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",isbn:"978-1-80356-345-9",printIsbn:"978-1-80356-344-2",pdfIsbn:"978-1-80356-346-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"37f858c8b681abe60704245c7a1e89ee",bookSignature:"Prof. Hideki Nakano",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11832.jpg",keywords:"Basic Research, Fundamental Theory, Animal Study, Human Study, Applied Research, Clinical Application, Clinical Study, Translational Research, Advanced Technology, Robotics, Regenerative Medicine, Deep Learning",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 17th 2022",dateEndSecondStepPublish:"March 17th 2022",dateEndThirdStepPublish:"May 16th 2022",dateEndFourthStepPublish:"August 4th 2022",dateEndFifthStepPublish:"October 3rd 2022",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Nakano is a pioneering researcher in neurorehabilitation and physical therapy. He has research training experience as a JSPS Research Fellow at Neurorehabilitation Research Center, Kio University, Japan, and Queensland Brain Institute, University of Queensland, Australia. Dr. Nakano has received 13 awards from academic organizations, has authored more than 120 journal papers and 10 book chapters, and was the editor member of 7 academic journals.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"196461",title:"Prof.",name:"Hideki",middleName:null,surname:"Nakano",slug:"hideki-nakano",fullName:"Hideki Nakano",profilePictureURL:"https://mts.intechopen.com/storage/users/196461/images/system/196461.jpg",biography:"Dr. Hideki Nakano is a physical therapist and associate professor at the Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kyoto Tachibana University, Japan. He received his Ph.D. in Health Science from Kio University, Japan, and has accepted research training experience as a JSPS Research Fellow at Neurorehabilitation Research Center, Kio University, Japan, and Queensland Brain Institute, University of Queensland, Australia. He specializes in neuroscience, neurophysiology, and rehabilitation science and conducts research using non-invasive brain function measurement and brain stimulation methods such as electroencephalography, transcranial magnetic stimulation, and transcranial electrical stimulation. 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WHO reclassified cardiomyopathies in 1995 to include diseases of myocardium associated with cardiac dysfunction that were earlier excluded. They expanded this criterion in order to include all known causes of cardiomyopathy and is based on anatomical and physiological features. It includes three main types of cardiomyopathy: hypertrophic (HCM), dilated (DCM), and restrictive (RCM).
In 2006, American Heart Association (AHA) in their document entitled “Contemporary Definition and Classification of the Cardiomyopathies” defined cardiomyopathies as “a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilation and are due to a variety of causes that frequently are genetic. Cardiomyopathies either are confined to the heart or are a part of generalised systemic disorders, often leading to cardiovascular death or progressive heart failure-related disability.” According to the new AHA classification, cardiomyopathies are divided into two broad groups: primary cardiomyopathies and secondary cardiomyopathies. Primary cardiomyopathies encompass those that are exclusively or predominantly confined to the heart muscle and are acquired, genetic, or of mixed origin. Secondary cardiomyopathies include the subset of multiorgan involving diseases, which cause involvement of the heart as a part of their pathophysiology. In spite of this detailed classification, some confusion may arise because some primary cardiomyopathies may have associated extra cardiac components while as a few secondary cardiomyopathies can affect the heart exclusively.
Genetic | Hypertrophic cardiomyopathy |
Arrhythmogenic right ventricular cardiomyopathy | |
Left ventricular noncompaction | |
Glycogen storage disease | |
Conduction system disease (Lenègre’s disease) | |
Ion channelopathies: long QT syndrome, Brugada syndrome, short QT syndrome | |
Mixed | Dilated cardiomyopathy |
Primary restrictive nonhypertrophied cardiomyopathy | |
Acquired | Myocarditis (inflammatory cardiomyopathy): viral, bacterial, rickettsial, fungal, parasitic (Chagas disease) |
Stress cardiomyopathy | |
Peripartum cardiomyopathy |
Infiltrative | Amyloidosis |
Gaucher’s disease | |
Hunter’s syndrome | |
Storage | Hemochromatosis |
Glycogen storage disease | |
Niemann-Pick disease | |
Toxic | Drugs: cocaine, alcohol |
Chemotherapy drugs: doxorubicin, daunorubicin, cyclophosphamide | |
Heavy metals: lead, mercury | |
Radiation therapy | |
Inflammatory | Sarcoidosis |
Endomyocardial | Hypereosinophilic (Löffler’s) syndrome |
Endomyocardial fibrosis | |
Endocrine | Diabetes mellitus |
Hyper- or hypothyroidism | |
Pheochromocytoma | |
Acromegaly | |
Neuromuscular | Duchenne-Becker dystrophy |
Neurofibromatosis | |
Tuberous sclerosis | |
Autoimmune | Lupus erythematosus |
Rheumatoid arthritis | |
Scleroderma | |
Dermatomyositis | |
Polyarteritis nodosa |
European Society of Cardiology in 2008 introduced a classification in which they accommodated five specific types of cardiomyopathies along with their genetic involvement: dilated, hypertrophic, arrhythmogenic, restrictive, and unclassified [2]. They further divided them into familial (genetic) or non-familial (non-genetic).
The most recent classification known as the MOGE(S) classification system had been introduced which is based on phenotype and genotype an it incorporates information on structural and functional abnormalities (M), organ involvement (O), genetics (G), aetiology (E), and disease severity (S) associated with the condition [3]. However, it cannot be considered as complete as it does not include certain cardiomyopathies like postpartum cardiomyopathy or the risk of sudden death and is very complex to use. The MOGES classification is beyond the scope of this review so we do not discuss it here.
Cardiomyopathy itself can present as either systolic dysfunction or diastolic dysfunction, which in turn are both related to the ventricular dysfunction.
The main types of cardiomyopathy that we come across clinically in our day-to-day practice are:
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Arrhythmogenic right ventricular dysplasia
Peripartum cardiomyopathy
Some other types of cardiomyopathy are known as “unclassified cardiomyopathy.” Another type of cardiomyopathy known as Takotsubo cardiomyopathy has been recently listed and is also known as “stress-induced cardiomyopathy,” or broken heart syndrome.
Therefore, we focus our attention towards the commonest types of cardiomyopathies in this chapter.
Dilated cardiomyopathy (DCM) is defined by cardiac enlargement with impaired systolic function of one or both ventricles. It is defined by the presence of:
Fractional myocardial shortening <25% and/or ejection fraction <45%.
Left ventricular end-diastolic diameter > 117% excluding any known cause of myocardial disease.
Familial DCM contribute about 20–48% of all DCM and can defined by
the presence of two or more affected relatives with DCM meeting the above criteria or
a relative of a DCM patient with unexplained sudden death before the age of 35.
The prevalence of DCM is 920/100,000 individuals and is common in Afro-Caribbean population. It is the commonest form of cardiomyopathy and is the third most common cause of congestive heart failure. DCM is the commonest indication for heart transplantation. In 30–40% patients, it is transmitted in an autosomal dominant fashion while in others it can be post viral or idiopathic. It can be of ischemic or nonischemic variety with ischemic type being related to atherosclerosis or CAD. The nonischemic variety may present itself secondary to the use of chemotherapeutic agents (doxorubicin and adriamycin), infections (Coxsackie virus, HIV, cytomegalovirus Chagas’ disease, trichinosis, toxoplasmosis, Lyme disease, and leptospirosis), drug abuse (alcohol, heroin, cocaine, and methamphetamines), or as peripartum cardiomyopathy.
Dilated cardiomyopathy presents with a decrease in LV ejection fraction (LVEF) as described earlier, congestive heart failure (CHF) or as ventricular arrhythmias. Initially, the ventricle dilates to increase the force of contraction and stroke volume in order to maintain the cardiac output (Frank-Starling law); however, as the disease progresses, these compensatory mechanisms gradually fail, leading to the ventricular failure and ultimately failure to maintain the cardiac output (CO).
The patients of dilated cardiomyopathy present with symptoms like dyspnea, orthopnea, fatigue, weakness, and oedema in the lower extremities. Physical findings are similar to those seen in CHF. Some patients complain of dyspnea on exertion that may look like angina pectoris. Patients may have jugular venous distention, crepitation on auscultation, resting tachycardia, audible s3 and s4 heart sounds, pulmonary oedema, and cardiomegaly. Mitral and/or tricuspid regurgitation may be audible clinically if the ventricular dilation is marked.
The ECG may show ST-T segment abnormalities, atrial fibrillation, intraventricular conduction defects, and PVCs. The echocardiography reveals dilated cardiac chambers, global hypokinesia, low EF/fractional shortening, raised LVEDP, mitral or tricuspid regurgitation and/or mural thrombi. Right-sided cardiac catheterisation using a Swan Ganz Catheter reveals a high pulmonary capillary wedge pressure, high systemic vascular resistance, and a low cardiac output. Additional laboratory tests carried out may reveal raised brain natriuretic peptide levels.
Management of DCM begins with lifestyle modifications such as adequate rest, weight control, low sodium diet, fluid restriction, stopping alcohol intake and smoking, and less physical activity during periods of cardiac decompensation.
Patients with a LVEF <30% and an intraventricular conduction defect with wide QRS complex ≥130 ms may lack synchronised contraction of both ventricles. Resynchronisation of right and left ventricle with biventricular pacing using a cardiac resynchronisation therapy device (CRT-D) can restore synchronous contraction of both ventricles, shorten the QRS interval, decrease left ventricular size and improve systolic function, stroke volume and the overall survival rate of patients.
