Classification of pesticides according to their chemical composition [6].
\r\n\tHealth and mental health issues of both children and adults and evidence-based treatments will be included. The types of sexual violence that occur and prevention efforts that have – or have not – been made to address the occurrence of these types of violence will be covered.
\r\n\r\n\tCultural and governmental policies, as well as legal and jurisdiction issues to address victims of these crimes, will also be incorporated in the book. For instance, Meagan’s Law and its worthiness in protecting children will be incorporated as well as the Federal program to reimburse victims of online child pornography and the legal entanglements and ramifications of that program.
\r\n\r\n\tThe typology of offenders and the effectiveness of treatment will also be addressed.
\r\n\tFinally, the direction of prevention strategies, treatment needs for both victims and offenders, and policy issues to move the field forward, particularly in terms of research, will be presented. The field of sexual violence has made significant strides in the past 45 years in terms of understanding sexually deviant behavior, the impact on children who then experience the symptoms of that trauma in adulthood, how to effectively interview sexually victimized children, and finally, treatment and social mores that make disclosure possible and recovery hopeful.
As a result of human activities, currently a large number of pollutants and waste are eliminated to the environment. Worldwide, more than one billion pounds of toxins are released into the air and water. Approximately 6x106 chemical compounds have been produced; annually 1,000 new products are synthetized and between 60,000 and 95,000 chemicals are commercially used [1]. Among these substances are chemical pesticides, which are used extensively in most areas of crop production in order to minimize pest infestations, to protect the crop yield losses and to avoid reducing the product quality.
The pesticides belong to a category of chemicals used worldwide as herbicides, insecticides, fungicides, rodenticides, molluscicides, nematicides, and plant growth regulators in order to control weeds, pests and diseases in crops as well as for health care of humans and animals. The positive aspect of application of pesticides renders enhanced crop/food productivity and drastic reduction of vector-borne diseases [2,3]. A pesticide is any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any pest (insects, mites, nematodes, weeds, rats, etc.), including insecticide, herbicide, fungicide, and various other substances used to control pests [4]. The definition of pesticide varies with times and countries. However, the essence of pesticide remains basically constant: it is a (mixed) substance that is poisonous and efficient to target organisms and is safe to non-target organisms and environments [5].
Pesticides are by no means a new invention. In fact, intentional pesticide use goes back thousand years when Sumerians, Greeks, and Romans killed pests using various compounds such as sulphur, mercury, arsenic, copper or plant extracts. However, results were frequently poor because of the primitive chemistry and the insufficient application methods. A rapid emergence in pesticide use began mainly after World War II with the introduction of DDT (dichlorodiphenyltrichloroethane), BHC (benzene hexachloride), aldrin, dieldrin, endrin, and 2,4-D (2,4-dichlorophenoxyacetic acid). These new chemicals were effective, easy to use, inexpensive, and thus enormously popular. However, under constant chemical pressure, some pests became genetically resistant to pesticides, non-target organisms were harmed, and pesticide residues often appeared in unexpected places [3].
Chemical pesticides can be classified in different ways, but one of the most used is according to their chemical composition, which allows to group pesticides in a uniform and scientific way and to establish a correlation between structure, activity, toxicity and degradation mechanisms, among others. Table 1 shows the most important pesticides according to their chemical composition. Some general characteristics of pesticides are shown in Table 2.
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
Organochlorine | \n\t\t\tCarbon atoms, chlorine, hydrogen and occasionally oxygen. They are nonpolar and lipophilic | \n\t\t
Organophosphate | \n\t\t\tPossess central phosphorus atom in the molecule. In relation whit organochlorines, these compounds are more stable and less toxic in the environment. The organophosphate pesticides can be aliphatic, cyclic and heterocyclic. | \n\t\t
Carbamates | \n\t\t\tChemical structure based on a plant alkaloid | \n\t\t
Pyrethroids | \n\t\t\tCompounds similar to the synthetic pyrethrins (alkaloids obtained from petals of | \n\t\t
Botanical origin | \n\t\t\tProducts derived directly from plants. Not chemically synthesized. | \n\t\t
Biological | \n\t\t\tViruses, microorganisms or their metabolic products. | \n\t\t
Copper | \n\t\t\tInorganic compounds of copper. | \n\t\t
Thiocarbamates | \n\t\t\tDiffer from carbamates in their molecular structure, containing an-S-group in its composition. | \n\t\t
Organotin | \n\t\t\tPresence of tin as a central atom of the molecule. | \n\t\t
Organosulfur | \n\t\t\tThey have a sulfur central atom in the molecule, very toxic to mites or insects. | \n\t\t
Dinitrophenols | \n\t\t\tThey are recognized by the presence of two nitro groups (NO2) bonded to a phenol ring. | \n\t\t
Urea derivatives | \n\t\t\tCompounds which include the urea bound to aromatic compounds. | \n\t\t
Diverse composition | \n\t\t\tTriazines, talimides, carboxyamide, trichloroacetic and trichloropicolinic acids derivatives, guanidines and naphthoquinones. | \n\t\t
Classification of pesticides according to their chemical composition [6].
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
Organochlorines | \n\t\t\tSoluble in lipids, they accumulate in fatty tissue of animals, are transferred through the food chain; toxic to a variety of animals, long-term persistent. | \n\t\t\tDDT, aldrin, lindane, chlordane, mirex. | \n\t\t
Organophosphates | \n\t\t\tSoluble in organic solvents but also in water. They infiltrate reaching groundwater, less persistent than chlorinated hydrocarbons; some affect the central nervous system. They are absorbed by plants, transferred to leaves and stems, which are the supply of leaf-eating insects or feed on wise. | \n\t\t\tMalathion, methyl parathion, diazinon | \n\t\t
Carbamates | \n\t\t\tCarbamate acid derivatives; kill a limited spectrum of insects, but are highly toxic to vertebrates. Relatively low persistence | \n\t\t\tSevin, carbaryl | \n\t\t
Pyrethroids | \n\t\t\tAffect the nervous system; are less persistent than other pesticides; are the safest in terms of their use, some are used as household insecticides. | \n\t\t\tPyrethrins | \n\t\t
Biological | \n\t\t\tOnly the | \n\t\t\tDispel, foray, thuricide | \n\t\t
General characteristics of pesticides [7].
Worldwide approximately 9,000 species of insects and mites; 50,000 species of plant pathogens, and 8,000 species of weeds damage crops. Different pests such as insects and plants causing losses estimated in 14% and 13% respectively. Pesticides are indispensable in agricultural production. About one-third of the agricultural products are produced by using pesticides. Without pesticide application the loss of fruits, vegetables and cereals from pest injury would reach 78%, 54% and 32% respectively. Crop loss from pests declines to 35% to 42% when pesticides are used [8].
Over 1990s, the global pesticide sales remained relatively constant, between 270 to 300 billion dollars, of which 47% were herbicides, 79% were insecticides, 19% were fungicides/bactericides, and 5% the others. Over the period 2007 to 2008, herbicides ranked the first in three major categories of pesticides (insecticides, fungicides/bactericides, herbicides). Fungicides/bactericides increased rapidly and ranked the second. Europe is now the largest pesticide consumer in the world, followed by Asia. As for countries, China, the United States, France, Brazil and Japan are the largest pesticide producers, consumers or traders in the world. Most of the pesticides worldwide are used to fruit and vegetable crops. In the developed countries pesticides, mainly herbicides are mostly used to maize. Since the 1980s hundreds of thousands of pesticides have been developed, including various biopesticides [5].
The global agricultural sector is the primary user of pesticides, consuming over 4 million tons of pesticides annually. Pesticides have been extensively used for decades and have substantially increased the food production [9]. However a large amount of applied pesticides often never reach their intended target due to their degradation, volatilization and leaching, leading to serious ecological problems [9-10]. Under actual agricultural practices, different groups of pesticides are often simultaneously or consecutively applied interacting with each other [11].
Although pesticides are beneficial in controlling the proliferation of pests, their unregulated and indiscriminate applications for the application of pesticides can cause adverse effects to human health, to different life forms and to the ecosystems, which depend on the degree of sensitivity of organisms and toxicity of pesticides. The continued application of pesticides has increased its concentration in soils and waters, besides; they enter to the food chains. Dispersion mechanisms also have increased the level of environmental risk for the occupationally exposed population and the inhabitants of surrounding villages. Despite ban on application of some of the environmentally persistent and least biodegradable pesticides (like organochlorines), in many countries their use is ever on rise. Pesticides cause serious health hazards to living systems because of their rapid fat solubility and bioaccumulation in non-target organisms [2]. The main forms of pollution are direct applications to agricultural crops, accidental spills during transport and manufacturing, as well as waste from tanks where cattle are treated to ectoparasites control [4].
The effects of the impacts of pesticides can be analyzed from two different points of view: environmental and public health. The first occurs when pesticides are introduced to food chains, for example: a) producing a change in the decline of populations of phytoplankton and zooplankton (indicators of water pollution); b) producing carcinogenic, neurotoxic, and on fertility and viability (in invertebrates, fish, amphibians, insects and mammals) of their descendants; c) the presence of pesticides in the environment have caused the resistance of organisms considered as pests and disease vectors (for example malaria, dengue and Chagas disease), and instead other beneficial insect populations are diminished (like pollinators); d) alter biogeochemical cycles by decreasing the macro and microbiota, e) leaching of pesticides pollute water bodies, f) can be adsorbed pesticides when soil particles interact with positively or negatively charged, thus increasing their persistence in the environment (4-26 weeks). From the point of view of public health impact of pesticides is mainly acute intoxications (especially in occupationally exposed populations) or indirect exposure of the general population (through air, water and food contaminated with pesticide residues) [12].
In natural environments, pesticides or their degradation products may be further transformed or degraded by other microorganisms or eventually leading to complete degradation by the microbial consortium. However, persistent xenobiotics like pesticides and metabolic dead-end products will accumulate in the environment, become part of the soil humus, or enter the food chain leading to biomagnification (Figure 1).
Fate of pesticides in the environment.
The fate of pesticides in the environment is strongly related to the soil sorption processes that control not only their transfer but also their bioavailability [13]. Contamination of soil from pesticides as a result of their bulk handling at the farmyard or following application in the field or accidental release may lead occasionally to contamination of surface and ground water [14]. The behavior of pesticides in soils, the efficiency, persistence and potential as environmental contaminants, depend on their retention and degradation on soil constituents [15]. In soils, several parameters influence the rate of biodegradation processes: environmental factors such as moisture and temperature, physicochemical properties of the soil, presence of other nitrogen sources or carbon, etc. can completely modify the microbial population and therefore the microbial activity [13].
On the other hand, liquid and solid wastes and obsolete products are stored or disposed in an inappropriate manner, which has favored the appearance of significant amounts of environmental liabilities, which in most cases are not reported to the appropriate authority. There are more than half a million tons of obsolete, unused, forbidden or outdated pesticides, in several developing and transitional countries, which endanger the environment and health of millions of people [16] In the absence of a clear obsolete pesticides management strategy, over the years, significant amounts of obsolete pesticides have been stockpiled in developing countries [17]. An obsolete pesticide may be recognized as one that is undesirable or impossible to use and has to be eliminated [17-20]. Because of their characteristics, obsolete pesticides are hazardous wastes that should be managed as such. Obsolete pesticides have accumulated in almost every developing country or economy in transition over the past several decades [17]. It is estimated that in Africa and Middle East there are more than 100,000 tons of these products, in Asia almost 200,000 and a similar quantity in East Europe and the old Soviet Union. Nowadays the FAO is elaborating the inventories of Latin America [19,21-22]. In Mexico, there is knowledge of the existence of obsolete pesticide products, both liquid and solid. A total of 551 records of obsolete pesticide products have been registered, distributed in 29 of 33 states of Mexico, achieving a total of 26,725.02 liters, 147,274 kg and 500 m3 of highly polluted soils. In addition there are 28 reports of pesticide-contaminated sites in 15 states of the Mexican Republic [23]. Besides, some data indicate that the total of empty pesticide containers can be about 7,000 tons annually [24].
Due to the problems mentioned above, development of technologies that guarantee their elimination in a safe, efficient and economical way is important. In order to reduce the effects of pesticides on the environment and health, for remediation of contaminated sites and for the treatment of pesticide residues and/or obsolete pesticides, different methods have been developed. Among the existent technologies there are those that apply physical treatments, such as adsorption and percolator filters; chemical treatments such as the advanced oxidation which involve the use of powerful transient species, mainly the hydroxyl radical. Other technique used for the degradation of pesticides the heterogeneous photocatalysis with TiO2 is a method for producing the radical mentioned [25]. A method currently used is high temperature incineration in special furnaces: pesticides are packaged in the places where they were abandoned, then transported to a country that has special facilities to dispose of hazardous wastes. FAO estimates that the cost of these operations varies between 3,000 and 4,000 USD/ton [6]. Other strategies that have been studied for the degradation of these compounds include the photodegradation [26]. However all these methods have several disadvantages such as the use of chemical catalysts, as titanium dioxide, and the use of expensive technology in the case of ozone. For some pesticides alkaline hydrolysis is used, such in the case of organophosphates, which must include a rigorous control of the conditions under which the experiments performed, such as maintenance of alkaline pH, as well as the presence of complexes formed with metal ions, which involves the formation of secondary pollutants.
