Most frequent procedures according to gender [1].
\\n\\n
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7991",leadTitle:null,fullTitle:"Understanding the Molecular Crosstalk in Biological Processes",title:"Understanding the Molecular Crosstalk in Biological Processes",subtitle:null,reviewType:"peer-reviewed",abstract:"It is essential to address the aspects related to the crosstalk approach in understanding complex biological processes in different organisms, including plants, microorganisms, animals, and humans. This will definitely provide the information required to achieve the biological advancements. Therefore, this book highlights the advances made in the research field covering crosstalk in different biological processes. Current research trends, future research directions, and challenges are also addressed. This book will provoke the interest of various readers, researchers, and scientists who will find this information useful for the advancement of their research on biological processes in living organisms.",isbn:"978-1-78984-893-9",printIsbn:"978-1-78984-892-2",pdfIsbn:"978-1-83881-965-1",doi:"10.5772/intechopen.77821",price:100,priceEur:109,priceUsd:129,slug:"understanding-the-molecular-crosstalk-in-biological-processes",numberOfPages:90,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a4b678bab3a6334187a4fb5bb44a3811",bookSignature:"Mohamed A. 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El-Esawi is a visiting research fellow at the University of Cambridge, United Kingdom, and Associate Professor of Molecular Genetics, Botany Department, Faculty of Science, Tanta University, Egypt. Dr. El-Esawi received his BSc and MSc from Tanta University, and his Ph.D. degree in Plant Genetics and Molecular Biology from Dublin Institute of Technology, Technological University Dublin, Ireland. After obtaining his Ph.D., Dr. El-Esawi joined the University of Warwick, United Kingdom; University of Sorbonne, France; and University of Leuven (KU Leuven), Belgium as a visiting research fellow. His research focuses on plant genetics, genomics, molecular biology, molecular physiology, developmental biology, plant-microbe interaction, and bioinformatics. He has authored several international peer-reviewed articles, book chapters, and books, and has participated in more than sixty conferences and workshops worldwide. 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In contrast, obese females accumulate excessive fatty tissue predominantly subcutaneously enjoying strong protection from the obesity-related diseases. The health advantage of obese women as compared with obese men may be attributed to their higher estrogen production and an increased transactivation of estrogen receptors (ERs). The recently clarified intracrine, paracrine, and endocrine functions of adipose tissue illuminate that concentrations of estrogens and the suitable expression and activity of ERs strongly define all regulatory functions in both men and women. All well-known cancer risk factors are in correlation with defects of estrogen signaling in partnership with glucose intolerance as estrogen regulates all steps of glucose uptake. In central obesity, increased secretions of cytokines and growth factors are not causal factors of developing insulin resistance, and unrestrained cell proliferation, but rather, they are compensatory processes so as to increase estrogen synthesis and ER transactivation. In conclusion, a causal therapy against obesity and obesity-related diseases aims to improve estrogen signaling in both men and women.",signatures:"Zsuzsanna Suba",downloadPdfUrl:"/chapter/pdf-download/66864",previewPdfUrl:"/chapter/pdf-preview/66864",authors:[{id:"290038",title:"Prof.",name:"Zsuzsanna",surname:"Suba",slug:"zsuzsanna-suba",fullName:"Zsuzsanna Suba"}],corrections:null},{id:"66554",title:"Oral Health and Cardiovascular Disorders",doi:"10.5772/intechopen.85708",slug:"oral-health-and-cardiovascular-disorders",totalDownloads:854,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Several studies reported the cross talk between oral health and cardiovascular disorders. The aim of the present chapter is to review the main mechanisms linking oral and cardiovascular disorders, the main pathologies which could be linked, and possibilities for prophylactic and therapeutic interventions. Periodontitis was associated with cardiovascular risk, and the links between the two entities are represented by bacteria and their toxins released into the blood, causing endothelial dysfunction and providing a proatherogenic and prothrombotic effect and an inflammatory and immune reaction. The mentioned mechanisms explain the reported associations of periodontitis with stroke, coronary heart disease, and peripheral vascular disease. Periodontitis was also associated with diabetes mellitus and impaired lipid metabolism. Not all studies confirmed the association between periodontitis and coronary artery disease or stroke. Tooth loss, the most important consequence of periodontitis, has been also associated with cardiovascular disease. Dental and pulpal caries were also found to be independent risk factors for atherosclerosis, while restorations were inversely related to an atherosclerotic burden. Sucrose is involved in both cariogenesis and atherosclerosis. Fluorides prevent aortic calcifications and enamel demineralization and inhibit bacterial metabolism but are cardiotoxic. Heightening awareness of good dental hygiene can improve cardiovascular health.",signatures:"Ioana Mozos and Dana Stoian",downloadPdfUrl:"/chapter/pdf-download/66554",previewPdfUrl:"/chapter/pdf-preview/66554",authors:[{id:"63258",title:"Prof.",name:"Ioana",surname:"Mozos",slug:"ioana-mozos",fullName:"Ioana Mozos"},{id:"182103",title:"Dr.",name:"Dana",surname:"Stoian",slug:"dana-stoian",fullName:"Dana Stoian"}],corrections:null},{id:"68073",title:"The “Weight” of Obesity on Arterial Hypertension",doi:"10.5772/intechopen.87774",slug:"the-weight-of-obesity-on-arterial-hypertension",totalDownloads:903,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The prevalence of obesity and its related diseases are increasing worldwide. This phenomenon has been observed not only in adults but also in adolescents and children. Numerous scientific studies have revealed a direct correlation between the increase in blood pressure and weight gain. In fact, visceral fat can contribute to the rise in blood pressure because it is associated with an increased production of inflammatory cytokines (such as interleukin-1-β, tumor necrosis factor-α and interleukin-6) and inflammatory factors (such as C-reactive protein), inducing endothelial dysfunction and consequently arterial hypertension (AH). Insulin resistance, which develops in obese individuals, may represent an additional risk factor in the onset of AH. Postprandial hyperglycemia is not able to inhibit lipolysis, inducing a greater release of free fatty acids causing metabolic abnormalities, oxidative stress and vascular dysfunction. In this chapter, we will examine the mechanisms that correlate obesity to hypertension, such as the involvement of the sympathetic nervous system, metabolic and renal alterations. Finally, the pharmacological and nutritional treatment of obesity-related hypertension will be described.",signatures:"Annalisa Noce and Nicola Di Daniele",downloadPdfUrl:"/chapter/pdf-download/68073",previewPdfUrl:"/chapter/pdf-preview/68073",authors:[{id:"292924",title:"Prof.",name:"Nicola",surname:"Di Daniele",slug:"nicola-di-daniele",fullName:"Nicola Di Daniele"},{id:"292925",title:"Prof.",name:"Annalisa",surname:"Noce",slug:"annalisa-noce",fullName:"Annalisa Noce"}],corrections:null},{id:"68293",title:"Predictors of Resistance Hypertension and Achievement of Target Blood Pressure Levels in Patients with Resistant Hypertension",doi:"10.5772/intechopen.88126",slug:"predictors-of-resistance-hypertension-and-achievement-of-target-blood-pressure-levels-in-patients-wi",totalDownloads:617,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Uncontrolled arterial pressure is associated with a fourfold increase in the risk of developing cardiovascular events compared to patients with hypertension who have reached the target blood pressure level. The aim of this study is to evaluate the characteristics of patients with resistant arterial hypertension undergoing inpatient treatment at the Department of Symptomatic Hypertension and assess the prevalence of true resistant hypertension in a cohort of patients who take 3 and more antihypertensive agents, the clinical predictors of resistant hypertension. The study included 1146 patients with resistant AH who received 3 or more antihypertensive drugs with the level of office blood pressure at admission ≥140/90 mm Hg. Patients were followed by the next examinations: body height and body measurements, office blood pressure, echocardiography, sleep apnea determination, blood biochemical analysis, determination of levels of TTH, T3, T4, blood renin, blood aldosterone, metanephrine urine, and cortisol. Our data showed that 31% of patients who received 3 or more antihypertensive drugs had true resistant hypertension. Fixed combinations were taken by 71.9% of patients. We have found which factors were significantly associated with the treatment regimen with ≥3 or 4 drugs. 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\r\n\tBook on Advances in Virtual Reality will intend to present current exercises and research in the area of VR in Business and Prediction Systems. The book is dedicated to designing, development, management, implementation, technology, and application issues in VR. It will aim to emphasize theories, systems, methods, algorithms, techniques, and applications in VR, AR, Security aspects, Business benefits, customer perception, etc. This book will intend to act as an interface between communication technologies and their contribution to the business. This book aims to include high-quality applications, survey and tutorial-related articles, case studies, and short research notes reflecting global business models contributing to the state-of-art advances in the fields. Chapters on the topics of VR and Artificial Intelligence, decision support systems and tools using VR, Data Storage in VR, Picture Quality in VR, and Embedded systems are welcome, as well as topics on emerging applications of VR, VR in tourism, and Travel, VR in On-line customer support, Storage of VR applications in the cloud, VR in biomedical Engineering.
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The American Society for Aesthetic Plastic Surgery reported that in 2016 in the USA 17.1 million surgical and nonsurgical cosmetic procedures were performed, a figure that indicates a 132% increase since 2000. These procedures represented an expenditure of approximately 16.4 billion US dollars, where breast augmentation is the most popular surgery and the application of Botox is the most performed nonsurgical procedure [1]. Other interesting aspects that have grown around plastic surgery are ambulatory surgery units, short-stay units, and procedures performed in plastic surgeons’ medical offices. It is important that anesthesiological care does not decline when surgery is performed in this type of facility and the media and plastic surgeons must be made aware, so they do not minimize the risks of this type of surgery, which from the point of view of the anesthesiologists are medium- and high-risk procedures [2, 3]. Regardless of where the surgery is performed, patient safety should be the primary issue at the time of anesthesia-surgery and during its immediate recovery. To ensure patient safety, there are several guidelines that list the most important points of accomplishment that should be followed in this regard. The published guide from SCARE [4], which emphasizes various points of safety, especially the mechanical and pharmacological prophylaxis of deep venous thrombosis (DVT) and pulmonary thromboembolism (PE). A review of the literature on liposuction complications establishes strict guidelines on lidocaine and epinephrine doses, PE prophylaxis, adequate hydration, and other management recommendations [5].
The advances in plastic surgery have been furthered by the progress in anesthesiology, making it the cornerstone on which the surgical progress has been made. Now, it is possible to carry out prolonged and more elaborate surgeries in patients with concomitant pathologies or with anesthesia risks that some years ago were not possible to achieve with the current safety. The availability of new anesthetics and adjuvant drugs, advances in trans- and postoperative monitoring, as well as the early prevention of complications have facilitated these advances. The list of plastic surgical procedures is very extensive, and anesthesia plays a vital role: from local techniques to neuraxial anesthesia and general inhaled or intravenous anesthesia procedures. The growth of outpatient procedures in cosmetic surgery requires effective anesthetic techniques that allow safe home returns shortly after the surgery is over. It is ideal that no surgical procedure in plastic surgery is performed without the presence of a qualified anesthesiologist.
This chapter serves as an introduction to this book, the most frequent plastic surgery procedures are listed, as well as the anesthesia techniques considered to be the most advanced.
It is important that the anesthesiologist be familiar with all surgical procedures to establish an optimal anesthetic approach (see Graphic 1 and Tables 1 and 2). It is also important to keep in mind that the original surgical plan changes frequently; these last-minute modifications obey the wishes of the patient and sometimes the needs that arise during surgery, situations that lead to adjust the original anesthetic plan.
