Living versus deceased kidney donation.
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Currently, he is an Associate Professor at Physics Department, Kasetsart University, Thailand. He is a specialist in the development of smart sensors and intelligent systems for food, agricultural and environmental applications. He has received over twenty-eight research awards such as TRF–OHEC–SCOPUS Young Researcher Award in physical science, Invention Award from National Research Council of Thailand, Highest Citation Award for the young researcher, etc. He has served as a reviewer, guest editor, and associate editor for several scientific journals. He is Top 2% World Ranking of Scientists in Electrical & Electronic Engineering in 2020 and 2021 ranked by the Stanford University researcher team. He has published several dozens of articles in reputed journals, proceedings, book chapters, patents, and copyrights. His research interests cover the topics of modern Nanoscience and Nanotechnology research ranging from theoretical modeling of nanomaterials to fabrication of intelligent nanodevices such as DFTB, hybrid gas sensors, electronic nose, chemical sensors, electrochemical sensors, printed sensors, flexible electronics, IoT systems, intelligent food and agricultural sensors, and smart devices.",institutionString:"Kasetsart University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Kasetsart University",institutionURL:null,country:{name:"Thailand"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"14",title:"Materials Science",slug:"materials-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"453623",firstName:"Silvia",lastName:"Sabo",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/453623/images/20396_n.jpg",email:"silvia@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"8398",title:"2D Materials",subtitle:null,isOpenForSubmission:!1,hash:"974977d9d7e76f2f4c93470c844f4cd5",slug:"2d-materials",bookSignature:"Chatchawal Wongchoosuk and Yotsarayuth Seekaew",coverURL:"https://cdn.intechopen.com/books/images_new/8398.jpg",editedByType:"Edited by",editors:[{id:"34521",title:"Associate Prof.",name:"Chatchawal",surname:"Wongchoosuk",slug:"chatchawal-wongchoosuk",fullName:"Chatchawal Wongchoosuk"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6391",title:"Intelligent System",subtitle:null,isOpenForSubmission:!1,hash:"e66e8d52ef62125a9f741ce0610d6899",slug:"intelligent-system",bookSignature:"Chatchawal Wongchoosuk",coverURL:"https://cdn.intechopen.com/books/images_new/6391.jpg",editedByType:"Edited by",editors:[{id:"34521",title:"Associate Prof.",name:"Chatchawal",surname:"Wongchoosuk",slug:"chatchawal-wongchoosuk",fullName:"Chatchawal Wongchoosuk"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6320",title:"Advances in Glass Science and Technology",subtitle:null,isOpenForSubmission:!1,hash:"6d0a32a0cf9806bccd04101a8b6e1b95",slug:"advances-in-glass-science-and-technology",bookSignature:"Vincenzo M. 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Nevertheless, transplantation activity is constrained by the shortage of organs. How can we maximize the utilization of organs that are abandoned from the deceased donors? The process for organ donation is a complex one involving medical, psychological, ethical, and social scientific aspect. Public opinion on organ donation and social maturity is also important factors for a stable and sustainable social system for organ donation. This chapter describes the essential knowledge, principles, and considering factors for the promotion of organ donation.
The demand for transplants continues to increase with the increasing aging population and prevalence of renal failure. Thousands of patients on the wait list die annually, and the wait for an organ transplant has significantly increased due to the wide gap between organ supply and demand. Transplantation has become a consolidated therapy to extend or improve quality of life, an activity that constitutes less than 10% of the global transplant needs [1].
Living and deceased donations are two sources for organ transplantation. Each organ donation has its advantages and disadvantages. The advantages and disadvantages for kidney transplantation from living and deceased donations are listed in Table 1.
Advantages | Longer graft survival than deceased donation Short cold ischemia time Planned surgery Possible pre-emptive transplantation No waiting time |
Disadvantages | Requires that the donor undergo major surgery Long-term donor safety concerns |
Advantages | No harm to the donor Possible options for patients without a living donor. |
Disadvantages | Shorter graft survival than living donation Long cold ischemia time Long waiting time on list Requires an unplanned surgery |
Living versus deceased kidney donation.
There are also ethical issues associated with each donation. In living donations, it is the safety of the healthy individual undergoing the surgical removal of an organ. This is associated with long-term consequences and affects donors’ quality of life. Another important ethical concern is the motivation of the donor. The decision to donate is a psychologically complicated one. Living donors can be impacted by a feeling of moral obligation, not just pure altruism. In addition, there are issues surrounding the commercialization of organ donation and donor rewards. Deceased donations also have important ethical issues. In particular, who should be the one to decide on the donation in the absence of a declared opinion. Does the family have the right to decide? Deceased donations can also result from moral obligation. Financial and non-financial incentives for the families can also affect deceased donations.
The medical safety associated with living kidney donations is an ongoing issue. The premise of living donations of the kidneys is that the removal of one does not impair survival or long-term kidney function of the donors. Data have shown that live kidney donations are safe in northern European populations who underwent nephrectomy [2, 3, 4, 5]. Nevertheless, Ellison et al. [6] identified 56 live kidney donors in the OPTN database who were subsequently listed for a kidney transplant. The rate of ESRD in donors (0.04%) is comparable to the rate in the general US population (0.03%). In a meta-analysis evaluating reduced renal mass in humans, Kasiske et al. [7] demonstrated that living donations were free of progressive renal dysfunction or an increased incidence of proteinuria. The data indicated little long-term medical risks in healthy donors after unilateral nephrectomy. However, it is recommended that before the donation, the donor receives a complete medical and psychosocial evaluation, provides informed consent, and is capable of understanding the information presented to ensure a voluntary decision.
Although living and deceased donations are important sources of organs for transplantation, a proportion of organs from deceased donors worldwide are not being used due to a lack of information, education, and social system. The use of organs from deceased donors could be significantly increased with the implementation of public education and social systems. Unlike the practical problems observed in living donors, the ethical issues associated with deceased organ donations occur post mortem and can be solved by social agreement and systemic supplementation. In addition to the efforts to increase living donation, a social infrastructure, including education and the creation of laws, should be established to promote deceased donations.
Most of the progresses made in modern transplantation were to overcome the organ shortage (Figure 1). Medical and surgical progresses include ABO-incompatible transplantation, en bloc transplantation, and using expanded criteria for donors. On a social level, progress includes the legalization of donations after circulatory death, an opt-out system, and donor action program. The establishment of these systems is needed to promote deceased donations. However, organ donation also needs to be socially accepted, and public opinion should change before the change of social system.
Measures used to overcome organ shortage.
Organ donation has traditionally been possible only after brain death. It now includes donations after cardiac death (DCD), which is increasing in European countries, North America, and Australia. However, the majority of deceased donor organs continue to be from donations after brain death (DBD). DCD are from donors who do not meet the criterion for brain death, and whose cardiac function stopped before the organs were procured. The cessation of cardiac function could have occurred spontaneously or initiated deliberately. There are two types of DCDs, controlled and uncontrolled. In controlled DCD, the donor is withdrawn from life support and his or her family has given written consent for organ donation in a controlled environment. The clinical steps for controlled DCD are shown in Figure 2. In uncontrolled DCD, the donor died in the emergency department or elsewhere in the hospital before consent for organ donation was obtained. Catheters are placed in the femoral vessels to cool organs and infuse perfusate until consent can be obtained.
Clinical steps for controlled DCD.
