Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
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This achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
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We are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
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Thank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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This book provides a comprehensive overview of the various types of muscular dystrophies, genes associated with each subtype, disease diagnosis, management as well as available treatment options. Though each different type and subtype of muscular dystrophy is associated with a different causative gene, the majority of them have overlapping clinical presentations, making molecular diagnosis inevitable for both disease diagnosis as well as patient management. This book discusses the currently available diagnostic approaches that have revolutionized clinical research. Pathophysiology of the different muscular dystrophies, multifaceted functions of the involved genes as well as efforts towards diagnosis and effective patient management, are also discussed. Adding value to the book are the included reports on ongoing studies that show a promise for future therapeutic strategies.",isbn:null,printIsbn:"978-953-51-0603-6",pdfIsbn:"978-953-51-6994-9",doi:"10.5772/1242",price:159,priceEur:175,priceUsd:205,slug:"muscular-dystrophy",numberOfPages:556,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"d6d8a96e17938c02e9611481a3b4bff8",bookSignature:"Madhuri Hegde\tand Arunkanth Ankala",publishedDate:"May 9th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/734.jpg",numberOfDownloads:82621,numberOfWosCitations:39,numberOfCrossrefCitations:23,numberOfCrossrefCitationsByBook:3,numberOfDimensionsCitations:53,numberOfDimensionsCitationsByBook:3,hasAltmetrics:0,numberOfTotalCitations:115,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 8th 2011",dateEndSecondStepPublish:"April 5th 2011",dateEndThirdStepPublish:"August 10th 2011",dateEndFourthStepPublish:"September 9th 2011",dateEndFifthStepPublish:"January 7th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"87795",title:"Dr.",name:"Madhuri",middleName:null,surname:"Hegde",slug:"madhuri-hegde",fullName:"Madhuri Hegde",profilePictureURL:"https://mts.intechopen.com/storage/users/87795/images/2548_n.png",biography:"Dr. Hegde is an Associate Professor/ Scientific Director at Emory Genetics Laboratory in the Department of Human Genetics. She received a B.Sc. and a M.Sc. from the University of Bombay, India, and a Ph.D. from the University of Auckland, New Zealand. She performed post doctoral studies at Baylor College of Medicine and is board certified in Clinical Molecular Genetics. The primary focus of her clinical work is the development of high-throughput sequencing strategies for rare disorders using sequence capture technologies, robotics, next generation sequencing, oligonucleotide array platforms, robotics and predictive analysis tools. Her research is focused on functional analysis of sequence variants in disease associated genes specifically for muscular dystrophies, with an ultimate goal of creating an algorithm for clinical interpretation of novel sequence variants. 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Later, he moved on to perform post-doctoral studies at Emory University School of Medicine in the department of Human Genetics. The primary focus of his clinical research work has been the elucidation of mechanisms underpinning the high frequency of intragenic deletions and duplications in human DMD gene causing Duchenne Muscular Dystrophy. His broader research interest has been the discovery of new disease causing genes associated with different muscular dystrophies especially congenital muscular dystrophies and limb-girdle muscular dystrophies. 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",isbn:"978-1-80356-576-7",printIsbn:"978-1-80356-575-0",pdfIsbn:"978-1-80356-577-4",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"4c3e68adcaeaa44f9fbfe9bb19bdd55b",bookSignature:"Dr. Yuri Kim",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11504.jpg",keywords:"Separation Theorem, Extended Kalman Filter, Covariance Matrix, Riccati Equation, FBGM, Analytical Implementation Forms, Physical Implementation Forms, Steady State Filter, Inertial Navigation System, Global Positioning System, Controllability, Multisensory Navigation",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 15th 2022",dateEndSecondStepPublish:"April 12th 2022",dateEndThirdStepPublish:"June 11th 2022",dateEndFourthStepPublish:"August 30th 2022",dateEndFifthStepPublish:"October 29th 2022",remainingDaysToSecondStep:"a month",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Prof. Y.V. Kim is a Doctor of Technical Science, having a broad and wealthy international scientific, engineering, and teaching experience, obtained in the former USSR, Israel, and Canada. He has many scientific publications and implemented inventions dedicated to Aerospace GN&C.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"316140",title:"Dr.",name:"Yuri",middleName:null,surname:"Kim",slug:"yuri-kim",fullName:"Yuri Kim",profilePictureURL:"https://mts.intechopen.com/storage/users/316140/images/system/316140.jpg",biography:"Yuri Kim\n24 Buttenut, Gatineau, QC, Canada\nTel : 1-(514)- 466-1033, e-mail: yurikim@hotmail.ca\n\nHIGHLIGHTS OF QUALIFICATIONS:\n\nExperienced scientist, engineer and manager with internationally recognized achievements in area of Aerospace Avionics, (GN&C); Analysis, design (HW&SW), integration, testing and operation for various aerospace platforms and missions. \n\nGained a broad experience in preparation of technical documents for Joint (Industry-Customer) State Commissions for the acceptance (commissioning) of Aerospace Avionics, Navigation and Special application experimental equipment for further serial production, and operational support. Last works have been dedicated to R&D projects developing new Satellite Navigation Control Technology and customer support of Canadian satellites Control system design.\n\n\nACADEMIC DEGREES:\n\n 1991 *Doctor of Technical Science Diploma in Aerospace Vehicles Guidance \n Navigation and Control \n Scientific Council of State Institute of Automatic Systems, Ministry of Aviation\n Industry of USSR, Moscow\n (Recognized by Canadian Professional Counsel of Engineers) \n1982 * Senior Scientific Fellow Diploma in Gyroscopes and Navigation systems \n Capital Certification Commission of Scientists, Ministry of High Education of\n USSR, Moscow.\n (Recognized by Canadian Professional Counsel of Engineers)\n1974 * Candidate of Technical Science Diploma in Aerospace Navigation\n and Control Systems (Accredited as Ph.D by York University, Toronto.)\n Scientific Council of Moscow Aviation Institute, Moscow.\n1970 * Engineer Electromechanic Diploma in Gyro and Navigation systems,\n Faculty of Flight Apparatuses Control Systems, Moscow Aviation Institute, \n Moscow (Accredited as between Masters Degree and Bachelor Degree by\n York University, Toronto).\n1965 * Radio and TV Systems Technician Certificate, Dnepropetrovsk Technical School \n of preparation of technical specialists for Soviet Army, Military Aviation and \n Navy.\n\nMILITARY EDUCATION:\n\n1970 * Engineer in ballistic rocket control system, Military Faculty of MAI, last rank senior engineer-lieutenant (in reserve)\n\n\n\nEMPLOYMENT HISTORY:\nA. GOVERNMENT\n\nAt present - Canadian Space Agency, Space Science and Technology Division, David Florida Laboratory\n\n Senior Aerospace System engineer \n\n° Performing, developing and supporting phases of design, testing, commissioning and \n operation for space vehicle orbit and attitude control systems, in particular: Tecsas, Scope, \n J2Sat, Small satellite, M3Msat, Cassiopea, Neossat, RCM, PCW\n\n° Reviewing and commenting on Attitude Control systems design documentations, related to \n all phases of system development commissioning and operation\n \n° Supporting Aerospace Industry R&D projects funding by CSA (STDP) as Scientific\n Authority, in particular: Microwheel (Dynacon), LOCOOS (NGC), PCW (Bristol)\n\n° Providing expertise on new initiatives for Space Exploration and Utilization regarding \n Attitude and Orbital Control and possible development of Canadian space launcher\n\n° Developing basic mathematical (Simulink/Matlab) simulator for developing the \n requirements and expected performance of AODCS for new space vehicles\n\n° Developing new basic technology (based on Kalman Filter) for satellite attitude\n determination and sensor calibration, developing of FF test-bed equipment and GPS \n navigation in environment of CSA laboratory, developing of methods of ACS sensors\n calibration, measuring and compensation of satellite residual magnetic moment, experimental determination of satellite inertia matrix during ACS integration tests\n\n° Interacting with Space Industry and Universities in the problems, related to development of \n new methods and systems for space vehicle attitude and orbit determination and control\n \n° Sharing with International Aerospace community CSA achievements and experience in\n development of new technologies and methods for space vehicle attitude and orbit \n determination and control through publications, presentations and participation in scientific\n conferences, meetings and symposiums as well as maintaining an awareness about new \n technological advancements\n \n° Providing professional training for students and post. Graduates in the area of Orbital and\n Attitude Dynamic and Control\n\nB. INDUSTRIAL\n\nSept. 