Heart transplantation is the definitive treatment and the most common indication for transplantation in patients with DCM for both adults and children. Patients that are likely to benefit highly from a heart transplant include patients who were previously very active, <60 years of age who show intractable symptoms of congestive heart failure despite optimal medical therapy.
Symptomatic patients with DCM who are referred to tertiary medical centres for care have a high 5-year mortality rate (50%). If the cardiomyopathy involves both the right and left ventricles, the prognosis is very poor. Haemodynamic abnormalities that predict a poor prognosis include:
an ejection fraction <25%,
pulmonary capillary wedge pressure > 20 mm Hg,
cardiac index <2.5 L/min/m2,
pulmonary hypertension,
systemic hypotension, and
an increased central venous pressure.
Any major surgeries on these patients can be associated with morbidity and mortality, therefore, requires planning. Optimisation of congestive heart failure (CHF) at least for a week before the planned surgery is advisable. In critically ill or patients undergoing a high-risk procedure or those in which CHF is not appropriately managed, intra-arterial BP line should be inserted preoperatively. Premedication should be tailored according to the patient’s requirement and may include short acting anxiolytic and/or sedative. Regional anaesthesia or nerve blocks alone or in combination with general anaesthesia can help us achieve the set goals of anaesthesia with a minimal haemodynamic compromise. However, the ongoing anticoagulation therapy may limit the option of regional anaesthesia. American Society of Regional Anaesthesia (ASRA) guidelines must be strictly followed if the patient is on an anticoagulation therapy.
The goals of anaesthesia are to [4]:
minimise any negative inotropic effect of anaesthetic drugs.
prevent increases in afterload.
maintain preload despite increased left ventricular end-diastolic pressure.
maintain perfusion and control arrhythmias,
avoid hypotension and tachycardia.
avoid overdose of medications during induction as the circulation time of drugs is slow.
These patients can become haemodynamically unstable due to the depressant effect of anaesthetic agents, fluid shifts and ongoing blood loss, which add to the already poor myocardial function due the cardiomyopathy. Propofol, thiopentone and inhalational agents cause vasodilation and myocardial depression. Benzodiazepines like midazolam and nitrous oxide may cause cardiovascular depression. Etomidate, ketamine, and narcotics like opioids are the ones that have minimal adverse haemodynamic response. We need to use a balanced anaesthetic technique. Slow induction should be carried out. Response of induction agents may be delayed due to prolonged circulation time, so slow and titrated doses of anaesthetic agents should be administered. Additional doses may not be required.
Optimal pain management helps to maintain haemodynamic stability. Regional anaesthesia may be a source of excellent postoperative pain relief, reducing the episodes of sympathetically mediated tachycardia, and afterload increases.
Transesophageal echocardiography (TEE) is also helpful as it identifies causes of hypotension, response to fluid therapy or inotrope support, estimates preload, cardiac output, diastolic dysfunction, valve function, and regional wall motion abnormalities.
Hypertrophic cardiomyopathy can be defined as abnormal LV thickening without chamber dilation that is usually asymmetrical, develops in the absence of an identifiable cause (e.g. aortic valvular stenosis[AS] and hypertension), and is associated with myocardial fibre disarray.
Hypertrophic cardiomyopathy (HCM) is very common and can affect people of any age group. It affects both sexes equally. It is a cause of sudden cardiac arrest and death in apparently healthy young people, including young athletes. HCM is a relatively common inherited disorder with an autosomal dominant pattern of inheritance with variable expression and has a prevalence of 1 in 500.
Defects of at least 11 genes and >1440 mutations sites demonstrate its genomic heterogeneity.
The underlying structural abnormalities in HCM are:
myocardial cell disarray where the cells are rearranged in a disorganised pattern as opposed to a normal parallel myocyte arrangement;
coronary microvasculature dysfunction due to increased wall to lumen ratio; and.
remodelling changes occurring in the heart.
These changes in HCM patients lead to diastolic dysfunction, impaired coronary reserve, supraventricular and ventricular dysrhythmias, and sudden cardiac arrest. Left ventricular remodelling can include fibrosis, focal, diffuse, asymmetric, or concentric hypertrophy, as well as decrease in the cavity size. The most common subtype of HCM presents as hypertrophy of the septum and the anterio-lateral free wall.
LV outflow tract obstruction (LVOTO) occurs in HCM, and initially it was proposed that the basal septal hypertrophy encroaching on the LVOT caused the obstruction of the tract. However, more recent studies have pointed towards the fact that during ventricular systole, flow against an abnormally positioned mitral valvular apparatus results in a Venturi effect on the anterior leaflet of the mitral valve and induces systolic anterior movement (SAM) of the anterior mitral valve leaflet. The mitral valve apparatus abnormalities can include hypertrophied papillary muscles touching the septum, elongated mitral leaflets, anterior displacement of papillary muscles, or anomalous insertion of the papillary muscle onto the anterior mitral leaflet. LVOTO can be precipitated or aggravated by increased contractility of the heart or tachycardia or decreased end-diastolic volume or systemic vascular (arterial) resistance. With HCM, incidence of diastolic dysfunction is more than LVOTO.
Myocardial ischaemia is present in patients with HCM, irrespective of the presence or absence of coronary artery disease. Myocardial ischaemia is precipitated by several factors including
a mismatch between ventricular mass and coronary artery size,
increased oxygen consumption due to hypertrophy,
abnormal coronary arteries,
decreased diastolic filling time,
increased LVEDP compromising coronary perfusion, and
the presence of a metabolic derangement regarding the utilisation of oxygen at the cellular level.
Supraventricular or ventricular dysrhythmias are relatively common in these patients due to the presence of disorganised cellular architecture, expanded interstitial matrix and myocardial scarring. They are the cause of incidence of sudden arrest in this group of cardiomyopathy.
The clinical presentation of HCM varies widely. These patients can present early in their life with debilitating symptoms or can live for decades asymptomatically while some others die suddenly. The most frequent symptoms include dyspnea, dizziness, exercise intolerance, angina, syncope, and/or sudden death.
Physical examination may be normal at rest but may reveal a double apical impulse, gallop rhythm, a systolic murmur and thrill in the presence of functional LVOTO. It is rare, but some people with hypertrophic cardiomyopathy can suffer sudden cardiac arrest during a vigorous physical workout. The physical activity can trigger dangerous arrhythmias leading to sudden death.
The major risk factors for sudden cardiac death are:
a family history of sudden death;
unexplained syncope;
extreme hypertrophy of the left ventricular wall (0.30 mm);
non-sustained ventricular tachycardia (VT)
Electrocardiography (ECG) changes include left atrial (LA) enlargement, pathologic Q waves, high QRS voltage complexes, ST segment depression, and inverted T waves in at least two or more consecutive leads.
Echocardiography can easily demonstrate the presence of myocardial hypertrophy. Ejection fraction is usually >80%, reflecting the increase in force of contraction of the heart. Echocardiography can also assess the mitral valvular apparatus, the presence of mitral regurgitation, and the presence of LVOTO by demonstrating turbulent flow across the aortic valve. Pressure gradients across the LVOT can be measured. Echocardiography is useful in evaluating diastolic function of the heart.
Invasive measures like cardiac catheterisation allow direct measurement of the increased left ventricular end-diastolic pressure and the pressure gradient between the left ventricle and the aorta.
The definitive diagnosis of HCM can be made by an endomyocardial biopsy and DNA analysis, but these diagnostic modalities are usually reserved for patients in whom the diagnosis cannot be established by non-invasive means.
The varied clinical profile of HCM makes it difficult to establish some precise guidelines for the treatment of this condition. The treatment plan should be titrated according to individual patient requirements. However, it is prudent to mention that the patients who are at high risk for sudden death should receive aggressive treatment.
Medical management: Pharmacotherapy is aimed at reducing LVOTO, improving diastolic filling, and possibly decreasing myocardial ischaemia. A variety of medical therapies have been used in these patients with the aim of altering the natural history. These include β-blockers, Ca2+ channel antagonists (verapamil or diltiazem), and disopyramide regimens, all of which seem to be effective as compared to no treatment in HCM patients. Most of these drugs used help HCM patients to improve their symptoms by reducing or eliminating the LVOT pressure gradient. These medications also reduce LVOTO during exercise by blunting the sympathetic response and are thus useful in treating the symptoms and attenuating the risk of sudden cardiac arrest. Atrial fibrillation often develops in these patients. It is associated with an increased risk of thromboembolism and congestive heart failure. Amiodarone is the most effective drug for prevention of repeated episodes of atrial fibrillation in these patients. Long-term anticoagulation is indicated in the patients with recurrent or chronic atrial fibrillation to prevent thromboembolic episode reducing the mortality and morbidity associated with it.
More recently, perhexiline, which augments myocyte energy supply, has been shown to improve diastolic dysfunction and symptomatology, but detailed studies are yet to follow.
labile obstruction and peak LVOT pressure gradients ≥50 mm Hg during exercise or provocation and resting gradients >30 mm Hg and.
NYHA class II through IV symptoms refractory to medical therapy.
Some patients may be candidates for implantable cardioverter-defibrillator (ICD) implantation while as principal surgical option is surgical myomectomy.