DCD now accounts for 17% of the 31,812 donors reported to the Global Observatory on Organ Donation and Transplantation in 2015 [1]. DCD is used in a limited number of countries, because of legislative and ethical obstacles, lack of technical expertise, and/or insufficient organizational capabilities [2, 8]. There are also differences in DCD practices, including differences in legislative and ethical frameworks, patterns of end-of-life care, and approaches for the treatment of patients with cardiovascular arrest outside of the hospital [9]. Although transplant outcomes from organs obtained from DCD donors are appropriate overall, they need improvement [9]. It is generally accepted that DCD can substantially increase the availability of deceased donor organs with optimal results.
The clinical course of patients with severe brain injury varies depending on the degree of injury and the clinical decisions made by the primary physician. The latter are impacted by legislative and ethical frameworks, as well as patterns of end-of-life care. Organ donation is one of the options in end-of-life decision, which must be considered in every patient who may become brain dead (Figure 3). Organ donation counseling is an essential step that should be incorporated in end-of-life decisions.
Clinical pathways of potential brain-dead donor. LST, Life-Supporting Treatment; DBD, Donation after Brain Death.
Although the consent rate for organ donation in Europe is 50–80% with approximately 85% of families being requested to donate, only 50% provide consent. Other studies have confirmed these findings [10, 11, 12, 13, 14]. It is important to identify potential cases of brain deaths and obtain informed consent for organ donation from the families of the patients. Because most countries have an opt-in system, voluntary consent is considered an essential factor in organ donation. Only a small portion of these brain-dead donors are being used for solid-organ transplantation, primarily because of the low percentage of families who consent to donation [15]. Several studies have evaluated the factors associated with these types [1, 2, 3, 4, 12, 14, 15, 16], which are listed in Table 2.
Age Religion Cause of death Wish to terminate life support Wish for organ donation |
Timing and preparation for decision Decoupling Time to decide Accurate information before decision Care for patient and relatives Supportive communication Critical events before request Respect for patients Care professional’s attitude toward organ donation |
Family culture Religion Education Information about brain death Information about organ donation Opinion about who has to decide Emotional stress and grief Family relationship Agreement among relatives Economic status Financial incentives |
Factors affecting deceased donation.
How to ask for an organ donation correctly is another important practical issue. The physician should call an Organ Procurement Organization (OPO) coordinator before meeting with the family of a potential donor and it must be a standard practice. Including an OPO coordinator in conversation is critical to successfully counsel families. Studies have shown that the time spent with an OPO coordinator is strongly associated with a family’s decision to donate organs [15]. Incomplete or inaccurate information about the donation process may limit consent. Furthermore, the early involvement of an OPO coordinator is the best way to deliver complete and accurate information to families. Discussion of common fears and misinformation about organ donation should be part of the organ donation request process during counseling. Important questions families typically have regarding organ donation focus on the process, physical impairment during organ recovery, and the way the organs are used. In addition, incentives for organ donations are a topic of interest. Most physicians cannot deliver enough information about these topics to the families. The early involvement of OPO coordinators is easy, and a definite solution for this problem has been recommended in many studies. A physician must be accompanied by an OPO coordinator before beginning family counseling, and precise information with supportive care must be given if the families need more information (Figure 4). Common reasons families refuse organ donation include the following:
Protecting and respecting the body
Fear that the surgery will disfigure the body
Belief that their loved ones have already experienced enough trauma
Concerns about the wholeness and integrity of the dead body
Wish to keep the body intact
Observation of a lack of respect for the deceased by the hospital staff
Gift of life is frequently considered by the relatives to be a sacrifice
Financial incentives do not influence the decision
Early involvement of OPO counseling.
OPO coordinators can counsel families on these specific topics. Families are often concerned about the physical impairment and pain sensation associated with preserving the donor’s body or thinking that the donor will feel the pain. In addition, a significant portion of families believes that the surgery causes excessive physical damage. These are significant concerns associated with decision making in families. Therefore, it is important that the medical staff or a transplantation coordinator offers specialized information about this subject during counseling. Efforts to address families’ concerns are an important step toward gaining consent to donate. OPO coordinators can provide the right information to families and address negative perspectives on organ donation (Figure 5).
Key negative perspectives on organ donation.
The decision to donate is often forced on families during complex clinical situations, at a time when they may be shocked and stunned, and ill-equipped to make a decision [16, 17, 18, 19]. It can be difficult to accept the death of a loved one, and many family members are not prepared to understand the medical concept of brain death because of emotional stress. In addition, one of the most stressful situations is when a family member has to make this type of decision without his or her previously specified opinion about organ donation. Even when counseling is done correctly, nearly half families refuse to donate. However, some of the families refuse to donate to avoid the request as a nonresponse. Frutos et al. suggest discussing organ donation as an option more than once with relatives who initially refuse or are unsure [20]. Relatives should also have the opportunity to spend time with the donor and say their final farewell. More than one-third of relatives regret declining to donate soon after the funeral [18].
Emotional upheaval in acutely bereaved families and lack of clarity on brain death cause dissonance and distress that adversely affect decision making in families and grieving over time [21, 22, 23]. Several factors have been shown to affect decision making in family members [12, 14, 15]. The complex situation and emotional stress make it difficult for families to understand the nature of brain death and accept the actual death of their loved one. This ultimately impacts the decision-making process regarding organ donation. Multiple factors negatively affect the decision to donate and lead to time delay for the final decision. A final decision may require several hours to days. This time delay, though justifiable, can be associated with the refusal to donate or failure of a successful donation. In one study, researchers reported that a delay in decision making does not reflect a negative attitude about organ donation, but a reasonable and necessary amount of time for deliberation [24]. Therefore, the medical attendant and OPO coordinator should continue their efforts to maintain organ viability and consider extended repetitive counseling to encourage donation.
Decoupling is one of the best principles in which making a donation request is delayed until the family understands that brain death is the same as death and has the opportunity to realize that their loved one is dead (Figure 6). This principle of waiting to discuss organ donation until the family is ready to make end-of-life decisions is important to correctly timed request. The principle of decoupling is a well-known way to increase the consent rate for organ donations [25]. In a study by the Kentucky Organ Donor Affiliates in 1989–1990, researchers reported that the consent rate increased from 18 to 60% if there was a separation between when death is pronounced and the approach for organ donation [25]. However, decoupling frequently becomes impossible when the hemodynamics of a potential donor worsens. The patient’s attending physician may feel an ethical conflict about providing active or invasive life-support care that seems to have no therapeutic benefit on the patient’s recovery and appears to have significance solely for maintaining organ quality, especially when the family’s opinion about organ donation is not specified yet. This frequently occurs in the emergency department or the intensive care unit [26]. In addition, decoupling is sometimes not consistent with the current recommendation of early referral to the OPO coordinator [26]. If we profoundly believe that there is value in organ donation, a more flexible high-dimensional strategy is needed when a potential donor is progressing to circulatory death.
Principle of decoupling.
Identifying a potential brain-dead donor is the fundamental step for a successful donor action program. The typical steps of actual organ donation in the intensive care unit are illustrated in Figure 7. OPO coordinators or transplantation teams typically identify only a small portion of potential brain-dead donors. If the OPO coordinator approached the families and appropriate counseling was performed, the families consent is an invincible one. A tight screening system must be established to increase the rate of identification of potential donors in the intensive care unit. The generally accepted criteria for potential deceased donors are shown in Table 3.
Multiple steps for organ donation after brain death in intensive care unit.
Glasgow coma scale of <5 Brain death test being considered Do-not-resuscitate or comfort care being considered Withdrawal of life support being considered Family initiates conversation about donation |
Criteria for referral of a potential donor.
Strategic efforts by the government and local authorities, as well as individual efforts by medical personnel, are necessary to promote organ donation. These include the revision of laws, simplifying the required procedures for receiving consent, expansion of the donor card system, adoption of a presumed consent concept known as an opt-out system, and the establishment of a DCD system. The strategic processes put in place in Europe and the United States have resulted in a progressive and gradual increase of organ donation [27, 28, 29, 30].
