Means and normal ranges of cerebrospinal parameters in neonates [51].
\r\n\tUsually, the most popular alternative to RWG is the printed circuit technology: microstrip or coplanar lines, for instance. Despite the benefits of reduced cost, volume, and manufacturing easiness, these technologies present quite high power losses.
\r\n\r\n\t
\r\n\tNew planar and substrate integrated waveguides are being developed since 2001 to achieve the desired performance of an RWG but synthesized on one or more printed circuit boards. The first one of its kind was the substrate-integrated waveguide (SIW), which emulates a dielectric-filled RWG in a single circuit board where side walls are made of metallic via holes. Although SIW is a good alternative to classic planar technologies, the presence of lossy dielectric makes it impossible to get a performance similar to an RWG. In 2014 the empty substrate-integrated waveguide (ESIW) was introduced as a composite of three soldered metalized circuit board layers where the middle layer had been emptied to emulate an RWG. By now, ESIW is the best approach to an RWG in terms of performance but retains the characteristics of planar circuits: easiness, compactness, mass production, low volume, low weight, and low cost. Newer hybrid planar – 3D waveguiding structures have also arisen since then, both implementing waveguides of just one conductor (no TEM mode) or two conductors (pure TEM mode).
\r\n\t
\r\n\tThese novel hybrid technologies are receiving much research efforts and continuous advances are being published. The maturity of these technologies and their use by the communication industry may come with an increase in the performance of the communication devices and a major economic impact on the high-frequency communication sectors.
\r\n\tThe goals of this book are to present the basis of these new hybrid structures and to show the advances in the design of devices and systems, manufacturing processes and tests, as well as applications where these technologies can be used.
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José Antonio Ballesteros, Dr. Hector Esteban and Dr. Angel Belenguer",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11511.jpg",keywords:"SIW, ESIW, ESICL, Tapered, Widened, Circulators, Power-Dividers, 3-D Printing, Measurements, Antennas, Satellites, Internet-of-Things",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 1st 2022",dateEndSecondStepPublish:"March 1st 2022",dateEndThirdStepPublish:"April 30th 2022",dateEndFourthStepPublish:"July 19th 2022",dateEndFifthStepPublish:"September 17th 2022",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Telecommunications engineer and Ph.D. in engineering. Researcher in empty substrate integrated waveguide devices and their manufacturing and applications. Present position: associate professor at Universidad de Castilla-La Mancha and Dean of the Escuela Politécnica de Cuenca.",coeditorOneBiosketch:"Ph.D. in engineering from the Universidad Politécnica de Madrid. The research focused on Empty Substrate Integrated Waveguide devices and their manufacturing and applications. Present position: associate professor at Universidad de Castilla-La Mancha.",coeditorTwoBiosketch:"Telecommunications engineer and Ph.D. in Universidad Politécnica de Valencia, Spain. Former positions: Joint Research Centre, European Commission, Italy, and European Topic Centre on Soil (European Environment Agency). Present position: full professor at UPV, and dean of the School of Telecommunication.",coeditorThreeBiosketch:"Telecommunications engineer and Ph.D. in engineering. Leader of the research group on applications on microwave, millimeter-wave, and antennas at the Escuela Politécnica de Cuenca. Present position: full professor at Universidad de Castilla-La Mancha.",coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"271424",title:"Dr.",name:"Marcos",middleName:"David",surname:"Fernandez",slug:"marcos-fernandez",fullName:"Marcos Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/271424/images/system/271424.jpg",biography:"MARCOS FERNANDEZ received his degree in telecommunications engineering from the Universitat Politècnica de Catalunya (UPC), Spain, in 1996, and his Ph.D. degree, from the Universidad Politécnica de Madrid (UPM), in 2006. He joined the Universidad de Castilla-La Mancha in 2000, where he is now an Associate Professor in the Departamento de Ingeniería Eléctrica, Electrónica, Automática y Comunicaciones and, since 2021, he is also Dean of the Escuela Politécnica de Cuenca. He has authored or co-authored several papers in peer-reviewed international journals and conference proceedings. 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He was with the European Topic Centre on Soil (European Environment Agency), in 1997. He rejoined the UPV, in 1998. He is a full professor and dean of the School of Telecommunication Engineering. His research interests include methods for the full-wave analysis of open-space and guided multiple scattering problems, and CAD design of microwave devices, especially using new empty substrate integrated waveguide technologies, and its characterization for use in space conditions.",institutionString:"Universitat Politècnica de València",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Universitat Politècnica de València",institutionURL:null,country:{name:"Spain"}}},coeditorThree:{id:"137520",title:"Dr.",name:"Angel",middleName:null,surname:"Belenguer",slug:"angel-belenguer",fullName:"Angel Belenguer",profilePictureURL:"https://intech-files.s3.amazonaws.com/a043Y00000rTNhXQAW/Co2_Profile_Picture__c%202021-11-30%2018%3A04%3A21.765",biography:"ANGEL BELENGUER received his degree in telecommunications engineering from the Universidad Politécnica de Valencia (UPV), Spain, in 2000, and his Ph.D. degree, also from the UPV, in 2009. 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Empirical antibiotic therapy for suspected meningitis, which should ideally succeed lumbar puncture, should be started immediately if lumbar puncture is to be delayed.
Lumbar puncture should always be performed as soon as the infant becomes clinically stable and can tolerate the procedure even if it has not been possible to be performed at the first suspicion of meningitis.
Lumbar puncture can be performed safely in patients with thrombocytopenia less than 10,000/μL, if they receive transfusion to a peripheral platelet count greater than 50,000/μL, and in patients with coagulopathy after appropriate correction of factor deficiency.
Physicians may have to treat suspected meningitis being deprived of cerebrospinal fluid (CSF) analysis guidance, since getting parental consent for lumbar puncture may be problematic.
During lumbar puncture, airway and resuscitation equipment should be immediately at hand.
Lumbar puncture in children younger than 12 months must be performed below the L2-L3 interspace.
The presence of a family member was found to be associated with neither an increased risk of traumatic or unobtainable lumbar puncture nor more attempts at the procedure.
The “ideal” angle for lumbar puncture as determined with ultrasonography was 50° in infants in both the lateral recumbent and sitting positions.
When lumbar puncture is traumatic, the wisest approach is to assume the patient as having meningitis and start empirical therapy.
Lumbar puncture (LP) may be considered one of the most well-known diagnostic procedures in the field of pediatric infectious diseases. It is an essential procedure for analyzing cerebrospinal fluid (CSF) in the evaluation for meningitis, sepsis, fever, or subarachnoid hemorrhage (SAH) in neonates.
Our knowledge of meninges dates back to ancient Egypt, where it was described in Ebers papyrus around 1500 BC. Hippocrates (and his physician contemporaries) must have been aware of the presence of CSF, since he is known to have referred to hydrocephalus as “water in the head.”
Despite, apparently, a long time has passed since the discovery of CSF, its usual collection technique, called lumbar puncture, has a relatively short history—about only a century long. The answer to the question of who has performed the first lumbar puncture is still a little matter of debate today:
In 1885, North-American neurologist Leonard Corning (1855–1923) published two articles, in which he described the application of “local medication” cocaine for local anesthesia to the spinal cord in thoracic D1–D2 interspace, most probably in the epidural space not removing any CSF.
Heinrich Irenäus Quincke (1842–1922), a German professor of internal medicine in Kiel, presented his first communication on LP in the “X. Kongress der Gesellschaft für inneren Medizin” (X. Congress of the Society of Internal Medicine) in Wiesbaden, Germany on April 8, 1891. In his first procedure of its kind, Quincke used a hollow needle with stiletto, which very closely resembles the LP needles that are routinely used today. He entered the subarachnoid space at the L3-L4 intervertebral level and drained CSF with the purpose of relieving headache, suffered by children with hydrocephalus. Quincke coined the term “Lumbalpunction” (LP) in his subsequent paper on this field.
According to English physician Walter Essex Wynter’s (1860–1945) article published in the Lancet on May 2, 1891, he made a skin incision at the second lumbar vertebra, and then made a big opening up to the dura mater, in addition to which laminectomy was often required. Next, he introduced a trochar and took CSF out for decreasing CSF pressure. Wynter used the term “paracentesis” for his procedure.
It is clearly seen that all three investigators have done the procedure for therapeutic, not diagnostic purposes, which is the main difference from today’s LP. It is also obvious that Corning’s performance involves a site (thoracic) and an intermeningeal space (epidural) that is very distinct from LP.
Although some authors mention the names of Corning and Wynter, it seems that Quincke was the first person in medical history to use LP for therapeutic, and subsequently, diagnostic purposes. Putting the common point of therapeutic use apart, during the time of publication, characteristics of puncture and nomenclature used were compared; we, in agreement with authors like Frederiks and Koehler, favor Quincke as the discoverer of LP. Besides, we believe that he deserves this title for being the first investigator to apply LP for diagnostic purposes thereafter [1, 2].
The main indication for LP in newborn period is suspected central nervous system (CNS) infection. LP is an indispensable and emergent tool in the diagnosis of neonatal meningitis and should ideally precede the initiation of empirical antimicrobial therapy. If LP should be delayed or cannot be performed for any reason, such as deteriorating clinical status of the patient or transferring the patient to another health institution, empirical antibiotic therapy should be started immediately, since minutes count in the diagnosis and early commencement of therapy [3].
Clinical findings of neonatal meningitis are similar to those of neonatal sepsis with or without meningitis. Thus, it is not possible to predict with physical findings alone whether the infant has sepsis, meningitis, or both. Although signs of sepsis and meningitis intertwine in the newborn period, some neonatologist deem it unnecessary to perform LP on neonates evaluated for sepsis, especially those with early neonatal sepsis [4, 5], because the antibiotics for both conditions would be the same. However, it should be kept in mind that blood cultures are negative in one-third of neonates with meningitis who are very-low-birth-weight and born over 34 weeks of gestation [6]. Thus, in case of LP is not performed, a significant portion of neonates with meningitis would not get a correct diagnosis and would not be observed for the likely complications of meningitis. For that reason, the author is in favor of the opinion that LP should always be performed as soon as the infant becomes clinically stable and can tolerate the procedure even if it has not been possible to be performed at the first suspicion of meningitis. CSF inflammation lasts for a considerably long duration of days, which would allow the clinician to diagnose or exclude the diagnosis of meningitis although CSF cultures may become negative within hours.
Suspected subarachnoid hemorrhage (SAH) is another emergent indication for LP. Computed tomography (CT) should be performed for all children suspected of having SAH. There are times when SAH is not detectable on a CT scan and LP becomes the sole method of diagnosing this condition [7].
Other indications for LP include the administration of chemotherapeutic agents, instillation of contrast media for imaging of the spinal cord, and the evaluation of various neurologic conditions including normal pressure hydrocephalus and Guillain-Barré syndrome. Among therapeutic uses of LP, removal of CSF in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri) is noteworthy [8].
A contraindication to LP can be absolute or relative. In all situations, the clinician should use her/his clinical judgment by taking into account the relative risk of performing LP.
Increased intracranial pressure (ICP): Increased intracranial pressure (ICP) is an absolute contraindication. Children with elevated ICP are at risk for cerebral herniation during LP. Therefore, cranial CT of all patients with clinical suspicion of increased ICP is essential for the physician’s decision to perform LP, including those at risk because of brain abscess [8].
Bleeding diathesis: Our knowledge regarding the safety of performing LP in patients with thrombocytopenia or coagulation factor deficiency is limited. The safety of LP in thrombocytopenia was investigated in 5223 LPs performed on 958 children with acute lymphoblastic leukemia in a retrospective study. Of these LPs, 912 were done at platelet counts of 11,000–20,000/μL, and 29 were performed at platelet counts of 10,000/μL or less. Serious complications of LP were not observed, regardless of platelet count. The authors concluded that prophylactic platelet transfusion was not necessary in children with platelet counts higher than 10,000/μL with a little caution that no conclusion can be made for children with platelet counts of 10,000/μL or less, due to the small number of patients in the study [9].
Because of the risk of subdural or epidural hematoma formation, many experts are against performing LP in patients with coagulation defects who are bleeding, severely thrombocytopenic (i.e., with platelet counts <50,000/μL), receiving anticoagulant therapy or an international normalized ratio of 1.4 or higher, without correcting the underlying abnormalities [8, 10]. However, LP can be performed safely in patients with thrombocytopenia less than 10,000/μL, if they receive transfusion to a peripheral platelet count greater than 50,000/μL, and in patients with coagulopathy after appropriate correction of factor deficiency [9, 11].
Cardiopulmonary instability: The position of the newborn during LP may result in cardiopulmonary compromise. This issue will be addressed further in detail elsewhere in the text.
Soft tissue infection at the puncture site
Shock
Respiratory insufficiency
Suspected meningococcal septicemia with extensive or spreading purpura [10]
Conditions listed below are conditions in which imaging is needed before LP to exclude brain shift, swelling, or space occupying lesion [10]:
Moderate to severe impairment of consciousness [Glascow coma scale (GCS) < 13 or 9 according to some experts] or fall in GCS of >2
Focal neurological signs (including unequal, dilated, or poorly responsive pupils)
Abnormal posture or posturing
Papilledema
After seizures until stabilized
Relative bradycardia with hypertension
Abnormal “doll’s eye” movements
Immunocompromise
Consequently, LP is sometimes contraindicated simply because the patient is too ill to safely undergo the procedure.
