\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"7014",leadTitle:null,fullTitle:"Horticultural Crops",title:"Horticultural Crops",subtitle:null,reviewType:"peer-reviewed",abstract:"Horticultural crops are important for human nutrition. To guarantee successful cultivation for quality and quantity yield, proper identification of pests and diseases, as well as abiotic factors undermining their production, is essential. This ten-chapter textbook describes fungi, bacteria, insects, and nematodes as important issues in horticulture. It documents their epidemiology and management strategies such as genetics and botanical and biological control used for their management. This comprehensive resource is essential for students and researchers of plant genetics, pathology, entomology, and nematology.",isbn:"978-1-83880-422-0",printIsbn:"978-1-83880-421-3",pdfIsbn:"978-1-83880-437-4",doi:"10.5772/intechopen.73771",price:119,priceEur:129,priceUsd:155,slug:"horticultural-crops",numberOfPages:220,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"62d269dbecb5881a63b040c9ec933e9d",bookSignature:"Hugues Kossi Baimey, Noureddine Hamamouch and Yao Adjiguita Kolombia",publishedDate:"February 5th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/7014.jpg",numberOfDownloads:10292,numberOfWosCitations:7,numberOfCrossrefCitations:14,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:30,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:51,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 28th 2018",dateEndSecondStepPublish:"April 18th 2018",dateEndThirdStepPublish:"June 17th 2018",dateEndFourthStepPublish:"September 5th 2018",dateEndFifthStepPublish:"November 4th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"201690",title:"Dr.",name:"Hugues",middleName:null,surname:"Kossi Baimey",slug:"hugues-kossi-baimey",fullName:"Hugues Kossi Baimey",profilePictureURL:"https://mts.intechopen.com/storage/users/201690/images/system/201690.jpeg",biography:"Dr. Hugues Kossi Baimey, Associate Professor, graduated with his\nMSc in nematology from Ghent University, Belgium (2000) and\nobtained a PhD at Pretoria University, South Africa (2006) on yam\nnematodes. He is currently a lecturer (2009-present) in the Faculty of Agronomy, University of Parakou, Benin where he gives eight\ncourses including plant-parasitic and entomopathogenic nematology. His research interests are primarily centered on the management of agricultural insect pest populations using entomopathogenic nematodes\nand the control of plant-parasitic nematodes associated with vegetable, root, tuber,\nand cereal crops. He is a past Director of the Higher National School of Agricultural\nSciences and Techniques, University of Parakou, Benin (2012-2016) and Director\nof international projects funded by Nuffic (2012-2016) and DANIDA (2015-2016).\nHe has been Principal Investigator of international projects funded by the VLIR-UOS\n(2010-2014), the Bill & Melinda Gates Foundation (2015-2019), and the National\nAcademy of Science/USAID (currently). Hehas also received funds from Pro-Sol/GIZ\n(2019), the GRiSP (2012-2014), BEST (2010-2014), Agropolis-Foundation-Capes\n(2011-2013), and TWAS (2008-2009) for nematology research. Dr. Kossi Baimey has\nworked for IITA, Cotonou Station (1995-2009 and 2016-2018), University of Alicante, Spain (2001); AfricaRice Cotonou Station (2009-2011) and has had collaborations\nwith IRD Montpellier, France (2010-2016); Ghent University, Belgium (2010-present); Oxfam Quebec NGO, Benin (2010); GERES NGO, Benin (2012-2014); eNema,\nGermany (2015-2019); CSIR-CRI and CSIR-SARI, Ghana (2015-2019). He has\npublished 62 articles in peer-reviewed journals and 47 conference abstracts. He is a\nco-author of two books: “Searching for better methodologies for successful control of\ntermites using entomopathogenic nematodes” (In: \\\\Nematology - Concepts, Diagnosis and Control\\\\, IntechOpen, 2017) and “Integrated pest management in vegetable\nproduction: A guide for extension workers in West Africa” (IITA, 2010). He has\nsupervised two PhD students and around 40 Master and 35 BSc students.",institutionString:"University of Parakou",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Université de Parakou",institutionURL:null,country:{name:"Benin"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"249620",title:"Dr.",name:"Noureddine",middleName:null,surname:"Hamamouch",slug:"noureddine-hamamouch",fullName:"Noureddine Hamamouch",profilePictureURL:"https://mts.intechopen.com/storage/users/249620/images/7025_n.jpg",biography:"Prof. Noureddine Hamamouch obtained his PhD degree in Molecular Cell Biology and Biotechnology from Virginia Polytechnic\nInstitute and State University in Virginia USA, and worked as a\npostdoctoral researcher at the University of Pittsburgh Medical\nCenter and at North Carolina State University. Prof. Hamamouch\nuses molecular tools to examine plant-pathogen interactions and\ngenetically engineer plant resistance to pathogens. He has been\nselected by the United States Department of Agriculture as a Biotechnology Expert to\nthe Biotechnology Center in Morocco. Prof. Hamamouch was a Lecturer at Longwood\nUniversity and at Central Virginia Community College, both in Virginia, USA. He is\ncurrently an Associate Professor at the University of Mohamed V, in Rabat, Morocco.\nProf. Hamamouch has given lectures at different universities in USA and Europe (Belgium, Portugal, and Spain), published 15 scientific articles in high impact peer-reviewed international journals including Nature Biotechnology, Journal of Experimental Botany and Phytopathology, and has received numerous grants and scholarships\nincluding the Erasmus Mundus Grant.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:{id:"249625",title:"Dr.",name:"Yao Adjiguita",middleName:null,surname:"Kolombia",slug:"yao-adjiguita-kolombia",fullName:"Yao Adjiguita Kolombia",profilePictureURL:"https://mts.intechopen.com/storage/users/249625/images/7027_n.jpg",biography:"Dr. Yao Adjiguita Kolombia obtained his PhD in Biology from\nGhent University, Ghent, Belgium. Dr. Kolombia is an agricultural engineer with research experience in the biological control of\nweeds, nematode taxonomy, and management. Dr. Kolombia is\ncurrently the banana pathologist at the International Institute of\nTropical Agriculture (IITA). Dr. Kolombia received several grants\namong which, the Erasmus Mundus Grant, the Special Research\nFund (BOF), and the Yam improvement for income and food security in West Africa\n(YIIFSWA). He has published several papers in impact factor journals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"38",title:"Horticulture",slug:"horticulture"}],chapters:[{id:"66035",title:"Seed Characteristics and Germination Behaviour of Bauhinia malabarica Roxb.",doi:"10.5772/intechopen.84970",slug:"seed-characteristics-and-germination-behaviour-of-em-bauhinia-malabarica-em-roxb-",totalDownloads:608,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Malabar Bauhinia (Bauhinia malabarica) is a native ornamental species belonging to the family Fabaceae, distributed throughout India in semievergreen and moist deciduous forests and in gardens. Information regarding seed characteristics and seed handling of the species is meagre. This study describes seed characteristics, germination behaviour and pretreatment for enhancing seed germination of B. malabarica. Treating the seeds with concentrated sulphuric acid for 30 min reduced germination duration up to 6 days and increased germination rate up to 100% against 22 days of germination duration and 10% germination in seeds without treatment. The results of this study are helpful for conservation and nursery practices of B. malabarica.",signatures:"Pazhayaveetil Kuttanpillai Chandrasekhara Pillai, Sanal Chalil Viswanath, Thoduvayil Karunakaran Hrideek and Aviyan Hari Jiji",downloadPdfUrl:"/chapter/pdf-download/66035",previewPdfUrl:"/chapter/pdf-preview/66035",authors:[{id:"249229",title:"Dr.",name:"Pazhayaveetil Kuttanpillai",surname:"Chandrasekhara Pillai",slug:"pazhayaveetil-kuttanpillai-chandrasekhara-pillai",fullName:"Pazhayaveetil Kuttanpillai Chandrasekhara Pillai"},{id:"316607",title:"M.Sc.",name:"Sanal C",surname:"Viswanath",slug:"sanal-c-viswanath",fullName:"Sanal C Viswanath"},{id:"316608",title:"Dr.",name:"Thoduvayil",surname:"Karunakaran Hrideek",slug:"thoduvayil-karunakaran-hrideek",fullName:"Thoduvayil Karunakaran Hrideek"},{id:"316609",title:"Dr.",name:"Aviyan Hari",surname:"Jiji",slug:"aviyan-hari-jiji",fullName:"Aviyan Hari Jiji"}],corrections:null},{id:"66386",title:"The Photosynthetic Characteristics of Wild Cymbidium faberi in the Qinling Mountains of Central China",doi:"10.5772/intechopen.84974",slug:"the-photosynthetic-characteristics-of-wild-em-cymbidium-faberi-em-in-the-qinling-mountains-of-centra",totalDownloads:749,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The large flowers of orchids make them popular as cultivated plants. Seven species of orchids in the genus Cymbidium (Orchidaceae) have been crossbred to create more than 220 hybrids that serve as popular cultivated ornamentals. The present study examined the daily variation in the patterns of the net photosynthetic rate and the photosynthetic response of wild Cymbidium faberi in the Qinling Mountains in northwestern China. The photosynthetic characteristics of this species were studied under natural conditions with a portable photosynthesis system. Double peaks were observed in the net photosynthetic rate with one around 09:00 and another around 17:00 in spring, as well as one around 11:00 and another around 15:00 in winter. Midday depression of photosynthesis was observed in wild C. faberi plants around 13:00 in both spring and winter. The net photosynthetic rate was strongly positively correlated with both stomatal conductance (R = 0.913) and the transpiration rate (R = 0.659) and weakly negatively correlated with the intercellular carbon dioxide concentration (R = −0.094). The results show that the light compensation point (LCP) and the light saturation point (LSP) of wild C. faberi were 25.78 and 384 μmol m−2 s−1, respectively. The result provides reference for cultivation management especially in light management of Cymbidium.",signatures:"Junyang Song and Ning Zhang",downloadPdfUrl:"/chapter/pdf-download/66386",previewPdfUrl:"/chapter/pdf-preview/66386",authors:[{id:"255238",title:"Dr.",name:"Junyang",surname:"Song",slug:"junyang-song",fullName:"Junyang Song"},{id:"316323",title:"Dr.",name:"Ning",surname:"Zhang",slug:"ning-zhang",fullName:"Ning Zhang"}],corrections:null},{id:"65909",title:"Summary of a Decade of South Ethiopian Coffee Improvement Activities at Awada Coffee Research Center: Fruit of the Landrace Arabica Coffee Variety Development