Initial patient evaluation should be aimed at determining the disease severity by assessing functional status of the patient, personal and family cardiac history, the presence or absence of cardiac and respiratory symptoms, history of rhythm disturbances, current medications, and previous strokes, or congestive heart failure history. During physical examination, all murmurs should be evaluated for dynamic changes with rest and exertion, and patients with murmurs that do not fulfil the criteria of a benign murmur should undergo an echocardiographic examination before surgery. Patients should be instructed to continue their rate controlling medications and maintain proper hydration preoperatively. Moreover, the presence of an automatic ICD and if it has been recently checked should be determined.
In patients with HCM, preoperative administration of anti-anxiety medications may help to reduce anxiety and prevent the activation of anxiety-induced sympathetic response. Adequate preoperative intravenous fluid administration may help in preventing LVOTO and minimise the effect of positive pressure ventilation on central blood volume.
For patients who have an ICD in situ, the device should be turned off just before the surgery and an external defibrillator should be readily available and the ICD should be positively reactivated in the recovery room.
The anaesthetic goals are [4]:
maintenance of sinus rhythm;
reduction in sympathetic activity to reduce chronotropy and inotropy;
the maintenance of systemic vascular resistance;
maintenance of left ventricular filling.
Tachycardia, arrythmias, and decreases in afterload will exacerbate LVOTO and may cause haemodynamic deterioration. In addition to this, increases in contractility (chronotropy) and decreases in preload will accentuate LVOTO. Therefore, the principle of treatment for hypotension is volume expansion (including increasing preload in the Trendelenburg position) and use of drugs that increase systemic vascular resistance without a positive inotropic or chronotropic response (e.g. phenylephrine and vasopressin). Sympathetic response secondary to patient anxiety, intubation process, and surgical site incision and acute changes in preload, afterload, and contractility secondary to the pharmacological effects of anaesthetic agents, blood loss during surgery, and postoperative pain can precipitate haemodynamic collapse. DC cardioversion may be necessary in case of sudden onset of atrial fibrillation that is haemodynamically unstable.
Although both general and neuraxial anaesthesia can be used, it is important to have a clear understanding of the haemodynamic changes associated with each option. Depending on the route of the anaesthetic drugs chosen, close monitoring and titration of the medications affecting heart rate, preload, afterload, contractility of myocardium, and sympathetic activity are important. Neuraxial techniques may also be considered. In general, a slow controlled titration of medication via an epidural is preferred over a single dose spinal anaesthesia with the aim of maintaining preload and afterload and avoiding sympathetic stimulation. Regional anaesthesia can be an invaluable tool to manage postoperative pain and in turn prevent the activation of sympathetic response in these patients.
In addition to the standard American Society of Anaesthesiologists monitoring requirements, an intra-arterial catheter and/or non-invasive pulse plethysmographic variability (PPV) index monitor and central venous pressure (CVP) monitoring may be considered. The overall haemodynamic goals include maintaining the mean arterial blood pressure at >65–70 mm Hg to maintain coronary perfusion pressure to the subendocardium in the hypertrophied heart. The most useful monitoring tool for patients undergoing high-risk surgery is TEE. TEE can determine whether haemodynamic alterations are caused by hypovolemia, increased LVOTO or SAM, or LV systolic dysfunction.
Restrictive cardiomyopathy (RCM) is a disorder of the myocardium that occurs due to increased myocardial stiffness (decreased compliance) that leads to impaired ventricular filling. Size of both ventricle chambers and systolic function usually remains normal or near-normal until later stages of the disease. RCM may arise as a result of either inherited or acquired predispositions and diseases or a combination of the both, and can broadly be classified as infiltrative, non-infiltrative, storage disease, and endomyocardial fibrosis. Restrictive cardiomyopathy is prevalent in tropical regions of the world, where incidence of endomyocardial fibrosis is high. In non-tropical regions, idiopathic fibrosis is the common cause and is associated with increasing age. Other rare causes of RCM include amyloidosis, haemochromatosis, sarcoidosis, and eosinophilic endocarditis.
RCM is characterised by contracted stiff ventricles with progressive impairment of diastolic filling, leading to the haemodynamic problem of a low preload but high ventricular filling pressure. This pattern of diastolic dysfunction leads to dilation of the atria and elevation of mean atrial pressures, resulting in biventricular “backward heart failure” manifesting itself as pulmonary venous congestion leading to dyspnea as well as systemic venous pressure elevation resulting in peripheral oedema. Systolic function is preserved in most cases. However, in spite of intact systolic function, the restrictive pathology on true ventricular preload limit the stroke volume, resulting in low cardiac output and ultimately hypoperfusion of the tissues.
RCM presents with signs and symptoms of both right and left heart failure. Patients complain of exercise intolerance because of diminished cardiac output. Patients often have a low volume pulse, an audible third heart sound, regurgitant murmurs, and a raised JVP with rapid X and Y descent that increases or fails to decrease on inspiration. Low blood pressures are often seen, complicating heart failure management. Pulmonary oedema is uncommon. Syncope occurs occasionally, often exertional, reflecting the limited ability of the heart to increase diastolic filling and is an ominous sign. Syncope may also be aggravated by antihypertensive medications. Concomitant autonomic neuropathy can precipitate orthostatic hypotension as can volume contraction from nephrotic syndrome.
Arrhythmias and conduction disturbances are frequent. Less frequent cardiac manifestations include dynamic LV outflow obstruction, often confused with hypertrophic cardiomyopathy; cardiac ischaemia caused by amyloid deposition in intramural coronary arteries; and intracardiac thrombosis caused by atrial wall standstill, with a risk for systemic embolisation.
The ECG may demonstrate conduction abnormalities. The chest X-ray shows signs of pulmonary congestion and/or pleural effusion, but cardiomegaly is absent. Echocardiography-based two-dimensional and Doppler are essential for determining diastolic dysfunction and for distinguishing patients with RCM from patients with restrictive physiology because of constrictive pericarditis. Echocardiography may also provide information to suggest a specific diagnosis such as the presence of regional wall motion abnormalities in a non-coronary distribution and aneurysms, which would raise the suspicion for cardiac sarcoidosis (CS). Cardiac magnetic resonance (CMR) imaging can aid in the diagnostic process, but the use should be determined on an individual basis. Endomyocardial biopsy (EMB) may be helpful for establishing a diagnosis in some cases. Ultimately, diagnosis of any of the RCMs relies on a constellation of clinical, laboratory, and imaging findings.
Medical management: Treatment of RCM includes treating the underlying cause (if identified) and heart failure management. Diuretics are the mainstay of treatment to reduce volume overload. However, volume status in patients with RCM may be challenging to manage, as patients with RCM rely on high filling pressures to maintain cardiac output and excessive diuresis may result in tissue hypoperfusion. Digoxin must be used with great caution because it is potentially dysrhythmogenic in patients with amyloidosis. The use of β-blockers or calcium channel blockers to increase filling time or to manage arrhythmias should be carefully introduced, as some patients may be intolerant. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers may also be considered, but the proof of benefit is lacking, and these agents may not be well tolerated. Anticoagulation is required in patients with atrial fibrillation, mural thrombus, or evidence for systemic embolisation and may be helpful in most patients because of propensity for thrombus formation in the left atrial appendage.
Surgical management: No corrective surgery has yet been proposed that would be 100% effective in improving the heart function in RCM. Advanced heart failure therapies, including cardiac transplantation, may be beneficial for selected patients. Heart transplantation is the only effective surgery that can be offered to the patients with restrictive cardiomyopathy. It may be the best option for those who are already symptomatic at the time of diagnosis or in whom reactive pulmonary hypertension exists. Left ventricular assist device (LVAD) therapy may be particularly applicable in patients with RCM as a bridge to transplant or as definitive therapy.
RCM presents a huge challenge for anaesthetists due to the high risk of morbidity and mortality. General anaesthesia causes vasodilation, suppresses the myocardium, and reduces venous return. The latter can be worsened by intermittent positive pressure ventilation resulting in cardiac arrest. Invasive arterial blood pressure monitoring and transesophageal echocardiography are useful in identifying the causes of cardiovascular instability [6].
The overall aims of anaesthesia are:
sinus rhythm to be maintained if possible;
to maintain adequate filling pressures;
to maintain SVR in the presence of relatively fixed cardiac output.
to manage electrolyte disturbances;
to use anaesthetic agents with minimal cardiovascular effect like ketamine or etomidate.
Arrhythmogenic right ventricle cardiomyopathy (ARVC) is characterised by structural abnormalities and cardiac dysfunction of mainly the right ventricle, but it can also involve the left ventricle. It is a rare type of cardiomyopathy. It occurs if the muscle tissue in the right ventricle dies and is replaced by a scar tissue. This disrupts the pathway of the heart’s electrical signals leading to arrhythmias.
ARVC usually affects teenagers or young adults. ARVC has a prevalence of 1 in 5000 among healthy young people. ARVC is seen in up to 20% of all causes of sudden death in young people. It is a complex genetic condition due to its genetic variation.
Histologically, the myocardial cells are replaced by the adipose and fibrous tissues. These alterations can form a re-entry electrical circuit triggering arrhythmias. ARVC usually starts as a localised disease with regional wall abnormalities. As the disease progresses, the right ventricle continues to lose the healthy tissue and dilates and becomes thin walled. Patients can develop right bundle branch block before they finally present with the symptoms of right ventricular failure between the fourth and fifth decades of life.