Since patients without appropriate decisional capacity cannot give their informed consent and written informed consent of the caregiver is required before the procedure, in many institutions including ours, it is customary for physicians to talk to parents for providing informed permission for an intervention like LP on their child. A straightforward explanation of the urgency and essentialness of the procedure, as well as the details of the procedure itself, maybe with the help of comparison with usual venipuncture (author’s practice), is usually reassuring and should routinely be provided. Sometimes parents refuse to give assent and physicians are forced to initiate and continue CNS infection treatment totally blindfolded—that is without being able to include or exclude the diagnosis, grow the etiologic organism, and confirm the treatment success. Although LP is a relatively safe process, results from studies show that the most frequent concern that lay behind a dissent is that LP would cause a complication [12, 13]. In a single-center study carried out in Turkey, the most feared complication was paralysis (60%) followed by sterility (22%) [14].
The decision to carry out imaging before LP should be done on a case-by-case basis. Children with the following conditions may have increased intracranial pressure (ICP) and, because of the assumption is that CT scan of the head can more or less reliably predict who will and who will not experience brain herniation after lumbar puncture, are advised to have a CT scan performed before LP [15]:
Altered mental status
Focal neurologic signs
Papilledema
Focal seizure
Risk for brain abscess (immunocompromise or congenital heart disease with a right-to-left shunt)
It should be noted that a normal CT scan does not fully exclude the presence of elevated ICP or the possibility that elevated ICP will not develop thereafter. It is also known from adult studies that even those not undergoing LP because of a mass effect on head CTs may experience brain herniation [16]. Thus, although imaging for this purpose has been questioned by some specialists of this field, we agree with the recommendation that LP can be considered within 6 hours of a normal CT scan and no other contraindications [8, 17].
Once the informed consent is obtained and imaging is performed if necessary, it is time for:
providing oxygen saturation, respirations, and heart rate (HR) monitoring for critically-ill children during the procedure;
“rehearsing” the position that infants will assume and getting help from a health care personnel who can hold the infant in sitting position if she/he is in respiratory distress (since in this position LP may be tolerated better) [18];
getting help from a radiologist for patients with spinal abnormalities, such as spina bifida or severe scoliosis, to perform the procedure under ultrasonographic guidance [19]; and
identification of infants who may require sedation or topical transdermal anesthesia for the procedure.
Materials needed for a smooth LP may be listed as follows [8]:
Lidocaine 1% without epinephrine and topical anesthetic cream, such as liposomal lidocaine or eutectic mixture of lidocaine 2.5% and prilocaine 2.5%
Sterile 3 mL syringe with 25-gauge needle for lidocaine injection
Four sterile collecting tubes
Sterile gloves
Sterile drapes
Povidone-iodine solution
Sterile sponges for preparing puncture site
Manometer (typically used in patients older than two years of age)
22-gauge and 1.5 inches (3.75 cm) long styletted spinal needle [7]
Resuscitation equipment
CSF circulates in the space between the pia mater and the arachnoid mater, called subarachnoid space that surrounds the brain, spinal cord, ventricles, aqueductus cerebri (Sylvius), and central canal of the spinal cord. After the formation of most of its volume in the choroid plexuses of the lateral ventricles, CSF passes through the foramina of Luschka and Magendie into the subarachnoid space, which is around the spinal column and over the cerebrum. The CSF is primarily absorbed by the arachnoid villi found next to the sagittal sinus and then drains into the venous circulation [7, 20, 21]. In full-term infants, the volume of total CSF is about 40 mL, a quarter of which is in the ventricles, and the remainder in the subarachnoid space. CSF serves as a cushion between bony structures and the brain, together with the spinal cord. Since brain has no lymphatics, CSF also has an important role of carrying chemical byproducts of metabolism out of the brain to the venous circulation [7].
In order to avoid an accidental nervous injury, LP should be performed distal to the spinal cord, at the level of the cauda equina. In older children, LP can be performed from the L2-L3 interspace to the L5-S1 interspace, because these interspaces are below the termination of the spinal cord [8]. At birth, the inferior end of the spinal cord is opposite to the body of the third lumbar vertebra (L3); therefore, LP in children younger than 12 months must be performed below the L2-L3 interspace. As the child’s spinal cord grows, the vertebral column grows more rapidly. An imaginary line that connects the two posterior-superior iliac crests intersects the spine at approximately the fourth lumbar vertebra. This landmark helps to locate the L3-L4 and L4-L5 interspaces [8]. Anatomic structures pierced during median LP in order are skin, subcutaneous fat, supraspinal ligament, interspinal ligament, ligamentum flavum, dura mater, and arachnoid mater [7].
Most of the time, LP is a relatively simple procedure, although it can sometimes prove challenging even for the most experienced physician. The potential for complications during and following LP makes it necessary that it be performed in an area with proper resuscitation equipment. Although not technically complex, LP is not a procedure that may be taken lightly, and it should only be performed by or under the supervision of a knowledgeable and experienced health professional.
HR, respiratory action, and oxygen saturation should be monitored closely during the procedure in neonates. Airway and resuscitation equipment should be immediately at hand. If the indication for the LP is elective, or by any other reason LP is not going to be done urgently, 4% lidocaine cream (effective after about 30 minutes) or eutectic mixture of lidocaine and prilocaine (effective after about 45–60 minutes) may be applied over the puncture site to lessen the pain [22, 23]. Due to the shorter time it takes for the onset of its effect, 4% lidocaine cream may be the preferred agent for this purpose.
According to a popular saying in pediatric circles in Turkey, “the person who performs the LP is the one who holds the infant.” This saying emphasizes the challenging task of achieving and maintaining a proper patient position for the performer of LP. The patient is placed on the examining table. The goals of positioning are to stabilize the infant, to stretch the ligamenta flava and to increase the interlaminar spaces. The most common positions used for the pediatric LP are the lateral recumbent and sitting positions (Figures 1 and 2). For the lateral recumbent position, the patient is laid on her/his side near the edge of the bed. For a right-handed performer, the patient’s head should face left because of ergonomics of the right upper extremity of the performer. The patient’s neck is flexed and the knees are drawn up to the chest by the assistant by placing one arm under the child’s knees and the other arm around the posterior aspect of the neck. The assistant should ensure that the spinal column is in no rotation by keeping the shoulders and hips perpendicular to the bed.
Lateral recumbent position (by Ziver Öncel).
Sitting position (by Ziver Öncel).
In the sitting position, the assistant holds the patient in the position with an arm and a leg in each hand while supporting the head to prevent from dropping, that is, excess flexion of the neck.
Choosing among the lateral recumbent and sitting positions with the neck or hip flexed or neutral, has not been standardized and is at the physician’s disposal, and most neonatologists prefer placing the infant in lateral recumbent position [24]. The positions are important because they may be superior over one another in avoiding a traumatic tap (peripheral blood staining the CSF specimen) and to get sufficient amount of cerebrospinal fluid, which should be feasible in a still infant with the widest interspinous space (the space between the spinous processes of two adjacent vertebrae) possible. Change of position does not alter subarachnoid space width, thus does not have a role in lumbar puncture success via this mechanism [25]. Safety, as well as the ease of the LP is a very important issue in the neonatal period especially considering the vulnerability of infants hospitalized in neonatal intensive care units. In adults, studies have uniformly showed that the maximal interspinal distance can be obtained with maximal hip flexion [26, 27].
We have shown in our study, in which the infants enrolled were placed in two lateral recumbent and two upright positions (lateral recumbent without flexing the hips, lateral recumbent with maximal hip flexion, sitting without flexing the hips and sitting with maximal hip flexion), that having the patient sit with maximal hip flexion provided the largest interspinous space for the grand majority of the infants, and that the lateral recumbent position without flexing the hips has resulted in the narrowest interspinous space. Although providing significantly larger interspinous spaces, sitting positions with/without flexion have resulted in significant increases in HR with respect to lateral recumbent position without flexion. Similarly, we observed statistically significant drops in oxygen saturations between lateral recumbent and sitting with flexion, lateral recumbent with flexion and sitting without flexion, and lateral recumbent with flexion and sitting with flexion positions. No adverse hypoxic events occurred during the procedure in the entire study [28]. In adults, the position providing the significantly greatest interspinous space was obtained with the so-called “sitting, feet supported position” in which the patient touches her/his ankles while sitting [27]. This position resembles sitting with maximal hip flexion position in newborns. In a survey, most (82%) pediatric emergency attending physicians were found to opt for the lateral decubitus position [29]. Gleason et al. found that although PO2 decreased and the HR increased with each position for LP, the decrease was significantly greater in the recumbent position with maximal hip flexion [30]. Cadigan et al. also found that recumbent with maximal hip flexion position provided wider interspinous spaces than did the recumbent without flexing the hips in healthy newborns in their well-child visits [24]. HR and oxygen saturation differed significantly with positioning of the infants in our study; however, this did not result in any apparent changes in clinical status. Although there were few infants weighing less than 1500 g in our study population, our results have shown that sitting-flexed position was a safe alternative to traditional-flexed recumbent position [28].
Once the patient is positioned, the most upper points of the posterior superior iliac crests are palpated. The line imaginarily drawn between these two points intersects the midline just above the fourth lumbar vertebra. The interspaces between L3-L4 and L4-L5 can then be located. Unlike children outside infancy, for whom the L2-L3 interspace may also be used, L3-L4 or L4-L5 interspace should be used for LP of neonates due to anatomical positioning explained above [7].
The puncture site should be cleansed with povidone-iodine solution, which can be removed with alcohol. Sterile drapes with a hole in the center to allow for a fine exposure are placed on the procedure site. The projection of interspace on the skin may be marked by depressing a fingernail on the skin so that the puncture site can be relocated.
If not previously anesthetized with one of the topical agents mentioned above, the skin and subcutaneous tissues are infiltrated with 1% lidocaine. Local anesthesia for LP is encouraged in neonates, because it has been shown to decrease the pain response to LPs without altering their success rate [31].
Two approaches are possible for inserting the spinal needle: in the median approach, the needle is inserted through the supraspinal ligament exactly in the midline. In the lateral approach, the needle is inserted lateral to the ligament. Unlike older patients, supraspinal and interspinal ligaments are rarely calcified in children, which renders a lateral approach unnecessary; therefore the median approach is most commonly used. With both approaches, the needle may be held in one hand or with both hands. It is better if the bevel of the spinal needle is positioned horizontally in the lateral recumbent position and vertically in the sitting position, because in this way, the fibers of the dura mater, which run longitudinally down the spinal cord, are pierced parallelly, the amount of CSF leakage is minimized, and likelihood of post-LP headache is decreased [7]. The needle is then advanced cephalad toward the umbilicus or slightly caudad according to the patient’s position of lateral recumbency or sitting, respectively. In the study by Bruccoleri et al., the “ideal” angle for LP as determined by ultrasonography was 50° in infants in both the lateral recumbent and sitting positions [32]. In the lateral approach, the needle should be inserted lateral to the upper border of the spinous process of L3 or L4. It should then be directed slightly medial and slightly upward (cephalad) to avoid contact with the supraspinal ligament.
It is normal that some resistance is felt during the advancement of the needle. When the ligamentum flavum is penetrated, this resistance may be lost a bit, especially in older children. There is a second resistance change when the dura is pierced. This second loss of resistance is often referred to as a “pop,” which may not be evident in infants. Inserting the needle too far may result in a traumatic LP. The most effective way to avoid this problem is by inserting the needle slowly and methodically, in increments of a few millimeters at a time, and frequently checking for return of CSF. For infants under 3 months of age, the appropriate distance of insertion is approximately 1.0–1.5 cm [33]. Various studies have been carried out to determine the proper depth of needle insertion for LP. Of these studies, numerous different formulae have been developed. Taking the studies of Craig et al., Shenkman et al., Arthurs et al., and Oulego-Erroz et al., whose formulae are applicable to neonates, as examples, the ideal distances of insertion were found to be
[0.03 × height (cm)] cm,
[13.19 + 0.0026 × weight (g) − 0.12 × post-conceptual age in weeks] mm,
[2 × weight (kg) + 7] mm, and
The spinal needle should be supported with fingers during fluid collection in order to prevent dural tugging, a potential source of local pain and post-LP CSF leakage.
If no CSF is coming after the needle has been inserted into an appropriate depth, rotating the needle 90° may be of help. If this is not effective, the stylet is replaced and the needle is advanced slightly. In some cases, withdrawing the needle incrementally will result in CSF flow when the procedure is initially unsuccessful. If spinal fluid is not obtained despite such maneuvers, the procedure should be attempted again by removing the spinal needle with the stylet in place till it arrives just under the skin and redirecting it. The needle can also be withdrawn entirely and a new needle used at a different insertion site. CSF may come very slowly in dehydrated infants when LP is performed using the lateral recumbent position. Getting the patient to a sitting position may increase flow in this situation.
If bony resistance is felt when the needle is not yet advanced into deep tissues, then puncture over the spinous process is likely, and the needle should be withdrawn till it is just below the skin and redirected through the interspace. If bony resistance is felt when it went deeper, then the likely cause is inadequate spinal flexion. Directing the needle more cephalad and improving the position usually overcomes this problem [7].
Traumatic or unsuccessful LP a neonates is a probability in 30–50% of the time [38]. A traumatic LP may stem from improper technique. Causes include inserting the needle too far into an epidural venous plexus or through the subarachnoid space into or adjacent to the vertebral body. Nigrovic et al. found that lack of local anesthetic use and advancement of the spinal needle with the stylet in place were most prominent risk factors for a traumatic LP [39]. In the study of Glatstein et al., its incidence was independent of physician experience, sedation use or time of procedure [40]. It is also surprising for the author of these lines that the presence of a family member was not found to be associated with an increased risk of traumatic or unobtainable lumbar puncture, nor was it associated with more attempts at the procedure [41]. If blood is seen during fluid collection but the spinal needle is in proper position, the CSF often clears and the specimen does not clot. If the bloody CSF does not clear and clots form when it is collected in the test tube, then the needle should be removed and LP attempted at a different interspace with a new needle [7]. Ultrasound may minimize the number of LP attempts and decrease patient and parent anxiety by easily identifying an insertion site. It may also be useful to determine the reason for failure and the likelihood of success on continued attempts [19].