Strategy",doi:"10.5772/intechopen.84886",slug:"summary-of-a-decade-of-south-ethiopian-coffee-improvement-activities-at-awada-coffee-research-center",totalDownloads:730,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Previously the coffee improvement strategy of Ethiopia was aimed to develop widely adaptable and stable cultivars across all coffee growing regions of the country although there is a significant ecological variation that prevails between the major coffee growing regions. Assessing the feedback from users on the performance of released coffee cultivars, the national coffee research program realized the need to initiate coffee improvement programs for each coffee growing region that possessed specific coffee quality and fetch premium price in the world market. In effect, coffee improvement program was initiated for Awada Agricultural Research Center mandated to improve south Ethiopian coffee with the financial aid of the Government of Switzerland. To date about 580 arabica coffee accessions have been collected and maintained in the center in separate sets of collection, and are under evaluation. Forty two (set I) and 16 (set II) selections are under variety trials, 12 selections are in variety verification trial, five hybrids are under variety verification trial and four high yielding cultivars that possessed the typical quality of Yirgachefe or Sidama coffee types were released to coffee growers in the region. In this paper, coffee improvement activities, such as collection and evaluation of germplasm, variety development activities and genetic studies are reviewed.",signatures:"Mesfin Kebede Gessese",downloadPdfUrl:"/chapter/pdf-download/65909",previewPdfUrl:"/chapter/pdf-preview/65909",authors:[{id:"255236",title:"Dr.",name:"Mesfin Kebede",surname:"Gessese",slug:"mesfin-kebede-gessese",fullName:"Mesfin Kebede Gessese"}],corrections:null},{id:"69264",title:"Grafting in Horticultural Crop Species: Effective Pest and Disease Management Technique with Potential in Michoacan, Mexico",doi:"10.5772/intechopen.89288",slug:"grafting-in-horticultural-crop-species-effective-pest-and-disease-management-technique-with-potentia",totalDownloads:717,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The grafting technique is an effective alternative in crop management, specifically for the management of pests and soil pathogens; therefore, it has been recognized in all agricultural areas, which makes the a horticultural production technique more respectful with the environment. In general, this technique has been widely used in fruit growing; however, it has also been of great importance in the production of vegetables worldwide. In vegetables, the same principles applied to the grafting of fruit trees are followed, as well as specific requirements, such as controlled climatic conditions and greater care. In Michoacan, Mexico, by the phytosanitary condition in cucurbits, Solanaceae, and Caricaceae, the use of rootstocks with specific resistance characteristics offers an option for the recovery of soils, without repercussion in the environment. Although in Mexico this technique has been little exploited, in Michoacan, it is innovative in crops of Solanaceae, Cucurbitaceae, and Caricaceae. The use of grafted plants helps to improve the conditions of the crop, but also, if this technique is included in a program of integrated management of pests and diseases, it ensures the success of the production.",signatures:"Juan Carlos Álvarez-Hernández",downloadPdfUrl:"/chapter/pdf-download/69264",previewPdfUrl:"/chapter/pdf-preview/69264",authors:[{id:"212259",title:"Dr.",name:"Juan Carlos",surname:"Álvarez-Hernández",slug:"juan-carlos-alvarez-hernandez",fullName:"Juan Carlos Álvarez-Hernández"}],corrections:null},{id:"70460",title:"Aspects of the Particular Genetics of Grapes Prolonged for All Horticulture Crops",doi:"10.5772/intechopen.90566",slug:"aspects-of-the-particular-genetics-of-grapes-prolonged-for-all-horticulture-crops",totalDownloads:620,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"The modern level of knowledge development in the field of fundamental sciences makes it possible to reliably investigate the processes of evolution. The purpose of our research was to determine the need to establish the existing evolutionary transformations in resistance to abiotic and biotic stress factors of the biosphere in a grape plant, which may be natural for all horticulture crops, and on the other hand, based on the postulate of natural and experimental evolution, to prove the processes of natural evolution as a result of experimental breeding. The results obtained in the study of particular issues of genetics of grapes, based on the existence of general biological regularities, can be prolonged for interpretation, with reference to other horticulture crops. We studied the genetics of grapes, in particular crossability, the inheritance of signs and characteristics, the establishment of regularities in the display of selection value, and heterosis, allowing us to formulate the principles of modeling a new variety. Investigating the process of creating grape varieties that are resistant to biotic factor, it was suggested to consider it from the point of view of the coevolution of the plant and pathogen.",signatures:"Vladimir Volynkin, Alla Polulyakh, Svetlana Levchenko, Irina Vasylyk and Vladimir Likhovskoy",downloadPdfUrl:"/chapter/pdf-download/70460",previewPdfUrl:"/chapter/pdf-preview/70460",authors:[{id:"252760",title:"Dr.",name:"Vladimir",surname:"Volynkin",slug:"vladimir-volynkin",fullName:"Vladimir Volynkin"},{id:"253334",title:"Dr.",name:"Alla",surname:"Polulyakh",slug:"alla-polulyakh",fullName:"Alla Polulyakh"},{id:"253335",title:"Dr.",name:"Svetlana",surname:"Levchenko",slug:"svetlana-levchenko",fullName:"Svetlana Levchenko"},{id:"253336",title:"Dr.",name:"Irina",surname:"Vasylyk",slug:"irina-vasylyk",fullName:"Irina Vasylyk"},{id:"313760",title:"Dr.",name:"Vladimir",surname:"Likhovskoy",slug:"vladimir-likhovskoy",fullName:"Vladimir Likhovskoy"}],corrections:null},{id:"67870",title:"Epidemiology and Management of South American Leaf Blight on Rubber in Brazil",doi:"10.5772/intechopen.87076",slug:"epidemiology-and-management-of-south-american-leaf-blight-on-rubber-in-brazil",totalDownloads:709,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The rubber tree (Hevea spp.) is one of the main forest crops in tropical regions due commercialization of natural rubber. Brazil currently imports most rubber that is consumed. According to the International Rubber Study Group, for an annual consumption of 350,000 tons in Brazil, 135,000 tons were produced, whereas 215,000 tons were imported. This failure of rubber cultivation in Brazil is primarily due to South American leaf blight (SALB), a disease caused by the fungus Microcyclus ulei (P. Henn. v. Arx.). The fungus is present in all Brazilian rubber-producing regions and attacks young leaflets, causing abscission and, ultimately, death of the tree. This disease occurs in almost all areas of rubber tree plantations in Central and South America. Strategies used to manage SALB are based on the use of fungicides in nurseries and young plantations and the use of resistant clones; on phenological aspects, taking into account the leaf shedding patterns of adult rubber trees, which in certain environments provide defense in addition to resistance; and on climatic factors that are favorable or unfavorable to epidemic development. The aim of this chapter was to describe all aspects related to the epidemiology and management of leaf blight in Brazil.",signatures:"Edson Luiz Furtado, Willian Bucker Moraes, Waldir Cintra de Jesus Junior, Breno Benvindo dos Anjos and Lilianne Gomes da Silva",downloadPdfUrl:"/chapter/pdf-download/67870",previewPdfUrl:"/chapter/pdf-preview/67870",authors:[{id:"148900",title:"Prof.",name:"Edson Luiz",surname:"Furtado",slug:"edson-luiz-furtado",fullName:"Edson Luiz Furtado"},{id:"264601",title:"Prof.",name:"Waldir Cintra",surname:"de Jesus Junior",slug:"waldir-cintra-de-jesus-junior",fullName:"Waldir Cintra de Jesus Junior"},{id:"280975",title:"Prof.",name:"Willian",surname:"Bucker Moraes",slug:"willian-bucker-moraes",fullName:"Willian Bucker Moraes"},{id:"284646",title:"MSc.",name:"Breno",surname:"Benvindo Dos Anjos",slug:"breno-benvindo-dos-anjos",fullName:"Breno Benvindo Dos Anjos"},{id:"284648",title:"Prof.",name:"Lilianne",surname:"Gomes Da Silva",slug:"lilianne-gomes-da-silva",fullName:"Lilianne Gomes Da Silva"}],corrections:null},{id:"69407",title:"Fusarium Wilt in Banana: Epidemics and Management Strategies",doi:"10.5772/intechopen.89469",slug:"-em-fusarium-em-wilt-in-banana-epidemics-and-management-strategies",totalDownloads:1263,totalCrossrefCites:0,totalDimensionsCites:5,hasAltmetrics:1,abstract:"Fusarium wilt, caused by Fusarium oxysporum f. sp. cubense (Foc), is one of the most threatening fungal diseases affecting banana plantations across the globe. It was first discovered in Australia in 1874 and has now spread to numerous different regions in the world hinting at the persistency of the pathogen. Various management strategies have been devised aiming mainly on improving the plant’s tolerance or suppressing the infection. Fungicide is commonly used to control the disease spread, but it does not provide total protection to the plants besides displaying selective effectiveness on certain Foc strains. Alternatively, farmers apply crop rotation, rice hull burning, biological soil disinfestation, and compound-supplemented soil in their banana plantations. Studies have also shown that certain biocontrol agents manage to curb the disease threat. Selection of somaclonal variants and genetic manipulation via induced mutagenesis and transformation are also among the alternatives that have been implemented in producing Fusarium-tolerant and Fusarium-resistant banana plants. This chapter will describe Fusarium epidemics in banana, the effectiveness and challenges of different management approaches, as well as the future alternatives that can be adopted by taking advantages of the latest advances in omics technologies.",signatures:"Fatin Nadiah Jamil, Chu-Nie Tang, Noor Baity Saidi, Kok-Song Lai and Nadiya Akmal Baharum",downloadPdfUrl:"/chapter/pdf-download/69407",previewPdfUrl:"/chapter/pdf-preview/69407",authors:[{id:"221544",title:"Dr.",name:"Kok-Song",surname:"Lai",slug:"kok-song-lai",fullName:"Kok-Song Lai"},{id:"276692",title:"Ms.",name:"Fatin Nadiah",surname:"Jamil",slug:"fatin-nadiah-jamil",fullName:"Fatin Nadiah Jamil"},{id:"276694",title:"Ms.",name:"Chu-Nie",surname:"Tang",slug:"chu-nie-tang",fullName:"Chu-Nie Tang"},{id:"276695",title:"Dr.",name:"Noor Baity",surname:"Saidi",slug:"noor-baity-saidi",fullName:"Noor Baity Saidi"},{id:"276696",title:"Dr.",name:"Nadiya Akmal",surname:"Baharum",slug:"nadiya-akmal-baharum",fullName:"Nadiya Akmal Baharum"}],corrections:null},{id:"69065",title:"Mango Diseases: Impact of