1998 – Feb. 1999 – Olympia Engineering Ltd. (Toronto)\n\nResearch and Development Engineer\n\n•\tDevelopment of measuring instrument for measuring remote measuring of micro- deformations of machinery (milling machine) equipment\n•\tResearch and testing of differential GPS survey equipment and antennas in environment of industrial facility for developing a new remote method for the measuring of machinery micro-deformations\n\n\n\n\nFeb.1999 – Jun.2002 – Saskatoon Engineering Division of Calian Company, \n Radarsat-1 Operation Team (CSA, Montreal)\n\nAttitude Control System Analyst\n\n•\tWorking as RADARSAT-1 Attitude Control System Analyst performing day-to-day operation TLM data analysis; reporting, monitoring and solving ACS flight anomaly problems, maintaining ACS software and performance \n•\tAuthor of many reports (see attached list of publications), devoted to solving of Radarsat-1 non-benign Safe Hold Mode problem, Momentum Wheel failure problems and improvement of the performance of attitude determination method with Magnetometer and Sun Sensor (back up, ADM3 mode for the case of potential failure of Horizon Scanner).\n•\tPreparation and implementation of the solution for RADARSAT-1 operation without failed Momentum Wheels, that saved the satellite mission after the wheel failures\n(This work was prolonged after in CSA and awarded by the Canadian Government Award for the invention used by the Government)\n•\tDesign and implementation of new dynamic simulators (based on Simulink\ntoolbox) for Radarsat-1 ACS for operation support\n•\tPreparation for operation of new Canadian satellites Scisat and RADARSAT-2 \n\n\n\nJan. 1994 – Sep. 1997 – Israel Aviation Industry (IAI factories: TASHAN, LAHAV)\n\nAvionics system engineer\n\n•\tResearch and preliminary design of the Special Data Fusion System for a fighter-interceptor\n•\tIntegration of Inertial Navigation System with Global Position System into Upgraded Avionics Suit and installation in aircraft cockpit for A/C – trainer T-38\n\nNov. 1977 – Apr. 1993 – Moscow Research and Design Institute of Electromechanic and Automatic (formerly P/B: M5537, presently “Aviapribor” Corporation)\n\n \nHead of Division (R&D in Pilot-Navigation Systems)\n\n•\tLeadership of the Division, performing planning, financial and methodological duties, related to this position, reporting to the R&D deputy director of the Institute\n•\tResponsibility for Pilot-Navigation System integration, interaction, tests and transferring for serial production and operational support\n•\tInitiation and methodical leadership of innovative research and development projects\n•\tReviewing, commenting and implementation of Technical standards and Navigation norms\nas well as sharing progressive methods and results within Aerospace organizations within former USSR\n \n Head of Department (INS and Flight Management System SW Development)\n\n•\tLeadership and performing of duties of Head of Department \n•\tResponsibility for the prospective research and preliminary design of the Inertial Navigation Systems (INS) and Flight Management Systems (FMS)\n•\tDesign of the INS and FMS algorithms and simulation of expected performance\n•\tDevelopment of INS/FMS flight code\n•\tDevelopment of test procedures and simulators for FMS, and pilot nav.complexis for aircrafts \n•\tResponsibility for system performance analysis in the ground and flight tests\n\n Head of Sector (System Flight Test data analysis) \n\n•\tLeadership of the Sector\n•\tDevelopment of ground and flight test simulation procedures and requirements for test equipment and simulators, for flight test aircraft measuring equipment, installation and recorded data processing\n•\tDesign of Estimation and Identification algorithms for ground and flight data processing\n•\tTest data analysis, preparation of test results analysis reports and conclusions\n\n Senior Scientific Fellow\n\n•\tResearch, development and principal design of the special Suboptimal Kalman Filter for the fusion of data of various navigation sensors for aviation and space platforms\n•\tDevelopment of new Guidance and Navigation methods for aviation and space platforms\n•\tAnalysis of INS and FMS performance in ground and flight tests\n\nC. ACADEMIC \n\n1977–1993 – Moscow Aviation Institute, Moscow Institute of Instrument -\n Making, Aviation Industry Ministry Upgrade Qualification Institute\n(Part Time) Professor, Associate professor, Chairmen of State Diploma Commission,\n Member of Scientific Council\n•\tLecturer of the disciplines: Applied Oscillation, Theory (MIIM), Design of Instruments (MIIM), Integrated Navigation Systems (MUQI)\n•\tChairman of the State Diploma Commission -Gyro Instruments and Systems (MAI)\n•\tLeadership of postgraduates, participation in sessions of Scientific Council (MAI)\n•\tMethodical management of cathedra of Orientation and Navigation in MAI \n\n2009 McGill University, Montreal\n\nPart time lecturer for course (in English): Aircraft Performance, Stability and Control\n\n1970–1977 – Moscow Aviation Institute \n(Full Time) Associate Professor, Senior Researcher, Assistant Lecturer \n•\tLecturer of the courses: Spacecraft orbital mechanics and attitude determination and control, Inertial Navigation Systems, Gyro Instruments and Systems\n•\tResearch and development of suboptimal robust estimation methods for navigation data processing\n•\tResponsibility for the navigation systems laboratory\n•\tDeputy head of cathedra of Orientation and Navigation\n\nFIELDS OF THEORETICAL AND METHODOLOGIC EXPERTISE:\n \n•\tSpace vehicle Orbit and Attitude determination and control\n•\tGyro instruments and systems\n•\tRadio navigation systems\n•\tInertial Navigation systems\n•\tAirplane Navigation and Control\n•\tAnalytical mechanics \n•\tApplied oscillation theory\n•\tAutomatic control theory\n•\tStochastic estimation theory\n\nENGINEERING EXPERIENCE:\n\n•\tFlight and laboratory tests of Aerospace Avionics Equipment\n•\tDistribution of mission requirements between Aerospace vehicle subsystems, definition of functions and ICD \n•\tSpacecraft operation and performance maintenance\n•\tAvionics system (hardware and software) development and testing (autonomously and integration)\n•\tInertial navigation systems\n•\t Development of Avionics for Soviet Military aircrafts: Tu-142, Tu-95MC, An-124, An-70, A-40, Soviet Space shuttle “Buran” (responsibility for preliminary design of radio-navigation automatic landing system), \n•\tIsrael (IAI) upgrade of Avionics system for T-38 (USA Air force trainer) \n•\tOperation and modification in space Canadian Satellite RADARSAT-1 Attitude Control system\n•\tParticipation in commissioning of ACS of Canadian Satellite Scisat\n•\tDevelopment of a generic mathematical simulator for satellite AODCS analysis and simulation of expected performance for a family of Canadian new generation small satellites\n\nSCIENTIFIC EXPERIENCE:\n\n•\tTheoretical and experimental investigation in the fields of S/C Orbital and Attitude Control\n•\tKalman Filter suboptimization and robust guarantee estimation theory development: authorship of new Suboptimal Kalman Filter modification, methods of INS correction and calibration, Geomagnetic Inertial Navigation System\n•\tResearch in areas of ACS and INS sensors development, their performance improvement\n•\tVarious Avionics Systems Mathematical models development and mathematical and semi-natural simulation\n•\tCoordination of research and development projects related to Aerospace equipment performed by Universities and Industries\n•\tScientific reports and articles reviewing and editorship \n•\tMembership in Scientific Counsels and Commissions\n•\tTutorship of under-graduate, graduated and post -graduate students \n\n•\tScientific reports and inventions in the field of GN&C for aircraft and spacecraft methods development \n•\tSeveral articles dedicated to the development of new methods in estimation theory: new suboptimal Kalman Filter with limited growth of the memory, observability and factor of state vector components estimation, guaranteed ellipsoidal estimation and stochastic estimation comparison \n\nLANGUAGES:\n \n•\tEnglish, Russian, Ukrainian, 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1. Introduction
A biomaterial is any material that comprises whole or part of a living structure or biomedical device which performs, augments, or replaces a natural function to improve the quality of life of the patients [1]. Over the past fifty years biomaterials has been developed as a science with various forms of implants/medical devices, and have been widely used to replace and/or restore the function of traumatized or degenerated tissues or organs. As a life-saving and life-improving option for countless patients, biomaterials have been paid more and more attention during the last decade. Only in the United States, more than 13 million implant/medical devices implanted annually. As a result, the impact factor of the journal of “Biomaterials” has boomed from 2.489 to 7.404 from the year 2001 to 2012.