Most frequent cosmetic surgeries.
Surgery | Women | Men |
---|---|---|
Breast augmentation | 355, 671 | |
Liposuction | 309,692 | 31,453 |
Blepharoplasty | 166,426 | 28,678 |
Abdominoplasty | 143,005 | |
Breast reduction | 139,926 | |
Rhinoplasty | 30,174 | |
Gynecomastia | 19,124 | |
Hair implantation | 18,062 |
Most frequent procedures according to gender [1].
Procedures | Anesthesia | Patient stay | Observations |
---|---|---|---|
• Facial surgery | |||
Rhytidoplasty | CS/GA | 24 hours | Moderate pain |
Coronal | CS/GA | Ambulatory | Fast track |
Open rhinoplasty | CS/GA | Ambulatory | Fast track |
Rhinoplasty with bone fracture | GA | Ambulatory | Moderate pain |
Blepharoplasty | MAC/CS | Ambulatory | Fast track |
Otoplasty | MAC/CS | Ambulatory | Fast track |
Laser dermabrasion | CS | Ambulatory | Moderate pain |
Implants | MAC/CS | Ambulatory | Fast track |
Fat grafting, synthetic materials | MAC/CS | Ambulatory | Fast track |
• Body surgery | |||
Breasts or pectorals | PDB/GA | Ambulatory | Moderate pain |
Liposuction | SB, PDB, GA, or local | Ambulatory −24 hours | Mild to moderate pain, bleeding, anemia |
Torso | PDB /GA | Ambulatory | Moderate pain |
Abdominoplasty | SB, PDB/GA | 24 hours | Moderate pain, anemia |
Breast pexia of inferior segment | PDB/GA | 24 hours | Moderate pain, anemia |
Buttocks implants | SB/PDB/GA | Ambulatory | Moderate pain |
• Limb surgery | |||
Brachioplasty | PDB/GA | Ambulatory | Moderate pain |
Cruroplasty | SB/PDB/GA | Ambulatory −24 hours | Moderate pain |
Liposuction | SB/PDB/GA | Ambulatory | Mild pain |
Most frequent procedures in cosmetic surgery.
CS = conscious sedation; GA = general anesthesia; PDB = peridural block; SB = spinal block; MAC = monitored anesthetic care; fast track = direct access to hospital room.
Table 2 lists the most frequent surgical procedures in plastic surgery and relates them to the most used anesthesia techniques, making some important observations in postanesthetic care and evolution. These techniques are the most recommended, being possible to use other alternatives or through combinations of anesthetic methods [6].
In plastic surgery, it is common to combine two or more surgical procedures (breast-abdominoplasty, mommy makeover), which in addition to increasing the risks, prolongs the surgical time, and therefore the anesthetic plan must be adapted to the surgeon’s new approach. This fact can be determined before starting anesthesia, and in some patients, it is modified during surgery. For example, in a case where breast surgery is combined with abdomen procedures that could otherwise be managed with neuraxial anesthesia, a lumbar spinal anesthesia with hyperbaric local anesthetic and Trendelenburg position could disseminate the blockade up to T3 for breast surgery, which must be performed first, followed by the abdominal procedure [7]. This approach avoids general anesthesia and favors adequate postoperative analgesia with optimal recovery. Combined epidural-spinal anesthesia is another management option in this surgical setting.
“Primum non nocere” is a Latin phrase meaning “first, to do no harm” and is an old statement that has been one of the principal precepts of bioethics for several centuries. This concept is the purpose of pre-anesthetic assessment, which in patients scheduled for plastic surgery should not be any different from that of patients operated of other procedures and should be timely, complete, interdisciplinary, and dynamic. This evaluation is a vital instrument for the medical and nursing team, as well as for the patients and their families since it gives them the opportunity to know the patient and their environment, the reasons that led to surgery, fears of, and above all, to discuss the prejudices and doubts about anesthesia. These patients have peculiarities that make them different; on the one hand, most are healthy people, individuals who do not intend to cure a disease but to improve their self-esteem through better physical appearance. On the other hand, they are extremely demanding patients in terms of perfection in the results and do not tolerate errors or side effects. It is prudent to explain the various anesthetic techniques available for the type of surgery scheduled, as well as the benefits and risks of each anesthetic procedure, especially those attributed to the planned technique. It is also the best time for them to meet the anesthesiologist and become familiar with his/her credentials and experience. These last points are fundamental to gain patient confidence and to diminish their anxiety and the possibility of an eventual legal conflict.
The pre-anesthetic evaluation should be made several days in advance. Regardless of the physical condition of each patient, a complete clinical history and detailed and oriented physical examination are fundamental in the pre-anesthetic assessment. It is essential to determine the physical integrity or possible deterioration of the patient, especially the neurological and cardiopulmonary systems, as well as a detailed analysis of the airway and the spine. The patients must be evaluated regarding their emotional state and their ability to tolerate surgeries with prolonged times and difficult recoveries. Plastic surgery patients are divided into two major categories: healthy patients and patients with one or more systemic pathologies, such as acquired heart diseases, pneumopathies, diabetes mellitus, venous insufficiency, and hyperlipidemia, this last one being the most common. The age at which cosmetic surgery is performed is variable: 35–50 years (45%), 51–64 years (26%), 19–34 (22%), 65 or more (6%), and minors to 18 years (2%) [3].
During this pre-anesthetic interview, the intake of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin E, weight loss medications, contraceptives, herbs, as well as history of illegal drug use or any prescription medicines should be questioned. It is frequent that these “healthy” patients utilize thyroid hormones, antidepressants, benzodiazepines, high doses of vitamins and minerals, as well as herbs, food supplements, and teas that could interact with the drugs used in the perianesthesiological time. Patients underestimate the importance to ingest these products, so it is imperative that both the surgeon and the anesthesiologist emphatically investigate whether patients ingest such products since many of them have anticoagulant, antiplatelet, procoagulant, and arrhythmic or potentiate the effects of anesthetics. Heller et al. [10] found that plastic surgery patients used herbs or supplements in 55% versus the general population 24% (p < 0.001). The most used by their patients were chondroitin 18%, ephedra 18%, echinacea 8%, garlic 6%, ginseng 4%, and ginger 4%. Fifty-four percent of the supplements/herbs taken by these patients have pharmacological interference with anesthetic drugs or can affect surgery. In 85% of the cases, patients were not told to stop taking these herbs or supplements before surgery, except for those who ingested ephedra in which 100% of the surgeons indicated their suspension. This study demonstrated the ignorance of physicians regarding the undesirable effects of herbalism in plastic surgery patients. A Mexican study in ambulatory patients [11] found that 65% took ginseng and
Product | Effect | Product | Effect |
---|---|---|---|
Fish oil | Antiplatelet, vasodilation | Kava ( | Interacts with local anesthetics, barbiturates, increase sedative potency |
Garlic ( | Antiplatelet | St. John’s wort ( | Induces cytochrome P450 3A4. Interacts with midazolam, alfentanil, lidocaine, calcium blockers, and serotonin receptor agonists |
Alfalfa ( | Anticoagulant Enhances warfarin and ginger effect | Ginseng ( | Anticoagulant |
Dong quai | Anticoagulant, antiplatelet | Wild lettuce | Enhances warfarin |
Anise | Anticoagulant | Black cohosh | Antiplatelet |
Celery | Antiplatelet | Arnica | Anticoagulant |
Saffron | Anticoagulant | Papain (papaya proteinase I) | Hemorrhage risk |
Boldo ( | Enhances warfarin | Kelp | Anticoagulant |
Bromelain | Anticoagulant | Coagulant | |
Anticoagulant | Horseradish | Anticoagulant | |
Onion | Antiplatelet | Licorice root ( | Antiplatelet |
Clove | Antiplatelet | Red clover | Anticoagulant |
Chili pepper (Nahuatl chili) | Antiplatelet | Turmeric ( | Antiplatelet |
Ephedra | Vasoconstriction, cardiac infarction, cerebral thrombosis, arrhythmias, hypertension | Increases sedative effect | |
Echinacea | Promotes infections, allergies, probable hepatotoxic and impaired blood flow | Vitamin E | Antiplatelets |
Gingko biloba | Antiplatelet | Asiatic ginseng | Anticoagulant, antiplatelets, hypoglycemic |
Effects of some herbs and foods.
Elderly patients require a more elaborate evaluation, in which it is wise to include the geriatrician. In this group of sick patients, a list that includes all the medications they take should be made, including antihypertensive, diuretic, vasodilator, MAO inhibitors, antidepressants, analgesics, hormones, hypoglycemic agents, vitamins and minerals, etc. The anesthesiologist must be familiar with these drugs and know their possible drug interactions. The usual pre-anesthetic assessment parameters in healthy patients and patients with comorbidities are listed in Table 4.
Parameters | ASA 1 | ASA 2–3 | Observations |
---|---|---|---|
Clinical history | Yes | Yes | The general and oriented clinical review made by the anesthesiologist anticipates problems such as difficult airway, spinal anomalies, mental alterations, family environment, and possibility of a lawsuit |
Physical examination | Yes | Yes | |
Specialist consultation | NE | Yes | It is prudent to know the opinion of the geriatrician, pulmonologist, cardiologist, endocrinologist, surgeon, and family therapist in search of polypharmacy, drug interactions, etc. |
Electrocardiogram | Only >50 years old | Yes | Arrhythmias, ischemia, growth, or dilatation of heart cavities |
Chest X-ray | NE | Yes | Useful in smokers, suspected tuberculosis, neoplasms, emphysema, kyphosis |
Echocardiogram | No | R | Compulsory study in patients with severe arterial hypertension, ischemic patients, and patients with dilated cardiomyopathy |
Spirometry | No | R | Its usefulness has not been demonstrated; however, it is recommended in chronic pneumopathy and smokers |
Blood test | Yes | Yes | Diagnosis of subclinical anemia |
Coagulation tests | Yes | Yes | TP, TPT, INR, and bleeding time are mandatory in anticoagulants, hepatocellular damage, severe sepsis, prolonged fasting, and extreme malnutrition |
Complete blood chemistry | Yes | Yes | Kidney, hepatocellular, metabolic, and electrolyte evaluation |
Urinalysis | NE | Yes | Loss of blood and proteins, changes in urine density |
HIV, hepatitis, drugs, pregnancy | R | R | They are requested based on the clinical history and experience data. HIV is prudent for the protection of medical and paramedical personnel |
Parameters for pre-anesthetic evaluation in plastic surgery [5].
NE = not essential; R = recommendable.
There are patients who should not be operated, and this decision must be made by the anesthesiologist, regardless of the opinion of the patient and his/her surgeon since loss of safety rules leads to catastrophic nonreversible events [14].
Once the anesthetic assessment has been finalized and the best anesthetic plan has been agreed upon and the possible eventualities discussed, the informed consent must be obtained, which as a rule must be signed by the patient, the doctor, and a witness. This document should mention the details of the proposed anesthetic technique, its side effects, and possible complications in a detailed manner. A well-prepared informed consent is a legal document that does not exclude us from a lawsuit, but when it is not done properly, it can be a legal component against the medical team [14, 15, 16].