Fungicides",doi:"10.5772/intechopen.87081",slug:"mango-diseases-impact-of-fungicides",totalDownloads:1800,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Mango, Mangifera indica L., is known to be the king of all fruits due to its delicious taste, marvelous fragrance, and beautiful appearance. However, several infectious diseases caused by many phytopathogens are deteriorating mango quality and quantity. Mango tree and fruit have been affected by about 83 diseases reported worldwide, and in Pakistan, 27 diseases are recognized as more important. Disease control always remains a challenge for the farmers to get optimum production especially due to pesticide resistance. Resistance to fungicide in current days is a major threat to plant disease management. In many cases, plant pathogen resistance could develop naturally; thus, several newly developed chemistries of fungicides remain at high risk. However, research toward an increase of resistance and delay in disease development has been undertaken. Existing fungicide chemistry, sometimes, renamed with new trade name does not satisfy the farmer to apply such fungicides for disease management. However, chemical fungicides are believed to be a significant way to control fungal pathogens or sometimes to inhibit and prevent the development of pathogens. However, due to pathogen resistance development, it is hard to manage plant diseases. Therefore, the impacts of such fungicide management in some important mango diseases are discussed in this chapter.",signatures:"Muhammad Ibrahim Khaskheli",downloadPdfUrl:"/chapter/pdf-download/69065",previewPdfUrl:"/chapter/pdf-preview/69065",authors:[{id:"266913",title:"Prof.",name:"Muhammad Ibrahim",surname:"Khaskheli",slug:"muhammad-ibrahim-khaskheli",fullName:"Muhammad Ibrahim Khaskheli"}],corrections:null},{id:"64004",title:"Use of Parasitoids as a Biocontrol Agent in the Neotropical Region: Challenges and Potential",doi:"10.5772/intechopen.80720",slug:"use-of-parasitoids-as-a-biocontrol-agent-in-the-neotropical-region-challenges-and-potential",totalDownloads:1761,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:1,abstract:"The agricultural production in the Neotropical region is highly affected by the attack of pests and diseases. Due to the overuse of pesticides, sustainable methods of control are in demand, such as biological control. Integrated Pest Management (IPM) considered the use of Biological control as a method to suppress the population of pests in several field agricultural systems and in protected crops systems. Biological control is generally appreciated today as an important component of IPM, and the demand for it is likely to spread as the IPM programs develop worldwide. The tropics present an important region for the application of biological control. The Neotropical region is characterized by its rich biodiversity, resulting in a wide range of natural enemies of pests represented by parasitoids, predators, and pathogens. Parasitoids are the natural enemies most used around the world for biological control. In this chapter, we present biological control programs using parasitoids established in the Neotropical region to control key pests of economic importance. Agricultural practices that maintain and enhance the action of natural enemies in crops will be reviewed, as the challenges and potential for the establishment of Biological Control programs using parasitoids in the Neotropical region.",signatures:"Yelitza C. Colmenarez, Natália Corniani, Simone Mundstock Jahnke, Marcus Vinicius Sampaio and Carlos Vásquez",downloadPdfUrl:"/chapter/pdf-download/64004",previewPdfUrl:"/chapter/pdf-preview/64004",authors:[{id:"172855",title:"Dr.",name:"Yelitza",surname:"Colmenarez",slug:"yelitza-colmenarez",fullName:"Yelitza Colmenarez"},{id:"188351",title:"Dr.",name:"Natália",surname:"Corniani",slug:"natalia-corniani",fullName:"Natália Corniani"},{id:"243574",title:"Dr.",name:"Carlos",surname:"Vásquez",slug:"carlos-vasquez",fullName:"Carlos Vásquez"},{id:"243575",title:"Dr.",name:"Marcus Vinicius",surname:"Sampaio",slug:"marcus-vinicius-sampaio",fullName:"Marcus Vinicius Sampaio"},{id:"243576",title:"Dr.",name:"Simone",surname:"Mundstock Jahnke",slug:"simone-mundstock-jahnke",fullName:"Simone Mundstock Jahnke"}],corrections:null},{id:"63500",title:"Essential Oil Nanoformulations as a Novel Method for Insect Pest Control in Horticulture",doi:"10.5772/intechopen.80747",slug:"essential-oil-nanoformulations-as-a-novel-method-for-insect-pest-control-in-horticulture",totalDownloads:1338,totalCrossrefCites:9,totalDimensionsCites:14,hasAltmetrics:0,abstract:"Eco-friendly biopesticides based on essential oils (EOs) appear to be a complementary or alternative method to chemically synthesized insecticides in integrated pest management programs. They have the advantage of reducing the adverse effects of chemical insecticides on human health and environment and at the same time increasing horticultural crop productivity and yield. Plant EOs exhibit toxic, repellent, and antifeedant effects on different insect species. However, the main problem in using plant EOs as biopesticides under field conditions is their chemical instability in the presence of air, light, moisture, and high temperatures which lead to the rapid evaporation and degradation of their active constituents. Incorporation of EOs into controlled-release nanoformulations may contribute to solve problems associated with their application; this kind of formulation is expected to be more effective than the bulk (free) substance.",signatures:"Samar S. Ibrahim",downloadPdfUrl:"/chapter/pdf-download/63500",previewPdfUrl:"/chapter/pdf-preview/63500",authors:[{id:"251921",title:"Dr.",name:"Samar S.",surname:"Ibrahim",slug:"samar-s.-ibrahim",fullName:"Samar S. 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The objective of the book will be to highlight the importance of sex education and explain normal human sexuality. With the growing number of males and females reporting sexual dysfunction the need for a ready reckoner of sexual dysfunction may be relevant and necessary.
\r\n\r\n\tThe book will have chapters on normal human sexuality, sexual health, Sexual dysfunction in the male and female, sexual dysfunction disorders related to libido, orgasm, ejaculation, erection, and genetic or hormonal or developmental or sexuo-erotic orientation defects.
\r\n\r\n\tThe book will also highlight the importance of sex counselors and therapists.
\r\n\tThere will be a chapter on secondary causes of sexual dysfunction disorders related to diabetes, cardiovascular disease, and obesity. A chapter on remedial measures to enhance sexual activity and maintain human relationships will be discussed. As there is a growing number of cancer survivors a chapter on cancer-related sexual dysfunction will be welcomed for including it.
Plant hormones (phytohormones) are not nutrients, but chemicals and not all plant cells respond to hormones, but those cells that do are programmed to respond at specific points in their growth cycle. The greatest effects occur at specific stages during the cell’s life, with diminished effects occurring before or after this period [1].
Plants need hormones at very specific times during plant growth and at specific locations. They also need to disengage the effects that hormones have when they are no longer needed. The production of hormones occurs very often at sites of active growth within the meristems, before the cells have fully differentiated. After production, they have sometimes moved to other parts of the plant, where they cause an immediate effect; or they can be stored in cells to be released later. Plants can also break down hormones chemically, effectively destroying them. Plant hormones frequently regulate the concentrations of other plant hormones [2, 3].
The small amounts of plant hormones promote, control, influence and develop the growth from embryo to reproductive development, also, stress tolerance and pathogen defense. According to the importance of plant hormones in this chapter will be divided into two main points: first: the effect of plant hormones on germination and growth of plants under internal or external suitable conditions, second: the effect of plant hormones on the germination and growth of plants under internal or external unsuitable environmental conditions.
Seed germination is attracted to the effective growth of the embryo when appropriate environmental conditions are present, leading to seed rupture and the appearance of a small plant. There are five basic steps to germination: water imbibition, enzyme activation, initiation of embryo growth, rupture of the seed coat and emergence of seedling, seedling establishment [4, 5].
In the second step stage of germination (enzyme activation), after the absorption of water through the natural openings in the casing of the seed and spread through the tissues of the seed, gibberellins which activate the formation of the hydrolytic enzymes, mainly α- amylase in the aleurone cells, which are responsible for hydrolysis of storage macro-molecules such as starch and proteins and convert them into available forms to the embryo, usage to increase in size, and raise the osmotic content of the seed, to increase water potential [6, 7].
In addition, plant hormones have an important role in plant growth not only germination such as cytokinins (CKs) which influence cell division, the formation of shoot and helping in delay tissues senescence [8, 9]. Also, the ratios of Cytokinins and auxins affect most major growth periods during a plant’s lifetime [10]. Also, Peptide hormones, control of cell division, expansion, and play crucial roles in plant growth and development [11]. Furthermore, gibberellins (Gas) strongly promote cell elongation in seedlings [12, 13]. It can also affect cell cycling in plant [14]. Meanwhile, the responses of
For enhances and increases plant hormones production in the plants, many studies have proved the need to add plant hormones either directly (GA3, kinetin and cytokinins) [17, 18] or indirectly (humic substances, manures, magnetite, natural zeolites,
Sometimes even under favorable germination conditions (an adequate water supply, a suitable temperature and the normal composition of the atmosphere) seeds do not germinate. In this case, seeds are considered dormant. Seed dormancy is defined as an inactive phase in which the growth and development are deferred and the respiration is greatly reduced [28, 29]. Seed coat dormancy involves the mechanical restriction of the seed coat. GA releases this dormancy by increasing the embryo growth potential, and/or weakening the seed coat so the radical of the seedling can break through the seed coat. ABA affects the testa or seed coat growth characteristics, including thickness, and affects the GA-mediated embryo growth potential [5].