Young patients often present with syncope, arrhythmia, cardiac arrest, or sudden death. The diagnosis of ARVC should be considered in:
Young male athletes with cardiac symptoms.
ECG showing ventricular tachycardia with left bundle branch block morphology.
T-wave inversion in leads V1–V3.
Premature ventricular complexes with left bundle branch block morphology.
Spontaneous non-sustained ventricular tachycardia.
An accurate diagnosis of ARVC is important due to the high risk of drug-resistant arrhythmias and sudden cardiac death. The diagnosis can be established by myocardial biopsy, which shows adipocytes and fibrous tissue. However, these changes can be localised and may not be present at the exact site of biopsy. The availability of cardiac MRI and the gadolinium enhancement techniques are now fundamental in diagnosing ARVC eliminating the need for biopsies.
The main aim of medical management is to prevent or reduce the risk of fatal arrhythmias.
Sotalol, verapamil, and amiodarone can be used.
Due to the recurrence of arrhythmias and drug resistance, continuous Holter monitoring, or an electrophysiological study may be required. Catheter ablation can be used as a palliative rather than a curative intervention. It is indicated in patients with monomorphic VT due to alocalised ARVC, with a drug-resistant arrhythmia, or with frequent intervention following ICD implantation [7].
Early placement of an ICD may be lifesaving.
In some exceptional cases, heart transplantation may be required.
Peripartum cardiomyopathy is a rare, dilated form of cardiomyopathy of unknown cause that occurs during the peripartum period, that is, the third trimester of pregnancy until 5 months after delivery. Peripartum cardiomyopathy (PPCM) is a major concern for anaesthetists and can occur in 1 in 10,000 pregnancies, but it is higher in subsequent pregnancies [8]. Patients may present with severe heart failure during the third trimester or up to 5 months postpartum. Many of these patients deliver via a normal vaginal delivery without complications; however, a few may require a Caesarean section.
Heart failure developing towards the end of pregnancy or up to 5 months’ postpartum
Absence of another identifiable cause of cardiac failure
Absence of cardiac symptoms or disease before late pregnancy
Left ventricular dysfunction - defined as an EF <45% or reduced fractional shortening of <30%
The patients usually present with sign and symptoms of heart failure: dyspnea, fatigue, and peripheral oedema. In early stages, these signs may mimic the presenting features of normal late pregnancy.
Echocardiography may show new onset of unexplained LV dysfunction and documentation of a new finding of dilated cardiac chambers with LV systolic dysfunction during the period surrounding parturition.
The main aim of treatment is to relieve the symptoms of heart failure. Diuretics, vasodilators, and digoxin can be used effectively. During pregnancy, vasodilation is accomplished with hydralazine and nitrates. Intravenous immunoglobulin may have a beneficial effect. Thromboembolic complications are not uncommon, and anticoagulation may be required in most patients. Heart transplantation may be considered in patients who do not improve over time.
The mortality in this group of patients is as high as 30–60% due to pulmonary oedema and systemic embolisation with most deaths occurring mostly within 3 months of delivery.
We have a very little literature regarding the anaesthetic management of PPCM yet. Optimum fluid management and avoiding myocardial depression are the major concerns for anaesthetists.
According to a few case reports, both general anaesthesia and neuraxial blocks have been successfully used for elective or emergency Caesarean section. Combined spinal epidural anaesthesia (CSE) is preferred by some. CSE causes less haemodynamic instability, has a higher success rate than epidural anaesthesia, results in better patient satisfaction, and provides good postoperative analgesia.
Recently, Takotsubo cardiomyopathy has been described. Takotsubo cardiomyopathy is a rare condition of transient, reversible severe LV dysfunction and characterised by chest pain, dyspnoea, ST-T changes in ECG, ventricular arrhythmias, regional wall motion abnormalities on echocardiography, elevated cardiac enzymes, haemodynamic instability, pulmonary oedema, cardiogenic shock, or cardiac arrest without angiographic evidence of CAD.
It is rare, usually occurs in postmenopausal women associated with stress and chest pain. ECG changes may include prolonged QTc interval which resolve in 1–2 days, ST-T changes, Q waves, resolve by discharge from hospital, and T inversion resolves slowly.
This condition is also known as apical ballooning syndrome and broken heart syndrome or stress-induced cardiomyopathy. Echocardiography shows akinesia of apical or midventricular segments leading to systolic dysfunction. The normal basal segments become hypercontractile, giving a ballooned-out appearance of the apical or mid-cavity segments. Ballooning may lead to altered spatial relationships between mitral leaflets and subvalvular apparatus, which may result in MR and dynamic LVOTO causing SAM.
Reversible myocardial ischaemia is seen on myocardial perfusion imaging, and positron emission tomography and magnetic resonance imaging confirm LV dysfunction. Biopsy may show lymphocytic infiltrates. Plasma levels of brain natriuretic peptide, catecholamines, cardiac enzymes and metanephrine are found to be elevated.
Optimal therapy is yet to be defined [9]. Beta blockers, diuretics, and ACE inhibitor and vasodilators have been used. Adrenergic agonists and antiadrenergic therapy (beta adrenergic blockers or alpha 2 agonists) and QT prolonging medications are to be avoided.
A principle anaesthetic goal is to avoid psychological and physical stress that could trigger acute cardiomyopathy in susceptible patients. Thorough patient counselling, effective premedication and preoperative beta blocker therapy before transfer to operating room are highly effective.
Laryngoscopy, intubation, extubation, emergence, and inadequate postoperative pain control may cause a sympathetic response and increase catecholamine levels, so an optimal anaesthesia/analgesia is required in these phases. It is suggested that regional anaesthesia may be beneficial, but adequate studies to support this theory are not available.
It is unclear whether administration of inotropic drugs to treat systolic dysfunction is harmful. Inotrope of choice remains unclear, though Milrinone, aphosphodiesterase inhibitor, and a calcium sensitizer, levosimendan are suggested. Mechanical support of circulation with IABP or LVAD is an option to tide over periods of crisis. Beta blocker therapy may not be haemodynamically tolerated or could be potentially hazardous. Beta agonists should be avoided or used carefully, vasopressors may be used and supportive treatment for CHF should be instituted. LV dysfunction resolves within 2–4 weeks. Most cases recover spontaneously with a mortality risk of 0–8%.Recurrence occurs in 2–5% cases [10].
When a person is admitted with a diagnosis of cardiomyopathy, the main aims of therapy whether in the intensive care or coronary care unit are, to reduce the workload of the heart and to improve the pumping ability of the heart. This can be achieved with the help of drugs such as inotropes, diuretics, ACE inhibitors, beta blockers, calcium channel blockers, and so on, which aids in improving the pumping action of the heart muscle and treatment to ensure the proper volume of blood in the body.
Treatment of the patients in the intensive care unit depends not only on the type and the severity of cardiomyopathy but also condition of patient. Treatment may include conservative management with drugs, implantation of pacemakers, defibrillators for those prone to fatal heart rhythms, ventricular assist devices or extracorporeal membrane oxygenators for severe heart failure, or ablation for recurring dysrhythmias that cannot be managed by drugs or cardioversion. The goal of management in the intensive care unit is often symptomatic, and some patients may eventually require a heart transplant.
Nowadays, cardiomyopathies are being identified increasingly as a result of improved means of detection with echocardiographic examination and an increase in the ageing population group. In addition, the presentation of this disease is varied. It may be sudden or already well known to the patient. Anaesthesia administration for patients with cardiomyopathy can lead to perioperative morbidity and mortality during elective or, more importantly in emergency surgeries. Therefore, anaesthesia and postoperative care have to be carefully titrated, planned, and monitored for every patient, for which we need a thorough understanding of the pathophysiology of cardiomyopathies. The best approach would be a multidisciplinary team that includes anaesthetists, cardiologists, and surgeons. As anaesthesiologists, we have to expand our horizon from operating room to ICU with a thorough understanding of non-invasive and invasive monitoring methods and a basic knowledge of transthoracic echocardiography.
AHA | American Heart Association |
ARSA | American Society of Regional Anaesthesia |
ARVC | arrhythmogenic right ventricular cardiomyopathy |
AS | aortic stenosis |
CAD | coronary artery disease |
CHF | congestive heart failure |
CMR | cardiac magnetic resonance |
CO | cardiac output |
CTR-D | cardiac resynchronisation therapy device |
CVP | central venous pressure |
DCM | dilated cardiomyopathy |
EF | ejection fraction |
EMB | endomyocardial biopsy |
HCM | hypertrophic cardiomyopathy |
IABP | intra-arterial blood pressure |
ICD | implantable cardioverter-defibrillator |
LA | left atrium |
LV | left ventricle |
LVAD | left ventricular assist device. |
LVEDP | left ventricular end-diastolic pressure |
LVEF | left ventricular ejection fraction |
LVOTO | left ventricular outflow tract obstruction |
NYHA | New York Heart Association |
PPCM | peripartum cardiomyopathy |
PPV | pulse plethysmographic variability |
PVC | premature ventricular complex |
RCM | restrictive cardiomyopathy |
SAM | systolic anterior moment |
ScVO2 | central venous oxygen saturation |
SVR | systemic vascular resistance |
TEE | trans esophageal echocardiography |
VT | ventricular tachycardia |
WHO | World Health Organisation |
The Generation Y (Gen Y) is a segment of great interest to the business sector in general [1, 2, 3] and to the tourism sector, in particular, due to its leading role in the last decade as consumers, prosumers and adprosumers [2, 3, 4, 5] and its importance to achieve the goals of destinations [5, 6]. As Richards [7] points out, Gen Y (as this generation is often referred to) is a market segment of great value to tourist destinations due to the economic potential and availability of its members to travel more frequently and for longer periods. The professional and academic fields have shown great interest in this generation, which is reflected in the recent publication of a remarkable number of research works, both general in scope [2, 3, 8, 9, 10, 11, 12, 13] and specific to the tourism sector [5, 14, 15, 16, 17, 18] The latter sector is particularly interested in this generation’s use of information and communication technologies (ICTs) for tourism purposes [19, 20, 21, 22, 23, 24].