Measurement of CSF opening pressure is recommended during any LP when possible. The infant’s struggling may be an obstacle for accurate measurement of opening pressure. The measurement is most reliable in a calm patient in the lateral recumbent position. As soon as the flow of CSF stabilizes and show pressure pulses with respiration, heartbeat, and jugular occlusion, the pressure manometer is immediately attached to the needle hub via a three-way stopcock. The pressure is measured at the highest level CSF reaches. Normal CSF pressure is 5–20 cm H2O in a child with neck and legs extended and 10–28 cm H2O with neck and legs flexed [7]. However, since an adult study reached totally opposite results, it is also possible that CSF pressure does not meaningfully decrease when the lower extremities are brought to extension from flexion in newborns. Kaiser et al. found the normal range of 0–7.6 cm H2O for newborns [42]. Of note, an estimation on CSF pressure can be made by counting the drops of CSF in a certain time. For 22-gauge, 1.5-inch needles recommended for use in the newborn period of life, the counting periods for which the number of drops counted equals the CSF pressure (in cm H2O) are 21 and 20 seconds for body temperatures of <40 and ≥40°C, respectively [43].
The CSF is collected in test tubes. Approximately, 1 mL per tube is required for routine studies. The first tube specimen should be sent for Gram stain and bacterial culture, the second for quantitative glucose and protein, and the third for cell count and differential. Additional tubes may be used for viral culture, fungal culture, bacterial antigens, cell pathology, or special chemistries, if needed. After CSF collection, closing pressure may be measured as previously described. The spinal needle is removed with the stylet in place. The puncture area should be cleansed and a sterile dressing applied. It is important to remember removing the dressing after a reasonable time so that it does not become a source of infection.
LP is frequently associated with the minor complications of localized back pain without neurologic abnormalities, transient paresthesia during the procedure, and post-LP headache, all of which a newborn may fail to express in some way.
Permanent peripheral nerve damage is rare, because the spinal needle does not pierce the nerve, instead, it may move or stretch it [7].
Major complications after LP include LP-induced meningitis, epidural or subdural hematoma, acquired epidermoid tumor, damage to adjacent structures (disk herniation, retroperitoneal abscess, spinal cord hematoma), and cerebral herniation. Fortunately, these complications are quite rare. As previously mentioned, in the young infant, the lateral recumbent position for LP can cause respiratory obstruction, hypoxemia, and cardiovascular instability.
Lumbar puncture is an indispensable diagnostic tool in neonatal meningitis. Direct microscopy should be performed as soon as possible, because if performed later, the erythrocytes and leukocytes likely undergo cellular lysis and escape detection. Gram- and Giemsa-stained smears of CSF should also be examined. CSF should be cultured, and if needed, sent for polymerase chain reaction. LP should ideally precede the initiation of antimicrobial therapy, but if delayed for any reason, empirical antibiotic therapy should be started immediately.
Interpretation of CSF findings is challenging in neonates, because glucose, and protein concentrations, and cell count are higher due to the high permeability of the blood-brain barrier [51] (Table 1).
Age | Erythrocytes (μL/L) | Leukocytes (μL/L) | Protein (mg/dL) | Glucose (mg/dL) |
---|---|---|---|---|
Preterm— < 7 d | 30 (0–333) | 9 (0–30) | 100 (50–290) (mostly <200) | 54 (27–99) |
Preterm— > 7 d | 30 | 12 (2–70) | 90 (50–260) (mostly <150) | 54 (27–99) |
Term— < 7 d | 9 (0–50) | 5 (0–21) | 60 (30–250) | 54 (27–99) |
Term— > 7 d | <10 | 3 (0–10) | 50 (20–80) | 54 (27–99) |
Many experts accept 20–30/μL as the cutoff value for pleocytosis. Low CSF glucose, elevated CSF protein, and pleocytosis may indicate either bacterial or viral (especially herpes simplex virus) meningitis. One of these parameters being in the normal range cannot be accepted as evidence against the presence of meningitis. In order to exclude meningitis, all three parameters should be normal; nevertheless, CSF findings may be completely normal in the very early course of neonatal meningitis. The most prudent approach would be to repeat LP after 24–72 hours in such boderline cases: if the infant had meningitis, pleocytosis and other abnormalities consistent with meningitis would be detected in CSF obtained in this second LP [52]. Ample number of erythrocytes in CSF may be interpreted as a clue to herpes simplex virus meningitis if the physician is sure that the LP was not traumatic. Pleocytosis is more marked in bacterial and Gram-negative meningitides than in viral and Gram-positive meningitides [6].
CSF protein concentrations higher than 100 mg/dL in term infants and 150 mg/dL in preterm neonates is consistent with bacterial meningitis and parameningeal infections, such as brain abscess, congenital infections, and intracranial hemorrhage [52]. Nigrovic et al. and Hines et al. found that CSF protein concentrations increased by approximately 1.1 and 2 mg/dL, respectively, for every 1000 CSF red blood cells [53, 54].
Glucose concentrations below 30 mg/dL in term newborns and 20 mg/dL in preterm infants are consistent with bacterial meningitis. Unlike in older children, CSF glucose to serum glucose ratio is not a reliable indicator of meningitis in the first 28 days of life, because newborns often receive intravenous glucose infusions and serum glucose concentrations can rise abruptly with stress [52]. In case of a bloody tap, assessing the CSF leucocyte count by correcting it with respect to that of the peripheral blood is not recommended in that it decreases the sensitivity and provides only a slight increase in specificity. When LP is traumatic, the wisest approach is to assume the patient is having meningitis and start empirical therapy [55]. Although no statistically significant difference in LP success rate was found between the lateral and sitting positions in infants in a randomized controlled trial, we, in order to lessen the chances of dealing with a difficult LP, favor sitting position with the legs flexed for it provides the widest interspinous spaces and is sufficiently safe [18, 28, 56].
Lumbar puncture of the newborn is not a smaller equivalent of the procedure performed in adults, even older children, as evidenced by its specific challenges of success and interpretation.
The author wishes to thank Ziver Öncel (83-year-old father) and Utkan Koray Öncel (7-year-old son) for their joint work in preparation of figures.
No potential conflicts of interest. No financial support.
The author contributed as the only person to this chapter with conception and design of the manuscript, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
None.
In contemporary implant prosthodontics, proper treatment planning prior to dental implant placement is equally important as the prosthetic factors. The good work of oral surgeon could be easily ruined by poor prosthodontic execution, thus changing the dental implant therapy success into therapy failure.
For decades, the scientific literature identified the following criteria for the survival and success of dental implant-based prosthetic rehabilitation:
Implant survival: At the time of measurement, the implant is in situ and loaded.
Implant success is determined using the Albrektsson criteria [1] with the following modifications: Adell [2], Buser et al. [3], Mombelli and Lang [4], and Misch et al. [5].
Absence of radiographic peri-implant bone resorption greater than 1.5 mm in the first year of function [2] and greater than 0.2 mm in subsequent years (i.e. 1.7 mm after 2 years); alternative cut-off values for radiographic bone resorption after 2 years of 2 mm (I. Success) and 4 mm (II. Satisfactory Survival) were also evaluated [5].
Currently, implant success is defined by these three criteria [6]:
Annual bone lose not more than 0.2 mm,
Periodontal probing depth (PPD) no greater than 5–7 mm,
No bleeding on probing.
These criteria are based on older studies, previous dental implant designs and restorations that are not biocompatible, and they might need to be re-evaluated. Porcelain fused to metal (PFM) restorations lack the biocompatibility of zirconia, which is widely used today, and current concepts allow bone stability or even growth over time. Therefore, the expected 1.5 mm loss after 1 year and subsequent gradual resorption can be considered relicts of the past [6].
The debate between cemented and screw-retained dental implant restorations is old as the implant prosthodontics itself. There are also different opinions in the scientific literature. Studies have shown that there are no significant differences in survival between the two methods, but screw connection has shown a total of fewer technical and biological complications [7]. But, from the clinical perspective, all cemented dental implant restorations should be checked very meticulously for any cement remnants. Even after many years of function, cement remnants can cause peri-implant mucositis which if undetected and untreated can lead to peri-implantitis with severe crestal bone loss around dental implants (Figure 1). This bone loss is the clinical issue which we are trying to avoid by careful treatment planning and precise execution of clinical and laboratory procedures.
Dental implant with cement-retained PFM crown; left image—immediately after delivery with no cement remnants visible on the radiograph; right image—patient did not come for regular follow-ups until he noticed bleeding while using dental floss, 9 years later. Unfortunately, dental implant needed to be removed due to severe bone loss.
Even when using screw-retained restoration, we can witness crestal bone loss around dental implants. This can be caused by the inappropriate size and/or shape of titanium base. Too short or too wide titanium base profile for screw-retained crown can compromise transitional zone of connective tissue and junctional epithelium around dental implant restoration leading to crestal bone loss (Figure 2).
The story of dental implant system, which was newly introduced to the market, with only one available titanium base height at that time (0.5 mm). Subsequent radiographs from top left to bottom right: initial situation; immediately after dental implant placement in augmented socket (two-stage surgery); second stage surgery and healing abutment; at the time of crown delivery (highly polished CAD/CAM zirconia abutment with laboratory cemented screw-retained lithium disilicate crown); 2 years follow-up with crestal bone loss; final radiograph at the time of new crown delivery (1.5 mm high titanium base was available on the market and micro-layered screw-retained zirconia crown with polished subgingival part was made in hope to prevent further crestal bone loss).
The difference in two titanium base height and screw-retained crowns is clearly visible in Figure 3. The impact of different titanium base as well the slight changes in emergence profile shape on the crestal bone level and density in a period of 3 months is shown in Figure 4.
Left: screw-retained crown with 0.5 mm high titanium base; right: screw-retained crown with 1.5 mm high titanium base for the patient in
Left: final radiograph at the time of new crown delivery; right: 3 months’ follow-up radiograph with clearly visible bone remineralization and bone density increase around dental implant neck.
Nevertheless, the clinical success of dental reconstructions is determined not only by survival rates, but also by the number of technical or biological complications that develop during clinical function. The optimum materials and techniques for implant-borne reconstructions are frequently debated to increase clinical outcomes. One of the current discussions is about the best fixation method between the implant and the reconstruction. For a patient-centred clinical approach, it is currently uncertain whether cementation or screw retention is the superior option for restoring dental implants. In clinical practice, both cementation and screw retention appear to have advantages and disadvantages. Clinically and technically, cemented implant reconstructions are quite similar to tooth-borne reconstructions. As a result, they may be easier to make and handle in the mouths of patients. However, prefabricated cement-onto or even custom abutments are required. Recently, CAD/CAM (computer-aided design/computer-aided manufacture) technologies enable a wide range of customized abutments to be used, and cemented reconstructions have become the preferred choice in many clinical settings. The difficulty in removing extra cement from cemented crowns and FDPs is one of their drawbacks. More worrying, excess cement has been demonstrated to cause peri-implantitis in the clinical setting [8]. Another notable disadvantage of cemented reconstructions is that, in the event of a problem, they are difficult or impossible to remove without causing damage, such as in the case of technical complications.
The retrievability of screw-retained reconstructions, on the other hand, is a big advantage. Furthermore, biological issues are extremely unlikely to arise if the reconstruction is well-fitting. Because the position of the screw access hole and the surrounding material parameters of the suprastructure must be considered, the horizontal and angular positioning of the implant is more delicate and has less tolerance than when employing screw-retained reconstructions. The fixation screw opening should ideally be located in a non-visible palatal or oral location, which is only possible if a suitable implant site and angulation are available. Furthermore, screw-retained reconstructions require more technical production because the reconstruction core must constantly be customized. Technical issues such as retaining screw loosening or veneering ceramic fracture have been clinically observed.
It is indeed difficult to choose between the two types of reconstructions, and it quite often comes down to personal preference rather than scientific data.
In a systematic review published by Sailer et al. [9], it was discovered that cemented restorations cause much higher bone loss than screw-retained restorations. From a total of 4511 titles, 59 clinical studies were chosen for this review, and the data were retrieved and analysed. For cemented single crowns, the estimated 5-year reconstruction survival was 96.5%, for screw-retained single crowns it was 89.3% (
This study found that both types of reconstructions had varied effects on clinical outcomes and that neither fixation approach was clearly superior to the other. Screw-retained reconstructions had more technical issues, while cemented reconstructions had more substantial biological consequences (implant loss, bone loss >2 mm). Screw-retained reconstructions are more easily retrievable than cemented reconstructions, allowing for easier treatment of technical and biological difficulties. These reconstructions appear to be preferred for this reason, as well as their apparent higher biological compatibility.