Hormones also can mediate endosperm dormancy: Endosperm in most seeds is composed of living tissue that can actively respond to hormones generated by the embryo. The endosperm often acts as a barrier to seed germination, playing a part in seed coat dormancy or in the germination process. Living cells respond to and also affect the ABA:GA ratio, and mediate cellular sensitivity; GA thus increases the embryo growth potential and can promote endosperm weakening. GA also affects both ABA-independent and ABA-inhibiting process within the endosperm [30]. In addition, [33] concluded that the prevented germination of some seeds of tomato [31], iris [32], and some varieties of cabbage was due to the present of inhibitors (ABA, parasorbic acid, and coumarin) which cases distributed in plants and to possess the property of inhibiting seed germination and other growth phenomena [5, 34].
Plant hormones affect seed germination and dormancy by acting on different parts of the seed such as [35] found that the inhibitors in seeds of peach were at least one of the factors controlling in germination by preventing or retarding cell division of the radical. In
The promotion of germination by gibberellin and cytokinins has been demonstrated in many seed species [38, 39]. Ref. [40] treated the seeds of
Ref. [42] found that fresh seed of
The effect of gibberellic acid and cytokinins were also recognized on the germination of other plant species seeds. Ref. [45] studied the effect of Kinetin at different concentrations on the seed germination of
Plant hormones can also alleviate abiotic stress such as drought, extreme temperatures, and salinity [52, 53]. The action of these hormones in response to situations of stress can be developed through synergistic or antagonistic activities [54]. Also, [55] concluded that the plant growth regulators like ABA, JA, and ethylene are involved in the regulation of the plant response to abiotic stress. Cytokinins are also able to enhance seed germination by the alleviation of stresses such as salinity, drought, heavy metals and oxidative stress [56, 57, 58, 59]. Ref. [60] found that GA3 plays an important role in the growth and metabolism of microalgae
The decreased cytokinin and gibberellic acid (GA3) and increased abscisic acid contents are often observed responding in plants subjected to environmental stresses [63, 64]. Exogenous application of plant growth regulators [such as cytokinin or antioxidants (ascorbic acid) [65], Moringa (
Also, bio-fertilization has beneficial microorganisms that increasing plant hormones, which led to enhances yield, plant growth and nutrient uptake under various environmental conditions such as salinity [73, 74, 75, 76], drought and low fertility supply [77, 78, 79], especially that some endomycorrhizal fungi (Arbuscular mycorrhizal fungi) have been proven to improve drought stress; they colonize bio-trophically the root cortex and develop an extra-metrical mycelium that helps the plants to acquire mineral nutrients from the soil particularly those, which are immobile. They can under drought conditions stimulate growth-regulating substances, increase photosynthesis, improve osmotic adjustment, optimize hormonal balance and enhance water uptake [80].
Numerous studies have found also, that it can be alleviation of salt stress on peanut [81]; on pumpkin plants [82]; on
This chapter was indicated by many studies that the plant hormones, including IAA, cytokinins, ethylene, gibberellins, and brassinosteroids, can positively affect seed germination and seedling growth, for many plants as mentioned previously in the chapter, under favorable conditions. While ABA has an adverse on affect seed germination and the growth.
Also, this chapter sheds the light on the important role of soil bacteria in the production of plant hormones or as an alternative in the case of the low rate of plant hormones in the plant, which led to hence seed germination, growth, and hence crop production.
In addition, this chapter provided many studies that prove that the plant hormones very important to overcome dormancy or growth under stress condition. Also, shed the lights on the importance of the exogenous application of plant growth regulators (cytokinin or antioxidants, Moringa leaves extract, humic acid, or seaweed extract, bio- or nano fertilizers) for enhancing the productivity of plant hormones which led to increased cell growth.
Finally, it can be stated that the plant hormones are essential for cell growth, whether under normal conditions or under stress conditions.
The author declares that she does not have any conflict of interest.
Respiratory compromise due to embolization is one of the leading causes of death among hospitalized patients, a condition known as acute pulmonary embolism (PE). In the United States alone, for every 100,000 individuals, about 70 people will experience pulmonary embolism each calendar year [1].
Simply put, acute pulmonary embolism is a restriction of arterial blood flow in the lung that can be detrimental when misdiagnosed. When the cause of obstruction is blood itself, it is known as venous thromboembolism (VTE). This being the most common cause of pulmonary embolism. It is apropos to mention that blood flow is not the only substance that can cause mechanical lung obstructions. Other substances include, but not limited to fat (traumatic bone fracture, especially of long bones, leads to bone marrow/fat freely circulating systemically), amniotic fluid (as a complication of labor), air (a complication of central venous access), septic embolism (heart valve damage by micro-organism) or even tumor cells metastasizing. The broad array of materials that can lead to this obstructive shock makes it imperative for a clinician to put the clinical picture with the patient’s symptoms to make the diagnosis early. Failure to do so in a timely manner can lead to catastrophic cardiopulmonary compromise and even death.
When PE is caused by venous thromboembolism, greater than 50% of patients will have some clot burden in their lower extremities or a deep vein thrombosis (DVT). The culprit vessels being the femoral and popliteal veins. Some patients may present with symptoms of DVT without PE. Therefore, a thorough investigation is warranted to diagnose, treat and prevent future propagation.
Acute pulmonary embolism is a mechanical obstruction of the blood flow to the lung vasculature and the functional unit involved in respiration, the parenchyma. The parenchyma being starved of oxygen leads to an inflammatory response and cellular death made evident by respiratory compromise and the compensatory respiratory alkalosis on patient presentation. It is imperative to note that both PE and DVT share a spectrum in the realm of VTE. The main difference between these two disease states lies in the location. The main mechanism that leads to PE and DVT, known as the Virchow’s triad, comprises of endothelial injury, venous statis and a hypercoagulable state.
Endothelial injury refers to damage to the vasculature which can lead to an inflammatory response in an attempt to heal with thrombus formation. Most commonly, this occurs in acute trauma, previous history of trauma or prior surgery. Venous stasis, which comprises of a no flow state of blood, can lead to thrombus formation as blood has an affinity to coagulate when not freely flowing. Venous stasis is mostly seen as a complication from immobility (postoperative states) or in patients with major strokes. Lastly, a hypercoagulable state can be a complication of disease states, such as active cancer, medications such as hormonal replacement therapy or oral contraceptives, and finally genetic mutations, most common being factor V Leiden. Other genetic mutations include: protein C and S deficiency, prothrombin gene mutation, antithrombin III deficiency.
Hemodynamically, there are many alterations that occur in the presence of an acute PE that is related to the size of the embolus, the duration of blood flow obstruction as well as the patient’s cardiopulmonary history. Large PEs tend to obstruct the main pulmonary artery along with its branches while smaller PEs are culprits of the smaller peripheral vessels. The obstructive burden coupled with neurohormonal release contribute to hemodynamic compromise and ischemic propagation is presence of neurohormonal release that progress propagate ongoing damage. Common neurohormones present include serotonin, thrombin and histamine [2].
Hypoxic vasoconstriction, a reflex response to acute PE, leads to increase in mean arterial pulmonary pressure. This increase is significantly high in patients with history of pulmonary hypertension. Increased pulmonary artery pressure contributes to increased right ventricular (RV) afterload causing right ventricular enlargement and a leftward bulging of the interventricular septum commonly found on echocardiography. Cardiac arrest is hence from the vascular compromise from increased pressure on the right coronary artery, causing myocardial ischemia.
Acute PE impairs efficient gas exchange. Hypoxemia and increase in the alveolar-arterial oxygen tension gradient are the most common gas exchange abnormalities. Total dead space increases. Ventilation and perfusion become mismatched, with blood flow from obstructed pulmonary arteries redirected to other gas exchange units [2]. The obstruction of blood flow in the pulmonary arteries leads to a redistribution of blood flow causing some alveoli to have low ratios of ventilation to perfusion, whereas others have excessively high ratios of ventilation to perfusion [2].
Assessment of PE in patients can be challenging as symptoms can be nonspecific. The patient could present with an array of different possibilities but a history of dyspnea, progressive or sudden onset in nature is a common complaint. Other complaints include pleuritic chest pain, cough and hemoptysis mostly in patients with pulmonary infarction. Due to the nonspecific symptoms that acute PE could present with, it is imperative to garner the appropriate risk factors that could lead to the suspicion. Another complaint that should increase the index of suspicion is a patient with dyspnea coupled with recent onset lower extremity tenderness or swelling.
Most patients with PE have tachypnea and tachycardia associated with hypoxemia. Similar findings can occur in disorders such as heart failure, pneumonia, or chronic obstructive pulmonary disease [2]. A good clinical examination is apropos to ascertain any other possible disease pathology that may mimic PE.
The diagnosis of PE relies on a high clinical suspicion along with the patient’s history and physical exam. After suspicion, confirmation with appropriate testing leads to the final diagnosis. Diagnostic tests alone are not the reflex course of action with a high index of suspicion due to the fact that there are many disease states that could present similarly. In patients with a high index of suspicion, the Wells criteria, developed by Wells et al., is a simple clinical model to predict the likelihood of PE. Scoring system has a maximum of 12.5 points, based on 7 variables: 3 points each for clinical evidence of DVT and an alternative diagnosis being less likely than PE, 1.5 points each for heart rate > 100 per minute, immobilization/surgery within 4 weeks, and previous deep vein thrombosis/PE, and 1 point each for hemoptysis or cancer [2, 3]. The pretest probability for PE after utilization of the Wells scoring system categorizes PE into low (score < 2), moderate (score between 2 and 6) or high risk (score > 6). This will then guide a clinician on subsequent tests such as a D-dimer assay, a byproduct of ineffective fibrinolysis released into systemic circulation. D-dimer elevation has high sensitivity for acute PE, as high as 98%, albeit poor sensitivity. Instances such as malignancy, advanced age and chronic inflammatory conditions are all reasons for an elevated d-dimer besides PE. Therefore, the benefit of a d-dimer assay lies in its high negative predictive value and its ability to effectively reduce further diagnostic testing in patients with an already low to moderate pretest probability with Wells scoring [4, 5].