The implant/medical device scope of biomaterials ranges from simple implants like intraocular lenses (which restore sight to millions of cataract patients every year), sutures, wound dressings, decellular matrices, bone plates, joint replacements to more complex materials like biosensors, catheters, pacemakers, blood vessels, artificial heart (that provide both mechanical and biological functions in a body), left ventricular assist devices and prosthetic arterial grafts. According to the resources and properties biomaterials can be assorted into autografts, allografts, organic polymers, such as natural collagen, fibrin, chitosan, hyaluronan, heparin, cellulose, and synthetic polyurethane (PU), polyester, metal, such as aluminium, steel, titanium, inorganic salts, such as calcium phosphate, hydroxyapatite, and their compounds or derivatives. There are more than one hundred different biomaterials which have been applied in vivo. All biomaterials when implanted into a body initiate a host response that reflects the first steps of tissue repair. The host/biomaterial interactions which follow implantation of any prosthesis or device are a series of complex events that have not been well defined. Generally, host reactions following implantation of biomaterials include injury, blood–material interactions, provisional matrix formation, acute inflammation, chronic inflammation, granulation tissue development, foreign body reaction, and fibrosis/fibrous capsule development [2]. There are numerous types of host responses to a broad spectrum of biomaterials.
When considering a biomaterial for implantation or medical use, the first and most important requirement is nontoxic, nonimmunogenic, chemically inert/active, and acceptable by the human body. Biocompatible in most cases means that the biomaterials must not form thrombi in the blood system, result in tumors in the surround tissues, or be immediately attacked, encapsulated, or rejected by the body [3]. According to the host responses to implantable biomaterials, there are many different kinds of biocompatibilities, including local tissue responses, such as necrosis, repulsion, infection, inflammation, calcification, scar, cyst, amalgamation, thrombus, tumor, cancer, and whole body responses, such as fever, toxicity, circulation impediment, nerve anesthesia, malformation, etc. The overall biocompatibilities including cyto-compatibility, hemo-compatibility, and tissue-compatibility, are often evaluated using histological sections, cell markers, and metabolite measurements. Sometimes, polymers with similar chemical characteristics behave differently in certain situations. For example, polyethylene and ultrahigh molecular weight polyethylene behave differently as orthopedic biomaterials for knee and hip replacement [4]. Until present, most of the implantable biomaterials trigger acute or/and chronic inflammatory responses in the body. These reactions can totally black a biomaterial and even lead to huge disasters or personal misfortunes. Among the numerous types of host responses, early interactions between implants and inflammatory cells are probably mediated by a layer of host proteins on the biomaterial surface. Franz and coworkers have described several typical host responses of implantable biomaterials (Figure 1) [5]. This model can be used as a reference for evaluation of an implantable biomaterial when it is implanted shortly in vivo.
In this chapter, I will focus on the in vivo host responses about twenty common used biomaterials which cover nearly every tissue and organ in human body. Advanced biologic techniques have been employed in determining the mechanisms behind observed macroscopic or microscopic responses. An understanding of the molecular and cellular events which occur in response to implantable biomaterials may allow us to manipulate responses and design more biocompatible, bioactive and functional biomaterials for clinical applications, such as regenerative medicine and controlled releasing drugs.
2. Allografts
Allograft (also called homograft) is a tissue/organ graft from one individual to another of the same species with a different genotype [6]. It has been successfully used in various medical procedures for more than 150 years. Approximately 1500000 allografts are transplanted each year for a variety of life-saving and life-enhancing surgeries. For example, skeletal grafts for patients with bone defects from cancer or traffic accidents; cornea transplants to help restore sight; heart valves to replace damaged heart tissues; skin grafts to save the lives of burn victims, and tendon replacements to help people with more active lives [7].
Figure 1.
Immune response toward biomaterials. (A) Adsorption of blood proteins and activation of the coagulation cascade, complement and platelets result in the priming and activation of polymorphonuclear leukocytes (PMNs), monocytes and resident macrophages. (B) Danger signals (alarmins) released from damaged tissue additionally prime the immune cells for enhanced function via pattern recognition receptor (PRR) engagement. (C) The acute inflammatory response is dominated by the action of PMNs. PMNs secrete proteolytic enzymes and reactive oxygen species (ROS), corroding the biomaterial surface. Interleukin (IL)-8 released from PMNs enhances PMN influx and priming. In the transition from acute to chronic inflammation, PMNs stop secreting IL-8 in favor of cytokines promoting immigration and activation of monocytes and macrophages. (D) Macrophages are the driving force of chronic inflammation. Constant release of inflammatory mediators like tumor-nekrose-faktor alpha (TNFα), IL-6, and monocyte chemotactic protein (MCP)-1 results in permanent activation of macrophages. Fusion-inducing stimuli like IL-4 and IL-13 promote the fusion of macrophages to foreign body giant cells (FBGCs,) which form a highly degradative environment on the biomaterial surface. Furthermore, FBGC promote extracellular matrix (ECM) remodeling and fibroblast activation resulting in excessive fibrosis and biomaterial encapsulation. (E) Macrophage-derived cytokines and pattern recognition receptor engagement activate dendritic cells (DCs) on the biomaterial surface. Depending on the nature of the stimulus, DCs mature to either immunogenic or tolerogenic subtypes, amplifying or suppressing the inflammatory response [5].
Compared with autografts which come from the same bodies and are only available in limited amounts, allografts are more readily available and accompany with less risk and postoperative morbidity. The healing times is therefore shorter and less painful for a patient with no second surgical site is required (as there is when an autograft is utilised). Currently, the use of allograft tissues is increasingly popular all over the world, with widespread orthopaedic surgeons and debilitating musculoskeletal conditions. Nearly one tissue/organ donor can save or improve the lives of up to 60 people. Especially, Musculoskeletal Transplant Foundation, the world\'s largest tissue bank, provides allograft tissue and biologic solutions for ligament reconstruction [8]. Meanwhile bone and soft tissue allografts from the SteriGraft™ line has been in existence for over 13 years and has helped doctors and their patients with over one hundred thousand successful transplantations. Before transplantation, a blood sample from the donor is normally tested in case any infected diseases, such as human immunodeficiency virus (HIV), Hepatitis, and Syphilis [9].
Specially, decellularized tissue/organ matrices derived from allografts have been used since the 1940s to support tissue repair and replacement. Their popularity has grown sharply during the last decade with the advent of tissue engineering [10]. At present, decellularized tissues/organs have been successfully used in a variety of tissue/organ regenerative medicines. The efficiency of cell removal from a tissue/organ is dependent on the origin of the tissue/organ and the specific physical, chemical, and enzymatic methods that are used. Each of these treatments affects the biochemical composition, tissue ultrastructure, and mechanical behavior of the remaining extracellular matrix (ECM) scaffold, which in turn, affect the host response to the material [11].
3. Collagen and gelatin
Collagen is one of the most prevalent proteins in the connective tissue of animals and constitutes approximately 25% of total body protein in vertebrates. It therefore is an important biomaterial in medical, dental, and pharmacological fields. After the immunogens in the collagen molecules are dislodged, collagen has excellent biocompatibilities either in vitro or in vivo. Collagen is capable of being cross-linked into solid or lattice-like gels. Resorbable forms of collagen have been used to dress oral, skin or some of the other soft tissue wounds, for closure of graft and extraction sites, and to promote healing [12]. During in vivo implantation, collagen irritates slight inflammation accompanying with some scar tissues.
A collagen sponge obtained from Beijing Yierkang Biengineering Development Center China was implanted subcutaneously in rats for time periods up to 8 weeks (Figure 2) [13]. One week after implantation, slight inflammation with some lymphocytes, myofibrils and fibroblasts were observed. The appearance of myofibrils and fibroblasts indicated that scar tissue was developed (Figure 2A). Two weeks after implantation, fibrous tissue was formed with scattered macrophage and lymphocyte cells in the fibrous layer. Newly formed blood vessels appeared in the implant site while the collagen sponges were completely resorbed (Figure 2B). Four weeks after implantation, the thin fiber layer had changed into wavelike scar tissue and tightly connected with the surrounding muscles. Capillaries were evident in the new fibrous scars (Figure 2C). Six weeks after implantation, scar tissue in the collagen samples was mature (Figure 2D). Eight weeks after implantation, the wave-like scar tissue in the collagen samples became thinner with some lipocytes and vacuoles (Figure 2E) [13].
Figure 2.
Light-microscope evaluation of the tissue response to collagen sponges with hamatoxylin-eosin (HE) staining: (A) 1 week after implantation; (B) 2 weeks after implantation; (C) 4 weeks after implantation; (D) 6 weeks after implantation; (E) 8 weeks after implantation. The scale bar indicates a distance of 50μm in (A), (C), and (D), and a 25μm in (B) and (E) [13].