In contrary, Nissan et al. published a study that compared the long-term outcomes of cement versus screw-retained implant supported partial dentures in a randomized controlled trial and found that cement-retained FPDs had a better outcome [10]. The study group consisted of consecutive patients with bilateral partial posterior edentulism. In a split-mouth design, implants were placed and cemented or screw-retained restorations were randomly assigned to the patients. Examinations for follow-up (up to 15 years) were done every 6 months in the first year and every 12 months in the following years. Ceramic fracture, abutment screw loosening, metal frame fracture, Gingival Index and marginal bone loss were all assessed and reported at each recall appointment. Total of 221 implants were used to support partial prosthesis in 38 individuals. No implants were lost throughout the follow-up period (mean follow-up, 66 47 months [range, 18–180 months] for screw-retained restorations and 61 ± 40 months [range, 18–159 months] for cemented restorations). Ceramic fracture occurred substantially more frequently (P.001) in screw-retained restorations (38% ± 0.3%) than in cemented restorations (4% ± 0.1%). Abutment screw loosening occurred statistically substantially more frequently (P = .001) in screw-retained restorations (32% ± 0.3%) than in cement-retained restorations (92% ± 0.2%). Neither technique of restoration resulted in metal framework fractures. The mean Gingival Index scores for screw-retained (0.48 ± 0.5) restorations were statistically substantially higher (P.001) than for cemented (0.09 ± 0.3) restorations. The mean marginal bone loss was statistically considerably greater (P.001) for screw-retained restorations (1.4 ± 0.6 mm) than for cemented restorations (0.69 ± 0.5 mm).
The long-term clinical and biological outcomes of cemented implant-supported restorations were found to be better to screw-retained restorations in this study. With such contradictory facts, it is difficult to determine which technique is superior. The choice between cement-retained and screw-retained restorations might be philosophical. By opting for cemented restorations, the clinician accepts responsibility for removing all cement residues. Peri-implantitis caused by cement remnants is entirely an iatrogenic condition with no delegation of responsibility to the patient’s oral hygiene habits.
Whether we use standard abutments or custom CAD/CAM abutments, the cementation margin is critical. One of the most common causes of cement residues in soft tissues around dental implant restorations is the widespread clinical practice of setting the implant restoration margin too deep subgingival for aesthetic reasons.
This is typically done to conceal the abutment-crown interface and to allow for eventual peri-implant soft tissue recession. When the margin is deeper than 1.5 mm below the soft tissue level, according to one of the Academy of Osseointegration’s consensus statements, the risk of cement residues is significant [11]. Furthermore, the American Academy of Periodontology recently included residual cement to the list of risk factors for peri-implant mucositis and peri-implantitis [12]. The key challenge is where to put the cementation margin and how deep it should be?
According to the literature, the margin depth should be deep enough to conceal the margin yet shallow enough to allow residual cement to be removed. Because it is difficult to identify the exact ideal cementation margin depth, this statement does not provide sufficient information for safe and successful everyday clinical practice. To identify a safe margin for cementation, several laboratory and clinical trials were conducted.
The study conducted by Linkevicius et al. sought to determine the amount of cement that remained undiscovered following cementation and cleaning of implant-supported restorations [13]. Fifty-three single implant-supported metal-ceramic restorations were used to treat 53 patients. A periodontal probe was used to assess the subgingival location of each implant’s margin mesially, distally, buccaly and lingually, giving 212 measurements. The data were separated into four groups: tissue level (14 samples), 1 mm subgingivally (56 samples), 2 mm (74 samples) and 3 mm (68 samples) below the tissues contour. Metal-ceramic restorations with occlusal holes were made and resin-reinforced glass-ionomer was used to bond them to conventional abutments. After cleaning, a radiograph was taken to determine if all of the cement had been removed. After that, the abutment and crown complex were unscrewed for testing. Adobe Photoshop was used to analyse the photographs of all quadrants of the specimens and peri-implant tissues. Two proportions were determined: (1) the area of cement remnants relative to the overall area of the abutment/restoration; and (2) the area of cement remnants relative to the total area of the implant soft tissue contour.
Excess on the crown groups were group-1 (0.002 ± 0.001); group-2 (0.024 ± 0.005); group-3 (0.036 ± 0.004) and group-4 (0.055 ± 0.007). The amount of undetected excess grew as the margin became deeper subgingivally (P = 0.000), and there was a significant difference between all groups (P 0.05). The soft tissue groups had the following remnants: group-1 (0.014 0.006), group-2 (0.052 0.011), group-3 (0.057 0.009) and group-4 (0.071 0.012). The increase in cement remnants was statistically significant as well as the difference between groups 1 and 2. Radiographic examination revealed cement residues mesially in four cases of 53, or 7.5 %, and distally in six cases of 53, or 11.3 %.
According to the findings of this investigation, the deeper the position of the margin, the more undetected cement was revealed. Dental radiographs should not be considered as a reliable method for cement excess evaluation.
Another study done by Linkevicius et al had the purpose to determine the relationship between patients with a history of periodontitis and development of cement-related peri-implant disease [14]. Between 2006 and 2011, in private practice, 77 patients with 129 implants were selected for this retrospective study from completed implant cases that were scheduled for routine maintenance or had mechanical or biological issues. Researchers analysed implants with extracoronal cement residues and implants without cement residues. The selected cases were then separated into two groups: implants in patients with a history of periodontitis (1) and implants in persons without a history of periodontitis (2). These groups were chosen based on the patient’s treatment history and orthopantomogram. As a control group, a set of 238 screw-retained implant restorations was investigated that were delivered to 66 patients throughout the same period. The incidence of peri-implant disease was assessed in all implant groups.
In 62 of 73 implants with cement residues, peri-implant disease was seen (85%). All implants in group 1 developed peri-implantitis—four cases of early disease and 35 cases of delayed disease. Twenty-one of 30 implants in the periodontally healthy group were diagnosed with peri-implant mucositis, 3 implants developed early peri-implantitis and 11 implants with cement remnants did not develop biological problems. Peri-implant illness was identified in 17 of 56 cases of implants without cement remains (30%). In comparison, just two occurrences of peri-implant disease were discovered in the control group of screw-retained restorations (1.08%).
This study concluded that implants with cement remnants may be more likely to develop peri-implantitis in individuals with a history of periodontitis than in patients without a history of periodontitis.
The literature established that each retention method has a number of advantages and disadvantages. However, there are some clinical situations in which one method of retention is preferable to the other. Shadid and Sadaqa’s review of the literature on screw-retained versus cement-retained fixed implant supported reconstruction identifies several clinical situations in which one method of retention is preferable to the other [15].
Screw-retained large-arch implant reconstructions are preferred, as complications with these long-span prostheses are more common than with short-span prostheses.
Screw-retained cantilevered prostheses are preferred, as some maintenance of restorative structures or implants is likely to be required during the life of such prostheses.
Screw-retained restorations are preferred in patients who are at a high risk of developing gingival recession. This enables their uncomplicated removal and subsequent modification of the restorations to reflect the changed circumstances.
Screw-retained restorations are preferred in patients who are expected to lose additional teeth in the future. This is to facilitate the removal of the restorations and subsequent modification of the restorations.
In situations where there is little interocclusal space, adequate retention for cement-retained restorations may be impossible, as these restorations require a vertical component of at least 5mm to provide retention and resistance form. However, screw-retained restorations can be used with as little as 4 mm of interocclusal space. Additionally, screw-retained restorations can be directly attached to implants without the use of an intermediate abutment, reducing the amount of interocclusal space required for these restorations.
In situations where it is difficult or impossible to remove excess cement (e.g. if the final restorative margin will be greater than 3 mm subgingivally, the use of screw-retained restoration is indicated). In this situation, an alternative to screw-retained restoration is to fabricate a custom abutment for cement retention with a restorative margin that follows the gingival contours.
Screw-retained restorations are preferred in cases where technical or biologic complications are anticipated, as they allow for easy removal of the restorations, thereby resolving the issues.
Cement-retained restorations are preferred for single-unit and short-span implant restorations, assuming that implant table size, implant number and abutment screw torque can be optimized. In such cases, screw retention would be used only if the implant’s long axis was excessively palatal in the anterior region.
Cement-retained crowns are preferred in cases involving small diameter crowns where screw access may jeopardize the crown’s integrity.
Cement-retained restorations are preferred in situations where the occlusal surface will be compromised in terms of aesthetics or occlusal stability as a result of the presence of a restorative material sealing the screw access.
If the divergence between the implant axis and the retaining screw of the angled abutment receiving the restoration is less than 17 degrees, conventional screw retention of the restoration using premachined abutments is not possible.
Very valuable information for clinicians was identified in a more recent review by Hamed et al, which comprised 12 clinical research (randomized controlled trials, clinical trials, prospective studies and retrospective cohort studies) with at least 2 years’ follow-up time and published between 2010 and 2020 [16]. One of the most important advantages of cement-retained restorations is it’s the passivity and simplicity in manufacturing process in comparison with screw-retained restorations. This feature comes to light especially when zirconia is used as material for framework. The review indicates that the cement-retained implant approach is appropriate when enhanced predictability, a patient’s desire for superior aesthetic outcomes and a cost-effective method are present. Due to the significant complications associated with screw-retained restorations in terms of technical and prosthetic outcomes, cement-retained implant restoration results in more successful outcomes. Whereas a biological complication associated with the cemented implant promotes the use of screw-based implant reconstruction. Additionally, the screw-retained repair is more suitable for multiple unit implantation for patients with restricted inter-arch space. For instance, screw retention reconstruction is advised when inter-arch space is restricted (less than 4 mm) and retrievability is necessary. Similarly, cement retention can be used to compensate for inappropriately angled implants and when occlusion is easier to control without the hole.
It must be emphasized that prosthodontics plays a crucial role in maintaining mucosal homeostasis. Plaque accumulation and the soft tissue reaction are directly related to design, structural connections (screw-retained or cement-retained) and characteristics of materials. Proper prosthetic design with an appropriate emergence profile that promotes excellent oral hygiene and prevents plaque accumulation is unquestionably critical in preventing peri-implant mucositis [17]. According to de Tapia et al, when peri-implant tissue inflammation arises, the prosthetic design should be evaluated and, if necessary, adjusted to correct design issues that may obstruct good hygiene and to reduce biomechanical stress factors that may be involved [18].
The ninth edition of the Glossary of Prosthodontic Terms (GPT9) defines ‘emergence profile’ and ‘emergence angle’ identically for natural teeth and implant prosthesis [19]. Emergence profile is defined as the contour of a tooth or restoration, such as the crown on a natural tooth, dental implant or dental implant abutment, as it relates to the emergence from circumscribed soft tissues. Emergence angle is the angle between the average tangent of the transitional contour relative to the long axis of a tooth, dental implant or dental implant abutment.
However, extrapolating these words to implant prostheses remains ambiguous at the moment, as there are no established outcome metrics or protocols to support quantitative measurements. Emergence profile and emergence angle are currently defined in terms of ‘circumscribed soft tissues’. While these can be clearly characterized and quantified in the relatively narrow periodontal sulcus, they present considerable complications when it comes to implant measurements [20].
The term ‘implant supracrestal complex’ has been recently proposed in order to describe the anatomic complex of human tissue, mechanical components and bacteria extending through the transmucosal part of an implant prosthesis. The paradigm of the ‘implant supracrestal complex’ aims to describe the human tissue in parallel with the design features of the implant-abutment-prosthesis complex and assists in identifying the role of design elements in health and disease of the peri-implant tissue [21]. The review article by Mattheos et al. investigated seven focus questions regarding emergence profile, emergence angle and/or ‘implant supracrestal complex’ [21]:
Is any particular design of the implant supracrestal complex’s emergence profile or emergence angle associated with an increased risk of peri-implant mucositis or peri-implantitis?
Is there evidence that peri-implant mucositis and peri-implantitis are more prevalent in bone-level implants than in tissue-level implants?
Is there evidence that certain components of the implant supracrestal complex increase the incidence of peri-implant mucositis or peri-implantitis by obstructing oral hygiene access?
Is there evidence that an increased risk of peri-implant mucositis or peri-implantitis is associated with the ‘implant supracrestal complex’ tissue height (total vertical tissue height and/or peri-implant sulcus depth)?
Is there evidence linking the material used in the abutment and/or prosthesis to an increased risk of peri-implant mucositis or peri-implantitis?
Is there evidence that the design and placement of implant-abutment-prosthesis junctions are associated with an increased incidence of peri-implant mucositis or peri-implantitis?
Is there evidence that the kind of prosthesis retention (cement or screw) increases the incidence of peri-implant mucositis or peri-implantitis?
The conclusions from this review article can be summarized as follows:
The highest rate of peri-implantitis (37.8%) occurred when a convex profile was combined with a restoration emergence angle of >30 degrees for the bone-level implants, but the same was not confirmed for tissue-level implants. The highest prevalence of peri-implantitis occurred in the combination of bone-level implants, emergence angle ≥30, convex profile and splinted-middle implant prosthesis.
Most of analysed studies did not find any significant difference in the prevalence of peri-implant mucositis/peri-implantitis or the respective clinical outcomes measures between tissue-and bone-level implants. Few of the analysed studies reported different prevalence of peri-implantitis between bone-level and tissue-level implants, yet no statistical comparison was attempted or if then being statistically insignificant.
The complete resolution of inflammation in cases affected by peri-implant mucositis was achieved in 66.6% of the patients who were treated with additional prosthesis contour modification versus only in 9.6% of the patients who received standard peri-implant mucositis treatment. Modifying the contour of the prostheses to improve access for oral hygiene significantly improved the clinical outcomes after standard mechanical treatment of peri-implant mucositis.
Sites with a shallow mucosal tunnel showed greater and faster resolution of inflammation after treatment compared with the deep ones.
Analysis of abutment material (titanium, zirconia or gold) and peri-implant tissue health outcomes measures reported no, or insignificant, differences.
Results from different studies concluded that the use or not of intermediary abutments on an external connection implant was not found to have any influence on the prevalence of peri-implantitis after 5 years. Marginal bone loss was significantly lower at superstructures connected to abutments compared with those at implant level. No significant difference was found between abutments with different surface topography.