Imaging studies in patients with acute PE in recent times have been with computed tomography pulmonary angiography (CT-PA). The benefit of CT-PA is direct thrombi visualization in the pulmonary arteries and effectively ruling out patients without PE [2]. The use of radiocontrast dye should be taken into consideration in patients with a suspicion of PE, but in patients with decompensation coupled with a high index of suspicion, the benefits of imaging clearly outweigh the risk. Furthermore, CT-PA with evidence of thrombus in the pulmonary arteries up to the segmental level provides strong evidence of PE. When negative, it does exclude PE but the presence of PE in the subsegmental regions, sometimes missed by CT-PA, does not alter patient outcome as these patients have at least as good an outcome as patients with a negative lung scan [2, 6].
There are indeed other modalities for investigation of acute PE, though by far a CT-PA has emerged as the more favorable option. Other modalities include a ventilation-perfusion (V/Q) scan, a two-part exam with a ventilation phase and perfusion phase. Diagnosis of PE based on a V/Q scan is made when PE-associated lung areas fail to enhance on the perfusion phase using technetium-labeled albumin macroaggregates. Magnetic resonance imaging (MRI) with gadolinium-enhancement has been shown to have similar efficacy to that of CT-PA.
Anticoagulation has become the mainstay treatment for acute PE though the degree of severity influences the length of treatment. The severity of acute PE depends on parameters such as hemodynamics, right ventricular dysfunction, presence of troponin and/or brain natriuretic peptide (BNP). Risk stratification using the appropriate criteria not only guides the choice of treatment, but also provides outpatient management options. It is also highly important to know if the patient has any contraindications to anticoagulation prior to initiation of treatment. Massive (high-risk) PE is the presence of hemodynamic compromise, right ventricular dysfunction and increased troponin and/or BNP levels. In such patients, the most common cause of death is not the PE, but the complication of acute right ventricular failure. To mitigate this complication, hemodynamic and respiratory support early is crucial. Due to the dependence of preload in right ventricular failure, both fluid expansion and inotropic agents, such as dobutamine, dopamine and/or norepinephrine, are needed to manage shock [2]. In patients with presence of right ventricular dysfunction and increased troponin and/or BNP levels without hemodynamic compromise, are classified as sub-massive (intermediate-risk) PE with consideration of fibrinolytic therapy if very symptomatic. Lastly, low-risk PE classification is in the group of patients with no hemodynamic compromise, right ventricular dysfunction or increased troponin or BNP levels. In such patients, a consideration of outpatient management is acceptable.
Anticoagulation has become the cornerstone modality of treatment in patients with acute PE. In patients with a very high index of suspicion or massive PE, anticoagulation should be initiated prior to confirmatory test. The most extensively studied anticoagulant in PE is heparin. Heparin, an anti-thrombin III inhibitor, acts mainly by inactivation of factor Xa in the clotting cascade, preventing the conversion of prothrombin to thrombin. Other options include low molecular weight heparin (LMWH), fondaparinux or the direct factor Xa inhibitors, rivaroxaban and apixaban. Dosing for heparin is usually 80 U/kg bolus followed by an infusion at the rate of 18 U/kg per hour with subsequent doses based on aPTT results [4]. Additionally, it is important to monitor platelet count while heparin is administered due to the risk of heparin-induced thrombocytopenia (HIT). After the initial heparinization phase, continued treatment is with an oral direct thrombin inhibitor, factor Xa inhibitor or warfarin.
The duration of treatment of PE is directly related to the precipitating factors that led to the PE. In other words, whether the PE was provoked or unprovoked. Special considerations in terms of treatment modality and duration are made for certain populations such as pregnant females or patients with active cancer. For all other patient populations with who present with a first time PE, the minimum duration of treatment is 3 months. If the PE is provoked and the factors are withdrawn such as a female stopping hormonal treatment, then a 3-month period of oral anticoagulation is sufficient. In patients with an unprovoked or life-threatening PE, indefinite anticoagulation is ideal due to a higher risk of recurrence. There must be a risk and benefit analysis when indefinite anticoagulation is being pursued, especially in patients with a higher bleeding risk [4].
Systemic thrombolytic therapy is an effective therapy in preventing deaths from PE, however it markedly increases bleeding risks, including intracranial and fatal bleeding [7]. The PEITHO (Pulmonary Embolism Thrombolysis Study), which compared tenecteplase with placebo in 1000 PE patients without hypotension but with right ventricular dysfunction, found no clear net benefit from systemic thrombolytic therapy; the reduction in cardiovascular collapse (odds ratio: 0.30) was offset by the increase in major bleeding (odds ratio: 5.2) [8]. Consequently, systemic thrombolytic therapy is usually reserved for PE patients with hypotension. Catheter-directed thrombolysis (CDT) was initially developed for treatment of arterial, dialysis graft, and deep vein thromboses (leg or arm). When used to treat acute PE, a wire is usually passed through the embolus, followed by placement of a multi-sidehole infusion catheter through which a thrombolytic drug is infused over 12–24 h. The delivery of the drug directly into the thrombus is expected to be as effective as systemic therapy but to cause less bleeding because a much lower dose of the drug is used.
SEATTLE II is a single-arm prospective cohort study in which 150 patients with lobar artery or more central PE (31 with and 119 without hypotension) were treated with ultrasound-assisted CDT using a standardized protocol [9]. Tissue plasminogen activator was infused into each treated lung at a rate of 1 mg/h, to a total dose of 24 mg (over 12 h for bilateral lung infusions), and no additional mechanical maneuvers were used to disrupt or aspirate thrombus. When computed tomography pulmonary angiography was repeated after 48 h, the right ventricular to left ventricular ratio was decreased by 27% and thrombus burden was reduced by 30%. Pulmonary artery pressure also decreased by 27% between the start to the end of CDT. These 3 improvements were each highly statistically significant. There were 17 episodes of major bleeding in 15 patients (10%): one was associated with hypotension; all required transfusion; none was intracranial; and none was fatal.
Acute pulmonary ischemia due to pulmonary embolism results in a cascade of events, from decreasing lung compliance to increasing pulmonary resistance ultimately resulting in RV dysfunction and hemodynamic collapse. Thus, in certain cases more rapid thrombus removal is required, and mechanical techniques are now available.
The FlowTriever System (Figure 1) is a mechanical thrombectomy device indicated for use in the peripheral vasculature and pulmonary arteries (PAs). FlowTriever received U.S. Food and Drug Administration 510(k) clearance for PE in May 2018—the first mechanical thrombectomy device to receive that indication. The FlowTriever System includes Triever aspiration catheters (16-F, 20-F, 24-F) capable of removing large amounts of thrombus via aspiration with a 60 cc syringe. The FlowTriever System also includes FlowTriever catheters with three self-expanding nitinol mesh disks of different sizes designed to aid in extraction, if needed, by engaging and disrupting thrombus. Anticoagulation with heparin is recommended per routine catheterization laboratory practice to prevent thrombosis of the catheter. The aspiration catheter is advanced over a 0.035-inch wire to the level of the right or left PA, just proximal to the occlusive thrombus. Once engaged, the clot is extracted via aspiration through the catheter. The procedure can be repeated several times per side at the discretion of the physician, depending on the amount of clot retrieved and the improvement in distal flow on repeat angiography.
The FlowTriever® system. The Triever aspiration catheter is shown in purple, and the optional FlowTriever® catheter with nitinol disks is shown emerging from the distal end of the Triever catheter.
The FlowTriever System has been evaluated in several clinical studies both prospectively and retrospectively. The first of these was a prospective multi-center study, the FLARE (FlowTriever Pulmonary Embolectomy Clinical Study) trial, which was the largest systematic evaluation of the effectiveness of mechanical thrombectomy for PE at the time [10]. From April 2016 to October 2017, 106 patients were treated with the FlowTriever System at 18 U.S. sites. Two patients (1.9%) received adjunctive thrombolytics. The mean procedural time was 94 min, and the mean intensive care unit stay was 1.5 days. Forty-three patients (41.3%) did not require any intensive care unit stay. At 48 h post-procedure, average RV/LV ratio reduction was 0.38 (25.1%; p < 0.0001). Four patients (3.8%) experienced 6 major adverse events, with 1 patient (1.0%) experiencing major bleeding. One patient (1.0%) died from undiagnosed breast cancer through 30-day follow-up. The trial concluded that percutaneous mechanical thrombectomy with the FlowTriever System appears safe and effective in patients with acute intermediate-risk PE, achieved significant improvement in RV/LV ratio, and resulted in minimal major bleeding.
Large-bore aspiration mechanical thrombectomy with the FlowTriever System was also evaluated in two retrospective single-arm clinical studies. The first of these [11] was a single-center study of 46 patients with both massive (high-risk) and submassive (intermediate-risk) PE. The authors reported a significant reduction in mean PA pressure from 33.9 ± 8.9 mmHg to 27.0 ± 9.0 mmHg (
More recently, the FlowTriever System was studied in a nonrandomized two-arm retrospective analysis versus routine care [13]. This single-center study compared outcomes for 28 patients who underwent mechanical thrombectomy with the FlowTriever System to those for 30 patients who received routine care, which consisted of anticoagulation alone, anticoagulation with CDT, or systemic thrombolysis. In-hospital mortality was significantly lower for patients undergoing mechanical thrombectomy versus routine care (3.6% vs. 23.3%,
Pre procedure planning\t\t
Patient Information
Prior to any pulmonary embolism procedure several patient conditions must be made clear. Several questions that all operators should ask include, what are the current hemodynamics and does that patient require vasopressor support? What is the current respiratory status (Ie O2 supplementation or on mechanical ventilation)? What is the bleeding risk and can the patient be anticoagulated? During our procedure we maintain and actual clotting time (ACT) of >250 secs.
Pre case Imaging
CT is the most rapid and common imaging tool used. Specific items to look for include, location and size of clot, RV/LV Ratio, and pulmonary infarct.
Echocardiography will not only show LV and RV size but RV systolic function.