Collagen compounds, such as collagen/chitosan, collagen/hyaluronan, have been investigated extensively during the past several decades. The biocompatibilities of these compounds depend largely on the incorporated constituents. For example, a corneal collagen cross-linked with riboflavin and ultraviolet radiation-A has been used for keratoconus repair of a 29-year-old woman with some good results [14]. In some instances, it is more competing to use a compound to improve the mechanical properties of the collagen based biomaterials. For example, a porous implantable dexamethasone-loaded polylactide-co-glycolide (PLGA) microspheres/collagen glucose sensors [15] and a mitomycin C (MMC) delivery system (MMC-film), incorporating polylactide (PLA)–MMC nanoparticles in a composite film from blends of collagen–chitosan–soybean phosphatidylcholine (SPC) with a mass ratio of 4:1:1 have been explored with no sign of internal infection and fibrous encapsulation in any animals after 20 days of implantation [16].
Gelatin is a mixture of peptides/proteins produced by partial hydrolysis of collagen extracted from the skin, boiled crushed bones, connective tissues, organs and some intestines of animals such as domesticated cattle, chicken, horses hooves, and pigs [17]. Gelatin possesses a better biocompatibility than its ancestry collagen. Alloimplants of bone matrix gelatin are effective in the treatment of bone defects with a low risk of complication such as rejection or infection [18]. Aqueous gelatin solution is an amorphous natural hydrogel in which cells can be encapsulated, extruded and deposited at desired positions. Unlike collagen hydrogel, gelatin hydrogel holds a special gelation property around 20℃. In Tsinghua University the author’s own group, this property has been explored extensively for rapid prototyping (RP) (or additive manufacturing) of three-dimensional (3D) complex geometrical structures with computer-aided design channel models [19-24]. Until now, a hybrid hierarchical 3D construct consisting both synthetic polyurethane PU and natural cell/ gelatin-based hydrogel with interconnected macro-channels has been produced via a double nozzle RP technique at a low temperature (-28℃). These constructs have demonstrated excellent in vivo biocompatibilities [23,25]. This technique holds the potential to be widely used in the future complex tissue/organ manufacturing areas.
Combination of gelatin microspheres/scaffolds with other biomaterials, such as collagen, alginate, chitosan, hyaluronan, and fibrin has also been explored extensively. For example, a gelatin microsphere containing basic fibroblast growth factor and preadipocytes, is essential to achieve a engineered fat tissue [26]. A PLGA microparticles containing an anticancer agent paclitaxel was formulated for the treatment of lung cancers [27]. Gelatin hydrogel incorporating hepatocyte growth factor induced angiogenic change around the implanted hydrogel [28]. A silk fibroin/gelatin composite scaffold was implanted into subcutaneous pockets on male Sprague-Dawley rats with a slight inflammation reaction. By day 30, the scaffold had been completely infiltrated and organized by fibroblasts and inflamed cells. The greater the gelatin concentration in the scaffold, the faster the degradation rate [29].
4. Fibrin
Fibrin (also called Factor Ia) is a fibrous, non-globular protein involved in the clotting of blood. It is formed from fibrinogen by the protease thrombin, and is then polymerised to form a hemostatic plug or clot (in conjunction with platelets) over a wound site [30]. The clot fibrin can be naturally degraded by proteolytic enzymes from the fibrinolytic system, such as plasmin [31,32]. In vivo, fibrin(ogen) plays an important role in hemostasis, inflammation, signal transduction, platelet activation, wound healing, osteoinductive and angiogenesis [33-36]. The food and drug administration (FDA) in American has approved commercially made fibrin sealants in 1998 [37].
During the last decade, autologous fibrin-based matrices have demonstrated great potential as being used as tissue engineered replacements, such as heart valves [38-40], cartilages [41], and blood vessels [42]. Immunohistochemistry and ECM assay demonstrated that the fibrin scaffolds can be completely absorbed in vivo in about 3 months with low granulomatous inflammation (Figure 3) [43-46]. Farhat and coworkers have evaluated whether a fibrin glue spray technique enhances cell seeded acellular matrix (ACM) repopulation in a porcine bladder model. The in vivo central fibrosis results indicated that while fibrin glue enhanced cellular organization on ACM in vitro, factors supporting seeded cell survival are lacking [47].
On the other hand, spatio-temporal controlled delivery of bioactive molecules within fibrin has been expanded rapidly. Various states of fibrin, such as scaffold, sheets, microparticles and fibrin-coated drug particles have been used as drug delivery systems [48,49]. Growth factors, such as vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) can easily bind to the fibrin molecules and be controlled released subsequently by diffusion [50-56]. In the future, autologous fibrin may play an important role in customized clinical applications, such as anti-immune drug delivery systems and human tissue/organ constructions to avoid any negative host reactions [57].
5. Dextran and its derivatives
Dextran, a high-molecular-weight polymer of d-glucose, formed by sucrose enzymes on the cell surface of certain lactic acid bacteria in the mouth adhere to the tooth surfaces and produce dental plaque. Uniform molecular weight dextrans (named for their average molecular weight) from Leuconostoc mesenteroides with specific preparations has been used for over 50 years in plasma volume expansion, thrombosis prophylaxis, peripheral blood flow enhancement and for the rheological improvement of, for instance, artificial tears [30,58]. Dextrans with an average molecular weight of 1000 to 2 million g/mol are commercially available for research purposes [59]. Two preparations of dextran with lower fractions (40000 and 70000 g/mol) are suitable for nontoxic clinical use [60]. However, high fractions of dextrans can produce erythrocyte aggregation, impaired microcirculation, and a clinical picture akin to shock and certain other diseases.
Figure 3.
Eleven-day Masson’s trichrome (MT) staining sections of a fibrin scaffold. (A) Untreated defects and (B) defects containing empty scaffolds were filled with new bone tissue. However, no reparative bone was observed in the center of defects containing (C) scaffolds filled with fibrin (low T) and (D) scaffolds filled with fibrin (high T). (Inset) Patches of multinucleated giant cells (striped arrow) were observed at the scaffold interface in all scaffold-containing groups. Black arrows point to areas occupied by the scaffold, whereas white arrows point to the advancing bone front. Field width 5.2 mm, inset field width 0.2 mm [46].
During 1990-1994, extensive toxicologic evaluations indicate that small-volume infusions of 7.5% NaCl/6% dextran 70 (HSD) at the proposed therapeutic dose of 4 mL/kg, present little risk as implantable biomaterials [61,62]. Dextran hydrogels have offered good opportunities as protein delivery systems or tissue engineering scaffolds because of an inherent biocompatibility [63]. The hydrophilic, soft and rubbery properties of the dextran hydrogels ensure minimal tissue irritation and a low tendency of cells and proteins to adhere to the hydrogel surface [59]. Althogh dextran itself is not toxic, some of the methods used for crosslinking the polymer may result in toxic byproducts. For example, the toxicity of dialdehyde crosslinked dextran/gelatin hydrogel can be detected in fibroblast and endothelial cell cultures. Subcutaneous implantation studies in mice showed that the foreign body reaction seen around the implanted hydrogel samples was moderate and became minimal upon increasing implantation time [64]. A methacrylate-derivatized dextran hydrogel also shows good in vitro biocompatibilities [65].
More recently another effect of dextran, namely that of antithrombogenesis, has been recognized [66]. Dextran sulfate, a dextran derivative, its effects on coagulation has already been proven [67]. It has been reported that dextran sulfate has been found to activate the polymerization of fibrin monomer, ATIII, conversion of prekallikrein to kallikreinand fibrinolysis. Kallikrein, the conversion of fibrinogen to fibrin appears to be inhibited by dextran sulfate. These effects are, inter alia, concentration dependent [67,68]. Meanwhile, a dextran sulphate sodium model of colitis has demonstrated several correlations of this biomaterial with human inflammatory bowel disease [69]. Furthermore, a lauric acid modified dextran-agmatine bioconjugate (Dex-L-Agm) was prepared by 1,1\'-carbonyldiimidazole activation and the nucleophilic reaction between tosyl of tosylated dextran and primary amine of agmatine was found to be highly cytocompatible without causing hemolysis and red blood cell aggregation [70].
6. Hyaluronan
Hyaluronan (also called hyaluronic acid or hyaluronate, HA) is a natural anionic, viscoelastic and hygroscopic glycosaminoglycan, discovered in 1934, by Karl Meyer and his assistant, John Palmer in the vitreous of bovine eyes [71]. As one of the chief components of the ECM, hyaluronan distributes widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglycans in that it is nonsulfated, forms in the plasma membrane instead of the Golgi, and can be very large in molecular weight (often reaching the millions) [72]. HA plays several important organizational roles in the ECM by binding with cells and other protein components through specific and nonspecific interactions [73] and is responsible for various functions within the ECM such as cell growth, proliferation, differentiation, migration [74], and even some malignant tumors [76].