Of the five analysed papers which suggested a difference, two papers found cement-retained restorations to be related to higher risk of peri-implantitis, while two found cement-retained restorations to be related to higher risk of peri-implant mucositis and one found screw-retained restorations to be related to higher risk of peri-implant mucositis.
Additionally, the authors state that there are insufficient data with bone-level implants to conclude that a large emergence angle in combination with a convex abutment or prosthesis may result in peri-implantitis. Additional study is necessary to characterize the emerging profile in respect to the real degree of peri-implant soft tissue and to interpret these results more accurately. A single randomized clinical study found no difference in the risk of peri-implant mucositis between tissue- and bone-level implants. Prosthesis modification may be an effective and necessary adjunct to anti-infective therapy for peri-implant mucositis in implant-supported prostheses with limited access to oral hygiene. At the moment, there are no data to suggest that increasing the vertical height of the peri-implant soft tissues alone increases the risk of peri-implantitis. However, it has been shown that treating established peri-implant mucositis is more difficult in the presence of a deep peri-implant sulcus. It has not been shown that the presence or absence of a prosthetic abutment, or the material of the abutment (Titanium or Zirconia), alters the risk of peri-implantitis. The evidence relating the kind of prosthesis retained and the risk of developing peri-implantitis is equivocal.
From a clinical standpoint, properly shaped dental implant restorations are critical for the treatment’s aesthetics and biological success. The primary challenge is the shift from a round dental implant to the cervical shape of the missing tooth. This transition is accomplished through the use of implant abutments. Su et al. [22] characterized this contour as having two adjacent but distinct zones within the dental implant abutment and crown, an apically located subcritical contour zone and a coronally located critical zone. The critical zone refers to the portion of the dental implant abutment and crown that lies between the free gingival margin and the deeper subcritical zone. This zone is circumferential in form, approximately 1 mm wide in the apicocoronally direction and is often convex or flat in shape. The critical zone may or may not contain a variety of restorative materials, depending on the kind of restoration (cemented or screw-retained). The subcritical zone is positioned apically to the critical zone and may be concave, convex or flat in shape. Changes in the shape of the critical and subcritical contour zones should be planned carefully in accordance with the dental implant site, soft tissue thickness and materials used. If the crown form cannot be adjusted, reshaping the subcritical zone can improve both the aesthetic and biological success of the treatment.
There are numerous strategies for peri-implant soft tissue conditioning, including immediate temporary restorations, custom-made healing abutments and gradual remodelling of soft tissues through modification of critical and subcritical zones of the temporary implant crown. Figure 5 shows the emergence profile shaping with custom-made temporary PMMA crown on PEEK abutment after the implant was integrated.
Emergence profile shaping with temporary PMMA crown on PEEK abutment. Upper-left: initial clinical appearance with stock healing abutment; upper-right: size and shape of soft tissue emergence profile after removal of stock healing abutment; middle-left: lateral view of temporary PMMA crown on PEEK abutment; middle-right: frontal view of temporary PMMA crown on PEEK abutment; lower-left: clinical appearance 2 months after temporary crown delivery; lower-right: newly formed and shaped emergence profile with soft tissue maturation.
In clinical cases like the one shown in Figure 5, additional challenge may emerge during copying and transferring emergence profile shape to either digital or conventional stone cast model. In both ways, the clinician needs to act fast due to fast tissue begin to collapse immediately after removing temporary crown (or custom-made healing abutment). In conventional prosthodontics impression, fast and predictable way is open tray pick-up transfer customization intraorally or extra orally with flowable composite resin material. This technique with intra oral customization with flowable composite resin material is shown in Figure 6.
Left: intraoral customization of open tray pick-up transfer and final impression with preserved emergence profile size and shape for final crown fabrication.
Additionally, the significance of the emergence profile and the interest of clinicians and researchers have increased significantly in recent years. Gomez-Meda et al. [23] defined a more detailed classification of emergence profile surfaces and areas. This article discusses the esthetic biological contour concept (EBC), which consists of distinguishing important zones of emergence profiles and recommending detailed design principles for those zones. The clinical significance of EBC is that it promotes aesthetic outcomes and a favourable biological response to implant-supported restorations when designed properly. The EBC concept denotes three zones that correspond to the subgingival contour of an implant restoration’s emergence profile (Figure 7). Each of these zones will come into contact with a distinct type of tissue and therefore must be designed differently.
Schematic presentation of three zones of EBC concept: E—esthetic zone (blue), B—bounded zone (green) and C—crestal zone (red).
The EBC concept is divided into three zones:
E Zone (esthetic zone) is a subgingival area that is 1 mm wide and located apical to the free gingival margin. It should be shaped similarly to the crown of the extracted or contralateral tooth to resemble a natural crown. Its contour should be convex and support the free gingival margin in the proper position, establishing the implant crown’s cervical morphology. This zone is adjacent to sulcular epithelium, a type of stratified squamous epithelium.
B Zone (bounded zone) is the emergence profile area apical to the E zone that is approximately 1–2 mm wide in cases where the dental implant is ideally placed 3–4 mm apical from the free gingival margin zenith point. Although the B zone is normally concave, in patients with deficient soft tissues, connective tissue graft may be required to improve gingival phenotype, crestal stability and aesthetics. This biologic boundary zone is in contact with junctional epithelium, which is a non-keratinized epithelium.
C Zone (crestal zone) is a 1–1.5 mm wide area immediately coronal to the implant neck. However, its dimensions vary depending on the depth of the integrated dental implant. In this area, the abutment contour should be flat or slightly concave to avoid putting pressure on the bone tissue surrounding the restoration. Figure 2 illustrates the detrimental effect of this pressure on crestal bone stability. Additionally, certain dental implant designs (i.e. tissue level implants) incorporate this zone into the implant body. This zone is critical for the stability of the crestal bone because it is in contact with connective tissue.
Each of the zones described in the EBC concept serves a distinct purpose in the emergence profile’s design. Understanding the significance and unique design features of the EBC zones enables the provision of aesthetic and biologically sound interim and definitive implant restorations.
Several new dental materials have entered the market over the last decade. They offer an aesthetic, functional and economical alternative to metal-ceramics, the most frequently used material for prosthodontic restorations. This is especially true for zirconium oxide and lithium disilicate ceramics. The incorporation of CAD/CAM manufacturing technology into daily work has resulted in a significant reduction in dental technicians’ labour costs. Furthermore, these increased aesthetic standards have resulted in an increase in the use of metal-free restorations at the expense of metal-ceramic restorations. These events also influenced the materials used and the manufacturing process for custom-made dental implant abutments, effectively eradicating stock dental implant abutments. Additionally, the titanium bases for implant abutments have been redesigned to incorporate anti-rotation properties and a cylindrical shape, allowing for more efficient extraoral cementation of prosthodontic restorations. Such prosthodontic restorations, particularly following the introduction of angulated screw access to the abutment screw, resulted in an increase in the proportion of screw-retained restorations versus cemented restorations. All these advancements are now being used more frequently in clinical practice, but they have also prompted scientists to explore new materials and techniques. Given the time, material, human and technical resources required to conduct a high-quality long-term prospective or retrospective study, there is still insufficient solid evidence of these new materials and technologies’ clinical benefits and effectiveness. However, prior research and the subjective clinical experience of numerous clinicians indicate that the new materials will eventually justify their partially uncritical use in clinical practice.
From the clinician’s perspective, 5- or 10-year success or survival rates are not the only criterion to consider when planning and implementing implant-prosthodontic treatment. Additionally, the clinician should consider the frequency with which technical and biological issues may emerge when specific materials are used.
With so much conflicting information and data, clinicians may depend on review articles that structurally describe and analyse more scientific studies on a given subject. Pjetursson et al. recently published a statement paper about material selection for implant-supported restorations [24].
For a long period of time, metal frameworks veneered with feldspathic ceramic have been used in dentistry. They are well-researched and documented restorations that can be used for single crowns and fixed partial dentures. The metal framework provides a high-strength core, protecting the whole restoration against tensile and flexural stress during chewing function. Besides the conventional casting technique, metal framework nowadays can be produced by milling or an additive laser printing process. There are two important published meta-review papers that examine the clinical outcomes, success and survival rates of metal-ceramic implant-supported restorations, as well as the complications rates.
The meta-review analysing metal-ceramic single crowns [25] included 30 studies with a total of 4542 crowns, with 83% of cement-retained crowns and 17% of screw-retained crowns, respectively. The meta-analysis estimated an annual failure rate of 0.35% (95% CI: 0.19%–0.66%), which corresponds to a 5-year survival rate of 98.3%. The respective complication rates were 13.3%, which means that one out of eight metal-ceramic single crowns showed some technical, biologic or aesthetic complication or failure. Only 86.7% of the metal-ceramic implant-supported single crowns showed no complications over the 5-year follow-up period. The 5-year incidence rate of peri-implantitis and soft-tissue complications was 5.1%, and significant bone loss of more than 2 mm at marginal bone level was 3.3%. Technical complications, including fracture of abutments or abutment screws, were rare complications, with an incidence rate of 0.2%. Abutment screws loosening was more frequent, with a 5-year complication rate of 3.6%. The incidence of ceramic fractures and chipping was 2.9%, and framework fractures were only reported to be 0.2%.
Another meta-review by Sailer et al was analysing multiple-unit metal-ceramic fixed partial dentures [26] and included 16 studies with a total of 993 fixed partial dentures supported by 2289 dental implant abutments, with 73% of cement-retained fixed partial dentures and 27% of screw-retained fixed partial dentures, respectively. The annual failure rate for metal-ceramic fixed partial dentures was 0.26% (95% CI: 0.10%–0.64%), corresponding to a 5-year survival rate of 98.7%. The respective complication rates were 15.1%, meaning that one out of six fixed partial dentures had some kind of complication. Hence, 84.9% of fixed partial dentures were free of any complications over the 5-year follow-up observation period. The 5-year rate of peri-implantitis and soft tissue complications was estimated to be 8.5%. The significant bone loss incidence rate was reported to be 2.6%. Among technical complications, the incidence rate was reported as follows: abutment screws loosening was 5.3%, ceramic fractures or chipping was 11.6% and framework fractures were 0.5%.
Both metal-ceramic single crowns and multiple-unit fixed partial dentures are well researched with very good long-term success rates. They can be used as a treatment option in a wide spectrum of clinical indications, especially in clinical cases with high clinical implant crowns, cantilever types of implant restorations and implant-supported fixed partial dentures with distal units extending more than 8 mm, fixed partial dentures with more than two pontics and in cases with small connector height due to limited interocclusal space.
Increasing aesthetic demands have led to the development of different subtypes of zirconia ceramics. With their appearance, they adequately imitate not only the appearance but also the structure of hard dental tissues. In addition, new generations of zirconia ceramics have excellent biocompatibility and improved mechanical properties. Previous generations of zirconia ceramics had an opaque whitish appearance and had to be veneered to make the restoration look aesthetically pleasing. Newer generations of zirconia ceramics come in multilayer blanks or blocks with different levels of translucency and can be used as monolithic restorations.
The previously mentioned meta-reviews also analysed zirconia-ceramic implant-supported single crowns and fixed partial dentures.
The review by Pjetursson et al [25] analysed eight studies with a total of 912 zirconia-ceramic implant supported single crowns for an average 5-year follow-up period. Of all the included single crowns, 51% were cement retained and 49% were screw retained. The annual failure rate for implant-supported zirconia-ceramic single crowns was 0.49% (95% CI: 0.21%–1.18%), which corresponds to a respective 5-year survival rate of 97.6%. The estimated 5-year complication rate was 16.2%, meaning that only 83.8% of implant-supported zirconia-ceramic single crowns were free of any complications over the complete 5-year observation period. The most frequent complication rates were: 5.3% for peri-implantitis and soft tissue complications, 4.4% for marginal bone loss of more than 2 mm, 2.8% for ceramic fractures or chipping and 2.1% for framework fracture.
Another meta-review by Sailer et al [26] included three studies with a total of 175 zirconia-ceramic fixed partial dentures and an average follow-up period of 5.1 years. Only 15% of all restorations were cement-retained and 75% were screw-retained. The annual failure rate for implant-supported fixed partial dentures was 1.455 (95% CI: 1.06%–1.98%), which corresponds to a respective 5-year survival rate of 93.0%. The most frequent complications were soft tissue complications with a 10.1% incidence rate and framework fracture with a 4.7% rate.
According to the previously mentioned research and numerous other published articles, today we cannot consider veneered zirconia-ceramic as the material of choice for implant-supported fixed partial dentures. They show a high degree of risk of chipping or catastrophic fracture of the restoration framework. The study by Larsson et al. [27] states that the frequency of chipping and framework fractures of fixed partial dentures is up to 50%, which is a clinically unacceptable value. These problems are largely eliminated by the use of monolithic zirconia-ceramic, which with its aesthetic properties satisfies everyday clinical applications. In addition to the lack of chipping, implant-supported restorations of monolithic zirconia-ceramic show greater fracture resistance because the framework of such structures has larger dimensions compared with the framework of coated veneered zirconia-ceramic restorations. Evidence of this is a recent systematic review paper by Pjetursonn et al. [28] that analysed the 3-year survival and failure rates of veneered and monolithic zirconia-ceramic implant-supported restorations. The estimated 3-year survival rates were 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia-ceramic single crowns and 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia single crowns. Veneered single crowns showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic single crowns (0.39%). Interestingly, the location of the single crowns, anterior vs. posterior, did not influence survival and chipping rates.