The goal of pre-anesthetic medication is to help the patient to arrive to the operating room with sedation, hypnosis, prevention of nausea and vomiting, and with preemptive analgesia. Midazolam and lorazepam are the most commonly used benzodiazepines. Midazolam is more useful in short procedures, although it is less amnesic than lorazepam. There is evidence that melatonin 3–10 mg administered as part of pre-anesthetic medication reduces preoperative anxiety, decreases postoperative pain intensity and opioid consumption, improves postoperative sleep quality, and reduces emergence behavior and postoperative delirium. Also, preoperative melatonin could reduce oxidative stress and anesthetic requirements [17, 18, 19, 20]. To prevent nausea and vomiting, it is advisable to use two or more drugs [21]; combining droperidol with dexamethasone is as effective as the combination of ondansetron with dexamethasone. Metoclopramide tends to disappear due to its low clinical effectiveness compared to the new antiemetics. It is convenient to administer omeprazole or ranitidine to reduce the acidity and volume of the gastric secretion. Preemptive analgesia is achieved with the administration of various drugs such as intravenous magnesium, NSAIDs, gabapentinoids, and ketamine to name a few.
In general terms, regional anesthesia techniques are more recommendable than those of general anesthesia since they have less complications and favor a safer recovery, with better postoperative analgesia. In the following paragraphs, several anesthetic procedures are discussed and are related primarily to outpatient surgery since most plastic surgery patients are discharged the same day of their intervention. Figure 1 shows all the anesthetic techniques that can be used in plastic surgery procedures, a wide range of combinations being possible.
Anesthesia techniques that can be used for plastic surgery.
For more details of some anesthetic technique, the reader is referred to the pertinent chapters of this book.
The objective of conscious sedation is to have a patient in a status of restfulness that allows the surgeon to inject local anesthetics and perform their operative procedure with safety and comfort for the patient, while the anesthesiologist is responsible for drug sedation and checking the stability of all systems using conventional monitoring and added BIS. The most frequent surgeries are those of the face and neck, hair implants, liposuction of small areas, dermabrasion with laser, and occasionally breast implants. A clear understanding must be established with the patient and the surgeon about the objectives of conscious sedation:
Spectrum of alertness, conscious sedation, deep sedation, and general anesthesia [
There are several types of drugs that are used in conscious sedation: anxiolytics, sedatives, butyrophenones, barbiturates, hypnotics, opioids, and alpha2 agonists (Table 5).
Anesthesia techniques | Opioids | Benzodiazepines | Hypnotics | Alpha-2 | Anesthetic gases | Muscle relaxants |
---|---|---|---|---|---|---|
TIVA | Fentanyl, remifentanil, alfentanil | Midazolam | Propofol, ketamine | Dexmedetomidine | Nitrous oxide | Vecuronium rocuronium, atracurium |
General | Fentanyl Morphine | Midazolam, diazepam | Propofol, ketamine, thiopental | Clonidine, dexmedetomidine | Desflurane Sevoflurane Isoflurane | Vecuronium rocuronium, atracurium |
Conscious sedation | Fentanyl Remifentanil Morphine Buprenorphine | Midazolam, lorazepam | Propofol, ketamine, barbiturates | Clonidine, dexmedetomidine | No | No |
TCI | Remifentanil | No | Propofol | No | No | No |
Anesthesia techniques and examples of usual drugs.
MAC = monitored anesthetic care; TCI = target-controlled infusion.
The 2018 ASA guidelines for sedation added the following recommendations: patient evaluation and preparation, continual monitoring of ventilatory function with capnography to supplement standard monitoring by observation and pulse oximetry, presence of an individual in the procedure room with knowledge and skills to recognize and treat airway complications, sedatives and analgesics not intended for general anesthesia (e.g., benzodiazepines and dexmedetomidine), sedatives and analgesics intended for general anesthesia (e.g., propofol, ketamine, and etomidate), recovery care, and creation and implementation of quality improvement processes [22].
General anesthesia can be used in all plastic surgery procedures if the location where they have been scheduled fulfills with all safety regulations. This rule should not be violated, especially in medical offices that have been supplemented with an operating room (office based). General anesthesia techniques are used in very short procedures, in patients who reject regional techniques, and as a complement to regional anesthesia when this is not sufficient. In prolonged surgeries of more than 3 hours, it is prudent to avoid the use of general anesthesia when this is possible to prevent risks and undesirable side effects such as nausea, vomiting, oropharyngeal discomfort secondary to the endotracheal tube or laryngeal mask, DVT, PE, postoperative pain, postoperative delirium, and so on. The costs of general anesthesia, although not a definitive factor, do influence the anesthesiological decision, particularly when the procedures are very long. The selection of patients for general anesthesia must be meticulous and exclude those cases with associated pathologies: angina, recent history of cardiac infarction, cardiomyopathies, uncontrolled arterial hypertension, terminal renal failure, sickle cell anemia, patients in need of organ transplantation, active multiple sclerosis, severe chronic obstructive pulmonary disease, difficult airway, malignant hyperthermia, abuse of illegal drugs, dementia, myasthenia gravis, obstructive sleep apnea, and etcetera [23, 24]. In some of these associated pathologies, it is possible to perform plastic surgery; however, precautions must be taken for each disease due to potential complications.
When general anesthesia has been chosen, the drugs to be used should be selected for safety and anesthetic efficacy, in accordance with the surgical location. The ideal technique does not exist, but it must be ensured that it is with a gentle and rapid induction, with adequate operative conditions, with great hemodynamic stability and fast recovery, without side effects, with good control of postsurgical acute pain, with emesis, and with preventive management of postoperative chronic pain. There is not enough evidence to select one drug over another; however, the halogenated anesthetics desflurane, sevoflurane, and isoflurane have demonstrated their versatility in outpatients with a minimum of differences that do not impact the transoperative evolution or the recovery of patients [23, 25]. It is convenient to avoid nitrous oxide due to the high incidence of postoperative nausea and vomiting. Propofol, ketamine, and remifentanil have been widely accepted in this field, each of them having certain advantages. The combination of propofol-ketamine has been studied by Friedberg [25] and proposed as an alternative to inhalational anesthesia.
Regional anesthesia has had an increasing resurgence since it favors several positive aspects in the trans, operative period, and in the recovery phase. Local anesthesia is performed by the plastic surgeon in cases of minimal invasion such as blepharoplasty, chin implant, and some small liposuction among other procedures. Neuraxial anesthesia, especially spinal anesthesia, has been favored by its advantages (Table 6). Capdevila and Dadure [26] consider that the various techniques of regional anesthesia, including spinal anesthesia, are superior to general anesthesia in limiting adverse effects and readmissions to the hospital, with better control of postoperative pain [27]. In the following paragraphs, subarachnoid and epidural block are described, although the latter is less used because it has more possibilities of undesirable effects.
General | Sedation | Peridural | Spinal | Combined | PNB* | |
---|---|---|---|---|---|---|
Bleeding | ++++ | ++ | ++ | ++ | + a ++ | + a ++ |
DVT/TEP risk | High | Low | Low | Low | Low | Low |
Anesthetic toxicity | Remote | Remote | Feasible | Very remote | Feasible | Feasible |
Hypoxia PO | Frequent | Possible | Possible | Possible | Possible | Possible |
Analgesia PO | No | No | Yes | Yes | Yes | Yes |
Technical difficulty | Remote | No | Possible | Possible | Possible | Frequent |
Cognitive disorders | ++++ | ++ | ++ | ++ | + | No |
Cost | High | High | Medium | Low | High | High |
Advantages and disadvantages of the different techniques in anesthesia for plastic surgery.
Peripheral nerve block.
Neuraxial blocks offer several advantages over general anesthesia, as shown in Table 6. The decrease in metabolic response to trauma, postoperative analgesia, lower incidence of nausea and postoperative vomiting, and their low costs are just some of these advantages.
Surgery | Spinal | Epidural | APEC | |||
---|---|---|---|---|---|---|
Anesthetic | Adjuvant | Anesthetic | Adjuvant | Anesthetic | Adjuvant | |
Liposuction | L, B, LB, R, M | C, F | L, R, B, LB, M | C, F | L, R,B, LB, M | C, F, S |
Liposculpture | B, LB, R, M | C, F | L, R, B, LB, M | C, F | L, R,B, LB, M | C, F, S |
Buttocks implants | L, B, LB, R, M | C | L, B, LB, R, M | C | L, R,B, LB, M | C, F, S |
Calf implants | L, B, LB, R, M | C | L, B, LB, R, M | C | L, R,B, LB, M | C, F, S |
Breast with liposuction | B, LB, R, M | C, F | L, R, B, LB, M | C, F | L, R,B, LB, M | C, F, S |
Breast | — | — | L, R, B, LB, M | no | — | — |
Frequent procedures and regional techniques in ambulatory cosmetic surgery [20].
APEC = combined peridural-spinal anesthesia; L = lidocaine; B = racemic bupivacaine; LB = levobupivacaine; R = ropivacaine; M = mepivacaine; C = clonidine; F = fentanyl; S = sufentanil.
Surgery | Concentration of local anesthetic and total dose in mg | |||
---|---|---|---|---|
Ropivacaine (0.75%) | Levobupivacaine (0.75%) | Bupivacaine (0.5–0.75%) | Lidocaine (2%) | |
Liposuction | 10–22.5 | 7.5–18 | 7.5–15 | 50–100 |
Liposculpture | 10–22.5 | 7.5–18 | 7.5–15 | 50–100 |
Buttocks implants | 15 | 10 | 10 | 100 |
Calf implants | 15 | 10 | 10 | 100 |
Breast with liposuction | 22.5 | 18 | 18 | No |
When the scheduled plastic surgery is longer than 2 hours, it is advisable to add an adjuvant drug such as clonidine in doses of 75, 150–300 μg, fentanyl 12.5–25 μg, or sufentanil 5–10 μg [27, 35]. It is imperative to consider that the operative time could be longer than the surgeon’s estimate since there are many “dead times” that prolong the total time required to complete the surgery. Table 9 shows the possibilities of mixtures of local anesthetic plus adjuvants according to the expected surgical times. Note that the possibility of 1-hour surgeries is included, which is rare in this field: scar reviews, small areas of liposuction, perineal plasties, etc. The combination of procaine + clonidine + fentanyl is excellent. Low doses of local anesthetic of the family pipecoloxylidide (PPX) (bupivacaine, mepivacaine, ropivacaine, and levobupivacaine) are good but usually last longer, and in a very busy environment, they could prolong the time of home discharge. For surgeries lasting up to 2 hours, local anesthetic PPX in low doses and added adjuvant drugs are an ideal combination.
Approximate duration | Drugs and recommended doses | Observations |
---|---|---|
Surgery up to 1 hour | Lidocaine 30–100 mg | The use of lidocaine tends to disappear due to the possibility of local neurotoxicity |
Lidocaine 30–50 mg + clonidine 75 μg | ||
Lidocaine 30–50 mg + fentanyl 25 μg | ||
Bupivacaine 5–7.5 mg + clonidine 75 μg or fentanyl 25 μg | Local anesthetics of the PPX family used in low doses tend to replace the use of lidocaine in brief procedures | |
Levobupivacaine 5–7.5 mg + clonidine 75 μg or fentanyl 25 μg | ||
Ropivacaine 7.5–10 mg + clonidine 75 μg or fentanyl 25 μg | ||
Procaine 100–200 mg + clonidine 75 μg or fentanyl 25 μg | Its short duration improves with the addition of adjuvants | |
Surgery from 1 to 2 hours | Bupivacaine 10–15 mg + clonidine 150 μg and/or fentanyl 25 μg | The duration of the average doses of PPX local anesthetics is prolonged with the addition of clonidine in a dose-dependent manner |
Levobupivacaine 10–15 + clonidine 150 μg and/or fentanyl 25 μg | ||
Ropivacaine 15–20 + clonidine 75 μg and/or fentanyl 25 μg | ||
Surgery greater than 2 hours | Bupivacaine 15–20 mg + clonidine 150–300 μg and/or fentanyl 25 μg | High doses of clonidine favor spinal anesthesia that can reach 3–5 hours of surgical anesthesia, with excellent postoperative analgesia |
Levobupivacaine 15–20 mg + clonidine 150–300 μg, and/or fentanyl 25 μg | ||
Ropivacaine 20–30 mg + clonidine 150–300 μg and/or fentanyl 25 μg |
Local anesthetics and coadjuvant drugs in spinal anesthesia [20].