Basically hyaluronan is a highly non-toxic, non-antigenic and non-immunogenic polysaccharide, owing to its high structural homology across species, and poor interaction with blood components [77,78]. The FDA in American has approved the use of hyaluronic acid for certain eye surgeries, such as cataract removal, corneal transplantation, and detached retina [79]. People take hyaluronic acid for various joint disorders (lubricant agents), lip fillers, "youth fountains”, and even wound healing catalysts [80]. Nowadays various hyaluronan hydrogels have been used to delivery drugs and cell growth factors [81,82]. There are some evidence show that fragmented hyaluronan stimulates the expression of inflammatory genes by a variety of immune cells at the injury site. With the protein-bonding abilities, hyaluronan fragments signal through both Toll-like receptor (TLR) 4 and TLR2 as well as CD44 to stimulate inflammatory genes in inflammatory cells. Hyaluronan presents on the epithelial cell surface can provide protection against tissue damage from the environment by interacting with TLR2 and TLR4 [83-85]. It is well known that accumulation and turnover of ECM components are the hallmarks of tissue injury. Current model of hyaluronic acid appear in the early stages of wound healing is to physically make room for white blood cells, which mediate the immune response and at least in part, reduce collagen deposition and therefore lead to reduced scarring [86]. This hypothesis is in agreement with the research of West and coworkers, who have showed that in adult and late gestation fetal wound healing process, removal of HA results in fibrotic scarring [87].
HA can be modified through several different ways, such as chemically esterify its carboxylic groups with some types of alcohol. The physico-chemical properties of the new biopolymers allow the preparation of many biomaterials with different biocompatibilities for various medical applications [88]. Shen and coworkers implanted hyaluronan hydrogel and periodate oxidated hyaluronan hydrogel in ischemic myocardium and found rapid degradation rates, low quantity of inflammation-mediating cells, thin fibrous capsules with dense blood vessels around the hydrogels at week 2 [89]. Praveen and coworkers used HA/polyvinyl alcohol (PVA) coating membrane to minimize the problems related to protein deposition and fibrous tissue formation on an implanted glucose sensor [90]. HA hydrogels modified with laminin could support cell infiltration, angiogenesis, and simultaneously inhibit the formation of glial scar after being implanted into the lesion of the cortex [91]. Compared with pure gelatin hydrogen, HA/gelatin composite has a better compatibility and contiguity with the surrounding brain tissue with no inflammatory reaction and fibrous encapsulation [92]. Intravitreal implants of hyaluronic acid esters represent useful biocompatible and biodegradable properties for a potential drug delivery system in the treatment of posterior segment ocular diseases [93]. A cross-linked HA hydrogel that contained a covalently bound derivative of the anti-proliferative drug MMC was synthesized and evaluated in vitro and in vivo. This hydrogel has strong potential as anti-fibrotic barriers for the prevention of post-surgical adhesions [94]. Two injectable thiolated HA derivatives were coupled to four alpha, beta-unsaturated ester and amide derivatives of poly(ethylene glycol) (PEG) 3400 and were found that the encapsulated cells can retained their original fibroblast phenotype and secreted ECM in vivo [95]. A fibrin/HA composite gel with autologous chondrocytes has been synthesized for tracheal reconstruction. Histologically, the grafts showed no signs of inflammatory reaction and were covered with ciliated epithelium [96].
7. Heparin
Heparin (from Ancient Greek ηπαρ (hepar), liver), a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule [97]. Heparins are involved in different pathways of the coagulation cascade with anticoagulant, antithrombotic, profibrinolytic, anti-aggregative, as well as anti-inflammatory effects [98]. As stated in the fibrin section, the primary anticoagulant effect of heparin is through the suppression of thrombin-dependent amplification of the coagulation cascade, and inhibition of thrombin-mediated conversion of fibrinogen to fibrin [99].
Heparin holds the ability to relieve pain, inhibit clotting and inflammation, restore blood flow, enhance healing, and can be a useful addition to a range of available treatments for burn wounds [100]. Unfractioned heparin exhibits a broad spectrum of immunomodulating and anti-inflammatory properties, by inhibiting the recruitment of neutrophils and reducing pro-inflammatory cytokines in the treatment of inflammatory bowel disease [101]. Low-molecular-weight heparin can reduce or prevent development of signs/symptoms associated with post-thrombotic syndrome [102]. Heparin has been widely used to form an inner anticoagulant surface on various experimental and medical devices such as membranes [103,104], tubes and renal dialysis machines [105,106].
Although heparin is used principally in medicine for anticoagulation, its true physiological role in the body remains unclear. Blood anti-coagulation is usually achieved by heparan sulfate proteoglycans which derive from endothelial cells stored within the secretory granules of mast cells and only released into the vasculature at sites of tissue injury [107]. Rather than anticoagulation, the main role of heparin may be defense at such sites against invading bacteria and other foreign materials [108]. A thiol-modified heparin in the Extracel-HP® mimics heparan sulfate proteoglycans also normally presents in the ECM and regulates the in vivo growth factor release for a functional microvessel network development [109]. A well-known adverse effect of heparin therapy is thrombocytopenia, a serious, immune system–mediated complication with significant mortality (Figure 4) [110-112].
8. Alginate
Alginate, is a salt of alginic acid ( medical-dictionary.thefreedictionary.com), and an anionic polysaccharide distributed widely in the cell walls of brown algae, where it, through binding water, forms a viscous gum (Wikipedia, the free encyclopedia). Sodium alginate (composed of mannuronic and guluronic (G) dimmers) is a biocompatible and biodegradable polymer, and has been widely used in cell encapsulation technology, though the biocompatibility of the alginates in relation to their composition is a matter of debate [113]. In the molecules of sodium alginate the primary block guluronic acid contains available carboxylic acid groups that allow the alginate to be reversibly crosslinked by divalent cations, such as Ca+2 and Mg+2, to form a relatively stable hydrogel [114,115]. Clinically, water-soluble alginates are useful as materials for dental impressions. Calcium alginates have been widely used as a base material to encapsulate glucose-sensing pancreatic islets that secrete insulin into the lymphatic system to reverse the effects of insulin-dependent diabetics [116]. Some investigators have utilized alginates to promote the viability of encapsulated cells [117]. Alginate-poly-L-lysine-alginate (APA) microcapsules continue to be the most widely studied device for the immuno-protection of transplanted therapeutic cells [118]. Alginate-chitosan-alginate (ACA) microcapsules have been developed as a device for the transplantation of living cells with protein adsorption onto the surface of microcapsules immediately upon implantation [119].
Figure 4.
Model of pathogenesis of heparin-induced thrombocytopenia (HIT). Heparin binds with Platelet factor 4 (PF4), which exposes neoepitopes on PF4 and leads to antibody production (1). Heparin-PF4-IgG immune complexes form (2), and IgG in multimolecular complex triggers platelet activation via binding to Fc receptors (3). Activated platelet releases additional PF4 (4a) and prothrombotic platelet microparticles (4b). Thrombotic risk is further promoted by binding of PF4 to heparin-like molecules on endothelial cells (EC), contributing to immune system–mediated endothelial damage (5) [112].
9. Chitin, chitosan and their derivatives
Chitosan is a naturally occurring linear polysaccharide, consisting of glucosamine and N-acetyl-glucosamine, normally made of deacetylated chitin which is the structural polymer found in the shells of crabs and shrimp (lobster, squid, some yeast and mould), by N-deacetylation using strong alkali [120]. More than 40 years have lapsed since this biomaterial had aroused the interest of the scientific community around the world for its potential biomedical applications [121]. Until now chitosan possess a number of commercial and biomedical applications in wound dressing, drug delivery and tissue engineering. For example, chitosan based scaffold biomaterials have demonstrated versatile properties to promote the epithelial and soft tissue regeneration in the body [122,123]. Chitosan patches in various sizes that have been cleared by the FDA are a topical hemostat for moderating severe bleeding. Nevertheless, an obvious disadvantage of this implantable, absorbable biomaterial is that chitosan initiates serious host inflammation reactions (Figure 5) [13,124]. Additionally, chitosan is bioadhesive and has the ability to transiently open tight junctions in the nasal epithelia, thereby permitting drugs to diffuse through this barrier. Advantages of this nasal route of administration include: a higher permeability of the nasal mucosa than in the gastrointestinal tract; a low degree of pre-systemic metabolism; and a high level of patient compliance, compared to injectable systems [125].
