and the AV node in the anterograde direction (concealed or not, in the Wolff-Parkinson-White syndrome)
atrial tachycardia (paroxysmal and nonparoxysmal)
Baseline rhythm strip showing atrial, ventricular and shock intracardiac electrogram leads, and marker atrial and ventricular channels. This is an example of initiation of common atrioventricular node reentrant tachycardia; see text.
A man aged 65 with history positive for high blood pressure, diabetes and renal failure actually undergoing haemodialysis receives a pacemaker for complete atrioventricular block with syncope. His treatment includes ramipril, aspirin and insulin. No immediate post-operative complications occur. Just before a haemodialysis session a few days later, the patient complains of feeling faint. An EKG shows evident signs of hyperkaliemia (very wide QRS complexes with tall peaked T waves and obliteration of the ST segment, as well as a long PR interval) and of double chamber stimulation without atrial or ventricular captures (Figure 14). Blood work-up confirms severe hyperkaliemia (potassium 7.8 mEq/L). The atrioventricular underdetection and the absence of capture are caused by the high level of potassium and corrected as soon as kaliemia is normalised by haemodialysis.
Twelve-lead EKG showing signs of hyperkaliemia and defiant AV detection and stimulation.
A 68 year old patient was admitted for class III dyspnoea according to the New York Heart Association (NYHA) score and repeated episodes of malaise since implantation of a single chamber pacemaker in another centre. Her personal history is positive for hypertension and sick sinus syndrome with atrial fibrillation associated with a slow ventricular rhythm and pauses of more than 8 seconds, hence the indication for cardiac pacing. Her treatment is comprised of ramipril, amlodipin and an oral anticoagulant, (acenocoumarol). Clinical examination is unremarkable. Blood pressure was 130/80 mmHg. Twelve-lead EKG shows regular ventricular stimulation at 70 beats per minute, and a basal sinus rhythm. Dissociated P waves are seen (Figure 15). Pacemaker syndrome is suspected, and confirmed. The pacemaker was reprogrammed to VVI 30 bpm to avoid deleterious ventricular stimulation in this patient.
Twelve-lead EKG showing a dissociated sinus rhythm with right ventricular stimulation.
/Comments:/ This is not a veritable implantation complication but the erroneous choice of a single chamber pacemaker whereas a physiological (or double chamber) stimulator would have avoided the problem. Pacemaker syndrome is described as a combination of symptoms evoking cardiac failure and hypotension in a patient with a cardiac stimulator (Chalvidan et al., 2000). It is caused by the loss of atrioventricular synchronism leading to a drop in cardiac output, elevated atrial pressure and hypotension. The Mode Selection Trial (MOST) investigators defined pacemaker syndrome as occurring if either one of two different criteria occurred (Link et al., 2004). The first criterion was new or worsened dyspnea, orthopnea, elevated jugular venous pressure, rales, and oedema with ventricular (VA) conduction during ventricular pacing. The second criterion was symptoms of dizziness, weakness, presyncope, or syncope, and a >20 mmHg reduction of systolic blood pressure when the patient had VVIR pacing compared with atrial pacing or sinus rhythm. Its incidence is 7-20% of stimulators in VVI mode with a sinus rhythm. Pacemaker syndrome can also be seen in AAIR mode and in double chamber modes (VDD, DDI, DDD) if the stimulator if programmation is sub-optimal or the stimulation mode is incorrectly selected. Dyspnoea should, besides pacemaker syndrome, evoke:
chronotrope insufficiency, especially during exertion, requiring programmation in rate-responsive mode.
Wenckeback functioning in DDD mode
intermittent dysfunction (sensing and pacing)
A 45 year old female patient suffering from idiopathic congestive cardiomyopathy with a left ventricular ejection fraction of 35%, class III dyspnoea on the New York Heart Association (NYHA) scale, left bundle branch block morphology, with a QRS duration of 175 msec, on EKG and under optimal medical treatment for over three months receives a pacemaker with left ventricular resynchronisation. Implantation was complicated immediately by left ventricular lead displacement. A Starfix Attain OTW 4194 (Medtronic Inc., Minneapolis, MN, USA) was necessary for stability (The Attain Starfix’s design includes three soft, polyurethane lobes near the lead tip that, when expanded, enable stable lead placement in the target location) (de Meester, 2010). After one month, the implantation site becomes suppurative (Figure 16). Local wound care and 10 day antibiotherapy did not help. Bacteriological studies revealed the presence of pseudomonas aeruginosa. Treatment required complete ablation of the material and prolonged antibiotherapy. Re-implantation on the counter-lateral side in this case was performed two months after the end of the antibiotic course.
Photograph showing suppurative wound with visible pacemaker leads. Ablation of all material was necessary.
Early complications after pacemaker and other cardiac device implantation are not uncommon. Hematoma, skin erosion and pocket infection, as well as lead displacement are the most common of these complications and should be looked for and recognised during routine follow-up, as well as during work-up of any patient presenting a new symptom in the first couple of weeks after implantation. Operator inexperience and implantation in a low-volume centre increases the risk of these complications. Adhesion to good practice and recommended guidelines is indispensable.