Within the diversity of ICTs, the boom and massive adoption of smartphones among Gen Y [20, 25, 26, 27, 28] as well as the proven relevance of these mobile devices for the tourism sector highlight the need for more studies on this regard to contribute to the development of a still incipient and scarce line of research [18, 29, 30, 31]. Just like with any other ICTs, the integration of smartphones into the digital marketing and communication strategies of the tourism business should take into account the particularities of the different stakeholders of the destinations [5, 17, 18, 32, 33, 34, 35, 36] to ensure their use actually generates positive emotions and sensations [31, 37, 38, 39] that contribute to a different, original, and satisfying tourist experience [40, 41, 42].
Current trends have shown the need for tourist destinations to evolve into smart tourism destinations [43, 44, 45, 46]. In this sense, the cost associated with the development of smart infrastructures (powerful transport networks, free Wi-Fi, etc.) should not be an obstacle for destinations with fewer resources [47, 48] because, as Huertas et al. [43] point out, there are other more affordable actions that serve the same purpose, such as proper integration and management of social networks and mobile apps.
Effectively, within the wide range of ICTs, smartphones have revolutionized the way tourists interact with the physical and digital worlds, and have become essential and highly valued tools [36, 49, 50] thanks to their capacity to shape and enhance the tourist experience [36, 42, 51, 52], which in turn can favor the promotion and dissemination of the destination by tourists themselves through word of mouth (WOM) and electronic word of mouth (eWOM) [53, 54, 55, 56, 57, 58, 59].
The use of smartphones for tourist purposes is nothing more than a reflection of the day-to-day of citizens, who use smartphones for everything (relationships, entertainment, etc.) [28]. As it happens with the use of other ICTs in the field of tourism, this technological dependence has psychological impacts that translate into negative and positive feelings [38, 60, 61, 62, 63] that in turn shape the perception of the tourist experience [52, 64, 65, 66, 67].
Based on the previous arguments, destination marketing organizations (DMOs) should consider the negative effects of smartphone use, particularly in relation to young users [68, 69, 70, 71], who are often victims of related addictions and disorders such as nomophobia, i.e., the irrational fear of not being able to use the smartphone [72, 73, 74]. In this regard, it is worth noting the impact that the type of activities performed with smartphones and the context on which it is performed have on the greater or lesser degree of anxiety or stress caused by not being able to use the smartphone [71]. In this sense, in times of loneliness and boredom, for example, not being able to interact with other people, mainly through social networks, or to search for information or use entertainment apps, can trigger an acute case of nomophobia [68, 70, 71, 74]. These effects underline the importance that people, particularly the youngest sector of the population, attach to the main values of the web 2.0 model that have given smartphones their protagonist role: multidirectional communication and universal access to information [1, 10, 24, 25, 40].
Hence the need is to identify the main uses given to smartphones for tourist purposes according to different generations and the consequent ICTs use habits [36], which is one of the objectives of this study. This information is necessary to successfully integrate smartphones into the digital marketing and communication strategies of tourist destinations. Given the numerous advantages of the communication and experiential potential of these devices [44, 45, 75, 76, 77, 78, 79], DMOs cannot ignore the fact that their use can also generate negative emotions and feelings, primarily among their younger stakeholders, including Gen Y [38, 60, 61, 62, 63], and that these feelings will in turn affect their perception of the destination and the opinions they share about it. Just like positive feelings and emotions resulting from smartphone use shape the perceptions and experiences tourists share through WOM and eWOM, which favor the promotion and dissemination of the tourist destination [53, 54, 55, 56, 57, 58, 59] the negative ones can have the opposite effect.
Therefore, and given the relevance of Gen Y for tourism [80, 81, 82] and the impact of smartphone use on the tourist experience [31, 36, 44, 45, 51, 52, 75, 76, 77, 78, 79], this study aims to describe the feelings and emotions that the use of the smartphone and its tourism-related functionalities generates during travel on members of this generation and the correlation between these variables.
Since this study focuses on a subject matter on which there is little research, it will adopt an exploratory design [83], based on the conduction of an online survey questionnaire applied to a sample of Gen Y respondents, who in turn shared the questionnaire with their contacts. It is therefore a representative sample of the Gen Y, selected through the snowball sampling technique.
The sample consists of individuals who meet the following criteria: belong to the Gen Y, own a smartphone, and used it on their last tourist trip. The first section of the survey questionnaire consists of items that verify these criteria to be able to exclude non-suitable respondents and select the final sample.
The questionnaire design, in addition to relying on previous studies and research [31, 84, 85], was validated by two well-known academic and researchers in the tourism sector and by a prestigious company specialized in digital marketing. This ensured the academic and professional validation of the instrument. Following this first review and subsequent correction, the questionnaire was pilot tested on a convenience sample of 50 people who met the same requirements set for the final sample. Based on these results, further adjustments were made to the instrument. The final version of the survey questionnaire was distributed online during May and June 2020. A total of 201 questionnaires were answered and returned, but 10 of them were discarded because the respondents did not meet the sample selection criteria. A total of 191 valid questionnaires were analyzed to achieve the research objectives.
The survey is structured in three sections. The first one, as mentioned, aims to confirm whether respondents meet the sample selection criteria. It consists of three questions about respondents’ age, smartphone ownership and smartphone use in latest trip. In addition, four more questions relating to gender, education level and country of residence were included for a better sociodemographic description of the final sample.
The next two sets consist of two and three closed-ended questions, respectively, that aim to gather quantitative data.
The first of these sets explores emotions and feelings based on the Positive and Negative Affect Schedule (PANAS) scale items [85] Respondents were asked to use a 3-point Likert scale to assess the positive or negative feelings they associated to their smartphone use during the latest trip. Following the scale developed by Watson et al. [85], the list of positive feelings and emotions included in the questionnaire are: interested, distressed, excited, upset, strong, guilty, scared, hostile, enthusiastic and proud. On the other hand, the set of negative feelings and emotions included: irritable, alert, ashamed, inspired, nervous, determined, attentive, jittery, active and afraid. In the scale, which served to indicate to what extent the respondent had felt those feelings and emotions, 1 means “almost never”; 2, “sometimes”; and 3, “almost always”. In this set, options 1 and 3 are nuanced because it is possible that specific circumstances unrelated to the tourist experience (receiving good news, losing internet connection, etc.) may translate into feelings and emotions that do not describe faithfully the respondent’s state of mind regarding smartphone use during their trip.
Respondents’ smartphone use for tourism purposes is examined in the last section using the scale developed by Tussyadiah and Zach [84], which focuses on a series of activities that are valued using a scale that ranges from “never” to “always.” The questionnaire includes the following three activities: navigation, information search and learn about destination, similarly to Lalicic and Weismayer [31] but using a 3-point Likert scale.
The age of the group of respondents (n = 191) ranges from 16 to 38, which fits the age range of Gen Y according to Strauss and Howe [86]. In terms of sex, 37% are male and 63% are female. All of them live in Spain, except for two respondents, from the USA and China, respectively. Regarding their education level, most of them are in high school (
Figure 1 presents the results regarding the feelings and emotions experienced by respondents when using their smartphone during travel.
As shown in Figure 1, surveyed Gen Y members (
Feelings and emotions associated with smartphone use during travel (total).
Given the age amplitude of Gen Y, it is relevant to delve into the results on the feelings and emotions associated with smartphone use during travel, by focusing on the following three age segments: 16–19, 20–29 and 30–38 (Figure 2).
Feelings and emotions associated with smartphone use during travel (age groups).
Negative emotions and feelings predominate in the 16–19 age group, since 93.83% of respondents in it selected the highest score for this type of feelings and emotions. Positive feelings and emotions are concentrated in the 20–29 age group. The intermediate score, “sometimes” (2), has been selected mostly for positive feelings by the youngest and oldest segments (
Having identified the feelings and emotions associated with smartphone use during travel, the next step was to describe the frequency or intensity with which this use is oriented to tourism-related activities: navigation, information search and learn about destination. The overall results are presented in Figure 3.
Use of tourism-related smartphone functionalities.
Most respondents claim to use the three aforementioned functionalities with the highest frequency (Figure 3). In all cases, the highest score (
Use of tourism-related smartphone functionalities by age group.