These conventional physicochemical approaches are generally expensive and remediation process is often incomplete due to the conversion of the parent compound to metabolites which are more persistent and equally or more toxic to non-target organisms [14].
An alternative pesticides treatment with important global boom is bioremediation, which is conducted through the biodegradation of these chemical compounds. This technique relies on the ability of microorganisms to convert organic contaminants in simple and harmless compounds to the environment. Bioremediation overcomes the limitations of traditional methods for the disposal of hazardous compounds, so it has allowed the destruction of many organic contaminants at a reduced cost. Consequently, in the last years, bioremediation technology has progressed to an unknown virtual technology considered for the degradation of a wide range of pollutant compounds. Bioremediation can offer an efficient and cheap option for decontamination of polluted ecosystems and destruction of pesticides [14, 27-30]. As an efficient, economical and environmentally friendly technique, biodegradation has emerged as a potential alternative to the conventional techniques. However, the biodegradation process of many pesticides has not been fully investigated [31].
Different biological systems, as microorganisms, have been used to biotransform pesticides. It has been reported that a fraction of the soil biota can quickly develop the ability to degrade certain pesticides, when they are continuously applied to the soil. These chemicals provide adequate carbon source and electron donors for certain soil microorganisms [32], establishing a way for the treatment of pesticide-contaminated sites [33-34].
Furthermore, the isolated microorganisms capable of degrading pesticides can be used for bioremediation of other chemical compounds to whom any microbial degradation system is known [14]. However, the transformation of such compounds depends not only on the presence of microorganisms with appropriate degrading enzymes, but also a wide range of environmental parameters [35]. Additionally, some physiological, ecological, biochemical and molecular aspects play an important role in the microbial transformation of pollutants [36-37].
There are different sources of microorganisms with the ability to degrade pesticides. Because pesticides are mainly applied to agricultural crops, soil is the medium that mostly gets these chemicals, besides pesticide industry\'s effluent, sewage sludge, activated sludge, wastewater, natural waters, sediments, areas surrounding the manufacture of pesticides, and even some live organisms. In general, microorganisms that have been identified as pesticide degraders have been isolated from a wide variety of sites contaminated with some kind of pesticide. At present, in different laboratories around the world there are collections of microorganisms characterized by their identification, growth and degradation of pesticides. The isolation and characterization of microorganisms that are able to degrade pesticides give the possibility to count with new tools to restore polluted environments or to treat wastes before the final disposition [16].
Microbial processes that eliminate organic environmental contamination are important. Progress in the biotechnology of biodegradation relies upon the underlying sciences of environmental microbiology and analytical geochemistry. Recent key discoveries advancing knowledge of biodegradation (in general) and the aromatic-hydrocarbon biodegradation (in particular) have relied upon characterization of microorganisms: pure-culture isolates, laboratory enrichment cultures, and in contaminated field sites. New analytical and molecular tools (ranging from sequencing the DNA of biodegrading microorganisms) have deepened our insights into the mechanisms (how), the occurrence (what), and the identity (who) of active players that effect biodegradation of organic environmental pollutants [38], (Figure 2).
Representation of the relationships between pesticides, microbial communities, and the discovery of new biodegradation processes, Omics = high throughput-based characterization of biomolecules characteristic of bioprocesses; DNA, genomics; mRNA, transcriptomics; protein, proteomics; metabolites, metabolomics.
In the literature there are some examples of microbial pesticide degradation, among them, the following reports deserve mention:
According to [39],
[41] isolated various fungi species from Algerian pesticide contaminated soils. Observing that the most frequent species isolated were
Another experiments have been demonstrated the efficiency of the bacterium
Several bacterial genera are adapted to grow in pesticide contaminated soils. These microorganisms have enzymes involved in the hydrolysis of P-O, P-F, P-S and P-C bonds, which are found in a wide variety of organophosphorus pesticides [14]. Some bacteria isolated from the soil are capable of degrading pesticides as ethyl-parathion and methyl-parathion.
Biodegradation that involves the capabilities of microorganisms in the removal of pollutants is the most promising, relatively efficient and cost-effective technology. Biodegradation is a process that involves the complete rupture of an organic compound in its inorganic constituents. The microbial transformation may be driven by energy needs, or a need to detoxify the pollutants, or may be fortuitous in nature (cometabolism). Because of the ubiquitous nature of microorganisms, their numbers and large biomass relative to other living organisms in the earth, wider diversity and capabilities in their catalytic mechanisms [44], and their ability to function even in the absence of oxygen and other extreme conditions the search for pollutant-degrading microorganisms, understanding their genetics and biochemistry, and developing methods for their application in the field have become an important human endeavor [45].
As much as the diversity in sources and chemical complexities in organic pollutants exists, there is probably more diversity in microbial members and their capabilities to synthesize or degrade organic compounds [46-47].The microbial populations of soil or aquatic environments are composed of diverse, synergistic or antagonistic communities rather than a single strain. In natural environments, biodegradation involves transferring the substrates and products within a well-coordinated microbial community, a process referred to as metabolic cooperation [48]. Microorganisms have the ability to interact, both chemically and physically, with substances leading to structural changes or complete degradation of the target molecule. Among the microbial communities, bacteria, fungi, and actinomycetes are the main transformers and pesticide degraders [49]. Fungi generally biotransform pesticides and other xenobiotics by introducing minor structural changes to the molecule, rendering it nontoxic. The biotransformed pesticide is released into the environment, where it is susceptible to further degradation by bacteria [50].
Fungi and bacteria are considered as the extracellular enzyme-producing microorganisms for excellence. White rot fungi have been proposed as promising bioremediation agents, especially for compounds not readily degraded by bacteria. This ability arises from the production of extracellular enzymes that act on a broad array of organic compounds. Some of these extracellular enzymes are involved in lignin degradation, such as lignin peroxidase, manganese peroxidase, laccase and oxidases. Several bacterial that degrade pesticide have been isolated and the list is expanding rapidly. The three main enzyme families implicated in degradation are esterases, glutathione S-transferases (GSTs) and cytochrome P450 [51].
Enzymes are central to the biology of many pesticides [52]. Applying enzymes to transform or degrade pesticides is an innovative treatment technique for removal of these chemicals from polluted environments. Enzyme-catalyzed degradation of a pesticide may be more effective than existing chemical methods. Enzymes are central to the mode of action of many pesticides: some pesticides are activated
For pesticides degradation, three are mainly enzyme systems involved: hydrolases, esterases (also hydrolases), the mixed function oxidases (MFO), these systems in the first metabolism stage, and the glutathione S-transferases (GST) system, in the second phase [55]. Several enzymes catalyze metabolic reactions including hydrolysis, oxidation, addition of an oxygen to a double bound, oxidation of an amino group (NH2) to a nitro group, addition of a hydroxyl group to a benzene ring, dehalogenation, reduction of a nitro group (NO2) to an amino group, replacement of a sulfur with an oxygen, metabolism of side chains, ring cleavage. The process of biodegradation depends on the metabolic potential of microorganisms to detoxify or transform the pollutant molecule, which is dependent on both accessibility and bioavailability [47].
Metabolism of pesticides may involve a three-phase process. In Phase I metabolism, the initial properties of a parent compound are transformed through oxidation, reduction, or hydrolysis to generally produce a more water-soluble and usually a less toxic product than the parent. The second phase involves conjugation of a pesticide or pesticide metabolite to a sugar or amino acid, which increases the water solubility and reduces toxicity compared with the parent pesticide. The third phase involves conversion of Phase II metabolites into secondary conjugates, which are also non-toxic. In these processes fungi and bacteria are involved producing intracellular or extra cellular enzymes including hydrolytic enzymes, peroxidases, oxygenases, etc [16, 56].
Due to the diversity of chemistries used in pesticides, the biochemistry of pesticide bioremediation requires a wide range of catalytic mechanisms, and therefore a wide range of enzyme classes. Information for some pesticide degrading enzymes could be founded in Table 3.
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
Oxidoreductases (Gox) | \n\t\t\t\n\t\t\t\t \n\t\t\t\t | \n\t\t\tGlyphosate | \n\t\t
Monooxygenases: | \n\t\t\t\n\t\t\t | \n\t\t |
ESd Ese | \n\t\t\t\n\t\t\t\t | \n\t\t\tEndosulphan and Endosulphato | \n\t\t
\n\t\t\t\t | \n\t\t\tEndosulphan, Aldrin, Malation, DDDT and Endosulphato | \n\t\t|
Cyp1A1/1ª2 | \n\t\t\tRats | \n\t\t\tAtrazine, Norflurazon and Isoproturon | \n\t\t
Cyp76B1 | \n\t\t\t\n\t\t\t\t | \n\t\t\tLinuron, Chlortoluron and Isoproturon | \n\t\t
P450 | \n\t\t\t\n\t\t\t\t | \n\t\t\tHexachlorobenzene and Pentachlorobenzene | \n\t\t
Dioxygenases (TOD) | \n\t\t\t\n\t\t\t\t | \n\t\t\tHerbicides Trifluralin | \n\t\t
E3 | \n\t\t\t\n\t\t\t\t | \n\t\t\tSynthetic pyrethroids and insecticides phosphotriester | \n\t\t
Phosphotriesterases: OPH/OpdA | \n\t\t\tAgrobacterium radiobacter Pseudomonas diminuta Flavobacterium sp. | \n\t\t\tInsecticides phosphotriester | \n\t\t
Haloalkane Dehalogenases: LinB | \n\t\t\t\n\t\t\t\t \n\t\t\t\t | \n\t\t\tHexachlorocyclohexane (β and δ isomers) | \n\t\t
AtzA | \n\t\t\t\n\t\t\t\t | \n\t\t\tHerbicides chloro-s-trazina | \n\t\t
TrzN | \n\t\t\t\n\t\t\t\t | \n\t\t\tHerbicides chloro-s-trazina | \n\t\t
LinA | \n\t\t\t\n\t\t\t\t Shingomonas sp. | \n\t\t\tHexachlorocyclohexane (γ isomers) | \n\t\t
TfdA | \n\t\t\t\n\t\t\t\t | \n\t\t\t2,4 - dichlorophenoxyacetic acid and pyridyl-oxyacetic | \n\t\t
DMO | \n\t\t\t\n\t\t\t\t | \n\t\t\tDicamba | \n\t\t
Hydrolases are a broad group of enzymes involved in pesticide biodegradation. Hydrolases catalyze the hydrolysis of several major biochemical classes of pesticide (esters, peptide bonds, carbon-halide bonds, ureas, thioesters, etc.) and generally operate in the absence of redox cofactors, making them ideal candidates for all of the current bioremediation strategies [53].
As an example of the catalytic activity of enzymes hydrolases, the degradation pathway of carbofuran, a pesticide the group of carbamates is presented (Figure 3). This pesticide can be transformed in the environment and different metabolites are generated and accumulated in potentially contaminated sites (soil, water and sediments, mainly). Different organisms isolated from contaminated sites that have been identified and characterized as transformers of carbofuran, resulting in different metabolites [57].
Among the hydrolases involved in the degradation of pesticides are including different types such as:
Among the most studied pesticide degrading enzymes, the PTEs are one of the most important groups [58]. These enzymes have been isolated from different microorganisms that hydrolyze and detoxify organophosphate pesticides (OPs). This reduces OP toxicity by decreasing the ability of OPs to inactivate AchE [14, 59-62]. The first isolated phosphotriesterase belongs to the
Degradation pathway of carbofuran. In a) several bacteria are involved in the hydrolysis of metabolites and b) fungal degradation of carbofuran may occur via hydroxylation at the three position and oxidation to 3-ketocarbofuran (University of Minnesota. Biocatalysis/Biodegradation Database, http://www.umbbd.ethz.ch/cbf/cbf_image_map1.html).
The phosphotriesterase enzyme is a homo-dimeric protein with a monomeric molecular weight of 36 Kda. As a first step in the PTE organophosphorous pesticide hydrolysis mechanism, the enzymatic active site removes a proton from water, activating this molecule, them, the activated water directly attacks the central phosphorus of the pesticide molecule producing an inversion in its configuration The oxygen is polarized by the active site, with the participation of a zinc atom [6, 69], (Figure 4). This enzyme has potential use for the cleaning of organophosphorus pesticides contaminated environments [65].
Proposed mechanism for PTE activity. Zinc’s active site functions in phosphate polarization, making phosphor more susceptible to the attack. 1) A base subtracts a proton from a water molecule with the subsequent attack of the hydroxyl to the central phosphorous. 2) The intermediary complex originates the products 3) p-nitrophenol and diethyl thiophosphate [
Esterases are enzymes that catalyze hydrolysis reactions over carboxylic esters (carboxiesterases), amides (amidases), phosphate esters (phosphatases), etc. [70]. In the reaction catalyzed by esterases, hydrolysis of a wide range of ester substrates occurs in their alcohol and acid components as following:
Many insecticides (organophosphates, carbamates and pyrethroids) have associated a carboxylic ester, and the enzymes capable of hydrolyze such ester bond are known with the name of carboxylesterases.
At present, multiple classification nomenclature systems are used for these enzymes. According to the International Union of Biochemistry and Molecular Biology (IUBMB) nomenclature, carboxylesterases are located in the group of hydrolases (3), subgroup 1, and within it, in subtype 1 (Enzyme Commission 3.1.1.1, EC 3.1.1.1). Another common classification is the nomenclature divides the esterases into three groups according to the nature of their interactions with organophosphorus insecticides. Carboxylesterases belong, according to this classification, the group of ali-esterases and B-esterases. Esterases are a large family of enzymes in arthropods [71].