When a clinician needs to choose between veneered or monolithic zirconia-ceramic implant-supported restorations, the following factors must be considered: aesthetic demands, location in the dental arch, physical properties of the material, possibility for surface modification and abrasion (wear) properties of the material [24].
To improve the physical properties of glass-ceramic and make it more suitable for prosthetic restorations, lithium disilicate or, in rare cases, leucite fillers were added. Nowadays, there are several techniques for the production of lithium-disilicate reinforced glass-ceramic, such as heat pressing and CAD/CAM milling from prefabricated blanks. Due to its mechanical properties, lithium-disilicate reinforced glass-ceramic can be used for both implant-supported single crowns and short-span fixed partial dentures in the anterior region of the dental arch. A systematic review article by Pjetursson et al. [28] evaluated five studies reporting on veneered leucite or lithium-disilicate reinforced glass-ceramic implant-supported single crowns (a total of 110 crowns) and 14 studies on monolithic leucite or lithium-disilicate reinforced glass-ceramic implant-supported single crowns (a total of 484 crowns). The mean follow-up period for veneered single crowns was 8.1 years and 2.6 years for monolithic single crowns, respectively. Results show a low annual failure rate of 0.80% (95% CI: 0.14%–4.64%) for veneered crowns and 1.02% (95% CI: 0.51%–2.05%) for monolithic reinforced glass-ceramic single crowns. This means that 3-year survival rates were 97.6% for veneered single crowns and 97.0% for monolithic single crowns. The study also reported that monolithic reinforced glass-ceramic crowns had the lowest annual complication rate of 1.7%, and veneered reinforced glass-ceramic crowns had an annual complication rate of 2.6%. In comparison, annual complication rates for monolithic zirconia-ceramic single crowns were 3.6% and for veneered zirconia-ceramic single crowns were 4.5%.
Considering these meta-review results, it is reasonable to conclude that lithium-disilicate reinforced glass-ceramic implant-supported crowns are the treatment of choice for high aesthetic-demanding clinical cases in the maxillary anterior region Figure 8 shows such a clinical case with tooth #21 replaced by a dental implant where the implant-supported crown was made on a titanium base abutment customized with a zirconia CAD/CAM abutment and a lithium-disilicate reinforced glass-ceramic crown.
Clinical case with tooth #21 replaced by a dental implant where the implant-supported crown was made on a titanium base abutment customized with a zirconia CAD/CAM abutment and a lithium-disilicate reinforced glass-ceramic crown.
Proper treatment planning prior to dental implant implantation is just as critical in current implant prosthodontics as the prosthetic components. The wonderful work of the oral surgeon may quickly be destroyed by inadequate prosthodontic execution, resulting in the failure of dental implant treatment.
The controversy between cemented and screw-retained dental implant restorations is as ancient as implant prosthodontics itself. Additionally, there are divergent views in the scientific literature. Although no substantial difference in survival has been shown between the two procedures, screw connection has demonstrated a total of less technical and biological problems. It is presently unknown whether cementation or screw retention is the preferable choice for restoring dental implants from a patient-centred clinical perspective. Both cementation and screw retention seem to have benefits and downsides in practical practice. Choosing between cement-retained and screw-retained restorations may be a matter of philosophy. By choosing cemented restorations, the physician is responsible for completely eliminating all cement residue. Peri-implantitis induced by cement remains is a completely iatrogenic disease with no blame assigned to the patient’s oral hygiene practices.
The emergence profile of a tooth or restoration, such as a crown on a natural tooth, a dental implant or a dental implant abutment, is described as the shape of the tooth or restoration in relation to its emergence from restricted soft tissues. Clinically, appropriately designed dental implant restorations are crucial for both the aesthetics and biological effectiveness of the procedure. The biggest difficulty is adapting the circular dental implant to the cervical form of the lost tooth. This shift is made possible by implant abutments. Changes in the critical and subcritical contour zones should be carefully considered in relation to the dental implant location, soft tissue thickness and materials employed. If the crown shape cannot be altered, altering the subcritical zone may significantly enhance the treatment’s cosmetic and biological success.
Over the recent decade, many innovative dental materials have reached the market. They provide an attractive, practical and cost-effective alternative to metal-ceramic restorations, the most often used material in prosthodontics. This is particularly true for ceramics made of zirconium oxide and lithium disilicate. Both metal-ceramic single crowns and multi-unit fixed partial dentures have a lengthy track record of success. They can be used to treat a wide variety of clinical indications but are particularly useful in cases requiring high clinical implant crowns, cantilever-type implant restorations, implant-supported fixed partial dentures with distal units extending beyond 8 mm, fixed partial dentures with more than two pontics and cases requiring a small connector height due to limited interocclusal space. When a clinician must choose between veneered and monolithic zirconia-ceramic implant-supported restorations, the following factors must be considered: aesthetic requirements, location in the dental arch, material physical properties, surface modification capability and material abrasion (wear) properties. Considering the findings of this meta-analysis, it is acceptable to infer that lithium-disilicate reinforced glass-ceramic implant-supported crowns are the treatment of choice for clinical situations requiring a high level of aesthetics in the maxillary anterior area.
The author declares no conflict of interest.
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\\n\\nThe Author and Co-Authors confirm that: (i) the Work is their original work and is not copied wholly or substantially from any other work or material or any other source; (ii) the Work has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) Authors and any applicable Co-Authors are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) Authors and any applicable Co-Authors have not assigned, and will not during the term of this Publication Agreement purport to assign, any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\\n\\nThe Author and Co-Authors also confirm and warrant that: (i) he/she has the power to enter into this Publication Agreement on his or her own behalf and on behalf of each Co-Author; and (ii) has the necessary rights and/or title in and to the Work to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licences in this Publication Agreement. If the Work was prepared jointly by the Author and Co-Authors, the Author confirms that: (i) all Co-Authors agree to the submission, license and publication of the Work on the terms of this Publication Agreement; and (ii) the Author has the authority to enter into this biding Publication Agreement on behalf of each Co-Author. The Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each Co-Author.
\\n\\nThe Author agrees to indemnify IntechOpen harmless against all liabilities, costs, expenses, damages and losses, as well as all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of, or in connection with, any breach of the agreed confirmations and warranties. This indemnity shall not apply in a situation in which a claim results from IntechOpen's negligence or willful misconduct.
\\n\\nNothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\\n\\nTERMINATION
\\n\\nIntechOpen has the right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Author and/or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Author and/or any Co-Author (being a private individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Author and/or any Co-Author (as a corporate entity) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for, or enters into, any compromise or arrangement with any of its creditors.
\\n\\nIn the event of termination, IntechOpen will notify the Author of the decision in writing.
\\n\\nIntechOpen’s DUTIES AND RIGHTS
\\n\\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen, at its discretion, agrees to publish the Work attributing it to the Author and Co-Authors.
\\n\\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen agrees to provide publishing services which include: managing editing (editorial and publishing process coordination, Author assistance); publishing software technology; language copyediting; typesetting; online publishing; hosting and web management; and abstracting and indexing services.
\\n\\nIntechOpen agrees to offer free online access to readers and use reasonable efforts to promote the Publication to relevant audiences.
\\n\\nIntechOpen is granted the authority to enforce the rights from this Publication Agreement on behalf of the Author and Co-Authors against third parties, for example in cases of plagiarism or copyright infringements. In respect of any such infringement or suspected infringement of the copyright in the Work, IntechOpen shall have absolute discretion in addressing any such infringement that is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\\n\\nIntechOpen has the right to include/use the Author and Co-Authors names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Work and has the right to contact the Author and Co-Authors until the Work is publicly available on any platform owned and/or operated by IntechOpen.
\\n\\nMISCELLANEOUS
\\n\\nFurther Assurance: The Author shall ensure that any relevant third party, including any Co-Author, shall execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\\n\\nThird Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\\n\\nEntire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by, or on behalf of, the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (known as the "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of any fraudulent pre-contract misrepresentation or concealment.
\\n\\nWaiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\\n\\nVariation: No variation of this Publication Agreement shall have effect unless it is in writing and signed by the parties, or their duly authorized representatives.
\\n\\nSeverance: If any provision, or part-provision, of this Publication Agreement is, or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted. Any modification to, or deletion of, a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\\n\\nNo partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Author or any Co-Author, nor authorize any party to make or enter into any commitments for, or on behalf of, any other party.
\\n\\nGoverning law: This Publication Agreement and any dispute or claim, including non-contractual disputes or claims arising out of, or in connection with it, or its subject matter or formation, shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of, or in connection with, this Publication Agreement, including any non-contractual disputes or claims.
\\n\\nPolicy last updated: 2018-09-11
\\n"}]'},components:[{type:"htmlEditorComponent",content:'When submitting a manuscript, the Author is required to accept the Terms and Conditions set out in our Publication Agreement – Monographs/Compacts as follows:
\n\nCORRESPONDING AUTHOR'S GRANT OF RIGHTS
\n\nSubject to the following Article, the Author grants to IntechOpen, during the full term of copyright, and any extensions or renewals of that term, the following:
\n\nThe foregoing licenses shall survive the expiry or termination of this Publication Agreement for any reason.
\n\nThe Author, on his or her own behalf and on behalf of any of the Co-Authors, reserves the following rights in the Work but agrees not to exercise them in such a way as to adversely affect IntechOpen's ability to utilize the full benefit of this Publication Agreement: (i) reprographic rights worldwide, other than those which subsist in the typographical arrangement of the Work as published by IntechOpen; and (ii) public lending rights arising under the Public Lending Right Act 1979, as amended from time to time, and any similar rights arising in any part of the world.
\n\nThe Author, and any Co-Author, confirms that they are, and will remain, a member of any applicable licensing and collecting society and any successor to that body responsible for administering royalties for the reprographic reproduction of copyright works.
\n\nSubject to the license granted above, copyright in the Work and all versions of it created during IntechOpen's editing process, including all published versions, is retained by the Author and any Co-Authors.
\n\nSubject to the license granted above, the Author and Co-Authors retain patent, trademark and other intellectual property rights to the Work.
\n\nAll rights granted to IntechOpen in this Article are assignable, sublicensable or otherwise transferrable to third parties without the specific approval of the Author or Co-Authors.
\n\nThe Author, on his/her own behalf and on behalf of the Co-Authors, will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Work as a consequence of IntechOpen's changes to the Work arising from the translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits as determined by IntechOpen.
\n\nAUTHOR'S DUTIES
\n\nWhen distributing or re-publishing the Work, the Author agrees to credit the Monograph/Compacts as the source of first publication, as well as IntechOpen. The Author guarantees that Co-Authors will also credit the Monograph/Compacts as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Work.
\n\nThe Author agrees to:
\n\nThe Author will be held responsible for the payment of the agreed Open Access Publishing Fee before the completion of the project (Monograph/Compacts publication).
\n\nAll payments shall be due 30 days from the date of issue of the invoice. The Author or whoever is paying on behalf of the Author and Co-Authors will bear all banking and similar charges incurred.
\n\nThe Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Work worldwide for the full term of the above licenses, and shall provide to IntechOpen, at its request, the original copies of such consents for inspection or the photocopies of such consents.
\n\nThe Author shall obtain written informed consent for publication from those who might recognize themselves or be identified by others, for example from case reports or photographs.
\n\nThe Author shall respect confidentiality during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Author and Co-Authors are confidential and are intended only for the recipients. The contents of any communication may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\n\nAUTHOR'S WARRANTY
\n\nThe Author and Co-Authors confirm and warrant that the Work does not and will not breach any applicable law or the rights of any third party and, specifically, that the Work contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy.
\n\nThe Author and Co-Authors confirm that: (i) the Work is their original work and is not copied wholly or substantially from any other work or material or any other source; (ii) the Work has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) Authors and any applicable Co-Authors are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) Authors and any applicable Co-Authors have not assigned, and will not during the term of this Publication Agreement purport to assign, any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Author and Co-Authors also confirm and warrant that: (i) he/she has the power to enter into this Publication Agreement on his or her own behalf and on behalf of each Co-Author; and (ii) has the necessary rights and/or title in and to the Work to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licences in this Publication Agreement. If the Work was prepared jointly by the Author and Co-Authors, the Author confirms that: (i) all Co-Authors agree to the submission, license and publication of the Work on the terms of this Publication Agreement; and (ii) the Author has the authority to enter into this biding Publication Agreement on behalf of each Co-Author. The Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each Co-Author.
\n\nThe Author agrees to indemnify IntechOpen harmless against all liabilities, costs, expenses, damages and losses, as well as all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of, or in connection with, any breach of the agreed confirmations and warranties. This indemnity shall not apply in a situation in which a claim results from IntechOpen's negligence or willful misconduct.
\n\nNothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\nTERMINATION
\n\nIntechOpen has the right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Author and/or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Author and/or any Co-Author (being a private individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Author and/or any Co-Author (as a corporate entity) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for, or enters into, any compromise or arrangement with any of its creditors.
\n\nIn the event of termination, IntechOpen will notify the Author of the decision in writing.
\n\nIntechOpen’s DUTIES AND RIGHTS
\n\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen, at its discretion, agrees to publish the Work attributing it to the Author and Co-Authors.
\n\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen agrees to provide publishing services which include: managing editing (editorial and publishing process coordination, Author assistance); publishing software technology; language copyediting; typesetting; online publishing; hosting and web management; and abstracting and indexing services.
\n\nIntechOpen agrees to offer free online access to readers and use reasonable efforts to promote the Publication to relevant audiences.