Olive oil occupied a key role in ancient Roman cooking and its culinary use expanded along with the Roman Empire, laying the foundation for what we now refer to as the Mediterranean diet. The culinary use of olive oil takes four basics forms: as a preservative, as a cooking medium, as an ingredient and as a condiment [1]. This chapter has a central focus on EVOO as a cooking medium.
As a cooking medium EVOO has a many functions, such as transferring heat from the heat source to the food, acting as a lubricant to prevent food from sticking to the cooking surface, adding flavour, crust and creating a more visually appealing look to the food [1]. It is an extremely healthy oil to use for all types of cooking and there is a lot of existing and emerging research related to the health benefits due to high levels of antioxidants (some of which are unique to EVOO) and the ability of the oil to enhance the health attributes of some ingredients once cooked [2, 3, 4].
However, myths related to cooking with EVOO have been prevalent from time to time, creating a lot of confusion for consumers.
Some of the prevalent myths related to cooking with EVOO are listed in Table 1.
Chemical reactions such as hydrolysis, oxidation, and polymerisation are prone to occur when edible oils are heated. Heating oils at high temperatures or for long periods of time can generate decomposition products such as free fatty acids (FFAs), alcohols, cyclic compounds, and polymers. Several factors can affect or influence these reactions, such as the type and quality of the oil, the kind of food used in cooking, the time and temperature of cooking and the food/oil ratio. These chemical reactions can affect both the nutritional value and the organoleptic properties of the oil. In addition, some of the products formed through oil decomposition may have adverse effects on human health. Physical changes in oil occur during heating and include increased viscosity, darkening in colour, and increased foaming. At the same time, the smoke point of the oil decreases [14, 15, 16, 17, 18].
There are two major properties of cooking oils commonly believed to dictate the behaviour of that oil, and subsequent safety when exposed to high cooking temperatures: smoke point and oxidative stability. While oxidative stability is a reasonable predictor of an oils’ ability to withstand heat, initial smoke point has proven to have very little correlation with the oils’ stability under heat while cooking, and the formation of polar compounds [5].
The smoke point is defined as the temperature at which a visible and continuous bluish smoke appears. At this point sufficient volatile compounds, such as FFAs and short chain oxidation products are emerging and evaporating from the oil.
The smoke point of an oil generally increases as the FFA content decreases, and the degree of refinement increases [19, 20].
The smoke point should not be considered a reliable measure of an oil’s stability and suitability for cooking for the following reasons:
The smoke point changes when an oil is heated, therefore it is not the same during the whole cooking process. The smoke point decreases faster when heating oils with a higher polyunsaturated fat content, such as in seed oils, than when heating oils with less poly-unsaturation and greater monounsaturated fat levels such as in EVOO [21].
The chemical fraction that mostly determines the smoke point of an oil is the FFA fraction which is under 1% of the total oil composition. This means that when the oil reaches the smoke point, only a minor part of it is evaporating and does not indicate the deterioration of the fat itself. In fact, studies have shown that the levels of FFA are not a reliable indication of deterioration of cooking fat [14].
When determining the smoke point, a small volume of oil is heated using a little brass cup in a confined and dark environment (Figure 1). Studies have shown that the smoke point rises when using a bigger container or a larger volume of oil in the presence of air. As a result, when cooking in a kitchen, smoke point temperatures could be greater than the ones that have been reported in the literature [22, 23, 24]. Thus, exact smoke point temperatures cannot be given [21, 24].
The standard procedure used to establish the smoke point relies heavily on the ability of the worker to determine visually the point at which the oil begins to smoke. This means that there can be analyst subjectivity when using this test procedure [19, 24].
The refining process used to produce other vegetable oils such as canola, peanut and rice bran oils involves high temperatures to neutralise FFAs. This gives the oils a higher smoke point but also produces secondary oxidation products which have been shown to have a detrimental effect on human health.
Smoke point determination equipment.
When heating oils, the process of fat oxidation is accelerated. Fat oxidation is where fat molecules interact with oxygen, leading to the potential formation of harmful compounds. Many authors agree that oxidative stability is the best predictor of the behaviour of oil during cooking [5, 16, 25].
Industrially and technically, the ability of an oil to withstand heat is measured by its resistance to the formation of polar compounds.
Non-volatile polar compounds, triacylglycerol (TAG) dimers and polymers are the main deterioration products of cooking oils. Several studies have associated these substances with certain types of cancer and neurodegenerative diseases including Alzheimer’s and Parkinson’s disease [26, 27]. However, this negative effect on health is related to the dose of these components. National and International legislation has identified that no more than 24–27% of polar materials in the final oil is a safe limit for human consumption [27]. These limits are made to ensure the oils used in cooking operations are safe for human consumption. When storing food after being cooked is required, then the recommended end point of polar compounds in the oil is <10% [14, 27].
Laboratory research is extremely important to understand the frying process and what the toxicological limits are to establish guidelines for consumers. However, it is important to highlight that sometimes the research completed with cooking oils has been pushed to the point of abusing the oils. These are extreme heating conditions and the results obtained do not always represent real-life situations, especially during home cooking. Therefore, proper judgement when drawing conclusions needs to be made. When cooking at home, normally one does not reach excessive temperatures for prolonged periods of time that deteriorate either the food or the oil in a way that makes them inedible or unsafe [27].