The esterases are a group of enzymes highly variable, which has been recognized as one of the most important in the metabolism of xenobiotics and its mechanism is associated with the mass production of multifunctional hydrolytic enzymes Organophosphate pesticides can be hydrolyzed by such enzymes [72-74]. There are different types of esterases and with very different distribution in tissues and organisms. The Carboxiesterases (type B esterases) are a group that hydrolyze, additionally to endogenous compounds, xenobiotics with ester, amide, thioester, phosphate esters (parathion, paraoxon) and acid anhydrides (DIPFP=DFP) in mammals.
Esterases A, contain a Cys residue in the active center and esterases B contain a Ser residue. In esterases A, the organophosphates interact with the functional group-SH forming a bond between P=S, which is easily hydrolyzed by H2O. In the esterase B, organophosphates interaction with the SER-OH forming a P=O bond that is not hydrolyzed by H2O. Organophosphates that bind to the esterase B stoichiometrically inhibit its enzymatic activity.
Esterases are a diverse group that protects the target site (acetylcholinesterase) by catalyzing the hydrolysis of insecticides, or acting as an alternative blank [75]. Esterases in general have a wide range of substrate specificities; they are capable of binding to phosphate triesters, esters, thioesters, amides and peptides [76].
Oxidoreductases are a broad group of enzymes that catalyze the transfer of electrons from one molecule (the reductant or electron donor) to another (the oxidant, or electron acceptor). Many of these enzymes require additional cofactors, to act as either electron donors, electron acceptors or both. Oxidoreductases have been further sub classified into 22 subclasses (EC 1.1-1.21 and 1.97). Several of these have applications in bioremediation, albeit their need for cofactors complicates their use in some applications. There are enzymes that catalyze an oxidation/reduction reaction by including the molecular oxygen (O2) as electron acceptor. In these reactions, oxygen is reduced to water (H2O) or hydrogen peroxide (H2O2). The oxidases are a subclass of the oxidoreductases [53].
As an example of the many functions of these enzymes in the degradation of pesticides, as an example we present the ensodulfan degradation pathway. In this process not only oxidoreductase enzymes are involved, but different microorganisms and catalytic activities, in combination, can lead to complete mineralization of a pesticide (Figure 5). Endosulfan (
Microorganisms play a key role in removal of xenobiotics like endosulfan from the contaminated sites because of their dynamic, complex and complicated enzymatic systems which degrade these chemicals by eliminating their functional groups of the parent compound. This pesticide can undergo either oxidation or hydrolysis reactions. Several intensive studies on the degradation of endosulfan have been conducted showing the primary metabolites to normally be endosulfan sulfate and endosulfan diol (endodiol). Endosulfan sulphate will be present in the environment as a result of the use of endosulfan as an insecticide. If endosulfan sulphate is released to water, it is expected to absorb to the sediment and may bioconcentrate in aquatic organism. This metabolite has a similar toxicity as endosulfan and has a much longer half-life in the soil compared to endosulfan. Therefore, production of endosulfan sulfate by biological systems possesses an ecological hazard in that it contributes to long persistence of endosulfan in soil. Endodiol is much less toxic to fish and other organisms than the parent compound.
Thus, it is important to note that some microbial enzymes are specific to one isomer, or catalyze at different rates for each isomer [78]. For example, a
Alternatively, hydrolysis of endosulfan in some bacteria (
In the reaction catalyzed by the MFO (EC 1.14.14.1), an atom of one molecule of oxygen is incorporated into the substrate, while the other is reduced to water. For this reason the MFO requires Nicotiamide-adenine dinucleotide phosphate (NADPH) and O2 for its operation.
It is an enzyme system comprising two enzymes, cytochrome P450 and NADPH-cytochrome P450 reductase, both membrane proteins. They are also known as dependent cytochrome P-450 monooxygenases or P450 system. The genes encoding the different isozymes comprise a superfamily of over 200 genes grouped into 36 families based on their sequence similarity. Cytochrome P450 enzymes are active in the metabolism of wide variety of xenobiotics [82].
The cytochrome P450 family is a large, well characterized group of monooxygenase enzymes that have long been recognized for their potential in many industrial processes, particularly due to their ability to oxidize or hydroxylate substrates in an enantiospecific manner using molecular oxygen [83]. Many cytochrome P450 enzymes have a broad substrate range and have been shown to catalyse biochemically recalcitrant reactions such as the oxidation or hydroxylation of non-activated carbon atoms. These properties are ideal for the remediation of environmentally persistent pesticide residues. Over 200 subfamilies of P450 enzymes have been found across various prokaryotes and eukaryotes. All contain a catalytic iron-containing porphyrin group that absorbs at 450 nm upon binding of carbon monoxide. In common with many of the other oxidoreductases described before, P450 enzymes require a non-covalently bound cofactor to recycle their redox center (most frequently NAD(P)H is used), which limits their potential for pesticide bioremediation to strategies that employ live organisms.
In insects, MFOs are found in the endoplasmic reticulum and mitochondria, are involved in a large number of processes such as growth, development, reproduction, detoxification, etc. MFO are involved in the metabolism of both endogenous and exogenous substances, for this reason these compounds promote their induction Due to its high inspecificity, the MFOs metabolize a wide range of compounds such as organophosphates, carbamates, pyrethroids, DDT, inhibitors of the chitin synthesis, juvenile hormone mimics, etc. [84].
Degradation pathway of endosulfan (University of Minnesota. Biocatalysis/Biodegradation Database, http://www.umbbd.ethz.ch/end/end_map.html).
The GSTs (EC 2.5.1.18) are a group of enzymes that catalyze the conjugation of hydrophobic components with the tripeptide glutathione (Figure 6). In this reaction, the thiol group of glutathione reacts with an electrophilic place in the target compound to form a conjugate which can be metabolized or excreted, and they are involved in many cellular physiological activities, such as detoxification of endogenous and xenobiotic compounds, intracellular transport, biosynthesis of hormones and protection against oxidative stress [85].
Representation of the conjugation reaction catalyzed by glutathione S-transferase (GST).
In order to investigate genetic basis of pesticides biodegradation, several works with special emphasis on the role of catabolic genes and the application of recombinant DNA technology, had been reported. Pesticide-degrading genes of only a few microorganisms have been characterized. Most of genes responsible for catabolic degradation are located on the chromosomes, but in a few cases these genes are found in plasmids or transposons. The recent advances in metagenomics and whole genome sequencing have opened up new avenues for searching the novel pollutant degradative genes and their regulatory elements from both culturable and nonculturable microorganisms from the environment. Mobile genetic elements such as plasmids and transposons have been shown to encode enzymes responsible for the degradation of several pesticides. The isolation of pesticide degrading microorganisms and the characterization of genes encoding pesticide degradation enzymes, combined with new techniques for isolating and examining nucleic acids from soil microorganisms, will yield unique insights into the molecular events that lead to the development of enhanced pesticide degradation phenomenon.
An understanding of the genetic basis of the mechanisms of how microorganisms biodegrade pollutants and how they interact with the environment is important for successful implementation of the technology for in situ remediation [86].
Different microbial enzymes with the capacity to hydrolyze pesticides have been identified [57], such as
In the various isolates of microorganisms capable of degrading pesticide, several genes have been described, in the table 4 shown the most studied.
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
\n\t\t\t\t | \n\t\t|
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t|
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Genes with the ability to degrade pesticides (Modified from 14).
Microorganisms respond differently to various kinds of stresses and gain fitness in the polluted environment. This process can be accelerated by applying genetic engineering techniques. The recombinant DNA and other molecular biological techniques have enabled (i) amplification, disruption, and/or modification of the targeted genes that encode the enzymes in the metabolic pathways, (ii) minimization of pathway bottlenecks, (iii) enhancement of redox and energy generation, and (iv) recruiting heterologous genes to give new characteristics [45,89]. Various genetic approaches have been developed and used to optimize the enzymes, metabolic pathways and organisms relevant for biodegradation [90]. New information on the metabolic routes and bottlenecks of degradation is still accumulating, requiring the need to reinforce the available molecular toolbox. Nevertheless, the introduced genes or enzymes, even in a single modified organism, need to be integrated within the regulatory and metabolic network for proper expression [89-91].
Detoxification of organophosphate pesticides was the first demonstrated by genetically engineered microorganisms and the genes encoding these hydrolases have been cloned and expressed in
Another strategy that has been used is phytoremediation, the use of plants to clean-up polluted soil and water resources is recognized as an economically cheaper, aesthetically pleasing, and environmentally friendly ‘Green technology [97,98]. However, the limitation with plants is that they lack the catabolic pathways for complete degradation/mineralization of externally added organic compounds. The potential of plants to degrade organic pollutants can be further enhanced by engineering plants by introduction of efficient heterologous genes that are involved in the degradation of organic pollutants [98].
Unfortunately, the rates of hydrolysis several enzymes differ dramatically for members of the family of OP compounds, ranging from hydrolysis at the diffusion-controlled limit for paraoxon to several orders of magnitude slower for malathion, chlorpyrifos, and others pesticides [99]. Although site-directed mutagenesis has been used to improve the substrate specificity and stereoselectivity of OPH [99-100], the ability to deduce substitutions that are important for substrate specificity is still limited to the active-site residues.
Two interesting papers have shown that an biological solution for efficient decontamination might be to direct evolution. Directed evolution has recently been used to generate OPH variants with up to 25-fold improvements in hydrolysis of methyl parathion [101], a substrate that is hydrolyzed 30-fold less efficiently than paraoxon, and other report the directed evolution of OPH to improve the hydrolysis of a poorly hydrolyzable substrate, chlorpyrifos (1,200-fold less efficient than paraoxon). Up to 700-fold improvement was obtained, and the best variant hydrolyzes chlorpyrifos at a rate similar to that of the hydrolysis of paraoxon by wild-type OPH [102].
The complexity of microbial diversity results from multiple interacting parameters, which include pH, water content, soil structure, climatic variations and biotic activity. Current estimates indicate that more than 99% of the microorganisms present in many natural environments are not readily culturable and therefore not accessible for biotechnology or basic research [103]. During the last two decades, development of methods to isolate nucleic acids from environmental sources has opened a window to a previously unknown diversity of microorganisms. Analysis of nucleic acids directly extracted from environmental samples allows researchers to study natural microbial communities without the need for cultivation [103-104].
Each organism in an environment has a unique set of genes in its genome; the combined genomes of all the community members make up the “metagenome”. Metagenome technology (metagenomics) has led to the accumulation of DNA sequences and these sequences are exploited for novel biotechnological applications [105,106]. Due to the overwhelming majority of non-culturable microbes in any environment, metagenome searches will always result in identification of hitherto unknown genes and proteins [105-106].
In its broadest definition, functional genomics encompasses many traditional molecular genetics and biological approaches, such as the analysis of phenotypic changes resulting from mutagenesis and gene disruption [107]. Functional genomics has emerged recently as a new discipline employing major innovative technologies for genome-wide analysis supported by bioinformatics. These new techniques include proteomics for protein identification, characterization, expression, interactions and transcriptomic profiling by microarrays and metabolic engineering [107]. The application of proteomics in environmental bioremediation research provides a global view of the protein compositions of the microbial cells and offers a promising approach to address the molecular mechanisms of bioremediation. With the combination of proteomics, functional genomics provide an insight into global metabolic and regulatory networks that can enhance the understanding of gene functions.
The fundamental strategy in a functional genomics approach is to expand the scope of biological investigations from studying a single gene or protein to studying all the genes or proteins simultaneously in a systematic fashion. The classic approach to assess gene function is to identify which gene is required for a certain biological function at a given condition through gene disruption or complementation. With the combination of technologies, such as transcriptomics and proteomics complementing traditional genetic approaches, the detailed understanding of gene functions becomes feasible [105-107].
Metabolic engineering combines systematic analysis of metabolic and other pathways with molecular biological techniques to improve cellular properties by designing and implementing rational genetic modifications [108]. Understanding microbial physiology, will adapt to the host cells to support changes and become more efficient bioremediation processes, events that would be difficult to acquire during evolution [105].
With these new genomics tools scientists are in a better position to answer questions such as how oxygen stress, nutrient availability, or high contaminant concentrations along differing geochemical gradients or at transitional interfaces impact the organohalide respiring community structure and function. Ultimately, by tracking the overall microbial community structure and function in addition to key functional players, informed decisions can then be made regarding how to best manipulate the field conditions to achieve effective bioremediation of, e.g., pesticides.
Cell immobilization has been employed for biological removal of pesticides because it confers the possibility of maintaining catalytic activity over long periods of time [109-111]. Whole-cell immobilization has been shown to have remarkable advantages over conventional biological systems using free cells, such as the possibility of employing a high cell density, the avoidance of cell washout, even at high dilution rates, easy separation of cells from the reaction system, repeated use of cells, and better protection of cells from harsh environments. Previous reports have suggested that this higher productivity results from cellular or genetic modifications induced by immobilization. There is evidence indicating that immobilized cells are much more tolerant to perturbations in the reaction environment and less susceptible to toxic substances, which makes immobilized cell systems particularly attractive for the treatment of toxic substances like pesticides [112]. In addition, the enhanced degradation capacity of immobilized cells is due primarily to the protection of the cells from inhibitory substances present in the environment. The degradation rates for repeated operations were observed to increase for successive batches, indicating that cells became better adapted to the reaction conditions over time [113].