\n\nIntechOpen is granted the authority to enforce the rights from this Publication Agreement on behalf of the Author and Co-Authors against third parties, for example in cases of plagiarism or copyright infringements. In respect of any such infringement or suspected infringement of the copyright in the Work, IntechOpen shall have absolute discretion in addressing any such infringement that is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\nIntechOpen has the right to include/use the Author and Co-Authors names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Work and has the right to contact the Author and Co-Authors until the Work is publicly available on any platform owned and/or operated by IntechOpen.
\n\nMISCELLANEOUS
\n\nFurther Assurance: The Author shall ensure that any relevant third party, including any Co-Author, shall execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\nThird Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\nEntire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by, or on behalf of, the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (known as the "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of any fraudulent pre-contract misrepresentation or concealment.
\n\nWaiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\nVariation: No variation of this Publication Agreement shall have effect unless it is in writing and signed by the parties, or their duly authorized representatives.
\n\nSeverance: If any provision, or part-provision, of this Publication Agreement is, or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted. Any modification to, or deletion of, a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\nNo partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Author or any Co-Author, nor authorize any party to make or enter into any commitments for, or on behalf of, any other party.
\n\nGoverning law: This Publication Agreement and any dispute or claim, including non-contractual disputes or claims arising out of, or in connection with it, or its subject matter or formation, shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of, or in connection with, this Publication Agreement, including any non-contractual disputes or claims.
\n\nPolicy last updated: 2018-09-11
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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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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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Over the past few decades, no major new types of antibiotics have been produced and almost all known antibiotics are increasingly losing their activity against pathogenic microorganisms. The levels of multi-drug resistant bacteria have also increased. It is known that worldwide, more than 60% of all antibiotics that are produced find their use in animal production for both therapeutic and non-therapeutic purposes. The use of antimicrobial agents in animal husbandry has been linked to the development and spread of resistant bacteria. Poultry products are among the highest consumed products worldwide but a lot of essential antibiotics are employed during poultry production in several countries; threatening the safety of such products (through antimicrobial residues) and the increased possibility of development and spread of microbial resistance in poultry settings. This chapter documents some of the studies on antibiotic usage in poultry farming; with specific focus on some selected bacterial species, their economic importance to poultry farming and reports of resistances of isolated species from poultry settings (farms and poultry products) to essential antibiotics.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Christian Agyare, Vivian Etsiapa Boamah, Crystal Ngofi Zumbi and\nFrank Boateng Osei",authors:[{id:"182058",title:"Dr.",name:"Christian",middleName:null,surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"261271",title:"MSc.",name:"Crystal Ngofi",middleName:null,surname:"Zumbi",slug:"crystal-ngofi-zumbi",fullName:"Crystal Ngofi Zumbi"},{id:"261272",title:"MSc.",name:"Frank Boateng",middleName:null,surname:"Osei",slug:"frank-boateng-osei",fullName:"Frank Boateng Osei"},{id:"261273",title:"Dr.",name:"Vivian Etsiapa",middleName:null,surname:"Boamah",slug:"vivian-etsiapa-boamah",fullName:"Vivian Etsiapa Boamah"}]},{id:"39599",doi:"10.5772/50046",title:"Encapsulation Technology to Protect Probiotic Bacteria",slug:"encapsulation-technology-to-protect-probiotic-bacteria",totalDownloads:12297,totalCrossrefCites:40,totalDimensionsCites:81,abstract:null,book:{id:"3145",slug:"probiotics",title:"Probiotics",fullTitle:"Probiotics"},signatures:"María Chávarri, Izaskun Marañón and María Carmen Villarán",authors:[{id:"150285",title:"Dr.",name:"María",middleName:null,surname:"Chávarri Hueda",slug:"maria-chavarri-hueda",fullName:"María Chávarri Hueda"},{id:"151613",title:"MSc.",name:"Izaskun",middleName:null,surname:"Marañon",slug:"izaskun-maranon",fullName:"Izaskun Marañon"},{id:"151621",title:"Dr.",name:"Mª Carmen",middleName:null,surname:"Villarán",slug:"ma-carmen-villaran",fullName:"Mª Carmen Villarán"}]},{id:"39607",doi:"10.5772/50121",title:"Recent Application of Probiotics in Food and Agricultural Science",slug:"recent-application-of-probiotics-in-food-and-agricultural-science",totalDownloads:10098,totalCrossrefCites:28,totalDimensionsCites:74,abstract:null,book:{id:"3145",slug:"probiotics",title:"Probiotics",fullTitle:"Probiotics"},signatures:"Danfeng Song, Salam Ibrahim and Saeed Hayek",authors:[{id:"107905",title:"Prof.",name:"Salam",middleName:null,surname:"Ibrahim",slug:"salam-ibrahim",fullName:"Salam Ibrahim"},{id:"150202",title:"Dr.",name:"Danfeng",middleName:null,surname:"Song",slug:"danfeng-song",fullName:"Danfeng Song"},{id:"151025",title:"MSc.",name:"Saeed",middleName:null,surname:"Hayek",slug:"saeed-hayek",fullName:"Saeed Hayek"}]},{id:"49246",doi:"10.5772/61300",title:"Chitosan as a Biomaterial — Structure, Properties, and Electrospun Nanofibers",slug:"chitosan-as-a-biomaterial-structure-properties-and-electrospun-nanofibers",totalDownloads:4607,totalCrossrefCites:24,totalDimensionsCites:55,abstract:"Chitosan is a polysaccharide derived from chitin; chitin is the second most abundant polysaccharide in the world, after cellulose. Chitosan is biocompatible, biodegradable and non-toxic, so that it can be usedin medicalapplications such as antimicrobial and wound healing biomaterials. It also used as chelating agent due to its ability to bind with cholesterol, fats, proteins and metal ions.",book:{id:"4648",slug:"concepts-compounds-and-the-alternatives-of-antibacterials",title:"Concepts, Compounds and the Alternatives of Antibacterials",fullTitle:"Concepts, Compounds and the Alternatives of Antibacterials"},signatures:"H. M. Ibrahim and E.M.R. El- Zairy",authors:[{id:"90645",title:"Dr.",name:"Hassan",middleName:null,surname:"Ibrahim",slug:"hassan-ibrahim",fullName:"Hassan Ibrahim"},{id:"175694",title:"Dr.",name:"Enas",middleName:null,surname:"El- Zairy",slug:"enas-el-zairy",fullName:"Enas El- Zairy"}]},{id:"51065",doi:"10.5772/63499",title:"Role of the Biofilms in Wastewater Treatment",slug:"role-of-the-biofilms-in-wastewater-treatment",totalDownloads:6759,totalCrossrefCites:24,totalDimensionsCites:55,abstract:"Biological wastewater treatment systems play an important role in improving water quality and human health. This chapter thus briefly discusses different biological methods, specially biofilm technologies, the development of biofilms on different filter media, factors affecting their development as well as their structure and function. It also tackles various conventional and modern molecular techniques for detailed exploration of the composition, diversity and dynamics of biofilms. These data are crucial to improve the performance, robustness and stability of biofilm-based wastewater treatment technologies.",book:{id:"5197",slug:"microbial-biofilms-importance-and-applications",title:"Microbial Biofilms",fullTitle:"Microbial Biofilms - Importance and Applications"},signatures:"Shama Sehar and Iffat Naz",authors:[{id:"180364",title:"Dr.",name:"Iffat",middleName:null,surname:"Naz",slug:"iffat-naz",fullName:"Iffat Naz"},{id:"183345",title:"Dr.",name:"Shama",middleName:null,surname:"Sehar",slug:"shama-sehar",fullName:"Shama Sehar"}]}],mostDownloadedChaptersLast30Days:[{id:"65613",title:"The Methods for Detection of Biofilm and Screening Antibiofilm Activity of Agents",slug:"the-methods-for-detection-of-biofilm-and-screening-antibiofilm-activity-of-agents",totalDownloads:9033,totalCrossrefCites:11,totalDimensionsCites:20,abstract:"Biofilm producer microorganisms cause nosocomial and recurrent infections. Biofilm that is a sticky exopolysaccharide is the main virulence factor causing biofilm-related infections. Biofilm formation begins with attachment of bacteria to biotic surface such as host cell or abiotic surface such as prosthetic devices. After attachment, aggregation of bacteria is started by cell-cell adhesion. Aggregation continues with the maturation of biofilm. Dispersion is started by certain conditions such as phenol-soluble modulins (PSMs). By this way, sessile bacteria turn back into planktonic form. Bacteria embedded in biofilm (sessile form) are more resistant to antimicrobials than planktonic bacteria. So it is hard to treat biofilm-embedded bacteria than planktonic forms. For this reason, it is important to detect biofilm. There are a few biofilm detection and biofilm production methods on prosthetics, methods for screening antibacterial effect of agents against biofilm-embedded microorganism and antibiofilm effect of agents against biofilm production and mature biofilm. The aim of this chapter is to overview direct and indirect methods such as microscopy, fluorescent in situ hybridization, and Congo red agar, tube method, microtiter plate assay, checkerboard assay, plate counting, polymerase chain reaction, mass spectrometry, MALDI-TOF, and biological assays used by antibiofilm researches.",book:{id:"8427",slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods"},signatures:"Sahra Kırmusaoğlu",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}]},{id:"62553",title:"Antibiotic Use in Poultry Production and Its Effects on Bacterial Resistance",slug:"antibiotic-use-in-poultry-production-and-its-effects-on-bacterial-resistance",totalDownloads:7129,totalCrossrefCites:42,totalDimensionsCites:82,abstract:"A surge in the development and spread of antibiotic resistance has become a major cause for concern. Over the past few decades, no major new types of antibiotics have been produced and almost all known antibiotics are increasingly losing their activity against pathogenic microorganisms. The levels of multi-drug resistant bacteria have also increased. It is known that worldwide, more than 60% of all antibiotics that are produced find their use in animal production for both therapeutic and non-therapeutic purposes. The use of antimicrobial agents in animal husbandry has been linked to the development and spread of resistant bacteria. Poultry products are among the highest consumed products worldwide but a lot of essential antibiotics are employed during poultry production in several countries; threatening the safety of such products (through antimicrobial residues) and the increased possibility of development and spread of microbial resistance in poultry settings. This chapter documents some of the studies on antibiotic usage in poultry farming; with specific focus on some selected bacterial species, their economic importance to poultry farming and reports of resistances of isolated species from poultry settings (farms and poultry products) to essential antibiotics.",book:{id:"6978",slug:"antimicrobial-resistance-a-global-threat",title:"Antimicrobial Resistance",fullTitle:"Antimicrobial Resistance - A Global Threat"},signatures:"Christian Agyare, Vivian Etsiapa Boamah, Crystal Ngofi Zumbi and\nFrank Boateng Osei",authors:[{id:"182058",title:"Dr.",name:"Christian",middleName:null,surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"261271",title:"MSc.",name:"Crystal Ngofi",middleName:null,surname:"Zumbi",slug:"crystal-ngofi-zumbi",fullName:"Crystal Ngofi Zumbi"},{id:"261272",title:"MSc.",name:"Frank Boateng",middleName:null,surname:"Osei",slug:"frank-boateng-osei",fullName:"Frank Boateng Osei"},{id:"261273",title:"Dr.",name:"Vivian Etsiapa",middleName:null,surname:"Boamah",slug:"vivian-etsiapa-boamah",fullName:"Vivian Etsiapa Boamah"}]},{id:"65914",title:"Introductory Chapter: The Action Mechanisms of Antibiotics and Antibiotic Resistance",slug:"introductory-chapter-the-action-mechanisms-of-antibiotics-and-antibiotic-resistance",totalDownloads:4310,totalCrossrefCites:6,totalDimensionsCites:8,abstract:null,book:{id:"8427",slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods"},signatures:"Sahra Kırmusaoğlu, Nesrin Gareayaghi and Bekir S. Kocazeybek",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"},{id:"248288",title:"Prof.",name:"Bekir",middleName:null,surname:"Kocazeybek",slug:"bekir-kocazeybek",fullName:"Bekir Kocazeybek"},{id:"406463",title:"Dr.",name:"Nesrin",middleName:null,surname:"Gareayaghi",slug:"nesrin-gareayaghi",fullName:"Nesrin Gareayaghi"}]},{id:"50992",title:"Probiotics: A Comprehensive Review of Their Classification, Mode of Action and Role in Human Nutrition",slug:"probiotics-a-comprehensive-review-of-their-classification-mode-of-action-and-role-in-human-nutrition",totalDownloads:5325,totalCrossrefCites:14,totalDimensionsCites:26,abstract:"Probiotics are live microorganisms that live in gastrointestinal (GI) tract and are beneficial for their hosts and prevent certain diseases. In this chapter, after a complete introduction to probiotics, definition, mechanism of action, and their classification, currently used organisms will be discussed in detail. Moreover, different kinds of nutritional synthetic products of probiotics along with their safety and drug interaction will be noticed. This chapter mentions all clinical trial studies that have been done to evaluate probiotic efficacy with a focus on gastrointestinal diseases.",book:{id:"5193",slug:"probiotics-and-prebiotics-in-human-nutrition-and-health",title:"Probiotics and Prebiotics in Human Nutrition and Health",fullTitle:"Probiotics and Prebiotics in Human Nutrition and Health"},signatures:"Amirreza Khalighi, Reza Behdani and Shabnam Kouhestani",authors:[{id:"179560",title:"Dr.",name:"Amirreza",middleName:null,surname:"Khalighi",slug:"amirreza-khalighi",fullName:"Amirreza Khalighi"},{id:"185238",title:"Dr.",name:"Reza",middleName:null,surname:"Behdani",slug:"reza-behdani",fullName:"Reza Behdani"},{id:"185239",title:"Dr.",name:"Shabnam",middleName:null,surname:"Kouhestani",slug:"shabnam-kouhestani",fullName:"Shabnam Kouhestani"}]},{id:"56849",title:"Physiology and Pathology of Innate Immune Response Against Pathogens",slug:"physiology-and-pathology-of-innate-immune-response-against-pathogens",totalDownloads:6083,totalCrossrefCites:20,totalDimensionsCites:26,abstract:"Pathogen infections are recognized by the immune system, which consists of two types of responses: an innate immune response and an antigen-specific adaptive immune response. The innate response is characterized