The local hyperbaric anesthetics have an ampler intrathecal cephalic diffusion than the isobaric ones, which is useful in the operative procedures in high dermatomes (upper abdomen and thorax). On the other hand, isobaric local anesthetics are better in the pelvis and lower extremities. Opioids, especially fentanyl, improve the quality of anesthesia without affecting recovery.
Subarachnoid anesthesia in plastic surgery procedures can be done with a single injection, with or without adjuvant drugs, usual doses, low doses or high doses, or combined with extradural anesthesia. The single injection with spinal anesthesia with mono-dose is an easy, safe, and economic technique that produces a deep anesthetic and motor block, with a low incidence of failure and undesirable side effects. It is the procedure most used in short- and medium-length surgeries, being able to be used in some prolonged procedures such as abdominoplasties with or without breast surgery. It is recommended to use small spinal needles G26, G27, and G29, with blunt tip, cutting tip, or special cutting tip. Low doses of long-acting local anesthetics play an important role in outpatients [27, 28]. A comparative study with 6 mg of hypobaric bupivacaine (0.5% in 1.2 mL) versus 6.1 mg of almost hypobaric bupivacaine (0.18% in 3.4 mL) had similar effects on the anesthetic level, duration of sensory, and motor block [36]. Dosage of 6 mg of bupivacaine versus 7.5 mg of bupivacaine [37], both doses added with 25 μg of fentanyl, has similar results in terms of diffusion, duration, and regression of the sensory block. Doses between 5 and 8 mg of ropivacaine, levobupivacaine, or bupivacaine provide up to 150 minutes of intrathecal anesthesia, enough time for most outpatient procedures in cosmetic surgery, time that can be prolonged with the addition of 150–300 μg of spinal clonidine up to 3–5 hours. The most used doses vary from 10 to 15 mg of hyperbaric bupivacaine, being possible to increase these doses up to 20–25 mg in special cases. Drowsiness, bradycardia, and hypotension of easy control are the most frequent effects.
|
|
General contraindications for neuraxial anesthesia.
Without pretending to exhaust the topic, this section reviews the usual anesthesia techniques for most common procedures in plastic surgery: breast implants, liposuction, abdominoplasty, rhytidoplasty, combined cosmetic surgeries, and fat transfer.
Breast implant surgery occupies the first place among cosmetic surgery procedures in the USA, and it is likely that the same happens in other countries. Most patients are healthy, but there are some cases of women with breast reconstruction and implants who have a history of surgery for breast cancer. Several anesthesia techniques have been described for this procedure such as general inhaled or intravenous anesthesia, cervicothoracic epidural block, intercostal blocks, facial plane blocks, and tumescent injection with lidocaine. The advantage of regional techniques is that it produces less nausea, vomiting, postoperative pain, and has a lower cost [41, 42]. Cervicothoracic epidural block with approach in C7–T1 and T3–T4, with lidocaine 1%, ropivacaine 0.75%, bupivacaine 0.5%, or levobupivacaine 0.5% (8–12 mL), produces enough anesthesia with better postoperative analgesia than general anesthesia. A single dose of one of the mentioned local anesthetics is adequate in most cases, and when required, a second epidural dose must be injected through the epidural catheter. Epinephrine 1:80,000 can be added (except when ropivacaine is used) to prolong duration of local anesthetics. The most common side effects include transient elevation of blood pressure with tachycardia, tremor, nasal congestion, and nausea. Hypotension and difficulty breathing are rare [42]. It is also possible to use paravertebral or intercostal nerve blocks. Since Blanco et al. described ultrasound-guided interfacial plane blocks for postoperative breast analgesia; modifications to the initial technique have been published [43, 44, 45]. Interfacial blocks score over traditional regional anesthetic procedures as they have no risk of sympathetic blockade, intrathecal or epidural spread which may lead to hemodynamic instability, and prolonged hospital stay [44]. These blocks are not an alternative to general anesthesia, epidural anesthesia, or paravertebral blocks since they do not produce adequate regional surgical anesthesia. However, they can be supplemented with intravenous sedation techniques, general anesthesia, or neuraxial anesthesia. Postoperative pain not only involves the breasts; it can extend to the sternum, lateral aspect of the thorax, armpits, and middle back, being more severe when the implants are submuscular. Postoperative pain can be managed with NSAIDs such as parecoxib, ibuprofen, ketoprofen, ketorolac, or diclofenac combined with low doses of opioids. Tramadol is recommended because of its dual mechanism of analgesic action. Methocarbamol can be associated with the previous scheme. Some investigators have found adequate analgesia with the continuous or intermittent administration of local anesthetics through catheters implanted during surgery [46, 47]. It has not been defined if paravertebral blocks decrease the incidence of chronic postoperative pain in breast surgery [48].
The evaluation of candidates for abdominal contour surgery allows patients to be classified according to the possibilities of surgery taking in consideration the skin, fat, and muscles. This group includes liposuction, abdominoplasty, abdominal muscle repair, and various combinations that lengthen the operative time such as a 360° liposuction and mommy makeover.
Plasticine model made by the patient to accurately show us the shape and size that she wants for her buttocks.
There are two types of liposuction: the dry technique and the tumescent one. The latter is defined as the removal of subcutaneous fat under anesthesia infiltrated with large volumes of saline solution added with epinephrine and a local anesthetic, usually lidocaine. The original definition excludes the use of another type of anesthesia, whether it is neuraxial or general, as well as the fact that it is done without the presence of an anesthesiologist. However, currently this type of liposuction is frequently done with epidural block, with spinal anesthesia, or with general anesthesia, in addition to infiltration with Klein’s solution (50 mL of 1% lidocaine solution (500 mg), 1 mL of 1:1000 epinephrine (1 mg), 1000 mL of 0.9% saline, and 12.5 mL of 8.4% NaH2CO3 solution (12.5 mEq)) [50]. This type of anesthesia involves a dose of lidocaine 35–55 mg/kg of body weight and added epinephrine to achieve concentrations of 0.25–1.5 mg/L, without exceeding total adrenaline total dose of 50 μg/kg. These high doses make it obligatory to perform these procedures in surgery rooms that have all the facilities for monitoring, cardiac resuscitation, ventilatory support, and, always, recovery area under the care of an anesthesiologist. It is an apparently low-risk procedure, which can be complicated by systemic toxicity from local anesthetics, hypothermia, fat embolism, electrolyte imbalances with fluid overload, and/or acute anemia [51, 52]. One of the limitations during cosmetic surgery, especially during tumescent liposuction, is the total dose of the local anesthetic. For this reason, it is advisable not to combine liposuction with other procedures that require the injection of local anesthetics as the maximum dose of these drugs can be exceeded. There is no informed agreement in the literature on what is the top dose of lidocaine; the literature written by dermatologists and plastic surgeons mentioned 55 mg/kg of weight [50, 52, 53, 54], whereas the literature that comes from investigations carried out by anesthesiologists mentions 5 mg/kg of weight. In Europe, it is considered safe to use a total of 200 mg of lidocaine without epinephrine, and up to 300 mg is allowed in the United States of America. When epinephrine is added, the lidocaine dose in both regions is 500 mg. Epinephrine 1:200,000 reduces absorption of subcutaneous lidocaine by 50% and intercostal, epidural, and brachial in 20–30% [55]. PPX local anesthetics should never be used in tumescent liposuction. There is no agreement on the best anesthetic technique for liposuction, whether it is the modality under local anesthesia with the Klein solution or with general anesthesia or neuraxial block. With both procedures deaths have been reported [49, 56, 57], and the reports are not completely reliable.
The total volume of fat removed should not exceed 5 L in a single intervention or not be greater than 5% of body weight [58, 59]. Higher volumes increase the risk of complications, especially hypovolemia due to bleeding and acute hydro-electrolytic alterations. Another topic of interest in the management of these patients is the replacement of fluids during the trans-anesthetic period; Trott et al. [60] recommended the following scheme: (a) liposuction of small volumes (<4 L of aspirate) = maintenance liquids + the volume of the injected subcutaneous solution and (b) liposuction of large volumes (aspirated ≥4 L) = maintenance liquids + the volume of the solution injected +0.25 mL intravenous crystalloids per mL of aspirate extracted after 4 L. These authors emphasize that this fluid replacement guide does not replace a good clinical criterion and communication between the surgeon and the anesthesiologist is always fundamental. The goal is to maintain a normal intravascular volume with a postanesthetic hematocrit above 30% and albumin levels above 3 g.
The so-called 360° liposuction has become fashionable. It is a procedure that combines liposuction of the entire truncal midsection to accomplish a complete curvier contour figure from every angle. It can be combined with dermolipectomy, with plication of the rectus abdominis muscle, and with or without umbilicoplasty or gluteal fat grafting [61, 62].
In our opinion, general anesthesia should be avoided and reserved for very select, complex cases or for patients who cannot tolerate or cooperate with conscious sedation [6]. The selection is indistinct and must be based on the physical conditions of the patient. In Lotus Med Group, we use isoflurane, sevoflurane, or desflurane and avoid or minimize the use of muscle relaxants. When the patient is extubated, special attention should be paid to avoid coughing and bowing that may facilitate bleeding in the surgical site.
Acute postoperative pain is an unresolved issue, including plastic surgery patients. Most plastic surgery procedures are accompanied by moderate/intense postoperative pain that can be disabling and prolong the hospital stay. The multiple neural ending injuries in liposuction and tummy tuck, even muscle elongations during breast implants, are just some examples that make it necessary to plan a rational analgesic scheme. The ideal analgesia should start from the pre-anesthetic phase using preemptive and preventing drugs. The combined use of opioids with NSAIDs is the cornerstone in the prevention and management of pain after plastic surgery. The controversy not clarified about the utility versus the negative effects of cyclooxygenase inhibitors has favored multiple investigations whose results allow the safe use of these drugs. Celecoxib 400 mg preoperatively followed by 200 mg every 12 hours reduces pain; total dose of opioids facilitates early recovery [70]. Parecoxib 40 mg i.v. every 12 hours is effective, and when methylprednisolone 125 mg intravenously is associated before surgery, it significantly reduces emesis [71]. This combination also reduces postoperative fatigue. The combination of tramadol with ketorolac is part of our routine, being able to replace acetaminophen with codeine. Mild pain can be treated with acetaminophen-codeine or sodium metamizole (dipyrone). Pregabalin and gabapentin may have a preventive analgesic effect. Sener et al. [72] found that in patients of septorhinoplasty lornoxicam (25 mg/day) has better tolerability and postoperative analgesia than dipyrone (5 mg/day) administered with a system of analgesia i.v. controlled by the patient. Gabapentinoids (gabapentin, pregabalin) and ketamine have additive or synergistic effects that decrease the doses of anesthetics in the transoperative and opioids in the immediate postoperative period.
Although the analgesic mechanism of esmolol (ultrashort-acting cardio-selective β1-adrenergic receptor antagonist) is not well known [73], some clinical studies have resulted in a decrease in propofol during the induction of general anesthesia, a reduction of general anesthetics during maintenance, and a reduced dose of transoperative opioids, as well as it reduces immediate postoperative pain [74, 75, 76]. Its use in rhinoplasty seems to reduce the dose of opioids in the intraoperative period and the intensity of immediate postoperative pain [77, 78].