Edible oils are composed of triacylglycerols (> 96%) and endogenous minor components. It is generally agreed that the inherent composition of edible oils exerts considerable influence on their heating stability [15, 18]. In the interest of understanding better why we can, and we should cook with EVOO, it is important to review first its chemical composition. EVOO has a high level of oxidative stability when compared to other types of cooking oil and is less likely to undergo oxidation. This is primarily attributed to the following factors:
EVOO contains high levels of oleic acid, a monounsaturated fatty acid (MUFA) with just one double bond and low levels of linoleic and linolenic acids, which are polyunsaturated fatty acids (PUFAs) with multiple double bonds. This high MUFA/PUFA ratio confers good oxidative stability making it highly resistant to the production of harmful substances (such as polar compounds). The high levels of double bonds in PUFAs in seed oils make them sensitive to damage by heat [28, 29, 30].
The presence of natural antioxidants in EVOO, such as biophenols and Vitamin E, enhance the oil’s stability and resistance to oxidative degradation. Besides adding health benefits to the oil, these minor constituents boost EVOO’s stability reducing oxidative processes when the oil is heated [31, 32].
The phytosterols are a significant fraction of the unsaponifiable matter in EVOO. These substances add to the oil’s health profile. Some sterols have been shown to provide higher protection against lipid thermal deterioration by decreasing the production of TAG polymers [33]. These sterols are sometimes lost during oil refining and because EVOO does not require this manufacturing step, it retains high concentrations of phytosterols. It has been documented that phytosterols can be transferred to food while cooking, which could have a nutritionally positive impact on consumers [34].
In a comprehensive trial in Australia [5] conducted by an ISO 17025 accredited laboratory in 2018, ten of the most used cooking oils were selected from the supermarket to test their performance when heated. The oils tested were EVOO, virgin olive oil (VOO), olive, canola, rice bran, grapeseed, coconut, peanut, sunflower, and avocado oils.
Two different volumes of oils were heated in open pans (250 mL) for 20 minutes from 25–240°C and in deep fryers (3000 mL) at 180°C for 6 hours. Samples were collected at different intervals and then tested.
Authors specifically assessed the correlation between smoke point and other key chemical parameters related to an oils stability and likelihood to break down and form harmful compounds.
From this study, it was concluded that under different heating conditions, the generation of polar compounds with temperature and time was more pronounced for refined seed oils with higher initial values of smoke point, PUFAs, K232 and K270 (oxidative by-products). Reasonable predictors of how an oil will perform when heated have been oxidative stability, secondary products of oxidation, total level of PUFAs. EVOO was the most stable oil of those tested when heated, followed closely by coconut oil and other virgin oils such as avocado and high oleic acid seed oils. EVOO yielded lower levels of polar compounds and TFAs when compared with other oils.
This research also showed that an oil’s smoke point is not a relevant parameter to explain the oil’s behaviour when heated. Smoke point does not correlate with the stability of the oil during heating, as it showed a positive correlation with the increase in polar compounds (Table 2). That is to say that the higher the smoke point, the more polar compounds that are produced. PUFAs, K232 and K270 showed a positive correlation with polar compounds. Oxidative stability was negatively correlated with final content of polar compounds, demonstrating that a non-stable oil in terms of thermal degradation, will produce more polar compounds when heated (Table 2).
Myth | Assumptions based on the myth | Truth/reality based on scientific evidence |
---|---|---|
Smoke point is a relevant factor in determining how suitable an oil is to cook with. | EVOO is not suitable for cooking at high temperatures given its lower smoke point. | The utilisation of smoke point as an indicator of the ability of an oil to withstand heat, and to determine suitability for cooking is technically incorrect, and is not supported by scientific evidence. Recent evidence [5] shows that EVOO is the most stable oil when heated when compared to other edible oils with higher smoke points. Mediterranean cultures have used EVOO as their only source of cooking oil for centuries and their diet has the highest amount of scientifically proven health benefits [2, 6, 7]. |
Cooking with EVOO can ruin cookware, such as non-stick pans (e.g., Teflon coated pans). | EVOO could be damaging to cookware coating. | Although there is no published scientific evidence to support this, these beliefs are specifically supported by some cookware manufacturers’ specifications that oils with higher smoke points are more suitable for cooking with Teflon coated cookware [8, 9]. On the contrary, EVOO, like any other oil, acts as a lubricant, preventing the food from sticking to the pan [1]. Cooking with EVOO does not ruin non-stick Teflon coated pans at a different rate than other cooking oils. |
Heating olive oil will increase the amount of saturated or trans fats. | You cannot heat olive oil. | All oils will oxidise and hydrogenate to a minor degree when heated several times using high temperatures, such as those used in industrial frying processes [10]. It has been documented that olive oil is less prone to oxidation and hydrogenation when heated than other oils when heated because it is rich in monounsaturated fat [11, 12]. Cooking with EVOO does not produce significant traces of trans fatty acids. In fact, EVOO is less prone to hydrogenation than other vegetable oils. |
When you cook vegetables with EVOO, the vegetables lose antioxidants. | EVOO is not suitable to use when cooking vegetables. | This is incorrect. Recent evidence shows that when cooking with EVOO (including deep frying and sautéing), there is a resultant increase in total phenols (antioxidants) in the cooked food (particularly when cooking raw vegetables) [13]. Cooking with EVOO may in fact improve the nutritional properties of the food. |
Myths related to cooking with EVOO.