There are two types of processes for cell immobilization: those based on physical retention (entrapment and inclusion membrane) and those based on chemical bonds, such as biofilm formation [114]. In cell immobilization methods may be used various materials or substrates inorganic (clays, silicates, glass and ceramics) and organic (cellulose, starch, dextran, agarose, alginate, chitin, collagen, keratin, etc.) [115]. Entrapment in polymeric gels natural has become the preferred technique for the immobilization of cells, however, immobilized cell on supports have been used more frequently in xenobiotics biodegradation as pesticides [116].
In order to degrade pesticides, is important to search for materials with favorable characteristics for the immobilization of cells, including aspects such physical structure, ease of sterilization, the possibility of using it repeatedly, but above all, the support must be cheap than allow in the future apply it for pesticide degradation. Table 5 describes the main methods of immobilization [115,117-120]. Thus, the methods can be grouped in two ways: the active that induce the capture of microorganisms in a matrix, and the passive that uses the tendency of microorganisms to attack surfaces either natural or synthetic, which form biofilms.
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
\n\t\t\t\t | \n\t\t\tCarrier union | \n\t\t\tBased on the union of biocatalyzers to insoluble carriers through covalent or ionic liknks, physical adsorption and biospecific union. The carrier materials must have enough mechanical strength, physical, chemical and biological stability. They must be economic and malleable but not toxic. This method does not apply with cells, for it is difficult to find the immobilization conditions. | \n\t\t\t• Water insoluble polysaccharides: dextran, cellulose, agarose • Proteins: albumin • Synthetic polymers: polystyrene deriver, ionic exchange resins • Organic materials: ceramics, magnetite and glass | \n\t\t
Cross-linked | \n\t\t\tIt uses multifunctional reactive. Cells are linked to a matrix in such way that they form concentrate pellets | \n\t\t\tDialdehydes, glutaraldehydes and diisocyanates are used. | \n\t\t|
\n\t\t\t\t | \n\t\t\tEntrapment | \n\t\t\tThis method consists on the retention in inner cavities of a porous matrix | \n\t\t\tIt uses porous matrix: alginate, agar, | \n\t\t
Inclusion in membrane | \n\t\t\tThe enzymes or cells are surrounded by semipermeable membranes. This method allows multiple steps. Reactions to take place in reactors | \n\t\t\tMaterials that form surfactant micelles | \n\t\t
Classification and description of methods of immobilization.
By the other hand, a biofilm can be defined as a coherent complex structure of microorganism organized in colony and cell products such as extracellular polymers (exopolymer), which either spontaneously or in forming dense granules, grow attached to a solid surface static (static biofilm) or in a suspension bracket [121,122]. The biofilm formation process is performed in several steps starting with the attack or recognition to the surface, followed by growth and utilization of various carbon and nitrogen sources for the formation of products with adhesive properties. In parallel a stratified organization dependent on oxygen gradients and other abiotic conditions takes place. This process is known as colonization. Then an intermediate period of maturation of the biofilm is carried out which varies depending on the presence of nutrients from the medium or friction with the surrounding water flow. Finally, a period of aging biofilm where a detachment of cells may occur and colonize other surfaces [123].
The hydrodynamic plays an important role in the development of biofilm as these organizations develop in a solid-liquid interface, where the flow rate passing through it influences the physical detachment of microorganisms. They possess a system of channels that allow the transport of nutrients and waste; this is vital when modify the environment that deprives microorganisms of molecules necessary for their development. Other biofilm characteristic is its resistance to host defenses and antimicrobial agents. While the microorganism are susceptible to different control factors, the colonies organized and included in a exopolymer form an impermeable layer where only the most superficial microorganisms are affected. Also when released biofilm cells, they can travel and to be deposited on new niche maintaining the same characteristics of a biofilm adhered to a surface. Microorganisms are communicated with each other. This is what has been called quorum sensing and involves regulation and expression of specific genes through signaling molecules that mediate intercellular communication [14, 124]. This characteristic is dependent on cell density; for example, biofilm with a high cell density, it induces expression of resistance genes that provide protection and survival [125]. Similarly, microorganisms can produce substances to promote the propagation of colonies and inhibit the growth of other leaving pathogens microorganisms in a more favorable position within the biofilm [126]. The supports may be of synthetic or natural origin (Table 6).
A material that has yielded good results in the degradation of mixtures of pesticides is the tezontle (in Nahuatl, tezt means rock and zontli means hair), that is a native volcanic rock of Morelos state (central Mexico). This rock is highly porous, provides a large contact surface, and can also be sterilized and reused. The presence of micropores allows the establishment of bacterial microcolonies. The immobilization method with this material is based on the colonization of the tezontle micropores through the formation of a biofilm. Subsequently, a current with the pesticides wastes is passed through to allow the contact with the immobilized microorganisms, so this way the biodegradation can be executed. This strategy has been really efficient and is a tool that can be used for the degradation of pesticides wastes [123]. In our work group, a bacterial consortium was immobilized in a biofilm on tezontle and exhibited a considerable capacity for the removal of a mixture of organophosphate pesticides, which are the pesticides widely used in agriculture and stockbreeding in Mexico. In addition, this material with immobilized cells was packaged in an up-flow reactor, which was obtained the greater viability of the bacteria as more efficient removal of pesticides [123].
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
Glass beads | \n\t\t\tCoumaphos | \n\t\t\t\n\t\t\t\t | \n\t\t\tRemoval: 80% | \n\t\t\t[127] | \n\t\t
Ceramic | \n\t\t\tPropachlor | \n\t\t\t\n\t\t\t\t | \n\t\t\tRemoval: 98% (39% absorption to the material) | \n\t\t\t[128] | \n\t\t
Ca Alginate beads | \n\t\t\tPoliphenols | \n\t\t\t\n\t\t\t\t | \n\t\t\tAfter 24 h of fermentation, removal of 69.2% and 55.3% of monophenols and polyphenols respectively, | \n\t\t\t[129] | \n\t\t
Polyurethane Alginate Alginate poly vinyl alcohol | \n\t\t\tPhenol | \n\t\t\t\n\t\t\t\t | \n\t\t\tRemoval time: 23 days (in suspension culture), 15 days (in polyurethane) and 7 days (in alginate) | \n\t\t\t[130] | \n\t\t
Coffe beans | \n\t\t\tDDT Endosulfan | \n\t\t\t\n\t\t\t\t | \n\t\t\tRemoval: 68% DDT | \n\t\t\t[131] | \n\t\t
\n\t\t\t\t | \n\t\t\tBlue ácido113 Disperse Blue 3 Basic Green 4 | \n\t\t\t\n\t\t\t\t \n\t\t\t\t \n\t\t\t\t | \n\t\t\t79.85% (9.98 mg/L/day) 62.39% (7.8 mg/L/day) 94.7% (11.84 mg/L/day) Mineralization | \n\t\t\t[132] | \n\t\t
Ca Alginate beads | \n\t\t\tCoumaphos, diethylphosphate and chlorferon | \n\t\t\t\n\t\t\t\t | \n\t\t\tDegradation: 163 mg/g biomass/h (immobilized) 0.034 mg/g biomass/h (suspended) | \n\t\t\t[113] | \n\t\t
Tezontle | \n\t\t\t2,4-D DDT | \n\t\t\t\n\t\t\t\t | \n\t\t\tRemoval: 99% | \n\t\t\t[133] | \n\t\t
Ca Alginate beads Tezontle | \n\t\t\tMethyl parathion/ tetrachlorvinphos | \n\t\t\tBacterial consortia | \n\t\t\tRemoval of 78% of methyl parathion Removal of 49 % of tetracholvinphos | \n\t\t\t[123] | \n\t\t
Different materials used as supports for immobilization of microorganisms in bioremediation.
Furthermore, there are several reports that indicate a variety of materials that provide the features necessary to immobilize microorganisms. For example, the use of various plant fibers as support for immobilizing bacterial consortium to degrade xenobiotics has important advantages. The use of the natural structural materials such as petiolar felt-sheath of palm for the cell entrapment has added another dimension to a variety of immobilization matrices. The advantages accruable from such biostructures are reusability, freedom from toxicity problems, mechanical strength for necessary support, and open spaces within the matrix for growing cells thus avoiding rupture and diffusion problems. These have suggested the need to search for other types of biomaterials from diverse plant sources that may be used for cell entrapment.
The loofa sponge (
\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t | \n\t\t\t
Nickel II, Chrome | \n\t\t\t\n\t\t\t\t | \n\t\t\tND | \n\t\t\t[135]. | \n\t\t
Lead II ions, copper II and zinc II | \n\t\t\t\n\t\t\t\t | \n\t\t\tAdsorption: 135.3, 102.8, 50.9 mg/g of Pb(II), Cu(II) y Zn(II) respectively. | \n\t\t\t[136] | \n\t\t
Pb II, Hg II and Cd II ions | \n\t\t\t\n\t\t\t\t | \n\t\t\tAdsorption: 247.2, 37.7 y 23.8 mg/g for Pb II, Hg II y Cd II respectively | \n\t\t\t[31] | \n\t\t
Black 5 (RB5) reactive | \n\t\t\t\n\t\t\t\t | \n\t\t\tND | \n\t\t\t[134] | \n\t\t
Blue 172 reactive | \n\t\t\t\n\t\t\t\t | \n\t\t\tTotal discoloration at 37 ° C and pH 8.0 to 5-h in static incubation | \n\t\t\t[137] | \n\t\t
Carbendazim and 2,4-diclorofexiacetic acid (2,4-D) | \n\t\t\tBacterial consortium \n\t\t\t | \n\t\t\tComplete degradation to 5.5 and 1.5 days respectively | \n\t\t\t[138] | \n\t\t
Carbendazim and 2,4-D | \n\t\t\tBacterial consortium | \n\t\t\tRemoval: 20 and, 50% respectively | \n\t\t\t[139] | \n\t\t
Removal of organic matter and ammonium from wastewater | \n\t\t\tAerobic bacteria | \n\t\t\tChemical oxigen demand removal: 80% Nitrogen removal: 85.6% | \n\t\t\t[140] | \n\t\t
Methylene blue, Crude oil Malachite green dye | \n\t\t\t-- | \n\t\t\tAdsorption of 49 mg/g Adsorption of 4.6 g oil/g sorbent (in 24 hours.). Adsorption capacity of 29.4 mg / g | \n\t\t\t[141-143] | \n\t\t
Loofa use (
For the biological degradation of pesticides, it is important to understand the molecular mechanisms involved in enzymatic catalysis, which will be possible to design new alternatives and/or efficient tools for the treatment of pesticide residues or for the bioremediation of contaminated sites. This information could be used in the future to treat pesticide residues in the field (such as waste resulting after washing pesticide containers), or the obsolete pesticides. Moreover, in implementing strategies to increase the efficiency of degradation, such as cell immobilization (bacteria or fungi), we may have tools to abate the existence of obsolete pesticides and waste generated, it will reduce the danger of pesticides on the environment and health.
There are a number of factors that influence patient outcome in trauma and orthopedic surgery in relation to hemorrhage. These can include patient factors, for example anticoagulant and antiplatelet medications, coagulopathies and other conditions, as well as surgical factors such as bony bleeding, large surgical incisions, diffuse venous bleeding and unseen sources of bleeding [1, 2].
Trauma still remains a leading worldwide cause of morbidity and mortality [3] and despite various developments over the years, hemorrhagic shock from trauma continues to form one part of the terrible triad contributing to mortality in both the military and civilian settings [4].
Effective hemostasis during surgery is advantageous to the surgeon as it prevents diffuse bleeding from capillaries and venules obscuring the surgical field and adding to operation time and infection risk [5, 6].
Significant blood loss has been associated with increased need for allogeneic and autologous blood transfusion [2, 7, 8]. These are associated with attendant risks including nosocomial infections [9], transfusion-related injury and fluid overload [10, 11]. In fact blood transfusion is an independent risk factor for infection, respiratory complications and the need for critical care support in traumatic injuries and resulted in a twofold increase in complications and critical care admissions, with more than two units of blood transfusion [7]. The risk of major perioperative complications is also increased with high intraoperative blood loss [2, 12, 13]. Therefore, patient outcome is optimal when the balance between bleeding and clotting is maintained during surgery such that tissue perfusion is adequate without excessive blood loss [5, 6].
Hemostasis in regard to trauma and surgery is a highly regulated process, maintaining flow through vessels at the same time as the thrombotic response to tissue damage is occurring [14], thereby ensuring tissue perfusion and limiting blood loss. The process is a complex interaction between vascular endothelium, platelets, the coagulation and fibrinolytic systems [15, 16].
Following injury, a temporary vascular smooth muscle contraction occurs in an attempt to stem blood flow. Endothelial disruption exposes the subendothelial layer and circulating Von Willebrand factor attaches to the site of injury. Surface glycoproteins also adhere to platelet surfaces. The subendothelial collagen activates adhering platelets and their surface receptors then bind circulating fibrinogen, forming a soft platelet plug comprising aggregated platelets and fibrinogen [14]. The adhering platelets secrete humoral factors including serotonin, prostaglandins and thromboxane that maintain a reduced blood flow, creating an environment that is conducive to clot formation at the site of bleeding. At the same time, circulating coagulating factors produced by the liver are activated in a series of precisely controlled sequential and dependant reactions [14, 17].