Despite the effectiveness of these strategies, public acceptance of organ donation is essential before these measures can be implemented in other countries. The establishment of social systems for organ donation depends on public consensus. There are currently two moral values on organ donation: deontologism versus consequentialism. This means where we put our maximum value of some behavior, as it were, the legitimacy of process or the benefit of consequence (Table 4). Many procedural details in organ donation and recovery have points of conflict, which can be solved with social agreement.
Deontologism | Consequentialism |
---|---|
Duty or obligation-based ethics Action or process is more important than the consequences. A moral obligation may arise from rules | Outcome-based ethics A morally right act is one that will produce a good outcome. The end justifies the means |
Donor’s will “Opt-in” system Informed consent Explicit consent No donor incentives Individual decision Donor management after consent Volunteering Resuscitation for organs forbidden Femoral cannulation after consent | Social need “Opt-out” system Presumed consent Implicit consent Donor incentives Social campaign Donor management before consent ICU screening and family approach Resuscitation for organs allowed Femoral cannulation before consent |
Moral dilemma surrounding organ donation.
Asking families for organ donations to families is generally regarded as a stressful task by primary physicians. Only a small portion of potential donors are being asked about organ donation as an option of end-of-life decision, and it is decided according to the primary physician’s point of view or belief. Despite the important role of the medical staff in recommending organ donation to families, imposing this burden on physicians alone may not be adequate. If we, including local authorities and the general population, agree on the importance of organ donation, its promotion would not be the sole responsibility of individual medical staffs. The authorities have to consider establishing an advanced system that links potential donors to organ donations, known as an “opt-out” system. Many valuable lessons can be learned from the efforts of European countries to adopt it [28].
Religious beliefs were found to be important. Officially, nearly all religious groups support organ transplantation as long as it does not impede the life or hasten the death of the donor [31]. However, only a small portion of the public knows about the stance of their religion on organ donation. More active involvement of religious bodies is needed to raise the public’s awareness and encourage organ donation.
Asian countries have delayed the creation and adoption of social systems for organ donation. Despite the socioeconomic development of several Asian countries, the number of organ donations per million is extremely low, compared with western countries. In addition, most of the data on organ donation consent after brain death are largely based on findings from Western populations. The current opinion on organ donation after brain death is unclear in Asian countries. Traditionally, the body of a loved one should not be tampered with after death in Asian cultures, especially in Korean, Japanese, and Chinese. This belief originates from the Confucian tradition, and it is believed that this tradition may be the main reason for the low consent rate of organ donation in Asian countries. In addition to cultural differences, it is thought that widely differing opinions, perceptions, and concerns may be related to low frequency of organ donation in Asia. However, these factors are not well studied. The general opinion on brain death and organ donation appears to be quite positive in Asia [24, 32]. The perception of brain death as death is widely accepted [32]. However, there were several perceptional barriers against organ donation in Asia [32]. Evidence-based strategies focused on these barriers should be established to increase the rate of organ donation effectively.
Living and deceased donations are two sources of organs for transplantation. Each type of donation has its advantages and disadvantages.
Many organs from deceased donors are still not being used worldwide because of lack of information, education, and social system.
Effective systems such as opt-out, donation after circulatory death, and donor action programs are needed to promote deceased donations.
DCD is developed in a limited number of countries, because of legislative and ethical obstacles, lack of technical expertise, and/or insufficient organizational capabilities. It is generally accepted that DCD can substantially increase the availability of deceased donor organs with optimal results.
Counseling on organ donations is an essential step for stable end-of-life decision of families. Standard practice should include that physicians call an Organ Procurement Organization (OPO) coordinator before meeting with the families of potential donors.
Delays in deciding on organ donation do not reflect a negative attitude, but a reasonable and necessary time for families to deliberate.
Decoupling is important to properly timed organ donation requests. However, a more flexible high-dimensional strategy is required when the potential donor is progressing toward circulatory death.
A tight screening system must be established to increase the rate of identification of potential donors in the intensive care unit.
The authorities have to consider the establishment of an opt-out system.
More active involvement of religions is needed to encourage organ donation. The participation of religious societies in public campaigns would also be helpful.
Our understanding of toxicity associated with exposure to radiation has increased since the discovery of X-rays in 1895. X-rays were used to treat a variety of malignant and non-malignant diseases. The effects of radioactive exposure on specific tissues can vary. Radioactive particles destroy or impair tissue by generating free radicals that damage important molecular structures, such as DNA. Radiation exposure can lead to catastrophic consequences, ranging from severe, acute injury to long-lasting effects that manifest years after the initial exposure. This chapter provides observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure, and the expectations and treatment management following exposure [1, 2, 3].
Exposure to radioactive particles is divided into intentional or unintentional causes. Notable intentional causes include the atomic weapons activated on Hiroshima and Nagasaki in Japan during World War II. The immediate injuries and fatalities were from the heat and mechanical force generated by the trauma and physical destruction. However, it became apparent that there were longer lasting consequences. Survivors in the surrounding area were exposed to high levels of radiation and suffered from acute toxicity injuries and organ failure. Many of those who did not succumb to the effects of acute toxicity were known to suffer lifelong chronic conditions, such as developmental problems in newborns and increased cancer risk [4, 5, 6].
Unintentional causes are usually the result of radiation exposure without intent to injure. These unintentional causes are typically related to the effects of radioactive materials utilized for energy or medical treatment. The first radiograph was taken in 1895 and early pioneers in the field were unaware of the consequences of exposure. Initial procedures were often associated with unintentional exposure and were fraught with numerous complications such as skin blistering, hair loss and systemic toxicity that we now know were due to radiation toxicity. These signs and symptoms were similar to those present in exposed workers in the first nuclear development programs, many of whom would later develop injuries and cancers as a consequence of their profession [7, 8].
Despite these risks, nuclear power continues to be used for its benefits. Fortunately, we now know much more about how to avoid and minimize radioactive exposure. Rigorous standards enforcing safe practices with radioactive material and the formation of numerous regulatory agencies such as the Nuclear Regulatory Commission are a testament to how far we have come [9]. However, accidents involving radioactive material do occur. In this chapter, we describe a brief history of well-known incidents involving unintended radioactive exposure, as well as the clinical consequences and care of the patient following exposure.
One of the most significant nuclear accidents in history was Chernobyl. On that day, a series of missteps during a routine safety check resulted in a massive explosion that sent a plume of radioactive material into the air for an entire week. The range of this explosion extended well beyond the immediate vicinity, exposing other parts of Europe to radioactive gas in the process. In addition to exposing civilians to the radioactive material, first responders also received significant radiation levels and thermal injury, many of which were lethal. More recently, the nuclear reactor in Fukushima, Japan experienced a meltdown following the 2011 tsunami in Japan. While there were no immediate casualties, there was lasting environmental damage and the long-term health consequences are yet to be fully understood [8]. These examples demonstrate the importance of proper safety measures and providing an effective response to nuclear accidents.
Toxicity from radiation exposure can be divided into three types: acute, subacute and chronic/late. Acute radiation toxicity is defined as signs and symptoms ≤90 days following exposure. In a medical setting, treatment of acute exposure is quite common. During radiation therapy, radiation is targeted and delivered to tumors and management of side effects from the radiation exposure remains a mainstay of modern oncology.