Regional analgesia, as mentioned before, has a very important role: local anesthesia infiltrations and interfacial, paravertebral, intercostal, or epidural blocks.
Outpatient or short-stay plastic surgery patients should observe home discharge criteria that have been established for other types of surgery. These basic criteria establish the home discharge of patients in a safe manner and avoid readmissions due to complications. Uncontrolled pain, nausea, vomiting, and urinary retention are examples of frequent readmission to the surgical unit or hospital. In some patients it is not necessary to meet 100% of these discharge criteria, but they should be warned of the natural evolution of the gradual disappearance of the side effects of anesthesia and facilitate telephone communication with the surgical unit, the surgeon, and the anesthesiologist. They require appropriate postanesthetic and postsurgical indications, transportation, and occasional professional company. Each ambulatory surgery unit/hospital must have its own discharge criteria, in accordance with the published guidelines and with its own characteristics and needs of their patients: from simple scales to more elaborate procedures such as the new Postoperative Quality Recovery Scale (PQRS) assessment that evaluates six areas: physiological, nociceptive, emotional, daily activities, cognition, and general patient perspective [79]. Table 11 shows the usual discharge home criteria. The proper information on the patient evolution at the recovery house or patient home favors the prevention and the opportune diagnosis of complications [80].
Hemodynamic stability | The return of vital signs to pre-anesthetic figures is mandatory |
---|---|
Alertness | Patient awake, well oriented. Spinal anesthesia favors this state of alert which facilitates optimal home discharges |
Permeable oral route | Tolerate the intake of liquids or solids without nausea or vomiting |
Analgesia | Controlled postoperative pain (EVA <2/10) with oral analgesics. Subarachnoid anesthesia with adjuvants provides a prolonged period of analgesia that facilitates early home discharge and reduces the dose of analgesics. It is convenient to prescribe a combination of opioid and non-opioid analgesics according to the expected postoperative pain and the profile of each patient |
Spontaneous micturition | This is a controversial requirement. Some centers consider it as mandatory to avoid readmissions by bladder balloon. In our practice we do not consider this requirement as indispensable, and the patient is informed of the remote possibility of difficulty urinating. We avoid the use of intrathecal morphine to reduce this risk |
Ambulation | Complete regression of the motor block is convenient. The patient can try to walk when he/she has recovered the perianal sensitivity and can flex and extend the foot. In some cases, it is feasible to discharge without 100% recovery |
Headache | Although the classic CPPD is presented as of the second post-block day, there are patients who can develop it in the immediate postoperative period. It is prudent to investigate it with the patient semi-seated or standing |
Other | Absence of bleeding at the operative site, ensure company, stay and transport to patients who do not drive, establish possible means of communication such as telephone, FAX, email |
Criteria for home discharge.
Medical ethics and government regulations emphasize excellent care and safeguard the health needs of patients. The correct and sensitive communication of this carefulness is essential for a correct anesthesiological care. The lesions associated with anesthesia are a frequent cause of morbidity and litigation, so it is mandatory to identify the common factors associated with peri-anesthetic injuries and thus reduces possible demands. In anesthesia for plastic surgery, as in other surgical procedures, cardiopulmonary events are the most common errors or incidents that cause severe neurological damage or death. The keys to prevent legal action against the anesthesiologist are simple acts such as establishing an adequate relationship with the patient and his family from the pre-anesthetic period, appropriate pre-anesthetic evaluation, filling out the informed consent, always using the correct monitoring, performing the best anesthesia, and postanesthetic care [14].
The complications in plastic surgery are due to four general factors: (a) characteristics of the establishment where the procedure is performed, (b) type of surgery and surgeon, (c) physical condition of the patient, and (d) quality of anesthesiological care. The study by Clayman and Caffe [81] conducted in Florida, USA, with deceased patients who had been operated in office-based surgery facilities found 36 deaths in 5 years, 18 related to plastic surgery, 3 of which were seen by non-plastic surgeons, and 12 under general anesthesia, 10 of which were administered by anesthesiologists and 2 by nurse anesthetists. Seven of these cases died before discharge and 11 after apparent appropriate discharge. The deaths that occurred before patients were discharged from hospital were due to bronchospasm, deep sedation, one related to illicit drug use, and the other to fatty embolism. Of the 11 patients discharged, seven died due to possible thromboembolism. In the rest, the cause of death was not determined. Most of these deaths could be avoided with simple measures such as adequate trans-anesthetic surveillance, prophylaxis of DVT/PE, and optimal patient selection.
Chapter 7 of this book discusses the most frequent and unusual complications of anesthesia and plastic surgery.
The challenges in anesthesia for plastic surgery patients are multiple since it is about people with perfectionist ideas that seek to improve their self-esteem through showing a better figure. This special personality makes them to search for a surgical medical team that guarantees their idealized success, which is based on information lacking scientific basis. On the other hand, the increasing sites offering plastic surgery has favored a demand not only for quality but also for more accessible prices. This nonmedical challenge is combined with the challenges of anesthesiological care in healthy patients, in apparently normal cases, and in people with systemic comorbidities. Each of these groups always requires a scrupulous comprehensive preoperative medical assessment and the development of a modifiable anesthetic plan. Another problem is the short and mediate term follow-up of these patients, since one way to improve our anesthesiological techniques is to study the evolution outside the operating room. The anesthesiologist rarely can see this type of outpatient or short-stay patient. So, it is prudent to establish a means of communication from the time of the pre-anesthetic visit to a long postanesthesia period. The Internet is by far the most viable way to determine what kind of evolution each of these patients have, especially the study of complications.
Patient-tourists represent a significant challenge very little studied in plastic surgery. They are people who have traveled for several hours or days, who come from other countries and who usually have not had a surgical or pre-anesthetic evaluation. They must be evaluated quickly and correctly to determine their viability to the procedures they want. It is common to see uncommon pathologies that do not contraindicate anesthesia, but can influence perioperative pharmacological management [2, 89].
Ambulatory and short-stay plastic surgery is growing logarithmically around the world. Anesthesiologists are more often subjected to the challenge of providing anesthesia to these patients, who on the other hand are scheduled every day for longer procedures and high risks that previously disqualified them for outpatient procedures. To favor an adequate outcome in this group of ambulatory patients—healthy and not so healthy, anesthesiologists should be oriented to the rational use of short and intermediate action drugs, with the goal of reducing morbidity and mortality. Techniques to prevent pain, nausea and vomiting, and early ambulation will be the most accepted procedures. The anesthetic techniques for outpatient surgery differ greatly from the procedures for short-stay patients, since the latter are scheduled to remain hospitalized for a minimum of 24 hours, unlike outpatient in which to prolong their stay beyond 5 pm can be considered as a failure in the anesthetic plan. A short recovery time after anesthesia is very important for the patient, his doctors, and the surgical unit.
Plastic surgery performed in ambulatory surgery units has some potential benefits such as ease of programming, reduced costs, and comfort for the patient and surgical staff. On the other hand, the inconveniences of ambulatory anesthesia should be considered, such as nausea and vomiting, uncontrolled postoperative pain, unplanned hospitalization, and, finally, occasional death. The latter is the most feared and should not happen.
Ambulatory cosmetic surgeries can potentially be managed with any anesthesiological technique. Although most anesthesiologists use general anesthesia for these procedures, regional anesthesia techniques have shown certain advantages such as better pain control, attenuation of the response to operative stress, preserving perioperative immune function, better preservation of oxygenation and lung residual functional capacity, improvement of visceral vascular flow, early recovery of postoperative ileus, and reduction of venous thrombotic disease and pulmonary embolism.
We thank the images of www.anestesia-dolor.org for allowing us to publish it.
None.
This chapter reports on the success and failure of making compost for soil amendment using green waste from a large fruit and vegetable market situated in Guatemala City, Central America. Perhaps the term “failure” is inappropriate and should be referred to as, “factors that contributed to limiting the intended success of a start-up business.” For anyone who has initiated a new business, you are continuously faced with innumerable problems complicating its success—such as the availability of skilled labor, licensure, market dependability for your product, managing the costs for materials, adapting to unpredictable weather and climate, marketing or branding of your product, and 100 s of other variabilities beyond your control. Perhaps the more successful ventures are those who can remain flexible and adapt quickly to externalities. Starting a new business and managing it on a daily basis is not for the faint of heart, however if the passion for what you have intended to accomplish is great and if it can bring significant improvement for people, the environment, and local economies, then this alone is a measurement of success. The challenges and “failings” of this work are discussed in the Results and Discussion section of this chapter.
Yet, how does one measure success in a broader context and how does one know that their efforts were productive and effective? For this research project, creating change within the lives and future prospects of perhaps the most disadvantaged youth from one of the poorest neighborhoods in the capital city of a developing world nation—Guatemala City—became the key measurement of success. Certainly, developing a successful business that embraced the principles of circular economy while not losing money and remaining solvent were equally important. However as stated above, achieving measurable social sustainability was the driver in defining success, perhaps even more so than simply being viable and achieving a measure of environmental and economic sustainability.
Guatemala is situated in the northern portion of Central America with the Pacific Ocean to the west and the Caribbean Sea to the east, with international borders of Mexico to the north, to the southeast Honduras and El Salvador, and Belize on its eastern frontier (Figure 1). The capital, Guatemala City, is centrally positioned in the southern portion of the country at 1500 meters in elevation (nearly 5000 feet). Thus, nighttime temperatures are moderately cool in the summer. This is in stark contrast to the very warm and humid climate of the eastern portion of the country, known as the Peten, home to Tikal and the Mayan Biosphere reserve. Guatemala City has a population of nearly 2.9 million residents with more than 4 million or greater migrating to the capital city during each business week from rural areas [1]. Many low-income people live within the city and are concentrated into 22 neighborhood and employment zones based upon social and economic class separation. Zone 3 is the most impoverished where squat housing has been constructed upon early remnants of the nearby landfill, referred to locally as the
Guatemala situated in the northern portion of Central American shares borders with Mexico, Belize, Honduras and El Salvador (Guia Geografico).
Dwellings have been constructed upon portions of a former landfill using concrete blocks and corrugated metal.
Families sort the recently dumped trash from garbage trucks to gather recyclables, discarded household items and edible food.
The research reported in this chapter set out to establish if compost could be produced to amend the marginal soil in the City’s parks and landscaped planting beds using green waste typically discarded from a large City-managed fruit and vegetable market known as CENMA. Diverting the additional organic waste from disposal in the landfill made logical sense; why throw away something that could be used to create something else of value? However, what was unknown were the challenges in using the organic waste to produce compost in this high altitude and temperately cool environment during the spring and summer months. In addition to selling the finished product locally, the research attempted to determine if the finished compost might have a regional market, meaning might there be a broader client for the newly prepared compost? Could the compost also be delivered to the farms who had originally grown the fruit and vegetables to be used for enrichment of their soil, employing the same trucks (Figure 4) that brought commodity to the market on their return trip?
Trucks that deliver farm produce to the central market could be used to deliver compost back to the farm for soil enrichment.