The final common pathway is the activation of thrombin that leads to conversion of soluble plasma fibrinogen to insoluble fibrin. The complex of activated factor XIII and fibrin results in cross-linking of fibrin monomers to form a stable clot [17].
Broadly speaking, there are mechanical, thermal, pharmacological and topical methods of hemorrhage control [2, 6, 8, 17, 18, 19, 20].
Mechanical methods include direct pressure, ligating clips and staples, sutures, fabric pads and gauze while hemostatic scalpels and lasers also reduce bleeding during surgery [6, 7, 17]. However, these methods have their drawbacks with respect to certain situations. The location of bleeding is particularly important with respect to orthopedics and in particular trauma. Bony surface bleeding and bleeding from the intramedullary canals are almost impossible to control with mechanical methods. Inflamed or friable tissues may contain a dense network of friable capillaries may prove a challenge [1, 2, 7]. Junctional bleeding in trauma may be potentially catastrophic and its control may not be amenable to the above methods.
The use of pharmacological methods can be a useful adjunct to other methods in these circumstances [7]. These may include epinephrine, desmopressin, tranexamic acid, vitamin K, aminocaproic acid and others.
In some situations though, even the above methods are ineffective or impractical [15] and hence the development of topical hemostatic agents. These are a diverse group of agents of varying composition and mechanisms of action. They can be versatile in the sense that when blood loss is minimal, they can be used sparingly and when there is severe blood loss then more liberal application could be an option [2]. They may be applied directly to the bleeding site and prevent or reduce continuous and unrelenting bleeding intraoperatively and postoperatively [2] and their topical nature broadly avoids the systemic adverse effects associated with systemic hemostatic medications including thrombosis [8].
Topical hemostasis is defined as a process that acts locally to stop bleeding from damaged vessels [21]. Recent and continuing developments have focused on agents that can be used as adjuncts to control bleeding during surgical procedures and control residual problematic bleeding if conventional methods fail. Broadly speaking, topical hemostats can be divided into three types [17, 20].
Passive—where the mechanism of action is to provide a physical scaffold around which platelets can aggregate. These act through contact activation and promote platelet aggregation so a clot can form. Examples include collagen, cellulose and gelatins.
Active—these have biological activity and their mechanism of action is actively influencing the clotting cascade to promote clot formation [17, 20]. These usually contain thrombin in one form or another [14].
Combined—combination of passive product with thrombin.
Contact activation occurs between receptors on platelets and collagen, promoting platelet aggregation [15, 17]. Preparation includes collagen sponges, pastes and powders [15, 17] and is obtained mainly from bovine sources [15], making it potentially immunogenic. In fact a 2–4% allergy in the total population to bovine collagen has been reported in the literature [22] (Table 1).
Hemostatic agent | Examples | Manufacturer |
---|---|---|
Collagen-based products | Avitene | Davol/BD BARD |
Helistat/Helitene | Integra Lifesciences | |
Instat/Ultrafoam | Ethicon, Johnson & Johnson | |
Oxidized cellulose | Surgicel Fibrillar | Ethicon, Johnson & Johnson |
Surgicel Nu-Knit | Ethicon, Johnson & Johnson | |
Gelatin-based products | Gelfoam | Pharmacia Corp, Pfizer |
Surgifoam | Johnson & Johnson | |
Polysaccharide spheres | Arista AH | BD BARD |
Passive hemostats.
The active ingredient in this product is oxidized regenerated cellulose (ORC). Its exact mechanism of action is poorly understood but contact activation is thought to play a part [15]. Often at reoperation, previously used ORC is visible, indicating reduced absorption and poor biodegradability, although this may be related to the amount used and the site of implantation [8]. For this reason, only the minimum possible amount to be used is indicated and it is recommended that the product be removed once hemostasis is achieved and before definitive closure [6, 8].
Their mechanism of action involves swelling while in contact with blood, providing a tamponade effect in confined spaces and restoring blood flow, and thereby producing a stable scaffold around which clots can form [17]. This does make it suitable for irregular wounds [6] and confined spaces [17]. However, it tends to stick to instruments when soaked with blood, making it difficult to handle and does not form a tight bond with the bleeding surface and can hence easily be dislodged [17].
Active agents have biological activity and actively participate in the coagulation cascade to induce clot formation at the site of bleeding [20]. They include thrombin, which comes into play in the last stages of the clotting cascade, converting circulating fibrinogen to a fibrin clot [17, 23]. Hence a significant advantage of thrombin is that its action is less susceptible to coagulopathies caused by clotting factor or platelet dysfunction [17]. Its activity constitutes the final steps in the clotting cascade and therefore it bypasses the initial steps in the cascade. Therefore, other aspects of the clotting cascade can be dysfunctional without significantly impairing the local hemostatic activity of thrombin [20].
Thrombin-based products are therefore excellent adjuncts in the presence of congenital and acquired coagulation and platelet disorders and in the presence of pharmacological and antiplatelet agents that are increasingly being used in the general population [5, 17]. Circulating fibrinogen is necessary for hemostasis to occur by active agents as thrombin converts it into insoluble fibrin that forms part of the clot. Therefore in rare cases of fibrinogen deficiency, clotting by thrombin-based products is impaired [17, 23].
These accomplish their action by bypassing the coagulation cascade to the final steps and converting fibrinogen to fibrin [24]. A fibrin precursor and thrombin stored in two separate adjacent syringes (dual syringe kit) with a single lumen enables delivery and mixing of these agents in the lumen and onto the surgical site, causing thrombin to cleave the fibrin precursor, resulting in fibrin monomers that polymerize at the site into a soluble mesh stabilized into a stable clot by factor XIII at the tissue surface [25]. Previously, bovine thrombin was used, which has recently been replaced by human thrombin [26] and more recently autologous human thrombin. Autologous fibrin sealants overcome the risk of allogeneic blood products, for example one is a patient-derived fibrin sealant utilizing the patient’s own blood as a source of fibrinogen and prothrombin and mixing it with an alkaline buffer solution to lower the pH, activating endogenous prothrombin [24] (Table 2).
Biosurgical | Examples | Manufacturer |
---|---|---|
Liquid fibrin adhesives | Tiseel | Baxter |
Evicel | Ethicon, Johnson & Johnson | |
Crosseal | Ethicon, Johnson & Johnson | |
Floseal | Baxter | |
Fibrin patches | Tachosil | Takeda |
Platelet gels | Vitagel | Orthovita |
Glutaraldehyde cross-linked albumin | BioGlue | Cryolife |
Sealants and adhesives.
These are a combination of thrombin, calcium and platelet-rich plasma, usually obtained from autologous sources using centrifugation systems that produce platelet-rich plasma. Platelets provide growth factors to stimulate wound healing and contribute to the strength of the clot [27].
These systems however rely on an intact coagulation system and may not be as effective in patients on antiplatelet or anticoagulant medications [27]. Also the extraction systems are expensive and there is a risk of contamination.
In addition to not requiring normal clotting mechanisms to work as mentioned before, active hemostats may offer other advantages. With many passive hemostatic agents, degeneration and reabsorption are a problem. This necessitates their removal from the surgical site prior to closure. With thrombin, this is not the case as degeneration and resorption of the resulting fibrin clot is achieved as part of wound healing [1, 8]. Thrombin and combination products also have a rapid onset of action with hemostasis being achieved within 10 min in most patients [7, 17, 28, 29]. Studies have shown that combining an active hemostat within a hemostatic product accelerates clotting. In a comparison of collagen-based products at different bleeding sites after surgical tumor resection, the combination of a collagen-thrombin product (n = 23) achieved complete hemostasis three times faster than the collagen sponge alone (n = 30). The median time to hemostasis was 78 seconds versus 243 seconds respectively (p < 0.001) [30]. Furthermore, approximately 80% achieved complete hemostasis within 2 min with an active topical hemostatic agent compared with only one-third of patients receiving a passive topical hemostatic agent [31]. Active hemostats are also very versatile and can come in various forms. These include sprays that can be advantageous in covering large bleeding surfaces quickly without the need for tamponade [31], and the concentration of thrombin in the formulation can also be varied depending on the severity and type of bleeding. Surgeons can use them in multiple ways during a single procedure due to their flexibility and range of delivery options [20]. Although bovine sources of thrombin may induce antibodies in hosts, this has not manifest itself as a major problem in the clinical setting [1, 32].
It has been shown that the terrible triad of hypothermia, coagulopathy and acidosis are associated with increased mortality in multiple trauma patients and that infection and multiple organ failure are other potential complications arising from severe blood loss [33, 34]. About a quarter of patients presenting to trauma centers have an established coagulopathy secondary to hemorrhage [35] with attendant risks of significant complications. Multiple defects in hemostasis can occur in combat injuries and as such, conventional methods of hemostasis may not be possible. Time is of the essence in these situations and non-transfusional approaches to hemostasis and the use of biosurgicals may be indicated [36, 37, 38, 39].
The combat setting has proved a challenging environment in many different ways in terms of management of hemorrhage. The tissue available for controlling life-threatening hemorrhage may be limited, the wound severity and the possibility of multiple injuries make the situation uniquely challenging [40]. Most combat injuries are penetrating in nature and a large proportion are limb wounds. Mortality from hemorrhage from these kinds of wounds is potentially preventable [36, 41, 42].
In the combat setting, the three principal sites of lethal hemorrhage are truncal (67%), junctional (19%) and extremity (14%). A report from the National Trauma Database suggests that the mortality from isolated lower limb extremity trauma with arterial injury is 2.8% with a 6.6% amputation rate [38]. Tourniquets can be used for these isolated injuries and their use in the military and civilian setting is supported by the Hartford consensus [39] and by the American College of Surgeons Committee on Trauma [38].
Junctional injuries (neck, axilla, groin and perineum) form a significant proportion of trauma in a combat setting and may damage the large vascular structures. These types of injuries are difficult to compress and are not amenable to tourniquet control [43, 44]. Topical hemostatic agents that have been developed in the last two decades [36, 45] can play a vital role in controlling severe bleeding in these situations and increase survival [33, 46] and have thus been listed as optional basic equipment for ambulances [39]. In addition, in a combat setting, more complex types of wound patterns are encountered than in a civilian setting, including blast injuries, which may be more amenable to topical hemostasis.
In 2003, USAIR [47] introduced guidelines of what should constitute the perfect hemostatic agent for use in the prehospital and battlefield settings [33, 41, 47, 48, 49] that included the following: being able to stop large vessel and arterial bleeding within 2 min of application, ability to be delivered through a pool of blood when applied, ready to use with no need for on-site preparation, simple enough to use by the wounded victim or a paramedic with minimal training, light weight and durable with a minimum 2-year shelf life in extreme environmental conditions, safe to use with no risk of injury to tissues or transmission of infection and inexpensive [41, 45, 50, 51]. In addition, hemostatic dressings need to be conformable and flexible enough due to the irregular shape, depth and wound configurations caused by modern explosive devices [40, 48].
These include gelatin [52], oxidized cellulose [53] and collagen and plant-derived polysaccharide spheres [54]. These agents are not biologically active and rely on the patients’ endogenous fibrin production for hemostasis. They provide a scaffold for platelet activation and aggregation, absorbing fluid several times their own weight to form a matrix at the site of hemorrhage, activating the extrinsic coagulation pathway and allowing clotting to occur. This makes them suitable only for patients in whom the coagulation system is intact [55, 56]. In fact in the absence of some coagulation factors, these agents may not be effective [53, 56]. They can be used as first line due to their ready availability and favorable cost-effectiveness, mostly as adjuncts with direct pressure at bleeding sites to control minimal residual hemorrhage [56].
These agents act by forming a physical matrix that stimulates platelet aggregation and degranulation to release factors that encourage clot formation [55].
Cellulose is a homopolysaccharide made by polymerization of glucopyranose molecules through glucosidic bonds. Surgical oxidized cellulose is either regenerated where organized fibers are formed prior to oxidation (regenerated ORC), or non-regenerated, with unorganized fibers prior to oxidation [55]. ORC conforms more rapidly to the surrounding environment. Surgical oxidized cellulose offers several favorable properties in hemostasis including bactericidal activity, good biocompatibility and ease of use [55]. It is usually resorbed but can take anywhere between 2 and 6 weeks depending on the amount used, the degree of saturation with blood and the tissue bed. The excess material may also cause foreign body reactions and granuloma formation without biodegradation and complicate radiological and clinical diagnoses of abscess, residual or recurrent tumor and granuloma [55, 57, 58]. For this reason, the minimal effective amount should be used and excess material removed prior to definitive closure. In addition, these products should not be used or left in place close to nerves, ureters, intestinal and vascular structures due to the risk of local inflammatory reactions and ischemia [55].
These can be used in combination with active agents such as thrombin in adhesives, or in a stand-alone manner. They are usually of bovine or porcine origin and act at the terminal stages of clotting to facilitate fibrin clot formation and are highly absorptive, forming a mechanical matrix for the clot to adhere to [55, 59]. They are quite versatile and available as sponges, powders or granules and are usually completely resorbed in 4–6 weeks [59]. It is important to use the minimum amount necessary to achieve hemostasis and to remove excess because part of the mechanism of action is swelling to cause a tamponade effect and this could potentially cause compression and necrosis in surrounding tissues if packed in tight spaces. This is particularly important around neural tissue and in bony spaces [59]. They are also useful in irregular wounds and surgical cavities as they can expand and fill these irregular spaces.