by being the first line of defense that occurs rapidly in which leukocytes such as neutrophils, monocytes, macrophages, eosinophils, mast cells, dendritic cells, etc., are involved. These cells recognize the pathogen-associated molecular patterns (PAMPs), which have been evolutionarily conserved by the diversity of microorganisms that infect humans. Recognition of these pathogen-associated molecular patterns occurs through pattern recognition receptors such as Toll-like receptors and some other intracellular receptors such as nucleotide oligomerization domain (NOD), with the aim of amplifying the inflammation and activating the adaptive cellular immune response, through the antigenic presentation. In the present chapter, we will review the importance of the main components involved in the innate immune response, such as different cell types, inflammatory response, soluble immune mediators and effector mechanisms exerted by the immune response against bacteria, viruses, fungi, and parasites; all with the purpose of eliminating them and eradicating the infection of the host.",book:{id:"5975",slug:"physiology-and-pathology-of-immunology",title:"Physiology and Pathology of Immunology",fullTitle:"Physiology and Pathology of Immunology"},signatures:"José Luis Muñoz Carrillo, Flor Pamela Castro García, Oscar\nGutiérrez Coronado, María Alejandra Moreno García and Juan\nFrancisco Contreras Cordero",authors:[{id:"214236",title:"Dr.",name:"Jose Luis",middleName:null,surname:"Muñoz-Carrillo",slug:"jose-luis-munoz-carrillo",fullName:"Jose Luis Muñoz-Carrillo"},{id:"216080",title:"Dr.",name:"Alejandra",middleName:null,surname:"Moreno-García",slug:"alejandra-moreno-garcia",fullName:"Alejandra Moreno-García"},{id:"216081",title:"Dr.",name:"Oscar",middleName:null,surname:"Gutiérrez-Coronado",slug:"oscar-gutierrez-coronado",fullName:"Oscar Gutiérrez-Coronado"},{id:"216082",title:"Dr.",name:"Pamela",middleName:null,surname:"Castro-García",slug:"pamela-castro-garcia",fullName:"Pamela Castro-García"},{id:"220717",title:"Dr.",name:"Juan Francisco",middleName:null,surname:"Contreras Cordero",slug:"juan-francisco-contreras-cordero",fullName:"Juan Francisco Contreras Cordero"}]}],onlineFirstChaptersFilter:{topicId:"13",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81760",title:"On the Selective Isolation of Actinobacteria from Different Mexican Ecosystems",slug:"on-the-selective-isolation-of-actinobacteria-from-different-mexican-ecosystems",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.104699",abstract:"Actinobacteria isolated from less studied sites on our planet represent a huge opportunity for the discovery of novel microorganisms that may produce unique compounds with biological activity. The class actinobacteria encompasses 80% of the microbes that produce the antibacterial compounds used in medicine today. However, the resistance acquired/showed by pathogenic microorganisms opens the opportunity to explore Mexican ecosystems as a source of novel actinobacteria. Air samples have shown to be an excellent site of study, marine ecosystems which include sediments and marine organisms are important sources of novel actinobacteria and soil samples are still a promising source to isolate this microbial group. The isolation of novel actinobacteria is a dynamic strategy that depends on the expertise, patience, and talent of the techniques applied and needs to be fully explored to untap the unknown actinobacterial diversity with potential in biology.",book:{id:"10893",title:"Actinobacteria",coverURL:"https://cdn.intechopen.com/books/images_new/10893.jpg"},signatures:"Erika T. Quintana, Luis A. Maldonado, Luis Contreras-Castro, Amanda Alejo-Viderique, Martha E. Esteva García, Claudia J. Hernández-Guerrero, Juan C. Cancino-Díaz, Carlos Sánchez, Luis A. Ladino, Juan Esteban Martínez-Gómez and Noemí Matías-Ferrer"},{id:"81741",title:"Chronic Intraocular Leptospiral Infection Relying on Biofilm Formation inside the Vitreous Cavity Leads to Recurrent Uveitis in Horses",slug:"chronic-intraocular-leptospiral-infection-relying-on-biofilm-formation-inside-the-vitreous-cavity-le",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.104527",abstract:"Equine recurrent uveitis (ERU) is a disease known and feared for centuries, as it almost always leads to blindness even with careful and meticulous conservative treatment of the individual episodes of uveitis. In about one-third of horses, both eyes are affected, often necessitating euthanasia. A link between ERU and leptospiral infection has been suspected for nearly 80 years. Vitreous lavage (vitrectomy) can preserve vision in affected eyes. After surgery, no further episodes of uveitis occur in up to more than 95% of operated eyes. With routine performance of vitrectomies, numerous vitreous samples could be used for further investigations. Intraocular anti-Leptospira antibody production was proven, leptospires could be cultured from the vitreous samples, and the LipL32 gene could be detected in the vitreous samples by PCR. Thus, there was convincing evidence of a chronic intraocular leptospiral infection, which can be eliminated most reliably by vitrectomy. Recently, it has been shown that the intraocular leptospires produce biofilm in the equine vitreous. Biofilm formation explains not only the success of vitrectomy, but also the survival of leptospires in the vitreous cavity for many years despite the presence of high intraocular antibody titers and immunocompetent cells, as well as the high tolerance to antibiotics.",book:{id:"11092",title:"Bacterial Biofilms",coverURL:"https://cdn.intechopen.com/books/images_new/11092.jpg"},signatures:"Bettina Wollanke and Hartmut Gerhards"},{id:"81758",title:"Growing Environmental Bacterium Biofilms in PEO Cryogels for Environmental Biotechnology Application",slug:"growing-environmental-bacterium-biofilms-in-peo-cryogels-for-environmental-biotechnology-application",totalDownloads:0,totalDimensionsCites:0,doi:"10.5772/intechopen.104813",abstract:"This Chapter discusses the entrapment, growing and biofilm formation by an environmental bacterium immobilized in polyethyleneoxide cryogel to be applied in environmental biotechnology. The KCM-R5 bacterium was isolated from the heavy metal-polluted environment near a large Pb-Zn smelter, also producing precious metals in Bulgaria. Molecular-genetic analysis revealed affiliation with Pseudomonas rhodesiae. The strain is capable of growing in high concentrations of phenol and different phenol derivatives. Polyethylene oxide was found to be friendly and nontoxic to bacteria polymer enabling bacteria easy to penetrate in it and fast to grow. KCM-R5 biofilms were grown for 30 days in batch culture with phenol (300-1000 mg L−1) dissolved in the mineral medium. The bacterium was able to involve phenol in its metabolism and use it as a single carbon supplier. The results obtained in the study showed 98% phenol biodegradation using the biotech installation described. The proposed PEO cryogel-P. rhodesiae KCM-R5 bacterium biotech biofilter can be used for environmental biotechnology application in industrial wastewater detoxification.",book:{id:"11092",title:"Bacterial Biofilms",coverURL:"https://cdn.intechopen.com/books/images_new/11092.jpg"},signatures:"Galina Satchanska"},{id:"81733",title:"Impairment of the Cardiovascular System during SARS-CoV-2 Infection",slug:"impairment-of-the-cardiovascular-system-during-sars-cov-2-infection",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.103964",abstract:"Although the infection with the severe acute respiratory syndrome (SARS-CoV-2) virus affects primarily the respiratory system, it became evident from the very beginning that the coronavirus disease 2019 (COVID-19) is frequently associated with a large spectrum of cardiovascular involvements such as myocarditis/pericarditis, acute coronary syndrome, arrhythmias, or thromboembolic events, explained by a multitude of pathophysiological mechanisms. Individuals already suffering of significant cardiovascular diseases were more likely to be infected with the virus, had a worse evolution during COVID-19, with further deterioration of their basal condition and increased morbidity and mortality, but significant cardiac dysfunctions were diagnosed even in individuals without a history of heart diseases or being at low risk to develop such a pathology. Cardiovascular complications may occur anytime during the course of COVID-19, persisting even during recovery and, potentially, explaining many of the persisting symptoms included now in terms as subacute or long-COVID-19. It is now well accepted that in COVID-19, the occurrence of cardiovascular impairment represents a significant negative prognostic factor, immensely rising the burden of cardiovascular pathologies.",book:{id:"11369",title:"RNA Viruses",coverURL:"https://cdn.intechopen.com/books/images_new/11369.jpg"},signatures:"Cristina Tudoran, Mariana Tudoran, Voichita Elena Lazureanu, Adelina Raluca Marinescu, Dorin Novacescu and Talida Georgiana Cut"},{id:"81718",title:"Advances in the Development of Anti-Trichinella spiralis Vaccine, Challenges, and Future Prospective",slug:"advances-in-the-development-of-anti-trichinella-spiralis-vaccine-challenges-and-future-prospective",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.103027",abstract:"Trichinellosis is a food-borne, zoonotic disease that causes infection by a nematode parasite belonging to the genus Trichinella. This is an important disease, and its causative agent is prevalent throughout the world (cosmopolitan). More clinical awareness of trichinellosis is required due to its many outbreaks, increase in the consumption of pork meat and its by-products. Trichinellosis is an epizootic in nature and its economic burden is associated with the prevention of this disease from the human food chain. This disease is transmitted from animals to humans through the consumption of raw or undercooked meat containing encapsulated muscle larvae of Trichinella spiralis. This paper demonstrates the direct effect of progesterone (P4) and mifepristone (RU486) on the progesterone receptors of T. spiralis. Also, studied the challenges in the preparation of DNA and recombinant protein vaccination to control trichinellosis. It is simply done this study at different life cycle developmental stages of T. spiralis. Vaccines development against T. spiralis infection is the new paradime shift from prevention of trichinellosis to fulfilling the food safety requirements.",book:{id:"11380",title:"Parasitic Helminths and Zoonoses - From Basic to Applied Research",coverURL:"https://cdn.intechopen.com/books/images_new/11380.jpg"},signatures:"Muhammad Tahir Aleem, Ruofeng Yan, Asad Khan, Rida Asrar, Amna Shakoor, Areej Asif, Zhaohai Wen, Zhengqing Yu, Muhammad Abdullah Malik, Tauseef-ur-Rehman, Rao Zahid Abbas, Muhammad Mohsin, Xiaokai Song, Lixin Xu and Xiangrui Li"},{id:"81699",title:"Efflux Pumps among Urinary E. coli and K. pneumoniae Local Isolates in Hilla City, Iraq",slug:"efflux-pumps-among-urinary-e-coli-and-k-pneumoniae-local-isolates-in-hilla-city-iraq",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.104408",abstract:"Urinary tract infections (UTI) are the most common bacterial infections affecting humans. Escherichia coli and Klebsiella pneumoniae were common enterobacteria engaged with community-acquired UTIs. Efflux pumps were vital resistance mechanisms for antibiotics, especially among enterobacteria. Overexpression of an efflux system, which results in a decrease in antibiotic accumulation, is an effective mechanism for drug resistance. The ATP-binding cassette (ABC) transporters, small multidrug resistance (SMR), and multidrug and toxic compound extrusion (MATE) families, the major facilitator superfamily (MFS), and the resistance-nodulation- cell division (RND) family are the five superfamilies of efflux systems linked to drug resistance. This chapter highlights the results of studying the prevalence of efflux pump genes among local isolates of E. coli and K. pneumoniae in Hilla City, Iraq. class RND AcrAB-TolC, AcrAD-TolC, and AcrFE-TolC genes detected by conventional PCR of E. coli and K. pneumoniae respectively. The result revealed approximately all studied efflux transporter were found in both E. coli and K. pneumoniae in different percentages. Biofilm formation were observed in 50(100%) of K. pneumoniae and 49(98%) of E. coli isolates were biofilm former and follow: 30(60%), 20(40%) were weak, 12(24%), 22(44%) were moderate and 7(14%) and 8(16%) were Strong biofilm former for E. coli and K. pneumoniae, respectively.",book:{id:"11373",title:"The Global Antimicrobial Resistance Epidemic – Innovative Approaches and Cutting-Edge Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11373.jpg"},signatures:"Hussein Al-Dahmoshi, Sahar A. Ali and Noor Al-Khafaji"}],onlineFirstChaptersTotal:87},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:86,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:96,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:283,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:138,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:128,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:100,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. By addressing hot topics in veterinary sciences, we aim to gather authoritative texts within each issue of this series, providing in-depth overviews and analysis for graduates, academics, and practitioners and foreseeing a deeper understanding of the subject. Forthcoming texts, written and edited by experienced researchers from both industry and academia, will also discuss scientific challenges faced today in Veterinary Medicine and Science. In brief, we hope that books in this series will provide accessible references for those interested or working in this field and encourage learning in a range of different topics.",coverUrl:"https://cdn.intechopen.com/series/covers/13.jpg",latestPublicationDate:"May 14th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"38652",title:"Dr.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:null,institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. 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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. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11404,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,series:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343"},editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",slug:"hitoshi-tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",slug:"marcus-vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",slug:"ramana-vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},onlineFirstChapters:{paginationCount:17,paginationItems:[{id:"81647",title:"Diabetes and Epigenetics",doi:"10.5772/intechopen.104653",signatures:"Rasha A. 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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.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",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. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. 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.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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