Initial Parameter | Correlation with final polar compounds levels (%) |
---|---|
Smoke Point | 83 |
Oxidative Stability | −65 |
FFA | −34 |
PUFAs | 74 |
UV Coefficient K232 | 80 |
UV Coefficient K270 | 54 |
Correlation between final polar compounds and initial oil’s chemical parameters.
These results are also supported by recent research carried out in New Zealand in 2019 [25]. The authors concluded that quality EVOO, in accordance with relevant olive oil standards, is the best cooking oil for use in the home from a stability and health viewpoint. These authors also recommended criteria to indicate an EVOO is stable for cooking:
Initial % free fatty acids (FFA) <0.2% (w/w as oleic acid)
Peroxide Value (PV) < 5.0 mEq/kg
Induction time in Rancimat >15 hours.
Total polar compounds after 8 hours heating at 180°C < 25%
p-Anisidine value after 8 hours at 180°C < 70
TFAs are formed during partial hydrogenation of oils. The interconversion from cis to trans requires a lot of energy (~65 kcal/mole), however the use of a high temperature or a catalyst can enhance the reaction [35]. Consumption of diets high in hydrogenated fat and/or TFAs has been shown to have an adverse effect on lipoprotein profiles with respect to cardiovascular disease risk [36, 37].
The formation of TFAs while cooking food using oil is closely related to the temperature and how many times oil is reused [38, 39]. Several European countries have determined that the frying oil temperature must not exceed 180°C. These measures not only contribute to decreased degradation of unsaturated fatty acids but also result in a lower formation of monounsaturated trans fatty acid (MTFAs) and polyunsaturated trans fatty acids (PTFAs) during frying.
Much research has been done to determine how typical cooking procedures used in food preparation affect TFAs formation in edible oils. Research suggests even applying normal and/or extreme temperatures when cooking does not significantly affect the amounts of TFAs in edible oils [40, 41]. Formation of minor amounts of trans-oleic acid, inferior to 0.2 g/100 g fatty acids was observed by [11, 12] for all the olive oil grades, which is lower than the trans amounts in other refined vegetable oils.
Recent research presented at the World Congress of Oils and Fats in 2020 [42] demonstrated that initially EVOO does not contain TFA and that the food TFA content decreased by approx. 70% or remained stable when using EVOO. The same behaviour was observed with oils: the lowest TFAs production was in EVOO in comparison with other vegetable oils.
Cooking with edible oils, such as deep frying, usually involves two phenomena. Firstly, when the oil, that acts as a heating medium to the food, reaches 100°C water starts to evaporate from the food. This in turn gives way to the oil being absorbed into the food which modifies the fatty acid composition of the food as it cooks. It has been proven that the fat content of the food after deep frying is more like the fat profile of the oil used to cook than the raw food itself [14]. In addition, although the antioxidant content is reduced somewhat during cooking many healthy substances still remain in EVOO and are absorbed by the food. The absorption of these antioxidants into the food gives the food a better nutritional profile. For this reason, the use of EVOO is a healthier option than using other oils with less bioactive components [13, 42, 43].
Frying is one of the oldest methods of food preparation. It improves the sensory quality of food by formation of aromatic compounds, attractive colour, crust and texture, which are all highly appreciated by consumers [44, 45]. The most common frying methods are deep-frying, being the food totally immersed in hot oil, and pan-frying, when the food is cooked in a pan with a little amount of oil [46, 47].
There is a higher degradation under pan-frying conditions for olive oil and other vegetable oils, that can be explained by the higher contact surface between the food and the oil, higher exposure to atmospheric oxygen, and lower temperature control under processing [46].
Frying with EVOO using a lower food:oil ratio presents lower total polar compound amounts than more unsaturated vegetable oils, and with apparently no interference by the presence of food [32, 48, 49]. Within olive oils, the higher the degree of polyunsaturation the higher the tendency for the formation of total polar compounds [50].
The volatile fraction formed during the heating process, apart from being important from the sensorial point of view, is rich in degradation compounds. The formation of low molecular weight volatile aldehydes has a clear dependence on the temperatures used, rather than frying time [51]. The high oleic acid content in olive oil, together with the presence of chlorophylls, pheophytins and carotenoids, seems to contribute to a reduced acrolein formation and lower amounts of toxic monoaromatic hydrocarbons, alkylbenzenes and alkenylbenzenes, in comparison with other vegetable oils with higher polyunsaturated acyl groups [51, 52, 53].
Furthermore, as mentioned previously, in comparison with other vegetable oils, the fried food is enriched with olive oil antioxidants, which improves the nutritional profile of the food [54].
Roasting with olive oil is common in both domestic and industrial food preparation in Mediterranean countries [55]. This procedure is highly prone to oxidation due to the higher surface area exposed to convention hot air and processing times. When comparing with other vegetable oils with a higher degree of unsaturation, olive oil is also more resistant to oxidation under these heating conditions [11, 56]. In opposition, the total polar compounds clearly increase with vegetable oils with higher unsaturation degrees such as sunflower and corn oil [57].