Whereas the author of this chapter is not an expert scholar within the burgeoning field of Circular Economy (CE), it is important to point out similarities of CE to what was once referred to as a closed loop system; the creation of a closed-loop system for producing compost, coffee or clothing, for example, should be based upon the principles of (CE). It is important to mention that the term circular economy first appeared in the literature as part of a study by Pearce and Turner (1990) [5]. This earlier research, referenced by Anderson (2007) and later Kumble (2019), worked to establish a link between production activities in industry [6, 7]. Thus, CE is recognized as a good strategy that can minimize any unneeded waste by increasing manufacturing efficient [8, 9, 10]. In general terms, this was called a closed-loop system, and was initially introduced by Boulding (1966) and later refined by Leontief (1991). The concept is based upon using raw materials and the superfluous waste contained within a closed loop [11, 12], meaning that you recycle the end product and its associated components in the manufacturing of a new item. Obviously, this is perhaps a standard used within the agricultural industry, but it can also be applied at a much smaller scale. An excellent example of this is where organic waste is converted into fertilizer and recycled into the soil. A closed loop system is a bit more complicated to achieve within the manufacturing industries given the huge variety of the product being produced. Nevertheless, if one were to try to explain CE as it might relate to ecological efficiency as demonstrated in agricultural production, things become perhaps less clear due to the diversity of what we make and how it is both distributed and consumed, as mentioned above. The literature has established that sophisticated cultures demand more resources to meet both their social and economic needs [13, 14, 15] at the cost of resource depletion, many of which are finite and ultimately not sustainable.
As presented in an extensive literature review of more than 500 articles, Merli et al. (2018), the authors established that CE can overcome what they referred to as the “take–make–disposal linear pattern of production and consumption” [16]. Whereas this may sound like a mouthful, pun intended, the principle behind this phrase aimed to preserve raw materials resources, within the production system as long as possible. Although one might think that all manufacturing aims to do this as a way to cut costs and improve efficiency, the sheer volume of industrial waste that ends up being disposed of in a landfill or elsewhere suggests otherwise. Merli et al. established a connection between the temporal scale with product production and reuse—the longer and greater diversity of how raw products are used play to the benefit of sustainable efficiency. Unfortunately, scholars seldom consider both the social and institutional inferences of CE at the environmental and economic level. Professor of landscape architecture John T. Lyle demonstrated this dysfunction as part of his applied research nearly 40 years ago, launching a movement which later became more broadly referred to as
It is interesting yet not surprising that Circular Economy is a contested title and description [18, 19]. I believe that this is attributed to the fact that it is very much an interdisciplinary topic, with feet in different scholarly and professional fields. Such definitive controversy or tension is not unique to CE. For example, ecotourism experiences a similar level of confusion and uncertainty; is it part of the tourism industry or simply a movement that promotes natural or cultural resource conservation with a focus upon nature-based experiences while also accounting for the intended educational and learning experience of the place visited? Perhaps even the often and over used terminology—sustainability—shares the dubious distinction of uncertainly, different meanings, and “gray” clarity. Regardless, ascribing CE within the context of compost production in a developing-world economy is not flawed or inappropriate, nor does it create confusion. In fact, it might even help to provide a clearer category for how recycling through compost production fits within the broader business of manufacturing. In an effort to lend clarity to this topic, Kumble (2019), reported on how Kirchherr et al. (2017) evaluated 114 definitions of the term CE, which led to the creation of the following definition:
More recent literature describes the need for quantifiable factors associated with the lifespan of a product to best determine the efficiency of CE. It seems that this current trend is attempting to alleviate the uncertainty mentioned above. This then introduces a new set of questions, such as what those indicators should be and of course how to account for variability? Again, this raises the question of boxing-in, a trend with rigid definitions. A plausible definition of lifespan of a product might be related to the number of times or repetition that a something is used and reused while also considering the longevity or duration of that use. Research by Figge et al. (2018) contend that the duration (temporal) and circularity (complexity) are necessary for sustainable resource use, but how should one clearly ascribe measurements that combine both approaches such as temporal complexity [22]? Again, Figge’s research team argued for a complex matrix to measure both, which is not surprising given their background in economic studies. If then one were to use this model and apply it toward the production of compost from green waste and brown carbon such as cardboard or wood chips, this production technique would achieve temporal longevity. What now becomes significant is that compost production suggests quantitative and qualitative factors that are key concepts of CE.
Sama, et al. (2018) described how the food industry has successfully made the more toward the production of fair-trade products and socially responsible consumption, both which are a critical measurement of sustainability within CE [23]. With that, the world has been moving, albeit slowly, toward circular economy with the demand to become more sustainable its daily life with the production of coffee, clothing, or perhaps compost. With the popularizing of fair-trade products, consumer demand for these goods produced in developing countries such as Guatemala can be found at a worldwide scale. This trend is evident in the move toward “green projects” that supports environmentally sustainable investments, as reported by Falcone el al. (2018) [24] on ethical socially responsible projects. They reported on the trend for funding radical green innovation. It could be argued that this is simply
The United Nations Environmental Program (UNEP) published a report in 2011 reporting on the trend toward an economy based upon low carbon outputs, signaling the move toward green businesses [26]. Has this been a true shift in response to climate change or as mentioned earlier, simply green washing? With regard toward the aforementioned biomass production, the movement toward renewable energy and associated industries—such as making compost from green waste in Guatemala—is no doubt significant. Again, the UNEP report found that the money required worldwide could be 2% of global GDP between 2010 and 2050 [27]. Although a significant sum, are their other viable alternatives?
When weighing the costs and long-term benefits of the global movement toward being more green, not because it is marketable but because it is necessary, what are then the implications of making compost from market waste, and how can this small action by the municipal government in Guatemala City be a model for other communities to follow? When trying to apply a change in how business is conducted, some world economies have adopted a top-down centralized approach [28], while others believe that a community-based bottom-up movement is more appropriate [29]. It is difficult to generalize which is more appropriate and perhaps local conditions and the size or scale of the problem is the main determinant.
No doubt, CE contains numerous complexities in both how it might be defined and quantified, likely due to the various disciplines associated, as argued above. With this understanding, or perhaps the uncertainty of how to best demonstrate the circular nature of making compost, in addition with how does it in fact represent a closed loop system applicable in Guatemala or any other culture, the research presented in this chapter attempted to achieve a variety of applied and theoretical objectives:
What is necessary for starting a business that demonstrates the principles of CE using the production of compost as an outcome?
Could this action trigger a break from what clearly appears to be dim prospects for teenagers from the Zone 3 neighborhood in Guatemala City thus providing an alternative for their future livelihood?
When considering the precepts of social sustainability [30] and basic human rights [31], what role could or should green investment in compost production play?
Are there unknown obstacles toward making compost in the high in altitude climatic conditions of Guatemala City with cool nighttime temperatures during the summer, periods of low rainfall during portions of the year, and inundation from rain during other times?
Could a simplified technique of making compost produce enough end product equal to the more industrial windrow commercial production approach?
The work reported in this chapter did in fact have multiple objectives as described above. Initiating a startup business and its associated challenges of balancing economic, environmental, and social objectives was not to be taken lightly, however altruistic as they may have seemed. These three pillars or three Es are the foundations of sustainability [32], but how should one bridge gap between pedagogical theory and real-world working conditions while factoring in a myriad of political and social challenges? Perhaps a brief revisit of how sustainability became part of the world dialog is in order.
Recognition of the critical importance for sustainable development within our lives began nearly 30 years ago in 1992 at the Earth Summit in Rio de Janeiro and again 20 years ago at the World Summit for Sustainable Development in Johannesburg [33]. Ironically, for some readers, these two important events predate their birth, yet they are no less significant as both signaled a paradigm shift in global awareness. Of the three Es as pillars of sustainability, one could argue that achieving social sustainability is particularly complex due to the constant changes or variability within localized society. As described by Kumble (2019) [7], Boyer et al. (2016) [30] enumerated and analyzed the particular difficulties in understanding social sustainability, however they citied the variable definitions and gaps due to the interdisciplinary nature of the topic. This is not necessarily a failing in the general research but more likely attributed to the complexity of interdisciplinary topics; each field is interpreted and understood differently by its associated scholars and proponents. In retrospect, social sustainability along with environmental factors and drivers of any economy are very much place based [7]. Boyer’s research team appropriately used the comparison of a three-legged stool and the 3Ps—prosperity, planet and people—for understanding complex problems withing the world and to not inventing new paradigms which would only busy an already crowded field of understanding.
Working on the principle of simplicity in action, the research presented in this chapter would appear to be a positive and logical situation whereby the compost that was created from organic waste diverted from a landfill could then be used to amend marginal soil, train workers, create jobs, mitigate an ecological and environmental crisis, and provide a future of skilled employment. Making compost would embrace the theories of CE, would mitigate the terrible environmental impacts from the batsuro while triggering new opportunities in the business market, consistent with the bottom-up model proposed by Ghisellini el al., 2016 [29] described above. As mentioned earlier in this chapter, the idea of the closed loop system of manufacturing has been in use for many generations in the industrial sectors of the world associated with manufacturing [34, 35]. The startup business for making compost wished to explore if this could be done in Guatemala City and not be hindered by the numerous complex cultural, environmental, and economic obstacles.
Although making compost from green market waste was one of key goals of the project reported in this chapter, it was really based on the foundational intention of creating future employment opportunities for the disenfranchised and poorly educated youth from the squat neighborhood in Zone 3. Perhaps if one of these goals could be accomplished—compost production—it would trigger the success of the other—future opportunities for the youth who had little future prospects. With this clear objective, the work aimed to explore how to achieve social sustainability. Minica and France (2008) postulated that social sustainability is in fact composed of the following four key objectives: 1. education and training; 2. promoting human health; 3. winning the fight against poverty; 4. creating a equitable and just working environment [36]. Yes, self-empowerment can be achieved through education, however with only 69.1% of the population in Guatemala who can read and write, it is perhaps the most illiterate nation in Central America. Similarly, 8 out of 10 people will never graduate from high school, not because they are lazy or lack ambition but because they must leave school while they are still kids to find work in support of their family (Figure 5). Finding jobs for this age group from Zone 3 is very difficult due to their insufficient education [37]. Thus, as mentioned above, the key research initiative of this work determined that the social pillar of sustainable development should be the most important because of the need to create opportunities for the future of the youth from Zone 3.
Approximately 80 percent of Guatemalans will never complete high school. This is particularly acute in Zone 3.
The CENMA fruit and vegetable market generates a huge amount of green waste each day as part of the trimming and packaging of the commodity for local and international markets. Not surprisingly, some 115 cubic meters (150 cubic yards) of organic waste is trucked daily to the landfill; yet it need not be. The head for Public Works of Guatemala City agreed to collaborate with the author and his graduate students from the University of Massachusetts, Department of Landscape Architecture and Regional Planning, for a variety of reasons: technical knowhow and enthusiastic students with a strong adherence to environmental justice. The City agreed to a student-initiated start-up business to produce useable compost on a small tract of land situated immediately adjoining CENMA. The site was unfortunately very small, 0.48 hectares (1.2 acres), but it would allow the team to attempt to test the principles of CE and pillars of sustainability.
The Municipal Parks Department in Guatemala City were investing nearly $300,000 USD each year to amend the soil on their land at the parks and landscaped planting beds. The director of Public Works agreed to the purchase of compost from the new startup business for their public-sector landscaping projects.
Whereas the intention of this chapter is not to explain new technologies for the production of compost, it is useful to review of how one makes compost, such as the careful mixing of brown and green raw material. It is important to point out that no animal manure or carcasses are used because animal waste can spread diseases. The composting process presented in this chapter describes the use of organic plant material often referred to as brown and green material (Table 1) [38]. Brown material is comprised of shredded wood chips, dry grass stalks, or cardboard and thus does not decompose as rapidly as green material. So why use brown material? It provides the finished compost product with a light texture. In comparison, green material refers to more recently cut or harvested wet waste such as vegetables or plant biomass and will decompose quickly. In the mixing of brown and green, the brown material is more stable, meaning that the amount of time required for it to break down or decompose is more predictable [39], likely due to the fact that it contains much less moisture.