The radioactive dose from these procedures is typically far less than the dose following unintended exposures outside of the clinical setting. The radiation treatment dose is usually fractionated, meaning the dose is given in intervals to reduce the short-term toxicity of the radioactive treatment. The clinical manifestations of acute toxicity following a radioactive accident may be much more severe than those typically encountered by most physicians and may warrant treatment in an emergency setting [4, 5].
Acute radiation toxicity involves many organ systems, including but not limited to the central nervous, gastrointestinal, and cardiovascular systems. Cells with self-renewal potential may be able to recover better from radiation damage compared to those without such protective mechanisms. Self-renewal processes are often accelerated as a response to injury where slowly proliferative tissues cannot. However, if the exposure is given in a single fraction of high enough dose, this ability for self-renewal potential will be overwhelmed. For example, a single total body dose >10 Gy will result in death within days from numerous possible causes. Damage to the central nervous system will result in cerebrovascular syndrome, with uncontrollable swelling in neuromuscular tissue. Despite best supportive care there are no medical interventions to prevent death at this level of exposure. Damage to the gastrointestinal system results in severe diarrhea and associated fluid loss. The mechanism involves depletion of most stem cells within the gastrointestinal crypts. Since these stem cells are required to replace the mucosal surface, these mucosal surfaces will disappear a few days after exposure and there will be no barrier to prevent fluid loss or bacterial entrance into the bloodstream. As a result, patients will typically present with fever, nausea, vomiting, fatigue, anorexia, and severe hypotension. Doses of 4–5 Gy are enough to cause death from depleted stem cells in the hematopoietic system without support. Those that survive the initial depletion typically succumb to infection a month later due to depleted lymphocytes and other immune elements. These manifestations can occur minutes after exposure, with severity being proportional to dose and a sharp decrease in lymphocytes within two days of exposure [1, 4, 5].
Should the patient be exposed to doses below 4 Gy, symptomatic and best supportive treatment is recommended. Nausea and vomiting are the typical initial symptoms and should be treated with hydration. If the exposure dose is unknown, noting the time of onset of vomiting is important as exposure dose is inversely proportional to time to emesis. It is not uncommon for patients at low exposure doses to feel fine for a few weeks before the gastrointestinal and hematopoietic symptoms drive a patient to seek medical care. Upon initiation of care, isolation and contact inhibition is vital since infection is a major contributor towards death in these patients as depletion of the hematopoietic system occurs. Blood transfusion and antibiotics can be delivered to alleviate these issues. A patient will often also present with skin injury burns at the site of radiation exposure as epidermal and dermal injury associated with stem cell depletion can mimic and appear similar to a thermal injury. These injuries should be treated promptly, as they are easy routes for infection to occur, which can be devastating to a patient with a compromised hematopoietic system. In patients with high exposure doses, end of life care is a possible consideration. At an exposure of 5 Gy, only about half of patients will survive after 30 days. An exposure of 10 Gy is considered lethal regardless of medical interventions [1, 5, 6]. Treating patients following radiation exposure is not only challenging in terms of clinical aspects, but emotionally as well.
Compounds that have been developed to reduce and even prevent the clinical manifestations following radiation exposure are called mitigators. These compounds work by altering the molecular response following radiation exposure. As such, a mitigator could inhibit lymphocyte recruitment at sites of radiation damage, increase proliferation of stem cells that would normally be inhibited by radiation exposure, or inhibit fibrosis. An example of a mitigator is Palifermin, a growth factor that stimulates cell growth in response to radiation exposure to reduce recovery time. Radioprotectors, on the other hand, are given before or immediately after radiation exposure to protect against the effects of radiation toxicity [10, 11]. Amifostone is one such radioprotector that has been approved by the FDA for reducing side effects from radiation therapy [12]. More mitigators and radioprotectors are expected to be approved as the need to protect against radiation toxicity increases. Although many compounds have been and are in development, no others to date are actively used in clinical practice and the role of both hematopoietic and mesenchymal transplant remains under investigation.
The subacute and/or late effects of radiation toxicity, by nature, are less visible and harder to identify for most emergency and primary care physicians. Often, these effects take many years to develop and are often mistaken as sequelae from another disease. However, they are nevertheless important to identify and address. A common misconception is that the degree to which a patient suffers from acute symptoms is proportional to severity of the long-term response. Unfortunately, patients who experience little to no acute sequela can experience serious long-term sequela, and vice versa. While both children and adults can experience the effects of late radiation toxicity, children are susceptible as they have a much longer period for these clinical manifestations to develop [13]. Unlike acute toxicity effects, anticipating long term effects is much more difficult. This technique relies heavily not only on a physician’s knowledge of potential long-term effects, but also their willingness to investigate a potential long-term effect.
A common theme in radiation injury is the ability of the tissue or organ to respond to cell death and self-regenerate. These aspects vary among organs and thus the clinical presentation and treatment is different depending on the organ involved. Injuries and treatment protocols for specific organs are as follows:
As previously discussed, damage to the hematopoietic system typically results from injury to progenitor cells, which can lead to hematopoietic crisis and infection. Fortunately, with the exception of whole-body exposure, the hematopoietic system is generally able to recover from radiation damage due to migration of stem cells from outside the site of exposure. Patients who are also receiving chemotherapy or taking medications that may result in immunosuppressed states should be carefully assessed. In the case of total body irradiation, an immediate decrease in circulating lymphocytes can be expected with subsequent defects in immune response. Symptomatic treatment, including blood infusions and antibiotics as needed, with isolation are crucial in these situations [13, 14]. Use of bone marrow transplants to replenish depleted progenitor cells has a theoretical survival benefit opportunity in total body irradiation patients, but to date has not been embraced as standard practice and often only applied to those most severely affected. The risk of graft-vs-host disease makes this approach controversial, especially in the setting of an emergency unrelated allogeneic transplant [6].
The skin is often the most direct site of radiation injury, as the epidermis covers all other organs and is susceptible to radiation damage. The dermal stem cells are the most susceptible component of the skin, as these are the actively dividing cells that replace other cells in the rest of the organ. Early symptoms of exposure typically involve erythema and swelling as vasodilation and the recruitment of inflammatory components localize to the area. These symptoms typically resolve within a month. Late term effects include decreased wound healing capacity with increased fibrosis and ulceration. Interestingly, the skin will appear to be more vascularized with more prominent vasculature. However, this is due to thinning of the epidermis, which causes veins to appear more prominent. Proper wound care is the standard treatment for these manifestations, with surgical debridement as needed. Particular concern must be paid for patients with medical conditions that are prone to fibrosis, such as those with dermatitis, lupus, and scleroderma. Skin infections, such as cellulitis, are particularly dangerous given the immunosuppressive effects of radiation therapy. Lastly, an interesting phenomenon occurs in some patients where previously irradiated skin can become erythemic and fibrotic several years later in response to certain medications like antibiotics and chemotherapy. The mechanism behind this phenomenon is unknown [15].
In the past, skin involvement from radiation therapy that could not be treated with topical ointments was relatively rare. However, with the increasing use of hypofractionation (radiation therapy with greater amounts of dose per treatment), these findings are becoming more common [16]. Thus, radiation damage to the skin is likely to become more prominent in the future as therapy becomes more compressed with higher doses delivered in a shorter period of time. Patients with a history of radiation therapy and significant skin sequalae should be carefully observed for more serious developments as injuries in treated tissues heal less well and contain less local immunity.