The lowest score and, consequently, the least commonly used of all three functionalities predominates in the youngest age segment (16–19 years old). None of the respondents in 30–38 age group claimed to have never used any of the three functionalities. At the next frequency level (“sometimes”), the number of respondents aged 16 to 19 increases considerably, although this category is led by respondents in the 30–38 age group, compared to the three functionalities analyzed. Finally, respondents in the intermediate age group, 20 to 29, use these functionalities more than the younger segments.
Figure 5 show the results on the emotions and feelings associated with each of the three tourism functionalities of smartphones.
First, Figure 5 shows the frequency of use of the navigation function and the feelings respondents associate to it. Negative feelings stand out among those who use it the least (Navigation 1), since
Tourism-related smartphone functionalities: Feelings and emotions associated with navigation.
Results regarding the use of the “information search” functionality, which refers to finding information about services, transport, for instance, are shown in Figure 6.
Tourism-related smartphone functionalities: Feelings and emotions associated with Information Search.
As in the case of the navigation functionality, negative feelings standout among those who use the Information search functionality the least (
The status of the “learn about destination” (Learn dest.) functionality shows similarities to the previous ones, although in this case the most prominent categories are those related to not having experienced feelings or emotions. Within the group of respondents who claim to use this functionality the least, negative feelings (
Generally speaking, it can be argued that younger generations, and in particular the Gen Y, arouse great interest in the business sectors, including tourism, due to their short, medium and long-term potential [1, 2, 3, 4, 5, 6, 7]. Likewise, ICTs and, especially smartphones, are also considered key elements for the development of this sector and necessary for the evolution of destinations into smart tourism destinations [43, 44, 45, 46]. Under the web 2.0 model, within the variety of ICTs, smartphones stand out for the numerous advantages and potential to create or improve the tourist experience [36, 42, 51, 52], contributing to the transformation of the consumer tourist into the “adprosumer” tourist [1, 2, 3, 4]. The high credibility of the comments and options of adprosumers makes them a key element for the dissemination and marketing activities that DMOs must procure and guarantee [53, 54, 55, 56, 57, 58, 59]. To this end, it is essential that smartphone tools are correctly integrated into the digital marketing and communication strategies of DMOs, for which it is essential to obtain detailed information about stakeholders’ expectations and ICTs usage habits.
This has been precisely the main objective of this study, focused on smartphone use by the Gen Y during travel and on the emotions and feelings associated with these uses, motivated by the effects of nomophobia on the young population. This is crucial information due to the impact of smartphone use on the perception of the tourist experience and, therefore, on the positive or negative nature of the eWOM Gen Y can generate motivated by factors unrelated to the tourist experience itself.
The main conclusion behind the results presented here is customization and individualization. As mentioned, Gen Y exhibits essential differences that need to be considered in strategic approaches.
Gen Y respondents have confirmed they experience, to a greater extent, negative feelings and emotions, which is one of the characteristic features of nomophobia [68, 70, 71, 74]. This situation occurs mainly among the youngest age segment (16–19), while the older age groups claim to experience greater indifference. It can be concluded that as their years of coexistence with the web 2.0 model decrease, their emotional involvement with the use of smartphones during travel also decreases. Having concluded that Gen Y experience negative emotions that can influence their perception of the tourist experience, the following step was to analyze the extent to which they use the tourism-related functionalities of these devices.
Regarding the tourist functionalities under analysis [84], most users claimed to use them frequently, being “Learn about destination” the least used. There are also intragroup differences in this regard, because the youngest age group (16–19) uses these functions the least, suggesting an area of opportunity for DMOs, which can enhance the use of these functionalities to influence the feelings and emotions Gen Y associate with smartphone use during travel. In fact, the results allude to a behavior among the youngest segment of the Gen Y that suggests that their smartphone use for non-tourism purposes during travel sometimes generates negative emotions and feelings. This behavior is confirmed by the analysis of the results about the emotions and feelings respondents associate with each of the three tourism-related functionalities. In all cases where respondents claim they almost never use any of the functionalities, negative feelings stand out. However, those who do use these functionalities claim they do not associate neither positive nor negative feelings with smartphone use during travel. This trend grows almost in parallel to participants’ age and is amplified in the case of the “learn about destination” functionality.
It is therefore concluded that smartphone use during travel affects the youngest tourists and is not a key element for the rest age groups. There is a clear need to enhance the tourism use of the smartphones among the youngest group (16–19), to promote the creation of positive feelings and emotions. The intermediate age group (20–29) uses the tourist functionalities frequently and is characterized by a more neutral emotional behavior. Finally, the oldest age segment (30–38) requires strategies that combine the virtual and real worlds because, for them, smartphones by themselves do not generate any kind of feeling, which is the main trigger of eWOM.
The conclusions indicate the future limitations and lines of this study on Gen Y′ smartphone uses during travel and their emotional effects. First, it is necessary to delve into the relationship between feelings and emotions, the perception of the tourist experience and the generation of eWOM. It is also relevant to compare the effects derived from the tourist activities performed virtually (via smartphones) and physically (consultation of printed guides, visits to tourist offices, interaction with destinations’ residents, etc.). In any case, the main conclusion, as mentioned above, lies in the complexity that characterizes stakeholders, which discourages the indiscriminate use of categorizations and taxonomies to approach digital marketing and communication strategies in the tourism sector. Generational classifications are undoubtedly of great interest and usefulness as a starting point, but they require further and deeper analyses of people’s desires and expectations according to their generation. In particular, the rapid and constant change that characterizes ICTs is shortening the periods of study necessary to extract valid general guidelines and premises. In this sense, a generation spanning 22 years, from 1982 to 2004, turns out to be too broad for a general description of smartphone use during travel and its associated emotions and feelings.
The authors would like to thank Dr. Asunción Huertas Roig, Dr. Estela Mariné Roig, and the Enfoca Group (www.grupoenfoca.com) for their invaluable contribution to the validation and implementation of the survey, as well as to the anonymous reviewers for their valuable observations. This paper has been funded by the I3CE Research Network Program for University Teaching of the Education Sciences Institute of the University of Alicante (Ref.: 4667. PROTOCOL Inter-University Network of Collaborative Work in Protocol, Event Management, and Institutional Relations, 2019–2020) and the research groups Experiential Marketing, Events and Integrated Communication (MAE-CO) and Aging & Communication (AgeCOM), also of the University of Alicante.
The authors declare that there is no conflict of interest regarding the publication of this article.
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Foodborne diseases can be prevented and acute diarrhea syndromes, fever and even death from dehydration can be avoided, especially in children under the age of 5 and in immunocompromised people.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Cecilia Hernández-Cortez, Ingrid Palma-Martínez, Luis Uriel\nGonzalez-Avila, Andrea Guerrero-Mandujano, Raúl Colmenero Solís\nand Graciela Castro-Escarpulli",authors:[{id:"204160",title:"Prof.",name:"Graciela",middleName:null,surname:"Castro-Escarpulli",slug:"graciela-castro-escarpulli",fullName:"Graciela Castro-Escarpulli"},{id:"204162",title:"Dr.",name:"Cecilia",middleName:null,surname:"Hernández-Cortez",slug:"cecilia-hernandez-cortez",fullName:"Cecilia Hernández-Cortez"},{id:"204163",title:"MSc.",name:"Ingrid",middleName:null,surname:"Palma-Martinez",slug:"ingrid-palma-martinez",fullName:"Ingrid Palma-Martinez"},{id:"204164",title:"MSc.",name:"Luis Uriel",middleName:null,surname:"González-Avila",slug:"luis-uriel-gonzalez-avila",fullName:"Luis Uriel González-Avila"},{id:"204165",title:"MSc.",name:"Andrea",middleName:null,surname:"Guerrero-Mandujano",slug:"andrea-guerrero-mandujano",fullName:"Andrea Guerrero-Mandujano"}]},{id:"56530",doi:"10.5772/intechopen.69955",title:"Poisoning by Anticoagulant Rodenticides in Humans and Animals: Causes and Consequences",slug:"poisoning-by-anticoagulant-rodenticides-in-humans-and-animals-causes-and-consequences",totalDownloads:1823,totalCrossrefCites:9,totalDimensionsCites:15,abstract:"Anticoagulant rodenticides (ARs) are a keystone of the management of rodent populations in the world. The widespread use of these molecules raises questions on exposure and intoxication risks, which define the safety of these products. Exposures and intoxications can affect humans, domestic animals and wildlife. Consequences are different for each group, from the simple issue of intoxication in humans to public health concern if farm animals are exposed. After a rapid presentation of the mechanism of action and the use of anticoagulant rodenticides, this chapter assesses the prominence of poisoning by anticoagulant rodenticides in humans, domestic animals and wildlife.