It is very interesting that when the number of N-acetyl-glucosamine units in a chitin/chitosan mixture is higher than 50%, the biopolymer is termed chitin. 50% deacetylated chitosan has a less inflammation reaction than the others when they are implanted in vivo [126]. Cross-linking of chitosan membrane using genipin and some other chemical agents can increase the membrane’s ultimate tensile strength but significantly reduced its strain-at-fracture and swelling ratio [127]. In the author’s own group, an ammonia treated chitosan sponge was implanted subcutaneously in rats for 8 weeks (Figure 5). One week after implantation, the chitosan sponges were entirely retained and wrapped with a layer of purulent cells. The purulent cells had infiltrated the outside chitosan sponges (Figure 5A). Two weeks after implantation, the encapsulated purulent layer was enlarged at the periphery of chitosan sponges. More acute inflammatory cells had infiltrated the chitosan sponges and there was no sign of biodegradation of the chitosan sponges (Figure 5B). Four weeks after implantation, the chitosan sponges still maintained their porous structure. A much thicker purulent layer and more acute inflammatory cells were found around or in the chitosan sponges (Figure 5C). Six weeks after implantation, most of the chitosan still maintained their scaffold integrity with numerous interspersed purulent cells. Some purulent cells even formed large channels throughout the chitosan sponges (Figure 5D). Eight weeks after implantation, purulent cell infiltrations had further increased in the chitosan sponges. Some collapsed matrix structures were detected at the outer margins of the implants and more channel structures were found between the remnants of chitosan lamellae (Figure 5E).
Figure 5.
Light-microscope evaluation of the tissue response to chitosan sponges with HE staining: (A) 1 week after implantation; (B) 2 weeks after implantation; (C) 4 weeks after implantation; (D) 6 weeks after implantation; (E) 8 weeks after implantation. The scale bar indicates a distance of 50 μm in (A), (C), and (D), and a 25 μm in (B) and (E) [13].
Also in this author’s own group, a series of bone repair materials were fabricated by adding three chitosan derivatives, such as phosphorylated chitin (P-chitin), phosphorylated chitosan (P-chitosan), and disodium (1→4)-2-deoxy-2-sulfoamino-β-D-glucopyranuronan (S-chitosan) into two kinds of biodegradable calcium phosphate cements (CPCs). All the chitosan derivatives can greatly improve the mechanical properties and reduce the biodegradation rates of the CPCs. At least six totally different tissue responses were detected when the implants were examined in tibial and radial defects of rabbits. Large bone defect (9 mm in length for radii and 3 mm in depth and diameter for tibias) repair in rabbits with the P-chitosan incorporated CPCs exhibits excellent tissue compatibilities with no any adverse or negative effects, such as fibrous encapsulation, osteolysis, hyperplasia, and inflammation, no matter the concentrations of P-chitosan is high or low (Figure 6) [128,129]. Tissue responses to P-chitin are highly sensitive (Figure 7) [130,131]. Three different bone formation types in the resorption lacuna of the P-chitin incorporated CPCs due to the P-chitin concentrations were found during the 22 weeks implantation. The first is that with low P-chitin content trabeculae formed directly from the implant (Figure 7A). The second is that with middle P-chitin content cartilages formed from the outside of fibers before they turned into trabeculae (Figure 7B, 7C). The third is that with high P-chitin content callous formed from the outside of fibers before they turned into trabeculae (Figure 7D, 7E). P-chitin content has a negative relationship with the biodegradation rate of the cements. However, the degradation rates are compatible with the ingrowth of trabeculae. A mild foreign-body reaction in the high P-chitin content sample during the first three time spans did not impair its placement by a newly formed bone. The generally properties of these biomaterials have met the main requirements for bone repair (Figure 7) [130,131]. Different from the above mentioned bone repair types, tissue responses to water-soluble S-chitosan, prepared from chitin by successive N-deacetylation, specific carboxylation at C-6 and sulfonation, was rather obtuse. No inflammation or other negative response was found in the S-chitosan containing samples (S-CPCs). After 4 weeks implantation, newly formed trabeculae contacted with the implant directly in the lower S-chitosan sample, while a thin layer of fibers formed between the newly formed bone and the implant in the higher S-chitosan samples [132,133]. These results indicate that the concentrations and functional groups in a linear polysaccharide play a key role in determining the ultimate biocompatibilities of an implantable biomaterial. In addition, as a derivative of chitin, chitosan initiates blood coagulation while S-chitosan inhibits blood coagulation when they are used as hemo-contact biomaterials.
Recently, chitosan and its derivatives have been widely used in skin wound, burn and disease treatments. For instance, a chitosan-gelatin-hyaluronic acid scaffold was found flexible with good mechanical properties when it was used as artificial skin substitutes [134]. A bacterial cellulose synthesized by Acetobacter xylinum and modified by chitosan was found to be optimal in providing wound dresses with a moist environment for wound healing [135]. When an artificial chitosan skin regenerating template was implanted subcutaneously it showed a similar inflammatory pattern as Integra, a two-layer skin regeneration system, constructed of a matrix of crosslinked fibers [136,137].
With the combination with other natural polymers, such as collagen, gelatin, hyaluronan, fibrin, the strong host inflammation reactions of chitosan can be reduced to a certain degree. It was found that a bioactive glass-chitosan composite containing 17% (wt%) chitosan produced by a freeze-drying process and implanted in the femoral condyl of an ovariectomised rat can promote a highly significant bioactive and osteoinductive property [138-140]. The ultimate biocompatibility of a chitosan compound depends largely on the ratio of the different components. Host tissues, such as smooth muscle and hepatic tissue have a similar response to the chitosan containing collagen/chitosan mixtures [141]. A collagen/chitosan matrix crosslinked by agent 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide in a N-hydroxysuccinimide and 2-morpholinoethane sulfonic acid buffer system has exhibited improved blood and cell compatibilities than the pure chitosan samples [142,143].
Figure 6.
Tissue responses to the P-chitosan incorporated CPC specimen at different time points with MT staining. (A) 1 week after implantation in the high P-chitosan content (0.12 g/mL) sample with very little hematoma. (B) 4 weeks after implantation in the high P-chitosan content (0.12 g/mL) sample newly formed woven bone clearly appeared with tightly bonding between the implant and host bone. No macrophage was found around the implant. The implant was directly changed into new trabeculae after degradation. (C) 12 weeks after implantation newly formed long bone in the low P-chitosan content (0.02 g/mL) sample. (D) 12 weeks after implantation newly formed long bone in the middle P-chitosan content (0.07 g/mL) sample. (E) 12 weeks after implantation newly formed long bone in the high P-chitosan content (0.12 g/mL) sample. Trabeculae formed after the implant was gobbled up (infiltrated) by body fluid. Clear evidence of remodeling around the implant surface was displayed. (F) 22 weeks after implantation the newly formed dense trabeculae in the high P-chitosan content (0.12 g/mL) sample [129].
Figure 7.
Tissue responses to the P-chitin incorporated CPC specimen 4 weeks after implantation. (A) P-chitin: 0.02 g/mL with MT staining. Magnification ×100. (B) P-chitin: 0.08 g/mL with MT staining. Magnification ×40. (C) A magnification of (B) with MT staining. Magnification ×400. (D) P-chitin: 0.14 g/mL with MT staining. Magnification ×40. (E) A magnification of (D) with HE staining. Magnification ×400 [131].
Current advances in some drug delivery systems make it possible to improve the therapeutic efficacy and minimized the side effects associated with toxicity of the drug. Chitosan has shown promise in the development of non-parenteral delivery systems for challenging drugs. For example, a 5-Fluorouracil (5-FU) loaded scaffold composed of chitosan fibers were prepared by a modified wet spinning technique [144]. Thermosensitive hydrogel composed of chitosan and glycerophosphate is proposed to be the potential candidate of in situ gel-forming implant for long-term drug delivery [145]. However, unpredictable body responses to the chitosan systems as stated above can complicate their applications to some degree. The composite chitosan-collagen-soybean phosphatidylcholine film impregnated with MMC-PLA-nanoparticles for treatment of hepatocellular carcinoma in mice has exhibited some special characteristics compared with pure chitosan delivery systems. In vivo, the growth of the tumors were inhibited considerably and dose-dependently by the MMC-film (P<0.05) with no any signs of vice reactions, such as inflammation, infection, and fibrous encapsulation after 20d of implantation [16,146,147]. Thus a careful balance between the immune reaction and drug effectiveness is needed when a chitosan pertaining template is used for biomedical applications.
10. Polyglycolide (PGA), Polylactide (PLA) and poly(Lactic-co-Glycolic Acid) (PLGA)
Polyglycolide also named polyglycolic acid (PGA) is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester which contains the ester functional group in it’s main chain [148]. It can be prepared starting from glycolic acid by means of polycondensation or ring-opening polymerization. PGA has been known since 1954 as a tough fiber-forming polymer. Owing to its hydrolytic instability, its use has initially been limited [149]. In vivo, PGA initiates a marked host reaction around the implantations. This leads to the development of a foreign body response that comprises an initial acute inflammatory phase and a subsequent chronic inflammatory phase. For example, when a synthetic PGA scaffold seeding with adult-derived or somatic lung progenitor cells from mammalian lung tissue was implanted in an immunocompetent host, a serious foreign body response totally altered the integrity of the developing lung tissue [150].