Like the skin, the gastrointestinal system is composed of mucosal cells with multiple layers underneath that are constantly replaced over time. Unfortunately, the rate at which some of these cells are replaced is higher than that of the skin, leading to more immediate and sometimes more severe clinical manifestations. Cells of the gastric and small bowel tend to have the highest rate of replacement, leading to very early nausea if these regions were exposed. Exposure to mucosal cells in the upper gastrointestinal system (mouth, esophagus, salivary glands) tend to present with clinical symptoms around two weeks after exposure due to a longer replacement rate. Damage to these cells tends to present with more localized pain and swelling. Exposure to the salivary glands can result not only with localized pain, but also xerostomia (dryness of mouth) and ageusia (loss of taste). Saliva can become more acidic which can further injure normal tissue and alter the environment of the oral cavity. Regardless of these manifestations, patients should be advised to maintain adequate nutrition and dental hygiene, as this practice helps mitigate the complications of an immunocompromised state. Symptomatic treatment of localized pain is also advised and considered standard of care as bone exposure can be a serious consequence of mucosal denudation [14]. Figure 1 represents modern head/neck radiation therapy treatment plan through the oral cavity demonstrating sparing of the parotid tissue with intensity modulation.
Parotid sparing. Image courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Farther along the digestive tract, the expected symptoms can be predicted based on the location of the tumor. Radiation exposure to the gastric mucosa during treatment of gastric tumors can result in near immediate nausea given the daily replacement the gastric mucosa. Treatment of esophageal tumors, which are now more commonly in the lower third of the esophagus, present with a timeline of symptoms similar to head and neck tumors (approximately two weeks after exposure). Tumors in this region typically cause dysphagia and anorexia. Treatment initially tends to relieve patient symptoms, but later patients may return thinking the tumor has returned when in reality these symptoms are due to swelling from the therapy. Like head and neck tumors, patients should be advised to continue maintaining adequate hydration and nutrition [13, 14].
Symptoms from radiation exposure in the small and large bowel are more complex and require more in-depth patient history and laboratory tests. The small bowel absorbs much of the nutrients from food. Damaging the microvilli of the mucosal surface, which are vital for nutrient absorption, can result in severe malabsorption regardless of a patient’s appetite. These findings can be confirmed by stool tests. Patients will often present to the emergency room with diarrhea, steatorrhea, bloating and general abdominal pain a few days after radiation exposure. The large bowel plays an important role in absorption of water, and exposure of large portions of this organ may compromise this function. Patients may complain of increased defecation frequency, which can lead to dehydration and electrolyte abnormalities that can be confirmed through electrolyte panels. To make matters more difficult, abdominal organs are prone to forming adhesions after surgical interventions, which disrupts blood flow to portions of the bowel that are exacerbated after concurrent radiation therapy. Anticipation of these issues through a careful patient history are vital to preventing severe complications from occurring [13, 14, 17].
Late effects of radiation also depend on location of the exposure. The mucosal cells of the oral cavity should theoretically recover like that of typical skin cells, but the combination of a tight space and harsh oral environment prone to infection and necrosis makes healing difficult. Thus, fibrosis and ulceration over a long period of time are possible. Acute effects of radiation typically damage mucosa of the gums and affect the pH of the saliva, facilitating microbial growth. These changes can lead to long-term problems with dental hygiene and patients should modify their dental habits accordingly through increased tooth brushing and fluoride mouthwash [13, 14]. Motility issues are also becoming more common, especially since patients who receive radiation therapy are now living longer. Dysphagia appears to be due to edema surrounding constrictor muscles, and physical therapy to encourage lymph drainage offers symptomatic treatment [18]. Gastric emptying issues due fibrosis at the gastric antrum and regions in the bowel where surgery was performed are also possible years after treatment. Atrophy of the pancreas many years after radiation exposure is also known to happen, although the clinical relevance of this is unknown [13, 14]. Symptoms can mimic malabsorption syndrome.
The main mechanism of radiation injury in the lungs is the generation of free oxygen and nitrogen radicals which damage the lung parenchyma with irregular repair of type I and II pneumocytes along the delicate reticulin network of pulmonary parenchyma. This oxidative damage causes disorganized repair and replacement of these cells associated with late fibrosis, impairs the ability for the lungs to oxygenate the blood. Pneumocyte damage also leads to recruitment of pro-inflammatory modulators that recruit immune cells to the region, leading to fibrosis and further depleting oxygenation capacity [19]. Furthermore, the radiation-driven production of nitric oxide has been suggested as a possible cause of damage to lung parenchyma outside of the field of radiation [20].
Complicating this situation is that many chemotherapeutic agents given with radiation therapy, such as bleomycin, also causes pulmonary fibrosis. The results of these sequelae are the development of pneumonitis up to two to six months after exposure. If asymptomatic, careful observation is standard of care. If symptomatic, the patient usually presents with occasional bouts of cough and dyspnea. Treatment with corticosteroids, supplementary oxygen, and prophylactic antibiotics are recommended in this situation. Once the pneumonitis resolves, fibrosis typically marks the site of radiation injury and can result in limited ventilation requiring long term use of supplemental oxygen. Given these findings, it is important to note that these patients tend to be at higher risk of developing chronic pulmonary disease compared to those who were unexposed [13, 21, 22, 23, 24]. Pulmonary rehabilitation is an important aspect to survivorship care and optimizing respiratory health is important to each patient as the rehabilitate from therapy. Figure 2 represents changes in lung parenchyma associated with immunotherapy and low dose radiation therapy with improvement seen after withdrawal of the immunotherapy.
(A) and (C) Therapy driven pneumonitis outlining the radiation therapy field while on immune check point inhibition. (B) and (D) Improvement after immunotherapy withdrawal. Courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Radiation injury to the liver, also known as radiation-induced liver disease (RILD), is unique in that it is often during the healing process that tissue function undergoes disorganized repair, including injury to the reticulum network, and limits the vascular relationship to the hepatocyte. While acute damage to hepatocytes affects liver function, as the cells divide during repair they tend to become disorganized, particularly if the structural reticulum of the liver is damaged. Increased distance between the hepatocytes and the blood supply leads to decreased liver function. This phenomenon explains why the state of the liver before exposure to radiation also plays an important role in this process. For example, a cirrhotic liver due to heavy alcoholic use or hepatitis will likely have pre-existing disorganized architecture, making this liver more susceptible to radiation damage. This includes veno-occlusive disease which also separates vascular anatomy from the hepatocyte. For these reasons, imaging studies such as magnetic resonance imaging before the delivery of radiation are obtained for evaluation of anatomy and function [25]. Disorganized repair can lead to migration of infusional therapies including radiolabeled therapy as the vascular anatomy can be disrupted and limit efficacy in spite of placement of therapy in close approximation to disease.
Patients with RILD typically experience symptoms that mimic cirrhosis, which include abdominal pain, elevated liver enzymes, jaundice, and ascites within four months of radiation exposure. Livers with pre-existing damage typically have earlier onset, with more severe symptoms. Treatment is symptomatic with keen observation of potential veno-occlusive and metabolic disease secondary to a congested liver with decreased function. Careful consideration must be given for medications that are metabolized in the liver, especially chemotherapeutic agents that are also hepatotoxic [25, 26].
All components of the kidney, including structures crucial for filtration, such as cells of the glomerulus, are susceptible to radiation damage. The signs of acute radiation damage are usually seen within 3–18 months, typically mimicking signs of renal failure. These signs include decreased glomerular filtration rate (GFR), increased serum β2-microglobulin, albuminuria, and other markers of poor renal function. Later signs of kidney radiation damage, which include hypertension and eventual renal failure, are often hard to distinguish from other pathological causes. For treatment of these sequelae, the use of hypertension medications such as angiotensin-converting-enzyme inhibitors (ACE) inhibitors are theoretically beneficial. Monitoring of renal function, both short and long term, also remains crucial in the standard of care for these patients [27, 28, 29]. In aging patients who are not candidates for surgery, radiation therapy with stereotactic techniques is being used more frequently to treat sub-total renal volumes for renal malignancies in an effort to spare as much renal function as possible.