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Sébastien Lefebvre, Isabelle Fourel, Stéphane Queffélec, Dominique\nVodovar, Bruno Mégarbane, Etienne Benoit, Virginie Siguret and\nVirginie Lattard",authors:[{id:"180156",title:"Dr.",name:"Virginie",middleName:null,surname:"Lattard",slug:"virginie-lattard",fullName:"Virginie Lattard"},{id:"185579",title:"Dr.",name:"Sébastien",middleName:null,surname:"Lefebvre",slug:"sebastien-lefebvre",fullName:"Sébastien Lefebvre"},{id:"185580",title:"Prof.",name:"Etienne",middleName:null,surname:"Benoit",slug:"etienne-benoit",fullName:"Etienne Benoit"},{id:"209023",title:"Dr.",name:"Isabelle",middleName:null,surname:"Fourel",slug:"isabelle-fourel",fullName:"Isabelle Fourel"},{id:"209031",title:"Mr.",name:"Stéphane",middleName:null,surname:"Queffélec",slug:"stephane-queffelec",fullName:"Stéphane Queffélec"},{id:"209032",title:"Dr.",name:"Bruno",middleName:null,surname:"Megarbane",slug:"bruno-megarbane",fullName:"Bruno Megarbane"},{id:"209033",title:"Dr.",name:"Dominique",middleName:null,surname:"Vodovar",slug:"dominique-vodovar",fullName:"Dominique Vodovar"},{id:"209034",title:"Prof.",name:"Virginie",middleName:null,surname:"Siguret",slug:"virginie-siguret",fullName:"Virginie Siguret"}]},{id:"56551",doi:"10.5772/intechopen.70199",title:"Toxicity of β-Lactam Antibiotics: Pathophysiology, Molecular Biology and Possible Recovery Strategies",slug:"toxicity-of-lactam-antibiotics-pathophysiology-molecular-biology-and-possible-recovery-strategies",totalDownloads:1662,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"Beta (β)-lactam antibiotics are wide-spectrum antibiotics used for various bacterial infections. The aim of this chapter is to summarize the knowledge about the toxicity of β-lactam antibiotics and issues associated to their inappropriate use. This review has highlighted that β-lactam antibiotics are a group of products that have a chemical structure characterized by a β-lactam ring and are one of the most common antibacterial agents. However, due to the inappropriate use including abuse and misuse, resistance to the β-lactam antibiotics is currently a global crisis. Moreover, even when used appropriately, they have been linked to triggering allergic reactions like urticaria, bronchoconstriction, also severe conditions like immune-mediated haemolytic anaemia and intravascular haemolysis. It is known that some β-lactam antibiotics are neurotoxic, some are nephrotoxic, some are genotoxic and some are toxic to urogenital system. Several factors are involved in the occurrence of toxic effects including the dosage and renal status. Several strategies are possible to overcome β-lactam antibiotics-triggered toxicity, including rational prescribing, substitution combination and phage therapy which seems promising. Public health education for clinical teams and patients is essential in ensuring that this group of antibiotics are retained in therapeutics.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Elif Bozcal and Melih Dagdeviren",authors:[{id:"190684",title:"Ph.D.",name:"Melih",middleName:null,surname:"Dagdeviren",slug:"melih-dagdeviren",fullName:"Melih Dagdeviren"},{id:"203449",title:"Ph.D.",name:"Elif",middleName:null,surname:"Bozcal",slug:"elif-bozcal",fullName:"Elif Bozcal"}]},{id:"57898",doi:"10.5772/intechopen.72006",title:"Occupational Risk Factors for Acute Pesticide Poisoning among Farmers in Asia",slug:"occupational-risk-factors-for-acute-pesticide-poisoning-among-farmers-in-asia",totalDownloads:1433,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"Types of pesticides are used in farming to increase the productivity and protection of crops or to control pests. However, exposure to acute pesticide poisoning is one of the most important occupational risk factors among farmers all over the world. They are directly exposed to high levels of pesticide poisoning when involved in the handling, spraying, mixing, or preparing of it. The low educational level, lack of information, training, judgment or experience, and the inability to read on pesticide safety are playing an important role for farmers’ acute poisoning. On the other side, poor technology, inadequate personal protection, inappropriate type of clothing and equipment also leads to farmers? acute poisoning. Hence, this paper focuses on occupational risk factors for acute pesticide poisoning among farmers and their occupational safety. Discovering risk factors is also crucial for investigating health problems of farmers and its inevitable effects on their body. As it is seen from previous studies instead of field research such as deep interview on farmers’ acute poisoning, data were mostly collected from hospitals. This study tries to emphasize the importance of field study to discover the risk factors for acute pesticide poisoning among farmers and their occupational safety in Asia.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Emine Selcen Darçın, Murat Darçın, Murat Alkan and Gürdoğan\nDoğrul",authors:[{id:"196869",title:"Dr.",name:"Murat",middleName:null,surname:"Darçın",slug:"murat-darcin",fullName:"Murat Darçın"},{id:"220223",title:"Dr.",name:"Murat",middleName:null,surname:"Alkan",slug:"murat-alkan",fullName:"Murat Alkan"},{id:"220224",title:"Prof.",name:"E. Selcen",middleName:null,surname:"Darçın",slug:"e.-selcen-darcin",fullName:"E. Selcen Darçın"},{id:"220225",title:"Dr.",name:"Gürdoğan",middleName:null,surname:"Doğrul",slug:"gurdogan-dogrul",fullName:"Gürdoğan Doğrul"}]},{id:"57953",doi:"10.5772/intechopen.72004",title:"Acute Poisoning with Neonicotinoid Insecticide",slug:"acute-poisoning-with-neonicotinoid-insecticide",totalDownloads:1881,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Neonicotinoids are a class of insecticides considered less toxic to humans than organophosphates, carbamates, organochloride and pyrethroids. The purpose of this chapter was to systematize existing data in the literature on acute intoxication with neonicotinoids to help practitioners. Clinical manifestations vary across different human systems. Gastrointestinal symptoms consist of nausea, vomiting, abdominal pain and corrosive lesions. In the central nervous system, headaches, agitation, confusion, fasciculations, seizures or coma may occur, while tachycardia or bradycardia, hypertension, hypotension and palpitations occur in the cardiovascular system. Respiratory effects are dyspnea, aspiration pneumonia or respiratory failure. Solvents that drive the insecticide also have an important role in the toxic effects. There are no specific biological tests of neonicotinoid intoxication, and their dosing is not routinely available. Treatment is symptomatic. Mortality is less than 3%, well below the poisoning with anticholinesterase insecticides, like organophosphates and carbamates.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Nicolai Nistor, Otilia Elena Frăsinariu and Violeta Ştreangă",authors:[{id:"219606",title:"Dr.",name:"Nicolai",middleName:null,surname:"Nistor",slug:"nicolai-nistor",fullName:"Nicolai Nistor"},{id:"219884",title:"Dr.",name:"Otilia",middleName:"Elena",surname:"Frasinariu",slug:"otilia-frasinariu",fullName:"Otilia Frasinariu"},{id:"219885",title:"Dr.",name:"Violeta",middleName:null,surname:"Streanga",slug:"violeta-streanga",fullName:"Violeta Streanga"}]}],mostDownloadedChaptersLast30Days:[{id:"56521",title:"Food Poisoning Caused by Bacteria (Food Toxins)",slug:"food-poisoning-caused-by-bacteria-food-toxins-",totalDownloads:5827,totalCrossrefCites:9,totalDimensionsCites:20,abstract:"In the environment, there are polluting substances that can cause adverse reactions in human beings when entering the body through different ways (ingestion, inhalation, injection, or absorption). The main pollutants can be poisons, chemical compounds, toxic gases, and bacterial toxins. These can be found in different places and their effects depend on the dose and exposure time. Furthermore, foodborne diseases (FBDs) can cause disability; these diseases can be caused by toxins produced by bacteria or other toxic substances in the food, which can cause severe diarrhea, toxic shock syndrome, debilitating infections such as meningitis and even death. FBDs are transmitted through food contaminated with pathogenic microorganisms that have multiple factors of virulence, which gives them the ability to cause an infection; some bacterial genres can produce toxins directly in the food, but other genres can produce them once they have colonized the intestine. Among the pathogens involved in FBDs that are also considered to be toxigenic are Salmonella spp., Vibrio parahaemolyticus, Vibrio cholerae, Staphylococcus aureus, Clostridium botulinum, Clostridium perfringens, Bacillus cereus, Listeria monocytogenes. Foodborne diseases can be prevented and acute diarrhea syndromes, fever and even death from dehydration can be avoided, especially in children under the age of 5 and in immunocompromised people.