Additional things to consider:
History or current DVT
IVC Filter in Place
Clot in Transit (is TEE or TTE available urgently)
Recent Surgery/Extended immobile time (travel)
Cancer History
History of PE
Infarct consideration (reperfusion injury/elevated wire perforation risk)
Anesthesia:
Conscious sedation is recommended. General Anesthesia has a risk of worsening hypotension and reducing preload to the RV. If systemic pressure is tenuous, a rapid reduction in RV filling can result in immediate hemodynamic collapse.
Patient Selection
Avoidance of thrombolytics
There are several advantages to the decision making for who would benefit from thrombolytic therapy for pulmonary embolism. The immediate decision is to determine who is at highest risk and thus has the largest to gain. Any patient with right ventricular (RV) dysfunction, we feel should be considered for thrombolytic therapy. Patients with an elevated RV: LV ratio; greater than 0.9, elevated pro-bnp, elevated troponins, and hemodynamics suggestive of reduced cardiac output, should be considered for thrombolytic therapy.
Patients need to be able to lay either supine or prone for a minimum of 30 minutes, thus taking oxygen requirements and body habitus into consideration.
Any patient with a relative contraindication to thrombolytic therapy, or felt to be at elevated risk, immediately should be considered for thrombotic intervention.
Access
US guidance
Access to venous circulation, when using large bore sheaths should always be performed with ultrasound guidance. It is advantageous in the venous system to evaluate for upper or lower extremity deep venous thrombosis, prior to starting the procedure, as well as avoidance of an arterial puncture.
Femoral
The most common access site for pulmonary thrombectomy is the common femoral vein
Jugular
When an alternative access is required another option is the internal jugular vein.
Pulmonary angiogram
Difficulties
Image quality tends to be the dis-advantage. Morbid obesity, patient movement, as well as variations in imaging acquisition (ie dye load, manual vs. power injection), can result in wide range of image quality.
Aspiration thrombectomy catheters
Inari Medical
Twenty-four french aspiration guide catheter that navigates through the right heart and delivers the catheter directly into the pulmonary artery. Aspiration is performed by a manual pull. The large bore catheter maximizes aspiration and collection of thrombus. The 24 F catheter creates an aspiration flow rate of 143 mLs/second.
Sixteen french curve
Due to the natural curvature of the pulmonary artery to the right, the 24 F catheter takes a turn to the right pulmonary artery typically with little difficulty. The catheter when placed in the left pulmonary artery, typically does not engage the left lower lobe. The 16 french curve catheter is placed within the 24F catheter and is preshaped to point down into the left pulmonary artery for selective thrombus aspiration.
Bloodloss technology
The FlowSaver blood return system is designed to be used with the FlowTriever aspiration catheter to reduced blood loss by filtering aspirated thrombi and blood for reinfusion back to the patient, thus enabling bloodless thrombectomy for pulmonary embolism procedure. The filtration system includes a 40-micro filter. Filtered blood can be reintroduced using a 60-cc collection syringe.
Penumbra, Inc.
The Indigo aspiration system is indicated for use in the peripheral arterial system and the pulmonary arteries, receiving U.S. Food and Drug Administration 510(k) clearance for PE in December 2019.
The Indigo system lightning 12 aspiration catheter that navigates through the right heart and into the selected pulmonary artery. The 12F system, unlike the manual aspiration of the Inari device, is connected to the Penumbra aspiration pump, resulting in a continuous vacuum system at −28.5 mmHg. If thrombus is not aspirated, the system also has a separator wire that can be advanced through the catheter to disrupt thrombus at the distal tip.
Intraprocedural complications
Perforation
The most common cause of pulmonary artery perforation is due to a wire complication. Wire perforation causes include treating distal clot, poor wire positioning and overlapping vessel (specifically on the left side)
Avoidance and Management
Limit use of guide wires, and always use Amplatz wire to work over
Use multiple shots to confirm location of wire and catheter
Use multiple angles of monitor to confirm locations
If Perforation does occur, increase supplemental oxygen, stop and reverse anticoagulation and consider placing a occlusion balloon proximal to the perforation.
Right heart trauma
If the tricuspid valve crossed safely with angled pigtail catheter or balloon tip catheter, typically not as concerned. If a end hold catheter was used, through a chordae tendinea of the tricuspid valve.
Always advance with caution as advancing through heart monitoring pain, excessive tension advancing catheter, and any arrhythmias happening
Never advance large bore catheters without dilators
Use buddy wires to assist stability in accessing multiple vessels to avoid kick back
Shock/RV failure
There are several methods of determining right ventricular systolic function. A calculated PAPi in the cardiac cath lab can determine who would benefit from RV mechanical support (ie Abiomed Impella RP). If the PAPi is calculated to be less than 1, and you have achieved enough thrombolytic therapy to allow for distal perfusion, mechanical support should be considered. Extracorporeal membrane oxygenation (ECMO) can also be considered for both hemodynamic support and oxygenation.
Closure
Most venous access sites can be closed with manual pressure alone. However, with large bore access we have using the Abbott Medical proglide perclose suture mediated closure. This device has been shown to reduce time to hemostasis, ambulation and discharge compared to manual compression
Post Procedure management
ICU avoidance
The use of thrombolysis for the treatment of PE at some institutions requires ICU level care.
Mechanical thrombectomy is a means of direct therapy which can result in immediate clinical response and will commonly not require intensive care management.
Additionally with the avoidance of tissue plasminogen activator (tPA), ICU admission post procedure is commonly unnecessary.
Venous dopplers
The most common source of PE is DVT. Thus, all patients require bilateral venous duplex for confirmation of residual disease.
Based on these results, it is a clinical decision whether therapy is required for DVT.
Hypercoagulable work up
Patients who benefit from this work up include:
those with/without a family history of VTE
patients age < 45 years
recurrent thrombosis or thrombosis in unusual sites
arterial thrombosis
history of warfarin-induced dermatologic necrosis
These patients will benefit from testing: activated protein C resistance, factor V Leiden, Prothrombin gene mutation, Protein C and S deficiency, Antithrombin deficiency.
DOAC
DOACS such as Factor Xa inhibitors, Apixaban or Rivaroxaban, have become more favorable than Warfarin for anticoagulation due to lower bleeding risk, monitoring for therapeutic INR levels and easier dosing. Apixaban is dosed twice daily while Rivaroxaban is daily dosing. A lower dose is required based on age ≥80, weight ≤60kg and creatinine ≥1.5
Follow up Echo
A follow up echo is used to determine RV dimensions, RV dysfunction and residual pulmonary hypertension.
It is our practice that if there is residual elevation of pulmonary systolic pressure, we refer the patient to a pulmonary hypertension specialist.
Case 1
A 33-year-old woman with no significant past medical history presented to our emergency department after multiple syncopal episodes. An ambulance service was called by family and the patient arrived hypotensive and poorly responsive. She required 6 L of supplemental oxygen and vasopressor support to keep a mean arterial pressure greater than 60 mmHg and oxygen saturation greater than 92%. A bedside anterior-posterior chest X-ray showed a normal cardiac silhouette and clear lung fields. A 12-lead electrocardiogram was consistent with a sinus tachycardia and right bundle branch block. Initial laboratory data was positive for an elevated d-dimer (> 5000 ng/mL), positive troponin (0.4 ng/mL), and pro-brain natriuretic peptide (> 10,000 pg/mL). A stat CT angiogram of the chest demonstrated a massive PE with complete occlusion of the left lower lobe and a RV/LV ratio of 1.5.
The patient was moved emergently to the cardiac catheterization laboratory for immediate therapeutic aspiration thrombectomy. Access was obtained in the right femoral vein using ultrasound guidance. Initial systolic PA pressure was 60 mmHg and the mean PA pressure was 35 mmHg. A pulmonary angiogram confirmed complete occlusion of the left lower lobe (Figure 2). The 24-F Triever aspiration catheter (Triever24) was positioned in the left pulmonary artery. A 20-F Triever Curve catheter, capable of curving up to 260° to aid in navigating in difficult anatomies, (Figure 3) was used coaxially with the Triever24 catheter to angle to the lower lobe where two aspirations were performed. A large amount of thrombus was removed (Figure 4) and repeat pulmonary angiography showed almost complete pulmonary artery opacification and large reduction in thrombus burden (Figure 5). Within minutes there was hemodynamic improvement and oxygen requirements returned to room air alone. Post-thrombectomy pulmonary artery systolic pressure was 33 mmHg. The patient was transferred to the general medical ward and started on oral Factor Xa inhibitor and discharged home the following day.
Case 2
A 75-year-old man with a past medical history of metastatic prostate cancer with known spinal involvement, presented to our emergency room with acute onset of shortness of breath and chest tightness. Initial oxygen saturation was 82% requiring high flow oxygen with a non-rebreather mask. Initial blood pressure was 110/80 mmHg and heart rate of 110 bpm. The pretest probability of PE was high thus the first diagnostic test was a CT pulmonary angiogram, which confirmed a saddle pulmonary embolism and large thrombus burden in the left and right lobes. The RV/LV ratio was 1.4.
Pulmonary angiography was consistent with CT findings (Figure 6). With a known history of spinal metastasis, thrombolytic therapy was contraindicated. The femoral vein access site was dilated to accommodate a 24-F sheath, the Flowtriever System was positioned into the mainstem pulmonary artery and a single aspiration was performed. The catheter was then positioned into the left pulmonary artery performing a single aspiration, followed by the right pulmonary artery, again requiring a single aspiration. Repeat angiography confirmed thrombus resolution and large clot removal (Figure 7). The patient was transferred to the general medical floor on room air. An echocardiogram performed the next day demonstrated normal right ventricular size and function with normal pulmonary pressures. The patient was discharged home the following day.
Case 3
A 44-year-old woman with a recent history of COVID-19 pneumonia presented from home with acute worsening of dyspnea and new pleuritic chest pain. Prior to this admission she required no supplemental oxygen, however, now was on 10 L of oxygen to maintain a saturation > 96%. A CT angiogram of the chest was consistent with a massive right middle lobe pulmonary embolism. The patient was taken to the cardiac catheterization laboratory for emergent intervention. Due to rapid decline in respiratory status and acute hypoxic respiratory failure, the patient was placed on mechanical ventilation. In order to provide rapid therapy, aspiration thrombectomy was performed in the right pulmonary artery. Initial pulmonary angiogram clearly demonstrated large thrombus burden of the right pulmonary artery (Figure 8, left). After a single aspiration was performed, repeat angiogram confirmed almost complete resolution (Figure 8, right), and large thrombus debulking (Figure 9). At the conclusion of the procedure, the patient required <40% fraction of inspired oxygen (Fio2) and positive end-expiratory pressure (PEEP) of 5, maintaining an oxygen saturation > 99%. That evening while in the intensive care unit she was successfully extubated and required 2 L of oxygen by nasal cannula. Seventy-two hours after her initial presentation, she was discharged home on room air.