In general, heating olive oil using a microwave demonstrates an apparent higher oxidation when compared with conventional heating, despite being probably lower than those achieved with other vegetable oils [58]. Researchers have compared microwave and conventional heating (in an electric oven) in several vegetable oils including sunflower, high oleic sunflower and olive oil. Among the studied oils, the EVOO exhibited better performance against oxidation with both heating methods. This is mainly due to its composition, including minor compounds with antioxidant properties (phenolic compounds and tocopherols) and a lower percentage of linoleic acid [59]. Still, all studies were performed without the presence of food, meaning further studies using real processing conditions are required for correct inferences [15].
In 2019, Modern Olives Laboratory, an Australian oil specialist laboratory, conducted research to assess the suitability of various cooking oils, including EVOO, for use on Teflon coated (TC) pans.
To investigate the hypothesis of whether cooking with EVOO ruins pans, the researchers measured the release of elements and metals from the pans when separately heated with different oils. They used three different brands of TC pans. These pans were heated with an acidic solution of water vinegar (WV) both prior to and after 6 cycles of heating with different oils (EVOO, olive oil, canola oil, rice bran oil and grapeseed oil). The WV solutions were tested to study the release of various metals.
Combining all TC pans, the authors found no significant differences in the chemical elements content between the final WV solutions from TC pans treated with the different oils. This indicates there is no significant difference between the volume of metals released from the cookware when various cooking oils were used. Hence, the various cooking oils had no effect on the pans’ integrity and quality when cooking. However, differences of statistical significance for Ca, Cu, Fe, P, Zn and SiO2 were observed between the different TC pan types. Higher values of these metals were detected in the most expensive pan compared with the cheapest TC pan. For example, Ca average values (including initial and final treatment) in the most expensive pan were ~ 2.92 mg/L vs. ~1.75 mg/L in the cheapest pan and ~ 2.42 mg/L in the average price pan. When considering each brand of TC pan, phosphorus levels were significantly higher between treatments when using rice bran oil in the average priced TC pan (4.7 mg/L vs. 2.5 mg/L) versus a low- or high-priced TC pan. Silicon dioxide was not detected before treatment and significantly increased using olive (1.1 mg/L) and grapeseed (1.03 mg/L) oils only in the lowest priced TC pan.
After all treatments, no visual deterioration of any of the TC pans was observed. This investigation indicates that higher differences in metal leaching were between pans quality, rather than between the treatments with the different oils. In no case the use of EVOO lead to the release of significantly higher levels of metallic substances from the pan than when using any other oil.
Even though these results are limited considering the lifetime of the TC pan, they indicate no initial impact of the oils’ smoke point on the performance of the TC pan and that EVOO performs similarly to other oils under normal cooking conditions when it comes to TC pan degradation.
Sufficient research has been done to demonstrate that an oil’s smoke point is not a reliable measurement as an indicator of the ability of an oil to withstand heat, and to determine suitability for cooking. Reasonable predictors of how an oil will perform when heated are oxidative stability, secondary products of oxidation, and total level of PUFAs. EVOO has been demonstrated to be the most stable oil when heated given its unique chemical composition, which is rich in monounsaturated fatty acid and antioxidant content.
Experts have agreed that one of the most versatile and healthy oils to cook with is EVOO and many studies have linked it to better heart and overall health.
Food cooked with EVOO also had lower levels of undesirable products of degradation such as TFAs and polar compounds when compared with other vegetable oils such as canola, grapeseed, peanut, sunflower and rice bran oils, while deep-frying under normal cooking conditions.
Furthermore, based on scientific evidence EVOO does not deteriorate the coating when using Teflon cookware. On the contrary it acts as a lubricant to prevent food from sticking to the pans.
Selecting a true high quality EVOO, that is certified to meet EVOO grade and quality requirements is important to ensure high oxidative stability and safety while cooking.
We thank the Olive Wellness Institute (OWI) and Modern Olives Laboratory for their help during this work. To know more about OWI please visit https://olivewellnessinstitute.org/.
The authors declare no conflict of interest.