The mechanism of radiation damage to the heart and blood vessels involves immediate cellular damage followed by fibrotic and disorganized repair, leading to reduced function in all cardiac segments including electrical conduction, myocardium, valves, and vascular anatomy. The time period is variable due to differences in size and functional architecture. However, what is clear is that unintended radiation exposure to the heart and blood vessels has a strong association with cardiovascular disease and complications [30, 31, 32, 33]. The lack of mitigation and therapeutic strategies in response to radiation of cardiovascular tissues explains why radiation oncologists spend such a large amount of effort to minimize cardiovascular exposure [34].
Generous radiation exposure to the heart can result in acute pericarditis. This diagnosis should always be in the differential in a patient with history of radiation exposure who presents with sharp, radiating chest pain that is relieved when sitting up. Anti-inflammatory medications like aspirin, colchicine and prednisone can offer symptomatic relief, with pericardiocentesis being an option in severe cases. Long term, patients who receive radiation exposure to the heart have a higher risk of heart disease and use of echocardiograms and nuclear stress tests in these patients is recommended if symptoms warrant use. Large blood vessels like the aortic, carotid, and femoral arteries can experience hyperplasia and atherosclerotic change from radiation doses. These changes can result in rupture and fistula formation, necessitating immediate treatment. This usually requires very high doses and prolonged exposure usually not seen in modern radiation therapy [30, 31, 32, 33]. With improvements in survival, patients can receive therapy with intentional overlap to previously treated volumes for second malignancies. These patients are vulnerable to vascular injury, including larger arteries and survivorship plans need to include periodic surveillance of vessels to optimize follow up care. Figure 3 demonstrates cardiac sparing for left-sided breast cancer treatment with breath-hold treatment techniques and optical tracking.
Cardiac sparing with deep inspiration breath-hold (DIBH), (left-free-breathing (FB); right-DIBH). Image courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Since most cells of the nervous system do not typically have a high turnover rate, it would seem reasonable to assume that the nervous system is more resistant to radiation damage than other organs. However, this assumption does not account for the immediate molecular effects of radiation. Regardless of the rate of cell division, all cells will receive damage to membranes, organelles, and other structures within the cell. Cells that do not divide very frequently will have to endure these injuries for long periods of time, leading to eventual clinical manifestations. Damage to nearby vasculature also limits growth and healing of these structures, leading to pronounced long term effects. There are clear reports of radiation damage to the central nervous system sometimes long after the initial radiation exposure [35, 36, 37, 38].
Patients who received radiosurgery or hypofractionation techniques are at risk of developing necrosis within six months of receiving therapy. Clinically, these developments can result in focal changes and change in behavior depending on the site of necrosis. Demyelinating syndromes, although rare, are also possible in the peripheral nerves and spinal cord. Often, neurotoxic symptoms are enhanced by chemotherapeutic agents, such as vinblastine, vincristine and cisplatin. Gathering a detailed physical exam, medical history and possible neurological referral may be required for definitive identification of these outcomes. Patients who received radiation therapy for pituitary adenomas or at sites near the optic structures are at risk for visual changes [36, 37]. This is because some structures, such as the lens and optic chasm, are sensitive to radiation exposure due to limited blood supply [15, 39, 40]. Patients treated for breast and head and neck cancers may rarely present with brachial plexopathy. Peripheral lymph nodes for these regions are often within the same field of treatment as the brachial plexus, resulting in unintended exposure to this region [41].
The effect of radiation therapy on the endocrine glands varies depending on the gland affected. The timeline for the development of clinical sequelae varies, with some cases even being reported many years after the radiation exposure. The pituitary gland is relatively radiation sensitive and results in panhypopituitary syndrome, requiring supplementation of depleted hormones. Secondary malignancies from un-intentional radiation exposure, while rare, have been reported [42]. Patients who received previous head and neck radiation therapy who now present with headache, vision loss and/or hormonal abnormalities should be carefully examined for the development of pituitary adenomas. The thyroid gland is also sensitive to radiation therapy, resulting in hypothyroid syndromes. Patients who receive radiation therapy to the head and neck often receive surgery that involves dissection of the thyroid gland, exasperating thyroid function loss. The thyroid also has a relatively higher incidence of developing secondary malignancies. This finding has been identified not only in patients receiving radiation therapy, but also victims of the Chernobyl incident [5]. The same care must be given to the parathyroid glands, given the proximity to the thyroid gland, which can present with signs and symptoms of hypoparathyroidism. Radiation exposure to the endocrine pancreas and adrenal glands are less characterized and are thought to be more radiation resistant. However, there are a few cases of injury to these organs associated with radiation exposure [42].
The reproductive organs are highly sensitive to radiation damage, with early exposure in pediatric patients leading to severe detriments like sterility and secondary malignancies (see Pediatrics). Since much of the reproductive system depends on hormonal homeostasis, radioactive effects on the endocrine system (see Endocrine) and the subsequent effect on hormone production, such as that on testosterone and estrogen, can drastically affect reproductive function and development depending on the effected hormone and gland. When investigating radiation injury to the reproductive system, it is always important to consider the location of exposure and any endocrine glands involved. Germ cells, such as spermatogonia, are particularly sensitive to radiation damage as they can experience inter-mitotic death. Even mild radiation exposure can lead to a heavy drop in sperm numbers. Mature sperm that receive radiation damage can harbor serious mutations or chromosomal abnormalities, leading to severe birth defects in progeny. Exposure to female reproductive organs can even lead to miscarriage and early menopause. As a result, it usually recommended for patients who receive gonadal exposure practice birth control methods for up to six months after the exposure. Because the ovaries rely on a regular, cyclical production of hormones from the follicles, radiation injury can lead to more pronounced effects on fertility. Mucosal atrophy and drying of female genitalia can cause great discomfort for the patient as well. Thus, fertility treatment and consultation should be considered for patients who received heavy or repeated radiation exposure to the gonads [13, 14, 42].
Pediatric patients are unique in that many organs and tissues are still developing. As a result, the cells involved are particularly sensitive to radiation damage as the fully developed adult organ can become abnormal or dysfunctional. Pediatric patients who receive radiation therapy are known to have a higher risk of developing growth abnormalities, chronic diseases, secondary malignancies and premature death compared to sibling controls [43]. Children who were treated with radiotherapy in the pelvis for tumors such as rhabdomyosarcoma or germ cell tumors are at high risk for gonadal abnormalities. Given the rapid growth in the musculoskeletal system during puberty, exposure to the spine at an early age can cause drastic changes to the respiratory and cardiovascular system. Radiation exposure to any cartilage or bone not only presents the risk of bone necrosis, but also may affect the fully developed form of such tissue, sometimes resulting in stunted extremity length and increased frequency of fractures. Children treated for Wilms tumors are at high risk of renal abnormalities later in their lifetime to the remaining kidney, therefore attention to detail for renal health as these patients become adults is an important aspect of a survivorship plan. Exposure to the bowel and hepatic structures are known to adversely affect the growth and development of intraabdominal organs. These effects can affect nutritional intake, indirectly causing developmental issues as the child matures [14, 43, 44]. As these patients mature into adulthood, detailed review of a patient’s radiation exposure history will play a pivotal role in survivorship plans.