Pre-treatment pulmonary angiogram showing complete occlusion of the left lower lobe in a patient with massive pulmonary embolism.
Intra-procedure pulmonary angiogram showing the Triever20 curve catheter coaxial within the larger Triever24 catheter in the left lower lobe of the lung in a PE patient.
A large amount of thrombus extracted with the FlowTriever® system from a PE patient.
Post-thrombectomy pulmonary angiogram showing almost complete pulmonary artery opacification and large reduction in thrombus burden.
Pre-thrombectomy pulmonary angiography of the right and left lungs demonstrating a saddle pulmonary embolism with large thrombus burden.
Thrombus extracted using the FlowTriever
Pre- (left) and post-thrombectomy (right) pulmonary angiograms demonstrating large thrombus burden prior to thrombectomy with the FlowTriever
Large amount of thrombus extracted with the FlowTriever
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It leads to a condition which was associated with the generation of catalytically active IgGs-hydrolyzing DNA, myelin basic protein (MBP), and MOG. Production of Abzs was associated with increased proteinuria, leading changes in differentiation of mice bone marrow hematopoietic stem cells (HSCs) and an increase in proliferation of lymphocytes in bone marrow, spleen, and thymus as well as a significant suppression of cell apoptosis in these organs. Treatment of control non-autoimmune CBA mice with MOG led to the different differentiation and proliferation of HSCs comparing with EAE C57BL/6 mice. The treatment of EAE mice with cuprizone inducing demyelination lead to a significant decrease in the size of the brain corpus callosum, but do not significantly change the differentiation profile of HSCs differentiation when compared with untreated mice. It indicates that cuprizone treatment is associated with demyelination, but not autoimmune reactivity. The possible differences in immune system reorganizations during preclinical phases of the disease, acute and late EAE, leading to production of different autoantibodies and Abzs as well other changes are discussed.",book:{id:"5156",slug:"trending-topics-in-multiple-sclerosis",title:"Trending Topics in Multiple Sclerosis",fullTitle:"Trending Topics in Multiple Sclerosis"},signatures:"Georgy A. Nevinsky",authors:[{id:"47119",title:"Dr.",name:"Georgy",middleName:null,surname:"Nevinsky",slug:"georgy-nevinsky",fullName:"Georgy Nevinsky"}]},{id:"21744",doi:"10.5772/19010",title:"Hallmarks in the History of Epilepsy: From Antiquity Till the Twentieth Century",slug:"hallmarks-in-the-history-of-epilepsy-from-antiquity-till-the-twentieth-century",totalDownloads:9305,totalCrossrefCites:6,totalDimensionsCites:27,abstract:null,book:{id:"627",slug:"novel-aspects-on-epilepsy",title:"Novel Aspects on Epilepsy",fullTitle:"Novel Aspects on Epilepsy"},signatures:"Emmanouil Magiorkinis, Kalliopi Sidiropoulou and Aristidis Diamantis",authors:[{id:"33300",title:"Dr.",name:"Emmanouil",middleName:null,surname:"Magiorkinis",slug:"emmanouil-magiorkinis",fullName:"Emmanouil Magiorkinis"},{id:"33563",title:"Ms.",name:"Kalliopi",middleName:null,surname:"Sidiropoulou",slug:"kalliopi-sidiropoulou",fullName:"Kalliopi Sidiropoulou"},{id:"33564",title:"Dr.",name:"Aristidis",middleName:null,surname:"Diamantis",slug:"aristidis-diamantis",fullName:"Aristidis Diamantis"}]},{id:"24857",doi:"10.5772/28930",title:"Hormonal Signaling Systems of the Brain in Diabetes Mellitus",slug:"hormonal-signaling-systems-of-the-brain-in-diabetes-mellitus",totalDownloads:1993,totalCrossrefCites:3,totalDimensionsCites:25,abstract:null,book:{id:"745",slug:"neurodegenerative-diseases-processes-prevention-protection-and-monitoring",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases - Processes, Prevention, Protection and Monitoring"},signatures:"Alexander Shpakov, Oksana Chistyakova, Kira Derkach and Vera Bondareva",authors:[{id:"75886",title:"Dr",name:"Vera",middleName:null,surname:"Bondareva",slug:"vera-bondareva",fullName:"Vera Bondareva"},{id:"75888",title:"Dr.",name:"Alexander",middleName:null,surname:"Shpakov",slug:"alexander-shpakov",fullName:"Alexander Shpakov"},{id:"81684",title:"Dr",name:"Oksana",middleName:null,surname:"Chistyakova",slug:"oksana-chistyakova",fullName:"Oksana Chistyakova"},{id:"81685",title:"Dr.",name:"Kira",middleName:null,surname:"Derkach",slug:"kira-derkach",fullName:"Kira Derkach"}]},{id:"19739",doi:"10.5772/18469",title:"Antiepileptic Medicinal Plants used in Traditional Medicine to Treat Epilepsy",slug:"antiepileptic-medicinal-plants-used-in-traditional-medicine-to-treat-epilepsy",totalDownloads:9699,totalCrossrefCites:7,totalDimensionsCites:23,abstract:null,book:{id:"628",slug:"clinical-and-genetic-aspects-of-epilepsy",title:"Clinical and Genetic Aspects of Epilepsy",fullTitle:"Clinical and Genetic Aspects of Epilepsy"},signatures:"E. Ngo Bum, G.S. Taiwe, F.C.O. Moto, G.T. Ngoupaye, R.R.N. Vougat, V.D. Sakoue, C. Gwa, E.R. Ayissi, C. Dong, A. Rakotonirina and S.V. Rakotonirina",authors:[{id:"31580",title:"Prof.",name:"Elisabeth",middleName:null,surname:"Ngo Bum",slug:"elisabeth-ngo-bum",fullName:"Elisabeth Ngo Bum"},{id:"46671",title:"Dr.",name:"Germain",middleName:"Sotoing",surname:"Taïwe",slug:"germain-taiwe",fullName:"Germain Taïwe"},{id:"46672",title:"MSc.",name:"Fleur",middleName:null,surname:"Moto",slug:"fleur-moto",fullName:"Fleur Moto"},{id:"46673",title:"Prof.",name:"Gwladys",middleName:"Temkou",surname:"Ngoupaye",slug:"gwladys-ngoupaye",fullName:"Gwladys Ngoupaye"},{id:"46674",title:"MSc.",name:"Espoir",middleName:null,surname:"Ayissi",slug:"espoir-ayissi",fullName:"Espoir Ayissi"},{id:"46675",title:"MSc.",name:"Christian",middleName:null,surname:"Dong",slug:"christian-dong",fullName:"Christian Dong"},{id:"46676",title:"MSc.",name:"Frédéric",middleName:null,surname:"Maidawa",slug:"frederic-maidawa",fullName:"Frédéric Maidawa"},{id:"46677",title:"MSc.",name:"Gildas",middleName:null,surname:"Djafsia",slug:"gildas-djafsia",fullName:"Gildas Djafsia"},{id:"46678",title:"MSc.",name:"Leopold",middleName:null,surname:"Nanga",slug:"leopold-nanga",fullName:"Leopold Nanga"},{id:"46679",title:"MSc.",name:"Saleh",middleName:null,surname:"Soudi",slug:"saleh-soudi",fullName:"Saleh Soudi"},{id:"46680",title:"Dr.",name:"Alice",middleName:null,surname:"Rakotonirina",slug:"alice-rakotonirina",fullName:"Alice Rakotonirina"},{id:"46681",title:"Dr.",name:"Silvère",middleName:null,surname:"Rakotonirina",slug:"silvere-rakotonirina",fullName:"Silvère Rakotonirina"}]},{id:"44560",doi:"10.5772/54744",title:"The Role of Epigenetics in Neurodegenerative Diseases",slug:"the-role-of-epigenetics-in-neurodegenerative-diseases",totalDownloads:4012,totalCrossrefCites:10,totalDimensionsCites:18,abstract:null,book:{id:"3278",slug:"neurodegenerative-diseases",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases"},signatures:"Luca Lovrečić, Aleš Maver, Maja Zadel and Borut Peterlin",authors:[{id:"75615",title:"Dr.",name:"Luca",middleName:null,surname:"Lovrecic",slug:"luca-lovrecic",fullName:"Luca Lovrecic"}]}],mostDownloadedChaptersLast30Days:[{id:"44555",title:"Pharmacological Treatment of Acute Ischemic Stroke",slug:"pharmacological-treatment-of-acute-ischemic-stroke",totalDownloads:3670,totalCrossrefCites:6,totalDimensionsCites:9,abstract:null,book:{id:"3278",slug:"neurodegenerative-diseases",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases"},signatures:"Humberto Mestre, Yael Cohen-Minian, Daniel Zajarias-Fainsod and\nAntonio Ibarra",authors:[{id:"72488",title:"Dr.",name:"José Juan Antonio",middleName:null,surname:"Ibarra Arias",slug:"jose-juan-antonio-ibarra-arias",fullName:"José Juan Antonio Ibarra Arias"},{id:"120571",title:"Mr.",name:"Humberto",middleName:null,surname:"Mestre",slug:"humberto-mestre",fullName:"Humberto Mestre"},{id:"165904",title:"Dr.",name:"Daniel",middleName:null,surname:"Zajarias-Fainsod",slug:"daniel-zajarias-fainsod",fullName:"Daniel Zajarias-Fainsod"},{id:"165905",title:"Mrs.",name:"Yael",middleName:null,surname:"Cohen-Minian",slug:"yael-cohen-minian",fullName:"Yael Cohen-Minian"}]},{id:"60608",title:"Mucuna and Parkinson’s Disease: Treatment with Natural Levodopa",slug:"mucuna-and-parkinson-s-disease-treatment-with-natural-levodopa",totalDownloads:4661,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Mucuna pruriens is a tropical bean containing large amounts of levodopa and is the most important natural remedy for Parkinson’s disease. Famous neurologists have patented methods of extraction for its advantages over the synthetic forms, Sinemet and Madopar. This natural levodopa is less toxic and has a faster and more lasting effect and can delay the need for pharmaceuticals and combination therapies. Currently, there are many patients with Parkinson’s disease who take Mucuna and spontaneously reduce the dose of conventional drugs and do so behind their doctors’ backs. Mucuna should always be taken under medical supervision.",book:{id:"6406",slug:"parkinson-s-disease-understanding-pathophysiology-and-developing-therapeutic-strategies",title:"Parkinson's Disease",fullTitle:"Parkinson's Disease - Understanding Pathophysiology and Developing Therapeutic Strategies"},signatures:"Rafael González Maldonado",authors:[{id:"214658",title:"Dr.",name:"Rafael",middleName:null,surname:"Gonzalez-Maldonado",slug:"rafael-gonzalez-maldonado",fullName:"Rafael Gonzalez-Maldonado"}]},{id:"19700",title:"Physiotherapy for Children with Cerebral Palsy",slug:"physiotherapy-for-children-with-cerebral-palsy",totalDownloads:21769,totalCrossrefCites:1,totalDimensionsCites:3,abstract:null,book:{id:"630",slug:"epilepsy-in-children-clinical-and-social-aspects",title:"Epilepsy in Children",fullTitle:"Epilepsy in Children - Clinical and Social Aspects"},signatures:"Mintaze Kerem Günel",authors:[{id:"38412",title:"Prof.",name:"Mintaze",middleName:null,surname:"Kerem Günel",slug:"mintaze-kerem-gunel",fullName:"Mintaze Kerem Günel"}]},{id:"51151",title:"Association Between Multiple Sclerosis Risk and Human Immunodeficiency Virus Infection: Insights and