Mucoporous polysaccharide hemispheres are among a relatively new class of hemostatic agents derived from plant starch. Their mechanism of action includes absorbing water and the low-molecular weight components of blood, hence concentrating platelets and clotting factors in the vicinity, thereby enhancing local clotting processes [58, 60]. They have been used safely in cardiothoracic and neurospinal surgery.
These are active formulations containing mostly two agents—human purified fibrinogen and thrombin. They may also have added other compounds such as factor XIII, fibronectin and antifibrinolytics such as aprotinin used previously and tranexamic acid currently [61]. However, formulations without tranexamic acid or aprotinin are available to avoid hypersensitivity associated with aprotinin and neurotoxicity associated with tranexamic acid [62, 63] (Table 2).
These products are available in liquid or low-viscosity forms (fibrin glues) or as part of stiff collagen fleece (fibrin patches) [55]. Once applied, their mechanism of action is cleavage of fibrinogen to fibrin monomers by thrombin, which also activates factor XIII and the complex fibrin matrix forms the clot [55]. Calcium is required in both these steps and then the clot is eventually resorbed via the fibrinolytic pathway [25]. Generally, they connect atraumatically to tissues and form a barrier to leakage and bleeding through covalent polymerization between themselves and adjacent tissue [55]. Chiara et al. set out the properties of an sealant as being strong, rapid to adhere, flexible, sterile, without toxicity, biologically inert, biocompatible and able to be used in relatively wet environments with low thrombogenicity [55].
True sealants are of two types: synthetic (PEG-based or cyanoacrylates) [53, 60, 64, 65, 66, 67] or semisynthetic glutaraldehyde [68] (Table 2).
True sealants are cross-linking sealants that polymerize through nonenzymatic reactions, free of the need for the presence of blood or coagulation factors although some do have some coagulation factors within them. Both can be used to control residual ooze [53, 67].
PEG sealants are composed of polyethylene glycol and come in both flowing form as well as pads or fleeces. They should be avoided in kidney disease due to the renal clearance of polyethylene glycol and may contain allergenic components such as human albumin that can also lead to the theoretical risk of disease transmission [55].
Cyanoacrylates are products generally used for skin closure or lacerations in areas of low skin tension, for example scalp wounds. They are synthetic sealants that rapidly polymerize with water acting as the catalyst. There are two formulations: octyl-2-cyanocrylate and N-Butyl-2-cyanoacrylate. In a systematic review looking at octyl-2-cyanoacrylate, there were no differences in infections, wound dehiscence or cosmetic appearance when compared with other methods of closure [65]. Polymerization generates heat and therefore the amount used should be just enough and should certainly be avoided in delicate areas such as the spinal canal and neural tissue [55, 65]. Below the skin, a foreign body reaction may occur [65] and intravascular use is contraindicated due to the risk of systemic embolization [55].
Semisynthetic sealants otherwise known as bioglues are compounds of semisynthetic glutaraldehyde—bovine albumin-based sealant. Proteins on the surface of bleeding human tissue link with those of bovine albumin in the bioglue, causing a sealant effect [55]. Within synthetic graft materials, bioglue permeates interstices within the graft matrix [69], making it suitable for sealing anastomotic sites and decreasing postop bleeding [70].
These can be used as an adjunct to surgical hemostasis to improve residual moderate bleeding [55]. They are usually applied by double syringe systems. Each component is located in a separate section of the syringe, which then combine in a single lumen. They subsequently are applied using a blunt needle or spray tips in cases of large bleeding surface areas to the bleeding surgical site [25, 61]. Since the components bypass the initial steps in the extrinsic coagulation pathway, they can be used in achieving hemostasis in patients with congenital or acquired bleeding disorders such as hemophilia and patients on anticoagulants or antiplatelet medications [25, 62, 71] (Table 2).
They do have some drawbacks including the risk of thrombosis if injected intravascularly, hypotension and death and the risk of air embolization with the use of gas-driven sprayers [55]. In addition, the cost of sealants is significant and hence they are not recommended for use except in particular situations where indicated, for example in those with coagulation disorders [61]. One cost-effectiveness analysis done in the United Kingdom in patients undergoing total knee replacement on Quixil, one of the commercial brands, in addition to conventional hemostatic agents estimated that the use of a 5-ml dose of Quixil in addition to conventional hemostatic methods was cost saving in comparison to conventional methods alone. But the use of a 10-ml dose increased the cost substantially and they recommended that liquid fibrin adhesives only be used in selected cases [25]. They have however been found to be effective. Echave et al. [59] carried out a systematic review of 27 studies on the effectiveness of human gelatin-thrombin matrix sealant in different surgical fields including orthopedics. All 27 studies demonstrated that this sealant was associated with a significantly higher rate of successful hemostasis, and a shorter time to achieve it (p < 0.001) in comparison to other alternatives when conventional methods failed.
These products are also available as patches, for example Tachosil. They may have slightly different components but all of them have essentially the same mechanism of action, offering mechanical support with either collagen, oxidized cellulose/polyglactin 910 matrix, binding coagulation factors, allowing better adherence to bleeding tissue even in the presence of brisk bleeding, preventing the so-called “streaming effect” observed with fluid adhesives [72, 73, 74]. Tachosil is a ready-to-use fixed combination of equine collagen patch on one side and coated with coagulation factors, human fibrinogen and human thrombin on the other side [55]. Fibrin-pad and PGA-felt are absorbable hemostats composed of polyglactin 910, oxidized regenerated cellulose, thrombin and fibrinogen shown to be effective in a variety of tissue types [25, 72] and can rapidly achieve hemostasis in brisk bleeding in the retroperitoneum and pelvis, compared with the standard of care [72, 73] (Table 2).
Junctional hemorrhage is a significant problem in major trauma especially on the battlefield and often conventional methods such as tourniquets are ineffective [55]. In this respect, science has led to the development of products that are effective options in these circumstances and they can be divided into factor concentrators [75], procoagulants [76] and mucoadhesives [77] (Table 3).
Biosurgical | Examples | Manufacturer |
---|---|---|
Zeolite dressings | QuikClot & QuikClot ACS | Z-Medica |
Smectite dressings | WoundStat | TraumaCure Inc. |
Kaolin dressings | QuikClot Combat Gauze | Z-Medica |
Rapid Deployment Hemostat | Marine Polymer Technologies | |
Celox | Med Trade Products, UK | |
Trauma Stat | OreMedix | |
Fibrin dressings | Dry fibrin sealant dressing (DFSD) | American Red Cross |
Hemostatic dressings.
These are compounds of either zeolite (microporous crystalline aluminum silicate) or smectite (a nonmetallic clay mineral sodium, calcium and aluminum silicate). Examples include QuikClot (Z-Medica LLC, CT,USA) and QuikClot ACS (advanced clotting sponge), Traumadex (Medafor Inc., MN, USA) and self-expanding hemostatic polymer (SEHP) [35]. As the group name suggests these agents rapidly absorb the fluid content of blood. The resulting effect is an increase in relative concentration of its cellular and protein content and therefore clot formation. Water molecules are held in its pores by hydrogen bonds and this results in a relative local increase in concentration of platelets and clotting factors [35]. The first generation of QuikClot was designed as granules that were poured onto the bleeding wound. A high efficiency rate of 92% was demonstrated in a series of 103 patients in the military and civilian setting. There were eight patients in which hemorrhage was not effectively controlled with QC in coagulopathic patients where it was used as a last resort [75]. There were also some side effects of QC including intense exothermic reaction and scar formation from foreign body reaction [75]. Animal and early human studies on QC revealed thermal injury, poor biodegradability and foreign body reactions as the main drawbacks of QC [78, 79, 80]. In fact temperature generated by QuikClot in contact with aqueous components of blood at bleeding wounds has been measured to reach and average of 61°C with a potential rise to 76°C [78].
QuikClot has been compared to other hemostatic agents including HemCon (HemCon Medical Technologies Inc., OR, USA) in a military setting in multiple patients injured after explosions and gunshot wounds [81]. In this study, QC was effective but thermal injury was an issue. This has also been investigated in other studies by McMannus et al. [82] in the combat setting and evidence suggests that the greater the amount of blood and the more the QC applied, the greater is the risk of thermal injury. Thus currently it is only recommended for external use and the minimum amount required to achieve effective hemostasis is recommended.
QuikClot ACS is a newer generation of product made by larger zeolite beads packaged into mesh bags. This makes it easier to pack into cavities and irregular wounds often found on the battlefield and at junctional sites of hemorrhage and in cavities [55] and is claimed to produce much less of an exothermic reaction [75, 78] although there is a lack of studies with sufficient numbers to confirm this unequivocally [41].
Self-expanding hemostatic polymer (SEHP) is a dual action factor concentrator. Its mechanism of action results from its extremely potent absorptive capacity following absorption of the fluid component of blood and its ability to expand to conform to large irregular cavities and spaces, exerting a tamponade effect [35]. The other action is the effect of the polymer absorbing the liquid phase of blood into its matrix, thereby leading to a relative increase in concentration of platelets and coagulation factors at the site of bleeding, thereby promoting clotting [83, 84].
Woundstat is a compound of smectite granules that come in granular form. Its mechanism of action is absorption of the aqueous phase of blood, forming a clay substance that adheres to bleeding tissue and acts as a sealant and also concentrates clotting factors and blood cells locally, contributing to hemostasis. Granules are negatively charged and activate the intrinsic pathway as well [85, 86, 87].
These are products where the basic component is chitosan, which is a polymer derived from crustacean chitin. It is a complex biodegradable carbohydrate [55]. The mechanism of action appears to be related to highly positively charged chitosan interacting electronically with negatively charged cell membranes of erythrocytes. The product adheres strongly to tissues and seals bleeding wounds [77, 88, 89]. Examples include HemCon (HemCon Med Tech, Portland, OR) and Celox (Med. Trade Products, UK).
Celox is a chitosan-based adhesive, which is biodegradable and causes absorption of the aqueous phase and the advancement of red blood cell bonding. The positively charged Celox binds negatively charged red blood cells independently of the body’s clotting system, resulting in clot formation without the exothermic reaction associated with certain factor concentrators like QuikClot [35]. Its action is independent of the body’s clotting system, a property that makes it useful in patients requiring antiplatelet or anticoagulant medications or in the presence of coagulopathy and its local action means that it is not associated with distant clot formation. It is also reported to be very versatile, being available in granular and bandage forms and easy to remove from the wound after its clot formation activity is complete [49, 90, 91, 92]. HemCon, however, does have a hard consistency and is made in a square shape. Therefore, it works best on flat bleeding surfaces rather than deep irregular wounds [79, 83]. Wedmore et al. [77] looked at a series of patients with prehospital combative injuries where chitosan-based products had been used externally in chest, groin, buttock and abdominal wounds in 25 patients, 35 extremity wounds and neck and facial wounds in 4 cases. In about two-thirds of cases, the chitosan dressings were used following failure of hemostasis using only gauze with 100% success. In 97% of cases, bleeding stopped or hemostasis was improved, with failure only occurring in two cases attributed to blind stuffing of bandages into large cavitational injuries [77].
Trauma Stat is another chitosan-based derivative that was developed in collaboration with the United States Army, in which the mechanism of action involves positive charges in the amine groups on the chitosan molecule interacting with negative charges on the red blood cell membranes and in addition the adsorption of chitosan for fibrinogen and plasma proteins [79, 93].
Te Grotenhuis carried out a study of 66 patients in which conventional treatment with gauze and compression failed to control excessive bleeding or where conventional treatment was unlikely to achieve hemostasis. Complete cessation of hemorrhage including arterial hemorrhage occurred in 70% using the HemCon ChitoGauze, and reduction in hemorrhage occurred in 20% of patients despite 21 patients being on anticoagulants or having a clotting disorder and no adverse events occurred [88].
Due to the fact that chitosan is derived from crustaceans, there is a theoretical risk of allergenic reactions in patients allergic to shellfish. However in a study of 19 patients who had a positive IgE test to shellfish, none of the patients demonstrated a positive skin prick test to chitosan powder or expressed a reaction to HemCon bandage during serial bandage challenges, indicating favorable but not completely risk-free use of these products [94].
Chitosan-based dressings are also easy to remove after hemostasis has been achieved [41] and are known to have some antimicrobial properties [41, 95].
Their mechanism of action is mainly to deliver factors that promote coagulation into the bleeding wound. Examples are dry fibrin sealant dressing (DFSD) and QuikClot Combat Gauze (QCG) [70, 96, 97]. QCG is a surgical gauze coated with kaolin. On contact with injured endothelium, kaolin activates the extrinsic pathway, enhancing coagulation and promoting hemostasis. It is not degradable and needs to be removed from the wound following achievement of hemostasis [76].
Kaolin-based products have been used in a military setting and have demonstrated good results in both junctional and non-junctional hemorrhage [76]. In the above study, Shina et al. retrospectively reviewed 133 kaolin-based dressings applied to 122 military patients. 27% were for junctional hemorrhage with a success rate of 88% while the rest were extremity trauma where the success rate was 92%.
In addition to problems specific to certain types of hemostatic agents, there are also general drawbacks.