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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Human errors in this works and decisions made big effect on last product quality and profitability are not able to be risked. This chapter deal with valuable information on the latest challenges and key innovations affecting the animal husbandry. Also, innovative approaches and applications for animal husbandry are tried to be summarized with detail latest research results.",book:{id:"6384",slug:"animal-husbandry-and-nutrition",title:"Animal Husbandry and Nutrition",fullTitle:"Animal Husbandry and Nutrition"},signatures:"Serap Göncü and Cahit Güngör",authors:[{id:"215579",title:"Prof.",name:"Serap",middleName:null,surname:"Goncu",slug:"serap-goncu",fullName:"Serap Goncu"},{id:"218971",title:"Dr.",name:"Cahit",middleName:null,surname:"Güngör",slug:"cahit-gungor",fullName:"Cahit Güngör"}]},{id:"58486",title:"Quality of Chicken Meat",slug:"quality-of-chicken-meat",totalDownloads:3351,totalCrossrefCites:19,totalDimensionsCites:28,abstract:"Chicken meat is considered as an easily available source of high-quality protein and other nutrients that are necessary for proper body functioning. In order to meet the consumers’ growing demands for high-quality protein, the poultry industry focused on selection of fast-growing broilers, which reach a body mass of about 2.5 kg within 6-week-intensive fattening. Relatively low sales prices of chicken meat, in comparison to other types of meat, speak in favor of the increased chicken meat consumption. In addition, chicken meat is known by its nutritional quality, as it contains significant amount of high-quality and easily digestible protein and a low portion of saturated fat. Therefore, chicken meat is recommended for consumption by all age groups. The technological parameters of chicken meat quality are related to various factors (keeping conditions, feeding treatment, feed composition, transport, stress before slaughter, etc.). Composition of chicken meat can be influenced through modification of chicken feed composition (addition of different types of oils, vitamins, microelements and amino acids), to produce meat enriched with functional ingredients (n-3 PUFA, carnosine, selenium and vitamin E). By this way, chicken meat becomes a foodstuff with added value, which, in addition to high-quality nutritional composition, also contains ingredients that are beneficial to human health.",book:{id:"6384",slug:"animal-husbandry-and-nutrition",title:"Animal Husbandry and Nutrition",fullTitle:"Animal Husbandry and Nutrition"},signatures:"Gordana Kralik, Zlata Kralik, Manuela Grčević and Danica Hanžek",authors:[{id:"207236",title:"Dr.",name:"Gordana",middleName:null,surname:"Kralik",slug:"gordana-kralik",fullName:"Gordana Kralik"},{id:"227281",title:"Prof.",name:"Zlata",middleName:null,surname:"Kralik",slug:"zlata-kralik",fullName:"Zlata Kralik"},{id:"227283",title:"Dr.",name:"Manuela",middleName:null,surname:"Grčević",slug:"manuela-grcevic",fullName:"Manuela Grčević"},{id:"227284",title:"BSc.",name:"Danica",middleName:null,surname:"Hanžek",slug:"danica-hanzek",fullName:"Danica Hanžek"}]},{id:"56453",title:"Goat System Productions: Advantages and Disadvantages to the Animal, Environment and Farmer",slug:"goat-system-productions-advantages-and-disadvantages-to-the-animal-environment-and-farmer",totalDownloads:4379,totalCrossrefCites:5,totalDimensionsCites:20,abstract:"Goats have always been considered very useful animals. Goats success is related to its excellent adaptability to the difficult mountain conditions, extreme weather and low value feed acceptance, versatile habits and high production considering their size. These are some reasons because goats are among the first animals to be domesticated. In terms of evolution, goats could be separated by their dispersion area in three large groups: the European, the Asian, and the African. Global goat populations, mainly in Africa and in Asia, have increased for centuries but very strongly in the past decades, well above the world population growth. They are also used for forest grazing, an integrated and alternative production system, very useful to control weed growth reducing fire risk. Despite some exceptions, no large‐scale effort to professionalize this industry has been made so far. There are consumers for goat dairy products and there is enough global production, but misses a professional network between both. Regarding goat meat, the world leadership also stays in Africa and Asia, namely in China, and there is a new phenomenon, the spreading of goat meat tradition through Europe due to migrants from Africa and other places with strong goat meat consumption.",book:{id:"5987",slug:"goat-science",title:"Goat Science",fullTitle:"Goat Science"},signatures:"António Monteiro, José Manuel Costa and Maria João Lima",authors:[{id:"190314",title:"Prof.",name:"António",middleName:"Cardoso",surname:"Monteiro",slug:"antonio-monteiro",fullName:"António Monteiro"},{id:"203680",title:"Prof.",name:"Maria João",middleName:null,surname:"Lima",slug:"maria-joao-lima",fullName:"Maria João Lima"},{id:"203683",title:"MSc.",name:"José Manuel",middleName:null,surname:"Costa",slug:"jose-manuel-costa",fullName:"José Manuel Costa"}]},{id:"70760",title:"Induction and Synchronization of Estrus",slug:"induction-and-synchronization-of-estrus",totalDownloads:1750,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Estrus cycle is a rhythmic change that occur in the reproductive system of females starting from one estrus phase to another. The normal duration of estrus cycle is 21 days in cow, sow, and mare, 17 days in ewe, and 20 days in doe. The species which exhibit a single estrus cycle are known as monstrous and species which come into estrus twice or more are termed polyestrous animals. Among them some species have estrus cycles in a particular season and defined as seasonal polyestrous. It includes goats, sheep, and horses. On the other hand, cattle undergo estrus throughout the year. The estrus inducers can grossly be divided into two parts, that is, non-hormonal and hormonal. Non-hormonal treatments include plant-derived heat inducers, mineral supplementation, uterine and ovarian massage, and use of Lugol’s iodine. The hormones that are used in estrus induction are estrogen, progesterone, GnRH, prostaglandin, insulin, and anti-prolactin-based treatment. Synchronization can shorten the