Challenges",slug:"association-between-multiple-sclerosis-risk-and-human-immunodeficiency-virus-infection-insights-and-",totalDownloads:2044,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Multiple sclerosis (MS) is a convoluted autoimmune and inflammatory disease of the central nervous system (CNS) in which the protective myelin sheath is eroded and the underlying nerve fibers are damaged. There is no conclusive knowledge on the role played by different etiological factors in its development, and studies have shown that it primarily results due to complex interactions between the genetic, geographic and infectious components. Among the risk factors reported to have a possible role in MS development, retroviruses also appear to influence it. Studies suggest human immunodeficiency virus (HIV) infection to be inversely related to MS risk, but to date, the association between the two remains enigmatic. This protective inverse association has become an area of active research and the most plausible explanations for this may be immune suppression and/or antiretroviral medications. The purpose of writing this chapter is to provide background information on the unfathomable relationship between HIV infection and the risk of developing MS while at the same time providing description of the insights garnered from recent studies. While highlighting the application of ART (antiretroviral therapy) as budding future alternative for MS management, this chapter provides momentum for further studies.",book:{id:"5156",slug:"trending-topics-in-multiple-sclerosis",title:"Trending Topics in Multiple Sclerosis",fullTitle:"Trending Topics in Multiple Sclerosis"},signatures:"Ehtishamul Haq, Insha Zahoor and Mushfiquddin Khan",authors:[{id:"181077",title:"Dr.",name:"Ehtishamul",middleName:null,surname:"Haq",slug:"ehtishamul-haq",fullName:"Ehtishamul Haq"},{id:"185233",title:"Dr.",name:"Insha",middleName:null,surname:"Zahoor",slug:"insha-zahoor",fullName:"Insha Zahoor"},{id:"185234",title:"Dr.",name:"Mushfiquddin",middleName:null,surname:"Khan",slug:"mushfiquddin-khan",fullName:"Mushfiquddin Khan"}]},{id:"63824",title:"Plasmapheresis in Treatment of Myasthenia Gravis",slug:"plasmapheresis-in-treatment-of-myasthenia-gravis",totalDownloads:1349,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Treatment of myasthenia gravis is still a rather difficult task, since there is no single tactic to use different drugs (corticosteroids, rituximab, immunoglobulins), especially since it is associated with a number of side effects. They are not able to remove the accumulating autoantibodies and immune complexes, the large size of which does not allow them to be excreted by the kidneys as well. Special problems of treatment arise when myasthenic crises develop associated with respiratory failure requiring artificial lungs ventilation. Plasmapheresis can help to solve this for it is possible to remove antibodies and other pathological metabolites. In addition, regular plasmapheresis is able not only to prevent exacerbations but also to reduce doses of the maintenance therapy with less risk of their side effects, which is confirmed by our own experience.",book:{id:"7160",slug:"selected-topics-in-myasthenia-gravis",title:"Selected Topics in Myasthenia Gravis",fullTitle:"Selected Topics in Myasthenia Gravis"},signatures:"Valerii Voinov",authors:null}],onlineFirstChaptersFilter:{topicId:"1056",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81721",title:"Atrial Fibrillation and Stroke",slug:"atrial-fibrillation-and-stroke",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.104619",abstract:"Atrial fibrillation (AF) represents a major cause of morbidity and mortality in adults, especially for its strong association with thromboembolism and stroke. In this chapter, we aim to provide an overview on this cardiac arrhythmia, addressing several important questions. Particularly, we faced the possible mechanisms leading to an increased risk of embolism in AF, emphasizing how Virchow’s triad for thrombogenesis is unable to fully explain this risk. Disentangling the risk of stroke caused by AF and by other associated vascular conditions is extremely challenging, and risk stratification of patients with AF into those at high and low risk of thromboembolism has become a crucial determinant of optimal antithrombotic prophylaxis. Moreover, we discuss the typical clinical and radiological characteristics of cardioembolic strokes, addressing acute, time-dependent reperfusional therapies in case of ischemic stroke. The role of anticoagulation in AF is also fully analyzed; the benefit of oral anticoagulation generally outweighs the risk of bleeding in AF patients, and a variety of scoring systems have been developed to improve clinical decision-making when initiating anticoagulation. With their predictable pharmacokinetic profiles, wide therapeutic windows, fewer drug–drug and drug-food interactions, and the non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have changed the landscape of thromboprophylaxis for AF patients, offering the opportunity to use effective anticoagulants without the need for intensive therapeutic drug monitoring.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Francesca Spagnolo, Vincenza Pinto and Augusto Maria Rini"},{id:"81639",title:"Atrial Cardiopathy and Cryptogenic Stroke",slug:"atrial-cardiopathy-and-cryptogenic-stroke",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.103736",abstract:"Cryptogenic stroke (CS) is defined as the presence of cerebral infarcts, the cause which has not been identified despite an appropriate diagnostic evaluation, and it accounts for approximately 30–40% of all ischemic strokes. There is a certain subgroup of CS with embolic characteristics on neuroimaging studies and no evidence of atrial fibrillation alternative or any alternative cause. Recent data suggest that disorders of the atrium, even without atrial fibrillation, could increase thromboembolic risk. The pathological atrial substrate, or atrial cardiopathy (AC), may be an important and underrecognized cause of cryptogenic strokes. This chapter will review the information on the rationale and data behind the concept of atrial cardiopathy, its pathophysiology, proposed biomarkers of atrial cardiopathy, and therapeutic implications.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Marianela López Armaretti, Natalia Romina Balian and María Cristina Zurrú"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:33,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:59,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"},{id:"80005",title:"Infarct Stroke and Blood Glucose Associated with Food Consumption in Indonesia",slug:"infarct-stroke-and-blood-glucose-associated-with-food-consumption-in-indonesia",totalDownloads:62,totalDimensionsCites:0,doi:"10.5772/intechopen.101548",abstract:"Stroke is the primary cause of death in adults. It is predicted that the death caused by stroke will increase twice in the next 30 years. In Indonesia, stroke is one of the diseases of the circulatory system, which has been taking the first place of causing death since 2007. Indonesia has rice as the main type of daily food consumed, which has higher glycemic index than other sources. This study aims to find the risk of blood glucose level that determines the incidence of infarct stroke. There were 164 patients enrolled in this study, 82 patients in each stroke and not stroke group. The blood examination is using the enzymatic method, which is the hexokinase method. The results of research revealed that indicators of high blood glucose level were found in infract stroke incidence, including casual blood glucose, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. These four indicators were found in a higher level in the infarct stroke than the non-stroke group. Other epidemiological studies have shown that diabetes is a risk factor for stroke. Therefore, education about food selection should be a priority in the effort to prevent infarct stroke and diabetes mellitus in Indonesia.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Santi Martini, Hermina Novida and Kuntoro"},{id:"80391",title:"COVID-19 and Seizures",slug:"covid-19-and-seizures",totalDownloads:59,totalDimensionsCites:0,doi:"10.5772/intechopen.102540",abstract:"The past two years were deeply marked by the emergence of a global pandemic caused by the worldwide spread of the virus severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. The plethora of repercussions on the health of those affected is extensive, ranging from asymptomatic individuals, mild flu-like disease, and severe respiratory failure, eventually leading to death. Despite this predilection for the respiratory system, the virus is responsible for multisystemic manifestations and soon became clear that neurological involvement was a frequent issue of coronavirus disease 2019 (COVID-19). Much have been pointed out about the neurotropic nature of the virus, the ways by which it invades and targets specific structures of the central nervous system, and the physiopathology behind the neurologic manifestations associated with it (namely encephalomyelitis, Guillain-Barré syndrome, lacunar infarcts, and vascular dysfunction, just to list a few). This chapter aims to raise light about the association between COVID-19 and the mechanisms of acute symptomatic seizures, through neurotropism and neuroinvasion features of SARS-CoV-2, and to review the variety of clinical presentations reported so far.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Rafael Jesus, Carolina Azoia, Paulo Coelho and Pedro Guimarães"}],onlineFirstChaptersTotal:16},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:140,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:"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"}}}},{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"}}}}]},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). 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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. 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