The hemostats that contain biological agents, usually the active hemostats, can be associated with the risk of disease transmission. For example, DFSD has the theoretical risk of viral disease transmission and hence has not achieved FDA approval.
Some agents have handling characteristics that are beneficial in certain situations. For example agents that have a granular nature can be used for complex irregular wounds with multiple bleeding points. However, the handling characteristics are difficult and they are difficult to apply in combat situations [89]. In addition, many agents are nonabsorbable and need to be removed after hemostasis is achieved. This may be difficult with some agents and require multiple washouts. Granular agents also have the potential to enter the vascular system and occlude the distal parts of vessels, causing endothelial injury and intravascular coagulation [41]. This has been demonstrated by Kheirabadi et al. [89] in their study, and for these reasons a bandage/gauze form of hemostatic agent is preferable as being safer for hemorrhage control, avoiding intravascular complications [38].
Any chapter on hemostasis in trauma and orthopedics is incomplete without the mention of tranexamic acid. This drug has been shown to be effective in reducing mortality due to bleeding in both the military and civilian setting.
The CRASH-2 (Clinical Randomization of an Antibrinolytic in Severe Hemorrhage-2) trial was a multicenter trial involving 40 centers looking at 20,211 adult trauma patients with significant bleeding who were randomized to two arms. One arm received TA within the first 3 hours of trauma and the other received placebo. The study demonstrated a reduction in mortality risk due to any cause from 14.5% compared with 16% in the placebo group (p < 0.001), with no increase in vasoocclusive events such as pulmonary embolism or myocardial infarction (0.3% versus 0.5% p-0.096) [98].
The MATTER (Military Application of Tranexamic Acid in Trauma) study looked at 896 patients with severe combat injuries and demonstrated a 6.5% absolute risk reduction in mortality in these patients with the use of tranexamic acid [99].
Both these studies have recommended incorporation of intravenous tranexamic acid into clinical practice [24].
Joint replacements are major procedures in elective orthopedics and can be associated with significant blood loss and increased transfusion requirements if appropriate steps are not taken to mitigate against this. In addition to the conventional methods of blood management including preoperative optimization, tourniquets if appropriate, intraoperative techniques such as cell saver and cauterization, topical and pharmacological hemostats and biosurgicals may offer some excellent solutions to reduce the transfusion requirements and achieve hemostasis.
A few studies have looked at human-derived fibrin sealants in total knee replacement [100, 101, 102]. A multicenter randomized control trial looking at 58 patients who underwent total knee replacement demonstrated a reduced postoperative blood loss, reduced postoperative decrease in hemoglobin and calculated blood loss in patients in whom fibrin sealant was used compared with that in the standard group (20% compared with the standard 83% p = 0.004) [100]. Another study that showed benefit was done by Dhillon et al. [25]. Results from other studies have been equivocal and have not demonstrated any clear difference.
In total hip arthroplasty, the use of fibrin sealants has been associated with reducing blood loss but inconsistent results have been demonstrated with regard to reduction in postoperative transfusion requirements [24, 103, 104, 105].
Multiple studies have looked at platelet gels in arthroplasty surgery. The evidence has been inconsistent in many. One randomized control trial looking at 100 total knee replacements did demonstrate significantly lower transfusion requirements in patients in whom platelet gels were used [106].
Desmopressin is a synthetic analog of anti-diuretic hormone. Its mechanism of action is to increase the levels of factor VIII and Von Willebrand factor, thereby enhancing primary hemostasis and platelet aggregation and adherence. This makes it suitable as a blood management strategy in patients with platelet dysfunction or other clotting disorders such as Von Willebrand’s disease and hemophilia A [107, 108]. It has also been used in healthy individuals for reducing postoperative bleeding in total hip and knee replacement surgery [109]. Six randomized placebo-controlled trials addressing the use of desmopressin in total hip and knee arthroplasty have been undertaken [110, 111, 112, 113, 114, 115]; however, evidence suggests that desmopressin is not significantly effective in reducing blood loss or transfusion requirements in these patients [24].
There are a number of good-quality randomized control trials that support the use of tranexamic acid in reducing blood loss and transfusion requirements in both knee and hip arthroplasty surgery [24]. There is however considerable amount of heterogeneity between the trials with regard to methods of delivery including single intravenous bolus dose, repeated boluses, prolonged infusion or intraarticular injection [116], and also differing dosing regimes [117]. In total knee arthroplasty, it has been shown that one intraoperative dose is sufficiently effective in reducing transfusion requirements and postoperative bleeding [118]. With the theoretical risk of intravascular thrombosis, intraarticular injection of tranexamic acid was investigated and compared to placebo and the studies showed reduction in blood loss but no reduction in transfusion rates [101, 119, 120]. Only one RCT by Seo et al. [121] showed a reduction in transfusion requirements with intraarticular (20%) rather than intravenous (34%) or placebo (94%). The evidence in total hip replacement with regard to intraarticular tranexamic acid is less convincing than in knee arthroplasty and more studies are needed.
With regard to aminocaproic acid, three RCTs did demonstrate benefit in hip and knee replacement surgery in terms of reducing blood loss in comparison with placebo. However, with regard to reducing transfusion requirements the evidence is much less convincing [24, 122, 123, 124].
Spine surgery presents a few unique challenges that limit the products that can be used for hemostasis in these situations. One of them is the friability of neural tissue and secondly the fact that the spinal cord and nerve roots are enclosed in rigid bony spaces that limit the kinds of hemostats that can be used due to the potential of swelling and compression of neural tissue in a rigid space. In addition, there is the potential for neurotoxicity with certain agents.
Cerebrospinal fluid leaks are a common source of postoperative morbidity in patients who have undergone spinal surgery. The morbidity burden includes severe postural headaches, vomiting, dizziness, photophobia, tinnitus, pseudomeningoceles and the risk of meningitis. It is therefore important that when dural tears occur or when an iatrogenic durotomy is created a water tight repair is essential. PEG hydrogel sealant has been found to be a safe effective way to augment dural closure and prevent these complications. A prospective study by Kim et al. [66] demonstrated that augmentation of standard dural closure techniques with this sealant in patients had significantly higher rates of watertight closure than with controls (100% and 64.3% respectively), without statistical differences in cerebrospinal fluid leaks, infections or wound healing. Complications due to swelling of polyethylene glycol and nerve compression were not demonstrated in this study but this remains a possibility. This led to the development of low-swell PEG hydrogel sealant (Duraseal) [55] and has been found to be safe and effective in a 3-to-1 randomized single-blind multicenter trial in which 100% of patients who had this low-swell formulation achieved watertight dural closure. Another study has also shown that BioGlue (semisynthetic glutaraldehyde-bovine albumin sealant) is safe and cost-effective in proximity to neurological structures despite previous concerns. Miscusi et al. [125] demonstrated a watertight dural closure in 23 patients requiring dural repair, with no incidence of neurological or infection related complications.
Collagen and gelatin-based products can be used to achieve hemostasis in spinal surgery. Xu et al. [64] carried out a study on 92 patients undergoing spinal fusion surgery and concluded that collagen-based products are superior to gelatin-based products in achieving hemostasis in spine surgery, with lower blood loss and postoperative drain volume.
Oxidized regenerated cellulose has been used for hemostasis in spine surgery. However when used around or in foramina with rigid bony walls, the swelling of small portions of the cellulose material may lead to significant mass effect and neural compression 1 day after surgery as demonstrated by Menovsky et al. [126] and may lead to rapid neurological deterioration. Therefore this material should be removed after hemostasis has been achieved prior to closure.
As mentioned before, liquid fibrin sealants can be used in spine surgery for hemostasis, but those containing tranexamic acid may be associated with neurotoxicity and should not be used if CSF leak or dural tear is present [55].
Topical hemostats and biosurgicals are a diverse group of compounds that have been developed and can be used in different situations as part of a comprehensive blood management program to limit the amount of blood loss. Trauma and orthopedics as a specialty also presents some unique challenges, with operations having significant blood loss and in trauma, junctional injuries on the battlefield with hemorrhage that is hard to control by conventional means. In addition, patients may be complex and frequently have platelet or coagulation disorders that preclude the use of certain classes of hemostatic agents. As mentioned before, these compounds are diverse, with different mechanisms of actions and indications, both in an elective and an emergency trauma setting. A comprehensive knowledge of these products is essential in modern-day trauma and orthopedic practice.
Despite recent developments, the perfect hemostatic or biosurgical agent still remains elusive and each of these products has their own drawbacks, side effects and unique indications and future research will hopefully continue to improve on these.
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',metaTitle:"Terms and Conditions",metaDescription:"These terms and conditions outline the rules and regulations for the use of IntechOpen Website at https://intechopen.com and all its subdomains owned by Intech Limited located at 7th floor, 10 Lower Thames Street, London, EC3R 6AF, UK.",metaKeywords:null,canonicalURL:"/page/terms-and-conditions",contentRaw:'[{"type":"htmlEditorComponent","content":"By accessing the website at www.intechopen.com you are agreeing to be bound by these Terms of Service, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. Use and/or access to this site is based on full agreement and compliance of these Terms. All materials contained on this website are protected by applicable copyright and trademark laws.
\\n\\nThe following terminology applies to these Terms and Conditions, Privacy Statement, Disclaimer Notice, and any or all Agreements:
\\n\\n“Client”, “Customer”, “You” and “Your” refers to you, the person accessing this website and accepting the Company’s Terms and Conditions;
\\n\\n“The Company”, “Ourselves”, “We”, “Our” and “Us”, refers to our Company, IntechOpen;
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\\n\\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\\n\\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\\n\\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\\n\\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\\n\\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\\n\\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\\n\\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\\n\\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\\n\\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
\\n\\nIntechOpen may revise its Terms of Service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of all Terms at the time of use.
\\n\\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\\n\\nCroatian version of Terms and Conditions available here
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\n\nThe following terminology applies to these Terms and Conditions, Privacy Statement, Disclaimer Notice, and any or all Agreements:
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\n\n“The Company”, “Ourselves”, “We”, “Our” and “Us”, refers to our Company, IntechOpen;
\n\n“Party”, “Parties”, or “Us”, refers to both the Client and ourselves, or either the Client or ourselves.
\n\nAll Terms refer to the offer, acceptance, and consideration of payment necessary to provide assistance to the Client in the most appropriate manner, whether by formal meetings of a fixed duration, or by any other agreed means, for the express purpose of meeting the Client’s needs in respect of provision of the Company’s stated services/products, and in accordance with, and subject to, the prevailing laws of the United Kingdom.
\n\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\n\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\n\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\n\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\n\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\n\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\n\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\n\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\n\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
\n\nIntechOpen may revise its Terms of Service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of all Terms at the time of use.