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Cecilia Hernández-Cortez, Ingrid Palma-Martínez, Luis Uriel\nGonzalez-Avila, Andrea Guerrero-Mandujano, Raúl Colmenero Solís\nand Graciela Castro-Escarpulli",authors:[{id:"204160",title:"Prof.",name:"Graciela",middleName:null,surname:"Castro-Escarpulli",slug:"graciela-castro-escarpulli",fullName:"Graciela Castro-Escarpulli"},{id:"204162",title:"Dr.",name:"Cecilia",middleName:null,surname:"Hernández-Cortez",slug:"cecilia-hernandez-cortez",fullName:"Cecilia Hernández-Cortez"},{id:"204163",title:"MSc.",name:"Ingrid",middleName:null,surname:"Palma-Martinez",slug:"ingrid-palma-martinez",fullName:"Ingrid Palma-Martinez"},{id:"204164",title:"MSc.",name:"Luis Uriel",middleName:null,surname:"González-Avila",slug:"luis-uriel-gonzalez-avila",fullName:"Luis Uriel González-Avila"},{id:"204165",title:"MSc.",name:"Andrea",middleName:null,surname:"Guerrero-Mandujano",slug:"andrea-guerrero-mandujano",fullName:"Andrea Guerrero-Mandujano"}]},{id:"56551",title:"Toxicity of β-Lactam Antibiotics: Pathophysiology, Molecular Biology and Possible Recovery Strategies",slug:"toxicity-of-lactam-antibiotics-pathophysiology-molecular-biology-and-possible-recovery-strategies",totalDownloads:1662,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"Beta (β)-lactam antibiotics are wide-spectrum antibiotics used for various bacterial infections. The aim of this chapter is to summarize the knowledge about the toxicity of β-lactam antibiotics and issues associated to their inappropriate use. This review has highlighted that β-lactam antibiotics are a group of products that have a chemical structure characterized by a β-lactam ring and are one of the most common antibacterial agents. However, due to the inappropriate use including abuse and misuse, resistance to the β-lactam antibiotics is currently a global crisis. Moreover, even when used appropriately, they have been linked to triggering allergic reactions like urticaria, bronchoconstriction, also severe conditions like immune-mediated haemolytic anaemia and intravascular haemolysis. It is known that some β-lactam antibiotics are neurotoxic, some are nephrotoxic, some are genotoxic and some are toxic to urogenital system. Several factors are involved in the occurrence of toxic effects including the dosage and renal status. Several strategies are possible to overcome β-lactam antibiotics-triggered toxicity, including rational prescribing, substitution combination and phage therapy which seems promising. Public health education for clinical teams and patients is essential in ensuring that this group of antibiotics are retained in therapeutics.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Elif Bozcal and Melih Dagdeviren",authors:[{id:"190684",title:"Ph.D.",name:"Melih",middleName:null,surname:"Dagdeviren",slug:"melih-dagdeviren",fullName:"Melih Dagdeviren"},{id:"203449",title:"Ph.D.",name:"Elif",middleName:null,surname:"Bozcal",slug:"elif-bozcal",fullName:"Elif Bozcal"}]},{id:"56530",title:"Poisoning by Anticoagulant Rodenticides in Humans and Animals: Causes and Consequences",slug:"poisoning-by-anticoagulant-rodenticides-in-humans-and-animals-causes-and-consequences",totalDownloads:1823,totalCrossrefCites:10,totalDimensionsCites:17,abstract:"Anticoagulant rodenticides (ARs) are a keystone of the management of rodent populations in the world. The widespread use of these molecules raises questions on exposure and intoxication risks, which define the safety of these products. Exposures and intoxications can affect humans, domestic animals and wildlife. Consequences are different for each group, from the simple issue of intoxication in humans to public health concern if farm animals are exposed. After a rapid presentation of the mechanism of action and the use of anticoagulant rodenticides, this chapter assesses the prominence of poisoning by anticoagulant rodenticides in humans, domestic animals and wildlife.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Sébastien Lefebvre, Isabelle Fourel, Stéphane Queffélec, Dominique\nVodovar, Bruno Mégarbane, Etienne Benoit, Virginie Siguret and\nVirginie Lattard",authors:[{id:"180156",title:"Dr.",name:"Virginie",middleName:null,surname:"Lattard",slug:"virginie-lattard",fullName:"Virginie Lattard"},{id:"185579",title:"Dr.",name:"Sébastien",middleName:null,surname:"Lefebvre",slug:"sebastien-lefebvre",fullName:"Sébastien Lefebvre"},{id:"185580",title:"Prof.",name:"Etienne",middleName:null,surname:"Benoit",slug:"etienne-benoit",fullName:"Etienne Benoit"},{id:"209023",title:"Dr.",name:"Isabelle",middleName:null,surname:"Fourel",slug:"isabelle-fourel",fullName:"Isabelle Fourel"},{id:"209031",title:"Mr.",name:"Stéphane",middleName:null,surname:"Queffélec",slug:"stephane-queffelec",fullName:"Stéphane Queffélec"},{id:"209032",title:"Dr.",name:"Bruno",middleName:null,surname:"Megarbane",slug:"bruno-megarbane",fullName:"Bruno Megarbane"},{id:"209033",title:"Dr.",name:"Dominique",middleName:null,surname:"Vodovar",slug:"dominique-vodovar",fullName:"Dominique Vodovar"},{id:"209034",title:"Prof.",name:"Virginie",middleName:null,surname:"Siguret",slug:"virginie-siguret",fullName:"Virginie Siguret"}]},{id:"56446",title:"Carbon Monoxide Intoxication: Experiences from Hungary",slug:"carbon-monoxide-intoxication-experiences-from-hungary",totalDownloads:2971,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Carbon monoxide (CO) is odorless, colorless, tasteless, and nonirritating gas. Hence, mild CO poisoning often remains unrecognized and appears lethally. Carbon and gas systems, unfavorable architectural designs and machines may also cause intoxications. The prevalence rates in Hungary ranged from 2.37 to 3.80 cases per 100,000 people per year between 2013 and 2015; fatality rates have been decreased from 5.96 in 2013 to 3.38 in 2015. Given the vagueness and the broad spectrum of complaints, misdiagnosis of CO toxicity is common. The gold standard diagnosis is detecting the level of circulating carboxyhemoglobin (CO-Hgb). The measurement of CO-Hgb can be performed via blood-gas analyses or by spectrophotometry. Treatment protocol should follow the ACBDE rule. Administration of 100% oxygen should be performed as soon as possible. Later in-hospital management includes evaluation, treatment and prevention of further peripheral organ damage and long-term neurological complications. Fetuses and children are prone to suffer more severe intoxication due to higher oxygen demand. Though hyperbaric oxygen is the mainstay therapy, a prompt cesarean section is effective in preventing further intoxication. In conclusion, fatal CO intoxication can occur due to plain early signs and symptoms. Hyperbaric oxygen therapy should be considered in severe intoxication, in fetal and children.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Edit Gara",authors:[{id:"198479",title:"Ph.D.",name:"Edit",middleName:null,surname:"Gara Dr",slug:"edit-gara-dr",fullName:"Edit Gara Dr"}]},{id:"57953",title:"Acute Poisoning with Neonicotinoid Insecticide",slug:"acute-poisoning-with-neonicotinoid-insecticide",totalDownloads:1882,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Neonicotinoids are a class of insecticides considered less toxic to humans than organophosphates, carbamates, organochloride and pyrethroids. The purpose of this chapter was to systematize existing data in the literature on acute intoxication with neonicotinoids to help practitioners. Clinical manifestations vary across different human systems. Gastrointestinal symptoms consist of nausea, vomiting, abdominal pain and corrosive lesions. In the central nervous system, headaches, agitation, confusion, fasciculations, seizures or coma may occur, while tachycardia or bradycardia, hypertension, hypotension and palpitations occur in the cardiovascular system. Respiratory effects are dyspnea, aspiration pneumonia or respiratory failure. Solvents that drive the insecticide also have an important role in the toxic effects. There are no specific biological tests of neonicotinoid intoxication, and their dosing is not routinely available. Treatment is symptomatic. Mortality is less than 3%, well below the poisoning with anticholinesterase insecticides, like organophosphates and carbamates.",book:{id:"5873",slug:"poisoning-from-specific-toxic-agents-to-novel-rapid-and-simplified-techniques-for-analysis",title:"Poisoning",fullTitle:"Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for Analysis"},signatures:"Nicolai Nistor, Otilia Elena Frăsinariu and Violeta Ştreangă",authors:[{id:"219606",title:"Dr.",name:"Nicolai",middleName:null,surname:"Nistor",slug:"nicolai-nistor",fullName:"Nicolai Nistor"},{id:"219884",title:"Dr.",name:"Otilia",middleName:"Elena",surname:"Frasinariu",slug:"otilia-frasinariu",fullName:"Otilia Frasinariu"},{id:"219885",title:"Dr.",name:"Violeta",middleName:null,surname:"Streanga",slug:"violeta-streanga",fullName:"Violeta Streanga"}]}],onlineFirstChaptersFilter:{topicId:"1010",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,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:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. 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Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",slug:"ana-isabel-flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",slug:"christian-palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",slug:"attilio-rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",slug:"yanfei-(jacob)-qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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He received his Ph.D. in Environmental Analytical Chemistry from Assiut University, Egypt, in 1989. His research interest is in analytical and environmental chemistry with special emphasis on: (1) monitoring and assessing biological trace elements and toxic metals in human blood, urine, water, crops, vegetables, and medicinal plants; (2) relationships between environmental heavy metals and human diseases; (3) uses of biological indicators for monitoring water pollution; (4) environmental chemistry of lakes, rivers, and well water; (5) water and wastewater treatment by adsorption and photocatalysis techniques; (6) soil and water pollution monitoring, control, and treatment; and (7) advanced oxidation treatment. Prof. Rashed has supervised several MSc and Ph.D. theses in the field of analytical and environmental chemistry. He served as an examiner for several Ph.D. theses in analytical chemistry in India, Kazakhstan, and Botswana. He has published about ninety scientific papers in peer-reviewed international journals and several papers in national and international conferences. He participated as an invited speaker at thirty international conferences. Prof. Rashed is the editor-in-chief and an editorial board member for several international journals in the fields of chemistry and environment. He is a member of several national and international societies. He received the Egyptian State Award for Environmental Research in 2001 and the Aswan University Merit Award for Basic Science in 2020. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"17",type:"subseries",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. 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Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",annualVolume:11413,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRqB9QAK/Profile_Picture_1626163237970",institutionString:null,institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/24082",hash:"",query:{},params:{id:"24082"},fullPath:"/profiles/24082",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()