Brown material | Green material |
---|---|
Straw or hay | Fruit |
Woodchips | Vegetables |
Cardboard | Egg shells |
Dry leaves or grass | Coffee grounds |
Tree bark | Freshly cut grass |
Sawdust |
The differences between brown and green organic material.
Organic waste is comprised of the leaves, stems, and bark of plants and insects. Interestingly enough, manure or animal feces is also a fertilizer that is referred to as organic. Brown materials such as wood chips, sawdust and cardboard, although processed by man, comes from trees and is organic unless it contains dyes or is coated with plastic. Man-made pesticides are natural and are not considered as organic material. However, it is important to understand that sometimes pesticides are organic because some plants will create chemicals naturally in their leaves to protect against insects [7].
The natural process of decomposition of organic material can be described as the breaking down of organic material. We can observe this process in the forest understory, within the leaf litter or dead wood from trees and shrubs. Nutrient-enriched humus returns organic material to the soil providing essential minerals supporting and accelerating plant growth; it should be thought of as enriched food stock for root system of plants [40]. Much of the decomposed humus is often in the top layers of soil—typically the O-layer—and is the darker color that can be seen when inserting a soil probe and extracting a sample. Non-organic waste is very slow to decompose and can take hundreds of years to break down into useful material [41].
A commercial or production compost operation manages the decomposition of organic material in a more controlled environment, allowing the process to occur more rapidly to produce a consistent and useable quality product. It does this by regulating the amount of oxygen, water, and brown to green material intentionally. When we refer to a ‘compost pile’ it suggests a mound or pile of organic measurable waste that is undergoing decomposing [42]. This finished end-product we call ‘compost’ (Figure 6), and can be used to amend existing soil, making that soil healthier or more alive and better suited for retaining soil moisture content and thus the growing of plants. When one tills the soil and harvests fruit and vegetables, the soil can become less vital or degraded. By adding compost or barnyard waste into soil, it becomes replenished with fresh nutrients, contributing to increased soil fertility [43].
This large pile of newly produced compost is mixed with existing soil to increase fertility and plant growth.
In a healthy forest, decomposition of organic matter occurs as part of the digestive processes enabled by a variety of microorganisms [41] that feed on dead or dying plant material and animals. The organisms reproduce, die, and recycle themselves as new organic material through the process of decomposition. These tiny creatures are contained in decomposing organic material and do not need to be added to a commercial composting pile. As with any alive material, these microorganisms require food, water, and air to live, consuming some of the organic material found in a compost pile. Whereas insects, worms, and even snails are valuable for making compost, they actually perform less work to in the decomposition process than do the microorganisms. Thus, microorganisms are an essential and necessary component for the production of compost.
As mentioned above, air, water, and the appropriate mix of organic material will allow the decomposition of organic material to reach its finished state in a predictable amount of time yielding healthy and useable compost. Typically, the composting process for organic material (in a compost bin, windrow, or pile) requires 90 to 120 days to occur [44], provided that the organic waste is receiving the needed combination of oxygen and moisture, and most importantly and that it is turned or churned regularly to allow air and moisture to effectively enter the pile [45]. Of course, this entire process can be accelerated significantly by increasing the amount of oxygen that enters the composting material; some operations can produce useable compost in very short time of 30 to 45 days, although the energy and financial costs of doing this may not be realistic.
How should one then choose to produce useable compost from organic brown and green waste? There are two commonly used technologies employed today; commercial operations often use a approach commonly referred to as windrows [46], which are basically very long and narrow piles of compost (Figure 7). A windrow is at a minimum 1.5 m (5 feet) tall with equal width and are difficult to manage with only manual labor [7]. As mentioned, a commercial operation often will use the windrow method due to their efficiency in accommodating a larger mass or volume of organic waste material. Due to their size and particularly their length, the windrow technology typically require many hectares of useable surface area and expensive commercial machinery such as a tractor that can effectively pull the mechanized windrow turner (Figure 8) which creates a uniform shape of the windrow pile while also churning or mixing the compost allowing necessary oxygen to enter and accelerate the decomposing process. Trial and error have determined that the tractor must use a ‘creeper’ gear whereby it moves very slowly yet allows the PTO (power take off drive) to spin the turner at a fast speed.
This is an example of a municipal compost facility using wind-rows for large-scale production.
This mechanized device is pulled by a tractor and is used to shape, turn, or churn the compost in the windrows.
As an alternative to windrows, smaller operations will use what is typically referred to as the in-cell technique. As its name suggests, this approach uses modular structures that hold the compost in place and look somewhat like a large cube [7]. The biggest advantage of the in-cell or 3-cell technology are that they can be maintained using manual labor and do not require expensive machinery such as a tractor and windrow turner for turning or churning the compost mix while it is in the process of decomposition. There were some obvious reasons why the in-cell composting technique was employed at the compost operation in Guatemala. These include the following:
By using manual labor to move the compost from one cell to another and thus accelerating the decomposition process, more youths could be employed;
Cells do not involve the need for expensive equipment typical of the windrow system; and
Cells do not require training of employees to operate mechanized machinery or do they require maintenance and upkeep.
The in-cell compost technique looks much more like the compost “bin” that a homeowner might use for decomposing kitchen and yard organic waste (Figure 9). Home-composting typically has one compost bin/cell. Yes, some households can and do have multiple compost bins, however the contents are seldom mixed or shoveled into an adjoining bin. For this reason, three cells should be employed to be more effective (Figure 10). But why three cells? One should begin with a new compost mix that is started in cell A: once the contents begin to shrink in size as the green waste decomposes, all of the contents from cell A should then be shoveled into cell B and a new batch started in the now available cell A. The act of moving the mix from cell A to cell B adds oxygen and mixes the contents, similar to what a windrow turning machine might accomplish. Later, the contents from cell B are moved into cell C for completion, and a new batch is begun in cell A, which has seen its material moved into cell B.
A compost bin or cell is used to make compost from household green waste, fallen leaves, and grass clippings.
This schematic illustrates how wooden pallets can easily fastened together as a three-cell compost system (illustration by Seth Morrow).
There are perhaps many ways to construct cells for producing compost, all based on the availability of cost-effective materials and creativity of the builder. Wooden shipping pallets were selected for use at the CENMA site because they are inexpensive and were easily obtained. Each of the shipping pallets were simply fastened together using long screws or nails to join one to another (Figures 10 and 11). Small sections of chain link fencing were used to enclose the front opening for each cell. Initially, the intention was to use steel fencing post which would be hammered into the ground forming each of the corners, coupled with welded wire fencing fastened to the posts to form the enclosed sides. However, the hard and rocky surface area found at the test site rendered this approach unfeasible as it was impossible to drive the metal posts into the ground. The wooden shipping pallets were readily available, easy to fasten together, and inexpensive.
Wooden shipping pallets are readily available and can be simply fastened together to replicate the three-cell compost system.
For a newly established compost pile (in cell A), one must regularly monitor the internal temperature during the initial weeks to determine the rate of decomposition (or cooking as it is referred to). At the same time, the size of the pile decreases or shrinks in size as the green material breaks down. Similar to that of a windrow, a thermometer with a long one-meter probe is used to measure the internal temperature (Figure 12) to determine if and how fast the compost process is successfully occurring. Table 2 illustrates cell-monitoring data for one of the two test cells constructed. The data was monitored in order to chart the time and temperature on a weekly basis, in addition to observed odor (smelliness). Approximately one month after the pile is made, the temperature cease increasing while the shrinkage of the pile should also decrease in rate. When this occurs, the pile should be shoveled into cell B. This process of turning the pile simply involves taking the material out of the cell and mixing it up, meaning that it is important to move the decomposing material from the middle of the pile to the outside layers of the relocated pile, now in the second cell (cell B).
Decomposition temperature is monitored regularly using this thermometer with a 1 meter long probe.
Date | |||||||||
---|---|---|---|---|---|---|---|---|---|
Wendell | |||||||||
5 | -4 | 45 | 0 | 0 | |||||
7 | −3 | 10 | −1 | −1 | |||||
10 | 0 | 0 | −1 | −2 | |||||
Wes | |||||||||
5 | −3 | 45 | 0 | −1 | |||||
7 | −1 | −45 | −1 | −2 | |||||
10 | 0 | 0 | −1 | 0 |
The rate of decomposition, changes in temperature, humidity and odor were monitored weekly in each of the test compost cells.
The units for Height are in inches, Temperature is in F, and Humidity is based upon relative %. Smell was subjective with 1 being low and 3 being high.
The microorganisms should be actively feeding on the organic material, meaning that they are now consuming the composting mass of material. Obviously, the microorganisms do not have the ability to move very far, so it is very important to adequately mix the pile, putting the microorganisms into direct contact with organic material to continue the decomposition process. Whereas the turning of a pile will introduce oxygen, it is quickly consumed, and it is not the primary function of turning or mixing the contents. Oxygen should enter a compost pile through proper ventilation and pore space (voids in the mix). Some people will also include perforated plastic pipe, similar to that used for stormwater under-drainage, and place the pipe across the bottom and then extending perpendicularly and vertically up through the pile to better allow the movement of oxygen.
The useable compost production space provided at CENMA could physically accommodate approximately 400 cells and produced approximately 1480 cubic meters of compost annually. The three-cell system, constructed from wooden shipping palettes, were 1.8 meters (6 feet) deep, 1.5 meters (5 feet) wide, and 1.2 meters (4 feet) tall. An estimated 140 cubic meters of newly produced compost was stored on-site each month [7]. The new compost was stored on-site to facilitate loading it onto transport truck for distribution to its final destination.
Much of the green waste deposited into collection barrels at the CENMA market actually contained a large amount of non-compostable garbage, such as cans, bottles, dirty diapers, etc. (Figure 13). It was an awful mess to clean and sort and necessitated a different approach; clearly those using the market mistook the collection barrels as suitable for general waste disposal. Clearly marked barrels were later placed in strategic locations close to where fruit and vegetables were being processed for sale (Figure 14). The prototype compost facility was able to receive 20 cubic meters of raw materials daily: (1/3 organic waste, 1/3 wood chips, 1/3 cardboard).
Non organic waste is unfortunately disposed of into the compost collection barrels in the market.
Clearly marked barrels were relocated close to fruit and vegetable processing.
Whereas then proposed composting business was to be situated next to the market on a large flat tract of land used by transport trucks, the market manager was concerned that the compost would smell and become a hinderance to market vendors and the general public. He was fearful that it would smell as bad as a landfill and would only allow the use of a narrow tract of land adjacent to CENMA. Unfortunately, this site was not ideal for two reasons: 1. it was not large enough to produce the volume of required useable compost to meet municipal demand by the City’s landscaping division, and 2. it was much too small to accommodate the available organic waste generated daily by the market.
The teenage employees from the Zone 3 neighborhood were hired, trained, and were responsible for many of the chores such as sorting waste from the collection barrels and mixing the compost from cell A to B and then to C (Figure 15). These young workers were also trained in how to monitor the moisture and temperature of the new compost piles in production. Ten to twelve workers were initially employed, selected from youth from Zone 3 who needed jobs. Only youth who were enrolled and remained in a secondary school were eligible and they had to remain in school to be employed in the compost business. Each of the youth were trained in how to maintain a bank account to receive their weekly pay. Sponsors from the USA participated in a cost-share program, matching the money earned by the Guatemalan youth with a matching donation, doubling the money earned.
This schematic illustration shows the alternating layers of brown and green material in addition to the perforated plastic pipes to allow for oxygen to move more freely (illustration by Seth Morrow).