Polylactic acid or polylactide (PLA) is another thermoplastic aliphatic polyester derived from renewable resources, such as corn starch, tapioca products, and sugarcanes [30]. A poly(L-lactide) (PLLA) coil stent has ever been implanted in pigs with no stent thrombosis and late restenosis [151]. However, PLA, as well as PLLA, and poly(D,L-lactide) (PDLA), induces a strong inflammatory response when they are implanted in the body due to their acidic products [152]. Aframian and coworkers implanted tubular PLLA, PGA coated with PLLA (PGA/PLLA), or nothing (sham-operated controls) in Balb/c mice either beneath the skin on the back, and found that inflammatory reactions were shorter and without epithelioid and giant cells in the sham-operated controls. Tissue responses to PLLA and PGA/PLLA scaffolds are generally similar in areas subjacent to skin in the back and oral cavity. Biodegradation proceeded more slowly with the PLLA tubules than with the PGA/PLLA tubules. No significant changes in clinical chemistry and hematology were seen due to the implantation of tubular scaffolds. [153]. It was reported that, after the PLLA segments were swallowed in vivo by phagocytes, cell damage and cell death were obvious. The highest numbers of necrotic cells were observed on day 2 [154]. These reactions can result in an unexpected risk for patients and have strongly limited in clinical applications of this kind of biomaterials.
To date, numerous strategies have been investigated to overcome body reactions induced by this kind of biomedical devices [155]. As a result, most of the PLA, PLLA, and PDLA have been used as a composite or compound with some other biomaterials. For example, a PLLA and poly(ethylene oxide) (PEO) blend has been prepared by mechanical mixture and fusion of homopolymers [156]. A biodegradable star-shaped 8 arms PEG-b-PLLA block copolymer was synthesized by Nagahama and coworkers to create a novel implantable soft material with drastically lowered crystallinity, increased swelling ability, and desirable mechanical properties [157,158].
Currently PGA, PLA and their copolymers, such as poly(lactide-co-caprolactone) (PLCA), poly(glycolide-co-caprolactone) (PGC), and poly (glycolide-co-trimethylene carbonate) are widely used as biomaterials for the synthesis of absorbable sutures and tissue engineering scaffolds in the biomedical field [159,160]. For example, a resorbable PLGA bone fixation implanted in craniofacial patients in 1996 resulted in 0.2 percent significant infectious complications, 0.3 percent device instability, and 0.7 percent self-limiting local foreign-body reactions [161]. As long-term implants, the toxicity of the accumulated acidate products made the situations even worse [162]. Until the present, most of the implanted PGA, PLA and PLGA related biomaterials still encounter an immune tissue response due to tissue trauma during implantation and the presence of foreign body reactions [163]. Surface coating has become one of the research hot points for the implantable devices with poor biocompatibilities. For instance, the biocompatibilities of some artificial polymer devices, such as heart valves, stents and vascular prosthesis that come into contact with bodily tissues or fluids particularly blood, have been improved by Venkatraman and coworkers with endothelialization surface layers [164,165].
Similarly, when a polyvinyl acetate (PVA)/PLGA microsphere was implanted into the subcutaneous tissue of rats, acute inflammation with neutrophils was found at day 3. Chronic inflammation with multinucleate giant cells, fibrosis, and mixed inflammatory cells was found at day 30. Mineralization around the implant was found at day 60 [166]. On the contrary, a dexamethasone/PLGA microsphere system can suppress the inflammation reaction by a fast releasing of dexamethasone [167]. A highly monodisperse and smooth PLGA-paclitaxel microspheres against malignant brain tumors were fabricated using an electrohydrodynamic atomization (EHDA) process [168]. In addition, PLA, PGA and PLGA can be tailored to meet mechanical performance and resorption rates required for applications ranging from non-structural drug delivery applications, nanoparticles (nanofibers), to resorbable screws and anchors [169,170].
11. Polycaprolactone (PCL)
Polycaprolactone (PCL) is a biodegradable polyester with a low melting point of around 60°C and a glass transition temperature of about −60°C. It is commonly used as an additive for resins or starch to improve their processing characteristics, lower their costs, and change their properties (e.g. impact resistance), or as a plasticizer in the manufacture of special polymers (e.g. Pus) [30]. PCL has been approved by the FDA for specific applications, such as a drug delivery devices, sutures, or adhesion barriers. It has been widely used as a scaffold material for tissue engineering with mismatched mechanical properties and slow degradation rate [171,172]. In rats the in vivo degradation of PCL is about 3 years [173].
Various categories of drugs have been encapsulated in PCL, in microsphere, nanosphere or bulk states, for targeted drug delivery and for controlled drug release [174-176]. For example, a PCL scaffold modified by grafting nerve growth factor (NGF) and Tirofiban (TF) has been used as nerve conduits to promote the regeneration of sciatic nerves [177]. Low molecular weight PCL pieces can be ingested and digested ultimately by phagocyte and giant cell without any cumulate vice-products (Figure 8) [178-180].
Figure 8.
Micrographs illustrating extracellular degradation of biomaterials by macrophage fused multinuclear giant cells. (A) A foreign body giant cell (FBGC) engulfed a fragment of poly(epsilon-caprolactone), PCL polymer in vivo. Nu, nuclei of FBGC. The PCL polymer was dissolved during sample preparation. Transmission electron microscopy (TEM), bar = 2 μm. (B) In situ cross-section of the interface between a multinuclear giant cell (MnGC) and PLGA film. Note the pseudopodia of the MnGC penetrated deep inside the surface of PLGA film and formed sealed compartments. PLGA polymers are eroded within the compartments. Focused ion beam (FIB) microscopy, bar = 5 μm. (C) In situ cross-section of the interface between an osteoclasts-like cell (OC) and calcium phosphate cement. Note the typical ruffled board of OC and vesicles (V) secreting from OC to the sealed extracellular space. FIB microscopy, bar = 2 μm [162].
12. Polyurethane (PU)
PU is a series of biomaterials that contains urethane radical and offers the greatest versatility in compositions and properties of any family of polymers. Especially, a few specific elastomeric PU compositions have demonstrated a combination of toughness, durability, biocompatibility and biostability for being used as implantable medical devices, which is not achieved by any other available materials [181]. Because urethane is available in a very broad hardness range (e.g. eraser-soft to bowling-ball-hard), it allows the engineer to replace rubber, plastic and metal with the ultimate goals in abrasion resistance and physical properties. During the last half century, PUs have become and remained the most valuable implantable elastomers for uses requiring toughness, durability, biocompatibility and biostability [182]. With their inherently stable in the body environment, some of the PUs have been widely used in medical applications such as synthetic heart valves, vascular grafts, and pacemaker electrodes. However, these usages of PUs have been limited by three major complications: calcification, thrombosis, and chemical degradation [183].
In the 1970s and 1980s as the PUs became recognized as the blood contacting material and were used in a wide range of cardiovascular devices in long-term implants, they fell under scrutiny with the failure of pacemaker leads and breast implant coatings in the late 1980s. According to the manufacturer\'s report, high voltage coil fracture and PU defects were the predominant causes of lead failure [184,185]. During the next decade PUs had been extensively researched for their relative sensitivity to biodegradation and the desire to further understand the biological mechanisms for in vivo implantation [186,187]. Some investors have seeded autologous sheep blood outgrowth endothelial cells (BOECs) on a cholesterol (Chol)-modified PU (PU-Chol) heart valve leaflet to result in an intact, shear-resistant endothelium that would promote resistance to thrombosis [188]. Because of the complex behavior of implantable PUs in the body environment, special attention to the choice of the constituted components must be paid for designing and manufacturing the PU-containing devices. Subsequent treatment during sterilization, storage, implantation, in vivo operation and explantation also determine the performance and provide the means for assessing the efficacy of the PUs implants [189].
The most prominent disadvantages of PUs being used as artificial heart valves include mineralization, environmental stress-cracking and oxidation. While the mechanisms of these forms of degradation are not fully understood, an awareness of their causes and effects that leads to all of the long-term functionality is required for the sophisticated PU-based devices of today and tomorrow [190-191]. Over the last half century, extremely efforts have been paid in the biomedical research field to improve the biocompatibilities and biodurability of the PU implants, but only resulted in very little clinical effects [192-194].