\n\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\n\nCroatian version of Terms and Conditions available here
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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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As such, the chapter shall focus on formative assessment in mathematics classroom mediated by a method of teaching (concept mapping) that promotes critical thinking, which assists teachers to teach and assess students’ understanding and make connections between concepts explicitly.",book:{id:"8039",slug:"theorizing-stem-education-in-the-21st-century",title:"Theorizing STEM Education in the 21st Century",fullTitle:"Theorizing STEM Education in the 21st Century"},signatures:"Benard Chigonga",authors:[{id:"298587",title:"Dr.",name:"Benard",middleName:null,surname:"Chigonga",slug:"benard-chigonga",fullName:"Benard Chigonga"}]},{id:"68547",title:"The Role of Mathematical Modeling in STEM Integration and Education",slug:"the-role-of-mathematical-modeling-in-stem-integration-and-education",totalDownloads:1246,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"With the rapidly developing technology, the labor force of the society has changed direction, and in the age of informatics, creative engineering applications have come to the forefront. Accordingly, the education levels of the labor force were also changed. The science, technology, engineering, and mathematics (STEM) education model in most countries aims to teach science, mathematics, technology, and engineering in relation to primary, secondary, high school, and higher education. STEM education, which has an impact in our country in recent years, has an important role in acquiring new skills, supporting creativity, innovation, and entrepreneurship, gaining the ability to transition between professions and adapting to new occupations. Nowadays, technology is expected to have different skills from individuals who will work in different fields with rapid development. Also, different teaching strategies play a major role in STEM integration and training. One of them, mathematical modeling, is the process of analyzing real-life or realistic situation using mathematical methods in the most general sense. The idea that mathematical modeling cycles should be used in STEM education at all levels from primary to tertiary education has gained importance in recent years, since it increases the students’ motivation towards the lesson and they learn better by concentrating their attention.",book:{id:"8039",slug:"theorizing-stem-education-in-the-21st-century",title:"Theorizing STEM Education in the 21st Century",fullTitle:"Theorizing STEM Education in the 21st Century"},signatures:"Murat Tezer",authors:[{id:"299964",title:"Associate Prof.",name:"Murat",middleName:null,surname:"Tezer",slug:"murat-tezer",fullName:"Murat Tezer"}]},{id:"66203",title:"Including Students with Disabilities in a Physical Education Teacher Preparation Program: An Institutional Perspective",slug:"including-students-with-disabilities-in-a-physical-education-teacher-preparation-program-an-institut",totalDownloads:1943,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"The increasing number of students with disabilities who have the goal of becoming a teacher in either elementary or high school is one of the challenges we are currently facing at the academic colleges of education in Israel. In this chapter, we address the inclusion challenge, namely how we have taken up the challenge to modify one existing teacher preparation program (TPP) in physical education (PE) to enable students with disabilities to study at the same level as the other students who are enrolled in the program. The chapter is composed of four sections. In the first section, we introduce the term inclusive education, elaborate upon its concepts, and highlight a number of developmental phases associated with this term. In the second section, we present the theoretical background and the practical frameworks of an inclusive pedagogy. In the third section, we describe a number of actions taken in one college that enabled students with disabilities to enroll in a PE TPP. In the fourth section, we conclude our discussion and provide a number of ideas for future research, in order to strengthen the understanding of how to integrate students with disabilities in PE TPP.",book:{id:"7804",slug:"teacher-education-in-the-21st-century",title:"Teacher Education in the 21st Century",fullTitle:"Teacher Education in the 21st Century"},signatures:"Ronnie Lidor and Yeshayahu Hutzler",authors:[{id:"293567",title:"Dr.",name:"Ronnie",middleName:null,surname:"Lidor",slug:"ronnie-lidor",fullName:"Ronnie Lidor"},{id:"293600",title:"Prof.",name:"Yeshayahu",middleName:null,surname:"Hutzler",slug:"yeshayahu-hutzler",fullName:"Yeshayahu Hutzler"}]},{id:"69651",title:"Parental Engagement in Children’s Learning: A Holistic Approach to Teacher-Parents’ Partnerships",slug:"parental-engagement-in-children-s-learning-a-holistic-approach-to-teacher-parents-partnerships",totalDownloads:1389,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"This study presents the standpoint of parental engagement, conceptualized by Janet Goodall and collaborators, as a framework that is coherent to the principles of the holistic approach of pedagogy to teacher-parents’ partnerships. We bring forward the evolution of the concept of parental engagement and its main standpoints, in relation to more traditional theories on parental involvement. We also discuss previous findings about teachers’ and parents’ roles in education and teacher-parents’ partnerships, as well as how do changes in educational paradigms challenge home-school collaboration. Finally, the article highlights the need to implement research-based parental engagement practices in educational systems around the world.",book:{id:"9040",slug:"pedagogy-in-basic-and-higher-education-current-developments-and-challenges",title:"Pedagogy in Basic and Higher Education",fullTitle:"Pedagogy in Basic and Higher Education - Current Developments and Challenges"},signatures:"Cristiana Levinthal de Oliveira Lima and Elina Kuusisto",authors:null},{id:"55240",title:"Challenging Performativity in Higher Education: Promoting a Healthier Learning Culture",slug:"challenging-performativity-in-higher-education-promoting-a-healthier-learning-culture",totalDownloads:1789,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The nature and context of education have changed dramatically in recent decades. The increased prioritisation of standardisation, performance indicators and metrics often means that holistic, affective and wellbeing education are seen as less important in the educational endeavour. The value of education for education's sake is under siege. Previous emphasis on the education of the whole person (i.e., moral and creative aesthetic development) is often replaced by a more functionalist perspective of education as servicing economic need and global capitalist interests. Marketization of education has increased at an exponential rate and has had an adverse impact on the health and well‐being of both educators and students. This chapter elucidates how the triad of assessment, student well‐being and academic well‐being intersects in the ever increasing performative and neo‐liberalist cultures of higher education. It demonstrates the reciprocal dynamic of stress that is becoming more and more evident among educators and students. The chapter makes the case for more empowering and human‐centred educative contexts in order to facilitate better educational outcomes for students and healthier outcomes for all involved in the educational endeavour.",book:{id:"5773",slug:"global-voices-in-higher-education",title:"Global Voices in Higher Education",fullTitle:"Global Voices in Higher Education"},signatures:"Christine Deasy and Patricia Mannix‐McNamara",authors:[{id:"198284",title:"Dr.",name:"Christine",middleName:null,surname:"Deasy",slug:"christine-deasy",fullName:"Christine Deasy"},{id:"198290",title:"Dr.",name:"Patricia",middleName:null,surname:"Mannix McNamara",slug:"patricia-mannix-mcnamara",fullName:"Patricia Mannix McNamara"}]}],onlineFirstChaptersFilter:{topicId:"1316",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81937",title:"Socialization Experiences among Undergraduate Students in Higher Learning Institutions (HLI)",slug:"socialization-experiences-among-undergraduate-students-in-higher-learning-institutions-hli-",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.99007",abstract:"This work portrays the problems of socialization among undergraduate students in higher learning institutions. The socialization processes in higher learning institution are significant for the successful navigation of students in the academic programs and university environment in preparing the next generation of professional practitioners and scholars. But the undergraduate student socialization experiences of students at university environment are overlooked. To navigate in the higher learning institutions, students should be socialized effectively to the normative contexts of the higher learning institutions. The normative contexts of the higher learning institutions are generally categorized into social and academic contexts, because these context academic and social context integration have been linked to student retention and success. Social integration involves interpersonal relationships, support, interactions with others, and a sense of belonging at a university, which stems from extracurricular activities, informal dealings with peer groups, and interactions with faculty and staff, whereas academic integration is described through grade performance and intellectual development that reflects an ability to meet the standards of the academic system; intellectual development involves a student valuing their education as a process of development in which they gain knowledge and ideas. Students’ background is also the contributing factor for students’ socialization in the University.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Mulusew Birhanu Ayalew"},{id:"80280",title:"Adoption of Online Learning during the Covid19 Pandemic Lockdown by Universities in Garowe",slug:"adoption-of-online-learning-during-the-covid19-pandemic-lockdown-by-universities-in-garowe",totalDownloads:88,totalDimensionsCites:0,doi:"10.5772/intechopen.99941",abstract:"In response to the Covid-19 outbreak the world closed and therefore countries like Somalia have not been exceptional. The government of Somalia and all higher education institutions adopted crisis intervention measures on implementation of blended learning approaches like online teaching and learning. In this chapter we explore the process and challenges of adopting online learning in response to the world wide lockdown due to the pandemic. Given that this was an abrupt requirement, the survey was interested in finding out whether universities adopted and adapted easily. Researchers compared findings from previous studies and theoretical inclinations on online learning. Results indicate that the adoption of online learning among universities in Garowe was as a matter of crisis management whereby administration, lecturers and students were all not ready and had no prior grounding in this pedagogical learning platform. Just like previous studies online learning implementers have continued to encounter several challenges like intermittent internet network, cost of gadgets and facilities, inadequate skills of both the instructors and students, aspects of communication and satisfaction from stakeholders. With the research survey in Garowe, results show that this is still pervading and therefore need for more rigorous contextualised research on this subject.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Tumwebaze Alicon Auf and Omer Abdi Hamdi"},{id:"78597",title:"Public-Private Participation in Funding University Education in Sub-Saharan Africa: A Nigerian Case-Study for Sustainable Development",slug:"public-private-participation-in-funding-university-education-in-sub-saharan-africa-a-nigerian-case-s",totalDownloads:134,totalDimensionsCites:0,doi:"10.5772/intechopen.99940",abstract:"The developing countries in Africa still cannot withstand the pressure of the highly competitive global education market. Together with the large numbers of people who make a living in various innovative companies, these countries have solved key contemporary issues affecting global education. For this reason, it is necessary to actively respond to current technological innovation and educational challenges and to eliminate new technology graduates who can effectively interact with students through the responsive expansion of education and training. Expansion of education can produce effective expansion that promotes educational development, but due to budget constraints, most African governments cannot successfully and sustainably implement such educational programs. This is difficult. However, public-private partnership efforts provide a way out of this financial dilemma. The Sub-Saharan Africa initiative has achieved important educational objectives, such as: ensuring relevance for quality; secure funding for sustainability and establish resource mobilization partnerships and connections; and promote international cooperation. This discussion is relevant to the basic conditions for a successful public-private partnership with educational institutions and extended education and sheds light on the impact, lessons, and challenges. The public is increasingly concerned about the importance of higher education in the 21st century. This chapter explores some of the key functions of an innovative education system that supports the development of education in Nigeria and enhances people’s ability to use information. Nigeria’s education system re-emphasizes the importance of public and private universities, but the country does not have a sustainable education system and well-equipped educational institutions to support people’s ability to use information, learning, education, and research activities.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Lawrence Jones-Esan"},{id:"79197",title:"University Teachers’ Conceptions of What University Is: Implications for the Future of Higher Education",slug:"university-teachers-conceptions-of-what-university-is-implications-for-the-future-of-higher-educatio",totalDownloads:107,totalDimensionsCites:0,doi:"10.5772/intechopen.100813",abstract:"This chapter presents the perception of university teachers about the university, the most recent changes and how they have influenced their activity. The phenomenographic study was conducted with 10 university teachers, nine females and one male with more than 15 years of professional activity. The perception of the university emerges, in the teachers’ voice, focused on the description of its mission, namely as a context for the production and diffusion of knowledge to society, as a space for creative and critical thinking about the world, as an interdisciplinary space and as a system focused on teaching and research. It also includes characteristics related to its structure and functioning, such as the level of hierarchization, bureaucratization, competitiveness, dehumanization and bibliometrics overvaluation. Regarding the perceived changes, they are related to the structural reforms resulting from the Bologna Process, diverse student populations, research and internationalization, new technologies, institutional cooperation, bureaucratization and relationship with the community. Teachers also revealed some dissatisfaction in the way they are experiencing university life due to the overwork resulting from the multiple tasks required in the four activity strands (teaching, research, management and extension) with an impact on quality and innovation, but in line with what the institution demands.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Elisa Chaleta"},{id:"78595",title:"Globalization and Education: Trends towards Sustainability",slug:"globalization-and-education-trends-towards-sustainability",totalDownloads:58,totalDimensionsCites:0,doi:"10.5772/intechopen.99974",abstract:"Higher Education Institutions (IES) have a very relevant role in the path towards sustainability. The problem of the implementation of curricular sustainability is the disparity of solutions that can be adopted depending on the political and economic situation of each country. The study of a practical case in the south of Honduras allows the student to approach key decisions in a real scenario to bring improvements to a very disadvantaged population, lacking basic services, such as water and electricity, under the premise of sustainability, facing aspects as relevant such as sustainable mobility, water resources management, energy and construction models, in a context where globalization and technological innovation play a very important role. It is essential to know in depth the real context where structural changes will be applied to understand that there is no single reality, that actions are built adapting to specific situations and that the effectiveness of the measures that can be adopted to establish models that prioritize that part of sustainability that best weighs the balance between the environment, society and the economy for each case.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Maria Olga Bernaldo and Gonzalo Fernandez-Sanchez"},{id:"79255",title:"Higher Education Institutions (HEIs) in Africa Embracing the “New Normal” for Knowledge Production and Innovation: Barriers, Realities, and Possibilities",slug:"higher-education-institutions-heis-in-africa-embracing-the-new-normal-for-knowledge-production-and-i",totalDownloads:128,totalDimensionsCites:1,doi:"10.5772/intechopen.101063",abstract:"If Africa is to remain relevant and competitive in today’s knowledge-based economy, it has to rely on higher education institutions (HEIs) as centers of excellence for knowledge production. HEIs nurture and sustain the production of highly-skilled individuals to support Africa’s growing economies. Among all possible ways, this could be achievable through strategic curricula innovation driven by emerging mobile technologies. Consequently, Africa’s HEIs need to embrace the ‘New Normal’ by optimizing online teaching and learning in their pursuit to expand information and communications technology (ICT) literacy as a means to increase students’ opportunities in higher education (HE). However, Africa’s ability to embrace the ‘New Normal’ has been marred by inadequate ICT infrastructures, low connectivity, unreliable power supply, and national budget constraints that may undermine Africa’s HEIs’ potential to augment knowledge production and innovation.",book:{id:"10911",title:"Higher Education - New Approaches to Accreditation, Digitalization, and Globalization in the Age of Covid",coverURL:"https://cdn.intechopen.com/books/images_new/10911.jpg"},signatures:"Christopher B. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. His research interests are focused on modern imaging methods used in medicine and pharmacy, including in particular hyperspectral imaging, dynamic thermovision analysis, high-resolution ultrasound, as well as other techniques such as EPR, NMR and hemispheric directional reflectance. Author of over 100 scientific works, patents and industrial designs. Expert of the Polish National Center for Research and Development, Member of the Investment Committee in the Bridge Alfa NCBiR program, expert of the Polish Ministry of Funds and Regional Policy, Polish Medical Research Agency. Editor-in-chief of the journal in the field of aesthetic medicine and dermatology - Aesthetica.",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},{id:"8",title:"Bioinspired Technology and Biomechanics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",isOpenForSubmission:!0,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",isOpenForSubmission:!0,editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",biography:"Dr. Luis Villarreal is a research professor from the Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana, Baja California, México. Dr. Villarreal is the editor in chief and founder of the Revista de Ciencias Tecnológicas (RECIT) (https://recit.uabc.mx/) and is a member of several editorial and reviewer boards for numerous international journals. He has published more than thirty international papers and reviewed more than ninety-two manuscripts. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. from Integral University, Lucknow, India, with his work titled ‘Development and evaluation of silymarin nanoformulation for hepatic carcinoma’. Currently, he is an Assistant Professor of Pharmaceutics, at the Faculty of Pharmacy, Integral University. He has been teaching PharmD, BPharm, and MPharm students and conducting research in the novel drug delivery domain. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than twenty-four original journal articles, two edited books, four book chapters, and several scientific articles to his credit. He is a member of the American Association for Cancer Research, the International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. 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