The startup composting business discussed in this chapter aimed to provide useable compost for the Guatemala City’s municipal government (MUNI) who were using on an annual basis nearly 15,000 cubic meters of soil for landscaping the along the roads and parks. Because the base soil was of such poor quality, the mix of compost to soil would need to be 1:1, creating a demand for up to 7500 cubic meters each year. As stated earlier in this chapter, the 0.48-hectare site adjacent to the CENMA market was inadequately small and could not meet the needs of the City for soil amendment; a larger production workspace had to be provided. This study found that in order to produce 7500 cubic meters of useable compost each year, nearly 625 cubic meters would need to be generated each month, or approximately 30 cubic meters on a daily basis. To meet the demand for just the compost needed by the City government, the necessary site had to be nearly six times larger than that of the CENMA site, or approximately 2.6 hectares (6.4 acres). Interestingly enough, if one were to adopt the wind-row method for compost production, discussed earlier in this chapter, the area needed to meet the municipal demand is estimated to be approximately 1.6 hectares (4.0 acres) because windrows are more efficient in their use of space and production. Discussions with the head for public works in Guatemala City promised space for a larger scale production facility situated below (to the south) of CENMA; unfortunately, this expansion never occurred. Ironically, the City requested an even greater volume of compost from the startup company if it could be produced. The positive element here was that a broader market demand existed for the compost, and at that point in time, no one else was able to or willing to step up and make it.
Also ironic was the volume of organic waste trucked to the landfill each day, equaling roughly 138 cubic meters. When one considers that the initial small production space, or for that matter the 2.6 hectares site discussed above, both were incapable to accommodate all of the organic waste generated by the market assuming that it could be converted into useable compost; to do so would require a site of approximately 5.8 hectares. Unfortunately, production space limitations resulted in unacceptable shortfalls of the volume of compost that was produced, and as such, the project could not live up to its potential. Yet from a more positive perspective, the raw unprepared product was available—free of charge—with a willing client and inexpensive labor, suggesting that the failure of the business idea was not due to a flawed business plan but rather necessary space. With some abandoned brownfield sites (former industrial manufacturing facilities) nearby, this could be readily overcome.
Referring back to the success and failures of this research projected mentioned in the introduction of this chapter, the startup business was never able to meet the real demand for compost by the Municipal Government of Guatemala City; however, with a larger working production site, this could be achieved in the future. And with that, the ability to achieve the intended goal for a business that would demonstrate the principles of circular economy and social sustainability could be achieved.
Monitoring data conducted weekly at the two test cells that were constructed as a control experiment (Table 2) reveled that the high altitude and dry climate of Guatemala City caused much of the moisture in the newly mixed compost (cell A) to dry out prematurely, resulting in a very slow or even stalled rate of decomposition. This was unexpected and required altering the brown to green mix to increase the green organic volume during the initial mixing of the new compost piles in cell A.
Initiating a startup venture Poverty in Guatemala City will never be completely overcome and improved living conditions for those from Zone 3 achieved through a commercial composting business. However, each step toward this goal can and will make a tangible, and most importantly a sustainable difference in the future of children who live in Zone 3 and who have minimal future opportunities for a prosperous life.
Such as the one presented in this chapter demonstrated that one must find their own unique skills to contribute, whether it is the desire for developing programs to address social justice, expanding the knowledge-base of composting methods in different environments, or finding creative fund-raising opportunities. Each part or component of the program for recycling green waste from CENMA, putting to work at-risk youths of Zone 3 neighborhoods, and creating a useable product that was economically viable adhered to the three pillars of sustainably (Figure 16).
This diagram depicts the three-pillars of sustainability in action.
Sustainability in practice applies here, regardless of whether one is a proponent of social justice, an entrepreneur in search of starting a sustainable company to help the poor, or a public official determining the level of feasibility of a project, or even a potential financial donor. One need not look for complex operations that utilize high technology. Simplicity in action and techniques that achieve multiple objectives simultaneously are often the most effective and resilient.
The author wishes to acknowledge the support and encouragement of Susana Asensio, Director of the Department of Urban Construction; Brady Greene, regional director for Vida Joven Guatemala; Rosario Burgos, Environmental Coordinator; Antonio Peña, Director of Nurseries; Lazaro Zamora, Director of the Central Wholesale Market (CENMA); and Kevin Gervais. In particular, this research effort could not have been possible without the hard work and commitment by eight outstanding graduate students from the University of Massachusetts; they are: Travis Shultz, Dan Shaw, Tamzeena Hutchinson, Adam Monroy, Brian Giggey, Seth Morrow, Megan Regan, and Jason Dell’Orfano.
The author declares no conflict of interest.
This research received no external funding.
All of the photographs depicted herein were made by the author using a Nikon D800 digital camera, unless otherwise noted.
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\\n\\nBulk discounts are granted for orders of 10 copies and more.
\\n\\nThere is no minimum or maximum threshold on the quantity of book orders.
\\n\\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\\n\\nWe currently accept the following payment options:
\\n\\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\\n\\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\\n\\nIn accordance with the best security practice, we do not accept card orders via email.
\\n\\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\\n\\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\\n\\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\\n\\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\\n\\nP.O. Boxes cannot be used as a Ship-To Address.
\\n\\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\\n\\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
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\\n\\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\\n\\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\\n\\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\\n\\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\\n\\nBooks International
\\n\\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
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\\n\\nRepresentative for: China, Taiwan, Hong Kong
\\n\\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\\n\\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\\n\\nLSR Libros Servicios y Representaciones S.A. de C.V
\\n\\nRepresentative for Mexico, Chile and Colombia
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\\n\\nFor partnership opportunities, please contact orders@intechopen.com.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
\n\nIntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\n\nIntechOpen books retail price range is:
\n\n100 - 159 GBP ex. VAT (available in USD and EUR)
\n\nDiscounts available:
\n\nBulk discounts are granted for orders of 10 copies and more.
\n\nThere is no minimum or maximum threshold on the quantity of book orders.
\n\nOrders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
\n\nWe currently accept the following payment options:
\n\nWhen paying with a credit card, you will be redirected to the PayPal.com online payment portal.
\n\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\n\nIn accordance with the best security practice, we do not accept card orders via email.
\n\nThe combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
\n\nIf you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
\n\nTax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
\n\nCustoms: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\n\nP.O. Boxes cannot be used as a Ship-To Address.
\n\nIntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\n\nWhen ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\n\nRestricted Ship-to Countries:
\n\nPOD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\n\nInspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\n\nPrint copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\n\nOur books are available at our direct Print Sales Department and through selected representatives throughout the world.
\n\nBooks International
\n\nRepresentative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
\n\nChina Publishers Services Ltd - CPS
\n\nRepresentative for: China, Taiwan, Hong Kong
\n\nIndia - CBS Publishers & Distributors Pvt. Ltd.
\n\nRepresentative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\n\nLSR Libros Servicios y Representaciones S.A. de C.V
\n\nRepresentative for Mexico, Chile and Colombia
\n\nMissing Link Versandbuchhandlung eG
\n\nRepresentative for: Germany, Austria, Switzerland
\n\nKuba Libri, s.r.o.
\n\nRepresentative for: Czech Republic
\n\nFor partnership opportunities, please contact orders@intechopen.com.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Noteworthy, the stroke — related brain tissue metabolic damages involve an essential ATP deplete clash along with a suppression of brain specific nucleotide — associated kinases and ATP synthase, both Mg2+ — dependent complex enzyme “machineries”. This itself makes the latter’s a legitimate target for some advanced pharmaceuticals as long as the drug — induced overstimulation of corresponding enzymatic activity is the case. Thus, magnetic isotope effects (MIE) of the nuclear spin possessing paramagnetic 25Mg2+ ions might modulate the brain creatine kinase, alfa-glycerophosphate kinase and pyruvate kinase catalytic activities in a way of a remarkable ATP hyperproduction required to compensate the hypoxia caused acute metabolic breakdown. To realize the Magnesium-25 pharmacological potential, a low-toxic amphiphilic cationite nanoparticles were introduced lately. 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He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Prosthodontics and Implant Dentistry",value:2,count:2},{group:"subseries",caption:"Oral Health",value:1,count:6}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"27",type:"subseries",title:"Multi-Agent Systems",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11423,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,series:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403"},editorialBoard:[{id:"275140",title:"Dr.",name:"Dinh Hoa",middleName:null,surname:"Nguyen",slug:"dinh-hoa-nguyen",fullName:"Dinh Hoa Nguyen",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRbnKQAS/Profile_Picture_1622204093453",institutionString:null,institution:{name:"Kyushu University",institutionURL:null,country:{name:"Japan"}}},{id:"20259",title:"Dr.",name:"Hongbin",middleName:null,surname:"Ma",slug:"hongbin-ma",fullName:"Hongbin Ma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRhDJQA0/Profile_Picture_2022-05-02T08:25:21.jpg",institutionString:null,institution:{name:"Beijing Institute of Technology",institutionURL:null,country:{name:"China"}}},{id:"28640",title:"Prof.",name:"Yasushi",middleName:null,surname:"Kambayashi",slug:"yasushi-kambayashi",fullName:"Yasushi Kambayashi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYOQxQAO/Profile_Picture_1625660525470",institutionString:null,institution:{name:"Nippon Institute of Technology",institutionURL:null,country:{name:"Japan"}}}]},onlineFirstChapters:{paginationCount:1,paginationItems:[{id:"82124",title:"Assessment of Diversity, Growth Characteristics and Aboveground Biomass of Tree Species in Selected Urban Green Areas of Osogbo, Osun State",doi:"10.5772/intechopen.104982",signatures:"Omolara Aremu, Olusola O. Adetoro and Olusegun Awotoye",slug:"assessment-of-diversity-growth-characteristics-and-aboveground-biomass-of-tree-species-in-selected-u",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg",subseries:{id:"94",title:"Climate Change and Environmental Sustainability"}}}]},publishedBooks:{paginationCount:1,paginationItems:[{type:"book",id:"7726",title:"Swarm Intelligence",subtitle:"Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/7726.jpg",slug:"swarm-intelligence-recent-advances-new-perspectives-and-applications",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Javier Del Ser, Esther Villar and Eneko Osaba",hash:"e7ea7e74ce7a7a8e5359629e07c68d31",volumeInSeries:2,fullTitle:"Swarm Intelligence - Recent Advances, New Perspectives and 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possibility to collaborate with more research groups interested in animal nutrition, leading to the development of new feeding strategies and food valuation while being more sustainable with the environment, allowing more readers to learn about the subject.",author:{id:"175967",name:"Manuel",surname:"Gonzalez Ronquillo",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",slug:"manuel-gonzalez-ronquillo",institution:{id:"6221",name:"Universidad Autónoma del Estado de México",country:{id:null,name:"Mexico"}}}},{id:"18",text:"It was great publishing with IntechOpen, the process was straightforward and I had support all along.",author:{id:"71579",name:"Berend",surname:"Olivier",institutionString:"Utrecht University",profilePictureURL:"https://mts.intechopen.com/storage/users/71579/images/system/71579.png",slug:"berend-olivier",institution:{id:"253",name:"Utrecht 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living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine"},{id:"8",title:"Bioinspired Technology and Biomechanics",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. 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Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Biomedical Engineering",id:"7"},selectedSubseries:null},seriesLanding:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 24th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:4,numberOfPublishedChapters:314,numberOfPublishedBooks:31,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. 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. 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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. 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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/321781",hash:"",query:{},params:{id:"321781"},fullPath:"/profiles/321781",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)}()