breeding period to less than 5 days, instead of females being bred over a 21-day period, depending on the treatment regimen. The combination of GnRH with the prostaglandin F2α (PGF2α)- and progesterone-based synchronization program has shown a novel direction in the estrus synchronization of cattle with the follicular development manipulation.",book:{id:"8545",slug:"animal-reproduction-in-veterinary-medicine",title:"Animal Reproduction in Veterinary Medicine",fullTitle:"Animal Reproduction in Veterinary Medicine"},signatures:"Prasanna Pal and Mohammad Rayees Dar",authors:[{id:"299126",title:"Dr.",name:"Mohammad Rayees",middleName:null,surname:"Dar",slug:"mohammad-rayees-dar",fullName:"Mohammad Rayees Dar"},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal"}]}],onlineFirstChaptersFilter:{topicId:"25",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82991",title:"Diseases of the Canine Prostate Gland",slug:"diseases-of-the-canine-prostate-gland",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105835",abstract:"In dogs, the most frequent diseases of the prostate gland are benign prostate gland hyperplasia (BPH), acute and chronic prostatitis, squamous metaplasia, and prostate tumors. New diagnostic tools comprise diagnostic markers in the blood and urine, as well as advanced imaging methods. The therapy can be initialized with the 5α-reductase-inhibitor finasteride or an anti-androgenic compound, and prolonged with a long-acting gonadotropin-releasing-hormone (GnRH)-agonist such as deslorelin. In case of prostatitis, effective antibiotics must be applied for weeks. Antibiotics must be able to penetrate into the prostate tissue; fluoroquinolones, clindamycin, and erythromycin are good choices and are in addition effective against mycoplasms. The chronical prostatitis cannot be differentiated from a neoplasia by sonography; a biopsy, histological, and bacteriological examination are required. Tumors of the prostate gland are seldom and mostly occur in castrated but in intact dogs. For the final diagnosis, a biopsy must be taken. Partial and total resection of the prostate gland by use of laser technique is possible but coincedes with many side effects and the prognosis is still futile. Immunotherapy combined with NSAIDs, targeted noninvasive thermotherapy, BRAF gene inhibitors, or prostate artery chemoembolization are promising methods.",book:{id:"11580",title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg"},signatures:"Sabine Schäfer-Somi"},{id:"82956",title:"Potential Substitutes of Antibiotics for Swine and Poultry Production",slug:"potential-substitutes-of-antibiotics-for-swine-and-poultry-production",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.106081",abstract:"Early of the last century, it was detected that antibiotics added to the animal feeds at low doses and for a long time can improve technical performances such as average daily gain and gain-to-feed ratio. Since then, the antibiotics have been used worldwide as feed additives for many decades. At the end of the twentieth century, the consequences of the uses of antibiotics in animal feeds as growth promoters were informed. Since then, many research studies have been done to find other solutions to replace partly or fully to antibiotic as growth promoters (AGPs). Many achievements in finding alternatives to AGPs in which probiotics and direct-fed microorganism, prebiotics, organic acids and their salts, feed enzymes, bacteriophages, herbs, spices, and other plant extractives (phytogenics), mineral and essential oils are included.",book:{id:"11578",title:"Antibiotics and Probiotics in Animal Food - Impact and Regulation",coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg"},signatures:"Ho Trung Thong, Le Nu Anh Thu and Ho Viet Duc"},{id:"82905",title:"A Review of Application Strategies and Efficacy of Probiotics in Pet Food",slug:"a-review-of-application-strategies-and-efficacy-of-probiotics-in-pet-food",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.105829",abstract:"In companion animal nutrition, probiotics (direct-fed microbials) are marketed as functional ingredients that add value to pet foods due to the impact they have on gastrointestinal and immune health of dogs and cats. The nature of the beneficial effect each probiotic strain exerts depends on its metabolic properties and perhaps most importantly, the arrival of a sufficient number of viable cells to the large bowel of the host. Pet food manufacturing processes are designed to improve food safety and prolong shelf-life, which is counterproductive to the survival of direct-fed microbials. Therefore, a prerequisite for the effective formulation of pet foods with probiotics is an understanding of the conditions each beneficial bacterial strain needs to survive. The aims of this chapter are: (1) To summarize the inherent characteristics of probiotic strains used in commercial pet foods, and (2) To review recently published literature on the applications of probiotics to pet foods and their associated challenges to viability.",book:{id:"11578",title:"Antibiotics and Probiotics in Animal Food - Impact and Regulation",coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg"},signatures:"Heather Acuff and Charles G. Aldrich"},{id:"82773",title:"Canine Transmissible Venereal Tumor: An Infectious Neoplasia in Dogs",slug:"canine-transmissible-venereal-tumor-an-infectious-neoplasia-in-dogs",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.106150",abstract:"Canine transmissible venereal tumor is the oldest cancer in dogs and is transplanted via viable cancer cells. This cancer has a specific host, easy transmission, noticeable gross lesions, a predictable growth pattern, an immunologic relative host response, unique molecular characteristics, and is responsive to chemotherapeutic treatment. These points make researchers and practitioners interested in this cancer. Genital cases are noticeable and therefore easier to diagnose and treat than extragenital cases. By contrasting the anatomical features of the two types of cases, we highlight the uniqueness of canine transmissible venereal tumors and discuss the diagnosis, treatment, and prevention of this ancient cancer.",book:{id:"11580",title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg"},signatures:"Chanokchon Setthawongsin, Somporn Techangamsuwan and Anudep Rungsipipat"},{id:"82797",title:"Anatomical Guide to the Paranasal Sinuses of