As many of the side effects of radiation therapy are difficult to anticipate and manage, a great deal of effort has been put into reducing the amount of non-tumor tissue exposed to radiation. In the early days of radiation, this was difficult simply due to the lack of technology. Now, most radiation oncologists have access to various new tools, such as 4-dimensional conformal avoidance techniques to minimize off-target exposure [34]. Compact structures that were traditionally difficult to irradiate without significant off-target, such as the axilla and chest, can now be treated much more accurately with minimal exposure to non-tumor tissue [41]. Modern imaging techniques can be utilized to assess organ performance even before the administration of radiation to determine the risk of post-radiation symptoms. Indocyanine retention assays used in conjunction with MRI have determined the pre-exposure function of liver to assess if the patient is a good candidate for radiation therapy [25]. New guidelines are constantly being updated to ensure that the risks of radiation therapy are minimized. Novel pharmacological agents, such as the development of immunotherapy, are being implemented to supplement the efficiency of radiation therapy. As medicine becomes more collaborative and data is more available, physicians outside of radiation oncology will be able to better understand the radiation therapy treatment plans and define survivorship care plans accordingly.
The discovery of nuclear power and the utilization to benefit humanity has been one of the defining moments of the modern era. While this discovery certainly has benefits, there are also unintended and intended consequences which we must continue to mitigate. In the field of medicine, what is clear is that radiation remains a crucial tool to diagnose and treat diseases. Understanding and minimizing the risks of using this tool remains a priority for the safety and well-being of patients, especially given the broad impact it has on organs throughout the body and the long-term effects. It falls upon health care professionals to remain vigilant and well-informed to ensure that nuclear energy and radiation therapy remains a blessing and not a curse.
The authors declare no conflict of interest.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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\n\nPlease complete the publishing proposal form. The completed form should serve as an overview of your future Compacts, Monograph or Edited Book. Once submitted, your publishing proposal will be sent for evaluation, and a notice of acceptance or rejection will be sent within 10 to 30 working days from the date of submission.
\n\n2. SUBMIT YOUR MANUSCRIPT
\n\nAfter approval, you will proceed in submitting your full-length manuscript. 50-130 pages for compacts, 130-500 for Monographs & Edited Books.Your full-length manuscript must follow IntechOpen's Author Guidelines and comply with our publishing rules. Once the manuscript is submitted, but before it is forwarded for peer review, it will be screened for plagiarism.
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\n\n4. ACCEPTANCE AND PRICE QUOTE
\n\nIf the manuscript is formally accepted after peer review you will receive a formal Notice of Acceptance, and a price quote.
\n\nThe Open Access Publishing Fee of your IntechOpen Compacts, Monograph or Edited Book depends on the volume of the publication and includes: project management, editorial and peer review services, technical editing, language copyediting, cover design and book layout, book promotion and ISBN assignment.
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Many health care providers are expected to be able to intubate the patients for different indications. As the case in any medical intervention, endotracheal intubation can cause complications. These complications are categorized as early or late according to the time of onset of the presenting symptoms. This chapter will discuss the long term complications of endotracheal intubation that might be encountered by the treating physicians. The chapter will stress on the predisposing factors for these complications and the available methods to avoid and treat them.",book:{id:"6495",slug:"tracheal-intubation",title:"Tracheal Intubation",fullTitle:"Tracheal Intubation"},signatures:"Abdelfattah A. Touman and Grigoris K. 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Knowledge of the functional anatomy of the airway in these forms the basis of understanding the pathological conditions that may occur. The upper airway extends from the mouth to the trachea. It includes the mouth, the nose, the palate, the uvula, the pharynx, and the larynx. This section also describes the functional physiology of this airway. Managing the airway of a patient with craniofacial disorders poses many challenges to the anesthesiologist. Anatomical abnormalities may affect only intubation, only airway management, or both. This section also focuses on the abnormal airways in obesity, pregnancy, children and neonate, and patients with abnormal facial defects.",book:{id:"6495",slug:"tracheal-intubation",title:"Tracheal Intubation",fullTitle:"Tracheal Intubation"},signatures:"Aslı Mete and İlknur Hatice Akbudak",authors:[{id:"237495",title:"Dr.",name:"Asli",middleName:null,surname:"Mete",slug:"asli-mete",fullName:"Asli Mete"},{id:"237882",title:"Dr.",name:"Ilknur",middleName:"Hatice",surname:"Akbudak",slug:"ilknur-akbudak",fullName:"Ilknur Akbudak"}]},{id:"53912",doi:"10.5772/67048",title:"Pharmacology of Local Anaesthetics and Commonly Used Recipes in Clinical Practice",slug:"pharmacology-of-local-anaesthetics-and-commonly-used-recipes-in-clinical-practice",totalDownloads:4083,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Local anaesthetics are commonly used drugs in clinical anaesthesia. The knowledge of their pharmacology is paramount for safe and optimal use of this group of drugs. This chapter consists of two sections. The first section will address the chemical and physical properties, pharmacokinetics and pharmacodynamics of the local anaesthetics. In the second section, examples of the commonly used doses and additives used for various peripheral and regional anaesthetics will be discussed. We will also address the treatment of toxicity as a result of inadvertent intravascular injection of the local anaesthetics.",book:{id:"5490",slug:"current-topics-in-anesthesiology",title:"Current Topics in Anesthesiology",fullTitle:"Current Topics in Anesthesiology"},signatures:"Jesse Musokota Mumba, Freddy Kasandji Kabambi and Christian\nTshebeletso Ngaka",authors:[{id:"190178",title:"Dr.",name:"Jesse",middleName:"Musokota",surname:"Mumba",slug:"jesse-mumba",fullName:"Jesse Mumba"},{id:"190180",title:"Dr.",name:"Freddy Kasandji",middleName:null,surname:"Kabambi",slug:"freddy-kasandji-kabambi",fullName:"Freddy Kasandji Kabambi"},{id:"192695",title:"Dr.",name:"Christian Tshebeletso",middleName:null,surname:"Ngaka",slug:"christian-tshebeletso-ngaka",fullName:"Christian Tshebeletso Ngaka"}]},{id:"53159",doi:"10.5772/66574",title:"Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies",slug:"postoperative-cognitive-dysfunction-preclinical-highlights-and-perspectives-on-preventive-strategies",totalDownloads:1965,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"One of the common complications associated with anaesthesia and surgery in geriatric patients is the postoperative cognitive dysfunction (POCD). This cognitive impairment affects the long-term prognosis and has been shown to be associated with long-term disability, higher health care costs, and even increased mortality. On the other hand, clinical research on POCD is in its infancy, the condition has not been clarified, and since no strategy for management is currently available, it is imperative to develop specific methods for prevention and management. Although its pathogenesis involves various factors, accumulating evidence suggests that surgery elicits an inflammatory response in the hippocampus, a brain area closely related to cognitive function, playing a key role in the development of POCD. Several studies suggest that age-related phenotypic change of microglia is associated with pathogenic neuroinflammation, and more importantly it may be modifiable. In this chapter, we discuss the current overview and preclinical highlights regarding POCD. We further discuss some perspectives on preventive strategies for POCD, based on the findings of our preclinical research and the available literature.",book:{id:"5490",slug:"current-topics-in-anesthesiology",title:"Current Topics in Anesthesiology",fullTitle:"Current Topics in Anesthesiology"},signatures:"Fabricio M. Locatelli and Takashi Kawano",authors:[{id:"169688",title:"Dr.",name:"Takashi",middleName:null,surname:"Kawano",slug:"takashi-kawano",fullName:"Takashi Kawano"},{id:"191676",title:"Dr.",name:"Fabricio",middleName:null,surname:"Locatelli",slug:"fabricio-locatelli",fullName:"Fabricio Locatelli"}]},{id:"77934",doi:"10.5772/intechopen.99282",title:"Regional Analgesia for Knee Surgeries: Thinking beyond Borders",slug:"regional-analgesia-for-knee-surgeries-thinking-beyond-borders",totalDownloads:301,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Knee surgeries are the most commonly performed joint surgeries in the modern world, which help maintain the quality of life by improving joint functions. These include open trauma, sports injury, or joint replacement surgeries. Among various available regional analgesia options for knee surgeries, the goal is to choose motor-sparing, opioid-sparing, and procedure-specific modalities. Therefore, it is essential to know the complex anatomy of the knee joint, essential steps of various surgical procedures, and innervations of the pain-generating structures for a particular surgery. Background knowledge of all these essentials helps select the most appropriate regional analgesia technique for knee surgeries.",book:{id:"10708",slug:"topics-in-regional-anesthesia",title:"Topics in Regional Anesthesia",fullTitle:"Topics in Regional Anesthesia"},signatures:"Kartik Sonawane and Hrudini Dixit",authors:[{id:"351728",title:"Dr.",name:"Kartik",middleName:null,surname:"Sonawane",slug:"kartik-sonawane",fullName:"Kartik Sonawane"},{id:"351737",title:"Dr.",name:"Hrudini",middleName:null,surname:"Dixit",slug:"hrudini-dixit",fullName:"Hrudini Dixit"}]}],mostDownloadedChaptersLast30Days:[{id:"65467",title:"Anesthesia Management for Large-Volume Liposuction",slug:"anesthesia-management-for-large-volume-liposuction",totalDownloads:5965,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"53389",title:"Anesthesia for Urological Surgery",slug:"anesthesia-for-urological-surgery",totalDownloads:3545,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Because of the variable techniques and patients’ positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this matter, it is important to follow current approaches for anesthesiologists. Different surgical procedures and complications due to different positions or anesthesia were evaluated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery.",book:{id:"5490",slug:"current-topics-in-anesthesiology",title:"Current Topics in Anesthesiology",fullTitle:"Current Topics in Anesthesiology"},signatures:"Zeki Tuncel Tekgül, Burcu Özalp Horsanali and Mustafa Ozan\nHorsanali",authors:[{id:"59702",title:"Dr.",name:"Mustafa Ozan",middleName:null,surname:"Horsanali",slug:"mustafa-ozan-horsanali",fullName:"Mustafa Ozan Horsanali"},{id:"190164",title:"Dr.",name:"Zeki Tuncel",middleName:null,surname:"Tekgül",slug:"zeki-tuncel-tekgul",fullName:"Zeki Tuncel Tekgül"},{id:"195091",title:"Dr.",name:"Burcu Özalp",middleName:null,surname:"Horsanalı",slug:"burcu-ozalp-horsanali",fullName:"Burcu Özalp Horsanalı"}]},{id:"61712",title:"Functional Anatomy and Physiology of Airway",slug:"functional-anatomy-and-physiology-of-airway",totalDownloads:3739,totalCrossrefCites:1,totalDimensionsCites:5,abstract:"In this chapter, we scope the importance of functional anatomy and physiology of the upper airway. The upper airway has an important role in transporting air to the lungs. Both the anatomical structure of the airways and the functional properties of the mucosa, cartilages, and neural and lymphatic tissues influence the characteristics of the air that is inhaled. The airway changes in size, shape, and position throughout its development from the neonate to the adults. Knowledge of the functional anatomy of the airway in these forms the basis of understanding the pathological conditions that may occur. The upper airway extends from the mouth to the trachea. It includes the mouth, the nose, the palate, the uvula, the pharynx, and the larynx. This section also describes the functional physiology of this airway. Managing the airway of a patient with craniofacial disorders poses many challenges to the anesthesiologist. Anatomical abnormalities may affect only intubation, only airway management, or both. This section also focuses on the abnormal airways in obesity, pregnancy, children and neonate, and patients with abnormal facial defects.",book:{id:"6495",slug:"tracheal-intubation",title:"Tracheal Intubation",fullTitle:"Tracheal Intubation"},signatures:"Aslı Mete and İlknur Hatice Akbudak",authors:[{id:"237495",title:"Dr.",name:"Asli",middleName:null,surname:"Mete",slug:"asli-mete",fullName:"Asli Mete"},{id:"237882",title:"Dr.",name:"Ilknur",middleName:"Hatice",surname:"Akbudak",slug:"ilknur-akbudak",fullName:"Ilknur Akbudak"}]},{id:"60582",title:"Indications for Endotracheal Intubation",slug:"indications-for-endotracheal-intubation",totalDownloads:3689,totalCrossrefCites:1,totalDimensionsCites:0,abstract:"Endotracheal intubation may be required when respiratory distress or airway integrity cannot be achieved or maintained for any reason. It should be considered that intubation may be required when evaluating the patient, and that in the long term, airway protection will be needed or that the problem cannot be solved by noninvasive ventilation via airway aids and devices. Identifying the problem causing the patient’s respiratory failure helps in making the decision to intubate. In fact, the clinician must be fast and self-confident when deciding on intubation. It is difficult to decide in some complex situations. It is very important to evaluate the patient, according to clinical status, age, and comorbidity, and to determine urgent intubation need. In non-diagnostic cases, further research is needed to investigate the causes of the condition such as hypoxia/hypercapnia resulting in patient respiratory distress. Different voice tone, swallowing difficulties, coughing attacks, stridor, dyspnea can be a sign of upper airway obstruction. Arterial blood gas analysis will facilitate our decision to make intubation. Non-invasive pulse oximetry and continuous capnography values may also be a guide, but the most important thing is that delayed intubation decision may bring life-threatening situations.",book:{id:"6495",slug:"tracheal-intubation",title:"Tracheal Intubation",fullTitle:"Tracheal Intubation"},signatures:"Yeliz Şahiner",authors:[{id:"236458",title:"Dr.",name:"Yeliz",middleName:null,surname:"Şahiner",slug:"yeliz-sahiner",fullName:"Yeliz Şahiner"}]},{id:"64750",title:"Perioperative Complications in Plastic Surgery",slug:"perioperative-complications-in-plastic-surgery",totalDownloads:1398,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. The proper selection and correct preoperative assessment of patients are the key to stay away from unwanted events. Preanesthesia evaluation is mandatory in each patient and must include clinical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, type of surgery, experience of the anesthesiologist, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of moving away from the guidelines already established for an excellent practice or the result of sentinel events rather than human errors. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most frequent complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, dehiscence of wounds, brain damage, and dead. Anesthesiologists, surgeons, nurses, and all personnel involved in the care of these patients must work as a team of highly qualified and updated professionals.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Víctor M. Whizar-Lugo, Jaime Campos-León and Alejandro\nMoreno-Guillen",authors:[{id:"169249",title:"Prof.",name:"Víctor M.",middleName:null,surname:"Whizar-Lugo",slug:"victor-m.-whizar-lugo",fullName:"Víctor M. Whizar-Lugo"},{id:"170821",title:"Dr.",name:"Jaime",middleName:null,surname:"Campos-León",slug:"jaime-campos-leon",fullName:"Jaime Campos-León"}]}],onlineFirstChaptersFilter:{topicId:"1139",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:317,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"June 11th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). 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Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",slug:"ana-isabel-flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",slug:"christian-palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",slug:"azhar-rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",slug:"sergey-sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",slug:"attilio-rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",slug:"yanfei-(jacob)-qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. 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He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. 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Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",annualVolume:11413,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://mts.intechopen.com/storage/users/81926/images/system/81926.png",institutionString:"Suez Canal University",institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/304293",hash:"",query:{},params:{id:"304293"},fullPath:"/profiles/304293",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()