Domestic Animals",slug:"anatomical-guide-to-the-paranasal-sinuses-of-domestic-animals",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.106157",abstract:"Paranasal sinuses are paired cavities within the skull, which develop by evagination into the spongy bone between the external and internal plates of the cranial and facial bones. Thus, each sinus is lined by respiratory epithelium and has direct or indirect communication to the nasal cavity. The purpose of this chapter is to present an anatomical reference guide of the paranasal sinuses in domestic animals, including large and small ruminants (cattle, buffalo, sheep, and goats), camels, canines (dog) and equines (horse and donkey), appropriate for use by anatomists, radiologists, clinicians, and veterinary students. Topographic descriptions and the relationships between the various air cavities and paranasal sinuses have been visualized using computed tomography and cadaver sections images. The anatomical features (including head bones, muscles, and soft tissues) have been compared using both dissected heads and skulls and computed tomography images. This chapter will therefore be useful as a normal reference guide for clinical applications.",book:{id:"10665",title:"Updates on Veterinary Anatomy and Physiology",coverURL:"https://cdn.intechopen.com/books/images_new/10665.jpg"},signatures:"Mohamed A.M. Alsafy, Samir A.A. El-Gendy and Catrin Sian Rutland"},{id:"81844",title:"Typical Changes in Carbon and Nitrogen Stable Isotope Ratios and Mercury Concentration during the Lactation of Marine Mammals",slug:"typical-changes-in-carbon-and-nitrogen-stable-isotope-ratios-and-mercury-concentration-during-the-la",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.103067",abstract:"The increase and decrease in the δ15N values of offspring owing to the suckling of δ15N-enriched milk (nursing) and the feeding shift from milk to solid food (weaning), respectively, are thought to be common traits observed in mammals. However, there are a few studies on lactation in marine mammals, especially large whales, because samples of calf, lactating mother, and milk are difficult to obtain. In this chapter, we review the studies on reproduction of marine mammals using δ13C and δ15N values analyzed in several tissues and describe the typical changes reported to date in those values and Hg concentrations in offspring and milk during lactation. Next, we present data on ontogenetic changes in δ15N and δ13C profiles and Hg concentration, especially focusing on the lactation period, in muscle samples of hunted bowhead whale, and stranded common minke whale (mysticetes), Dall’s porpoise (odontocete), and the harbor seal (phocid). Finally, we compare the δ15N and δ13C values in muscle samples of calves from common mink whale, Dall’s porpoise, and killer whale and suggest that these values could be excellent proxies for maternal forging habits and trophic levels.",book:{id:"11335",title:"Marine Mammals",coverURL:"https://cdn.intechopen.com/books/images_new/11335.jpg"},signatures:"Tetsuya Endo and Mari Kobayashi"}],onlineFirstChaptersTotal:25},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"August 12th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"3",title:"Bacterial Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/3.jpg",isOpenForSubmission:!0,editor:{id:"205604",title:"Dr.",name:"Tomas",middleName:null,surname:"Jarzembowski",slug:"tomas-jarzembowski",fullName:"Tomas Jarzembowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKriQAG/Profile_Picture_2022-06-16T11:01:31.jpg",biography:"Tomasz Jarzembowski was born in 1968 in Gdansk, Poland. He obtained his Ph.D. degree in 2000 from the Medical University of Gdańsk (UG). After specialization in clinical microbiology in 2003, he started studying biofilm formation and antibiotic resistance at the single-cell level. In 2015, he obtained his D.Sc. degree. His later study in cooperation with experts in nephrology and immunology resulted in the designation of the new diagnostic method of UTI, patented in 2017. He is currently working at the Department of Microbiology, Medical University of Gdańsk (GUMed), Poland. Since many years, he is a member of steering committee of Gdańsk branch of Polish Society of Microbiologists, a member of ESCMID. He is also a reviewer and a member of editorial boards of a number of international journals.",institutionString:"Medical University of Gdańsk, Poland",institution:null},editorTwo:{id:"484980",title:"Dr.",name:"Katarzyna",middleName:null,surname:"Garbacz",slug:"katarzyna-garbacz",fullName:"Katarzyna Garbacz",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003St8TAQAZ/Profile_Picture_2022-07-07T09:45:16.jpg",biography:"Katarzyna Maria Garbacz, MD, is an Associate Professor at the Medical University of Gdańsk, Poland and she is head of the Department of Oral Microbiology of the Medical University of Gdańsk. She has published more than 50 scientific publications in peer-reviewed journals. She has been a project leader funded by the National Science Centre of Poland. Prof. Garbacz is a microbiologist working on applied and fundamental questions in microbial epidemiology and pathogenesis. Her research interest is in antibiotic resistance, host-pathogen interaction, and therapeutics development for staphylococcal pathogens, mainly Staphylococcus aureus, which causes hospital-acquired infections. Currently, her research is mostly focused on the study of oral pathogens, particularly Staphylococcus spp.",institutionString:"Medical University of Gdańsk, Poland",institution:null},editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,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. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. 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He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Prosthodontics and Implant Dentistry",value:2,count:3},{group:"subseries",caption:"Oral Health",value:1,count:6}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:3},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\r\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\r\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Orthodontist, Assoc Prof in the Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"August 3rd, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:107,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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