In the later l990s a number of new bioresorbable materials with all the versatility of PUs in terms of physical properties and biocompatibility have been yielded. AorTech Biomaterials was set up in 1997 to commercialise a range of medical grade PUs developed by the Australian research group (Commonwealth Scientific and Industrial Research Organization, CSIRO). The company estimates that the worldwide market for surgical heart valve products is worth more than $1bn (€705 m) and to be growing at a rate of 8% a year. Meanwhile, the market for catheter-delivered heart valves is worth around $200 m (€141 mm) [195]. In the authors’ own group in Tsinghua University, China, a novel PU made of PCL, PEG, and 1,6-hexmethyldiisocyanate has been synthesized. The hydrolytic degradation property of the PU can be highly tuned by changing the composition and structure of copolymers, such as PEG and PCL. When this kind of PU was used as a small-caliber (1.2 mm inner diameter) vein and nerve repair grafts it demonstrated excellent antithrombogenicity and superior biocompatibility (Figure 9) [196,197].
Figure 9.
An implantable small-diameter nerve and blood vessel repair PU conduit. (A) PU conduits with different inner diameters. (B) The PU conduit was connected to the vein of a rabbit. (C) The vein defect repair processes with a very thin layer of fibrin-platelet deposition. (D) The nerve repair processes in rabbits with growing myelinated axons. (E) The PU conduits degraded gradually in vivo in 12 weeks [196, 197].
13. Polytetrafluoroethylene (PTFE)
Polytetrafluoroethylene (PTFE), Discovered in 1938 by Roy J. Plunkett, is a synthetic high-molecular-weight compound consisting wholly of carbon and fluorine with numerous applications [198]. The best known brand name of PTFE is Teflon made by DuPont Co. It is insoluble in all normally used organic solvents, not biodegradable in vivo and can suffer high temperatures as 260 ℃ permanently. Clinically, PTFE has been widely used as a large blood vessels repair materials.
A 5 year research using PTFE-Gore-Tex grafts mainly for superficial femoral occlusion has been conducted. The majority of the grafts were inserted in an elderly poor risk group of patients with critical ischaemia of the lower limb. The overall cumulative patency at 2 years was 29% falling to 18% at 5 years. Perioperative angiographic indicated that inflammatory reaction is the only risk factor significantly affecting the cumulative graft patency. The presence of diabetes was found to have a significant detrimental effect on limb salvage [199]. A permanently implantable left ventricular assist device, made of Dacron velour, Teflon felt, and Teflon-coated polyester fiber sutures, has been tested in chronic animal experiments. In vivo experiments demonstrated that all components elicited mild to moderate inflammatory reactions. Tissue responses to PTFE are rather passivated. Hematocele occurred only when the components were implanted in the aorta with direct blood contact and exposed to arterial blood pressures [200]. An 8 cm long PTFE prosthesis was implanted into defects of the abdominal aorta of dogs, and the following changes were found: the blood flow through the vascular prosthesis induced a shortening of the blood clotting time and a slight increase in the prothrombin consumption. It has a favourable effect of the sealing of pores in the prosthesis and covering its internal surface with a fibrin membrane [201].
14. Silicone
Silicon is a metal in the same column as carbon in the periodic table with the symbol Si and atomic number 14 [30]. It is the most abundant element on earth and does not occur naturally in its pure metallic state. Dimethylsiloxane is the building block for most medical-grade silicone products, including breast implants. This FDA Grade Silicone sheeting is commonly used in applications where food or consumables are present. For more than 20 years silicone miami breast implants have gone through a lot of changes since their first uses. After the mid-1980s many reports concerns the rupture rate of the thinner-shell products, the risk of subsequent breast cancer, and the connective-tissue diseases or symptoms in women with silicone gel-filled breast implants appeared. In the United States a moratorium (in place since 1992) on the use of these prostheses has been maintained by the pressure of overwhelming litigation. At the same time, Australian authorities also restricted the availability of silicone breast implants. Huge damages awarded by United States courts forced Dow Corning, manufacturer of a large percentage of breast prostheses, to file for Chapter 11 bankruptcy in May 1995 [202].
As with any implantable medical devices or drugs, the risk of possible adverse effects must always be weighed against the ability to provide benefits. A great deal of safety research combined with more than 40 years of clinical experience has proven the efficacy and relative safety of the silicone gel breast implants. A rough estimate of implant shell rupture rate is ~10% at 10 years with both biocompatibility and biodurability problems [203]. A fibroconnective tissue capsule was found around all the samples [204]. The capsule formed around implanted mammary prosthesis is highly differentiated and organized, consisting of three layers: interface layer in three variations, intermediate fibrous layer of dense rough collagen fibers and light elongated cells with oval nucleus between them and adventitious layer. Between the fibers of the interface and the middle strata intra- and extracellular silicone droplets and bulks were observed, representing the location where further pathological processes can take place [205]. It is said by Dr. Sidney Wolfe, director of Public Citizen\'s Health Research Group, in a statement that: "Public Citizen continues to oppose the FDA\'s 2006 decision to return silicone breast implants to the market for cosmetic use in women for augmentation. The agency\'s newer information about the risk of implant-associated lymphoma and the previously known risks are serious enough to warrant advising women against having these implanted.”
On March 9, 2012 a new silicone breast implant, which joins the two other silicone breast implants on the market - one made by Allergan and the other by Mentor, was approved by the FDA of the United States of America. Recommended monitoring after initially silicone breast implantation is 3 years and then every two years thereafter. In a review Roach and coworkers concern the importance of length and time on physicochemical interactions between living tissue and biomaterials that occur on implantation. The review provides detailed information on material host interactions, dynamic material/cell surface states, surface chemistry and topological roles during the first stage of implant integration, namely protein adsorption. Generally, after the first contact of material with host tissue a state of flux due to protein adsorption, cell adhesion and physical and chemical alteration of the implanted material is followed (Figure 10) [206]. This model can answer many questions concerning the conformational form and bound proteins and therefore has instruction meanings in new implantable biomaterial design field.
Figure 10.
Schematic of protein–surface interactions: Chemistry—adsorption onto biotinylated stripes which appear white, whilst adsorption is hindered on square oligoethylene-glycol regions, the white box shows an intentionally bleached area Topography—albumin adsorption onto hydrophilic silica spheres of varying dimensions as a model of surface curvature [206].
Beside the breast implants a silicon-silk transistor about one millimeter long and 250 nanometers was created. So far the technique has been tested on mice with no adverse effects. Electrical, bending, water dissolution, and animal toxicity studies suggest that this approach might provide many opportunities for future biomedical devices and clinical applications [207]. A silicone catheter attached to a 2-5 x 1-3 cm stainless steel chamber with a self sealing injection port had been intravenously for antimicrobial chemotherapy. Peripheral venous access had become unsatisfactory in all of patients, and six had required central venous catheterisation [208]. More recently, a silicon-based neural probe with microfluidic channels was developed [209].
Origins of controlled release of implantable drug delivery dates back to 1964 when silicone implants were used to prolong a drug effect. Over 40 years, the progress to a safe, effective and acceptable implant system has been slow. The critical factors in implant research which need to be addressed include: erodibility, reproducibility, lack of irritation and carcinogenicity, lack of dose dumping, duration and pulses. While it is possible to surgically implant and remove drug-containing devices or polymeric matrices, the requirement for such intervention could have a significant negative impact on the acceptability of a product candidate. In recent years, two implant systems have been approved for human use; (a) a silicone-based device (NorplantR), and (b) a system based on lactide/glycolide copolymers to release a luteinizing hormone - releasing hormone (LHRH) agonist for treatment of male reproductive tract tumours. This drug delivery approach is very appealing for a number of classes of drugs, particularly those that cannot be given via the oral route, and drug candidates whose therapeutic index is relatively large [210].
15. Aluminium (or aluminum) and ceramics
Aluminium (or aluminum) is the third most abundant chemical element (after oxygen and silicon in the boron group) with symbol Al and atomic number 13. It is one of the typical metals which has been widely used as hard tissue repair materials with unique properties, such as strong mechanical strength, not soluble and degradable in body fluid under normal circumstances, combined in over 270 different minerals, low density (weight) and corrosion resistances [211]. It is generally accepted that metallic implant materials with higher strength/modulus ratios are more favorable for hard tissue repair due to a combined effect of high strength and reduced stress-shielding risk [212].
Al alloys, such as Al-silicon (Si), Al-platinum, and Al-titanium (Ti) are widely used in implantable engineering structures and components where light weight or corrosion resistance is required except for blood-contacting surfaces [213,214]. For example, an implantable double-sided electrode microdevices, called flexible nerve plates, with a prototype of Al layer could reduce the number of insertion sites and thereby the insertion trauma during implantation of neural prostheses [215]. A Ti-6Al-4vanadium (V) alloy was selected as the ceramic-to-metal seal because its excellent mechanical properties and favorable biocompatibility [216]. The first-generation of implantable left ventricular assist devices (LVADs) were Ti-Al-vanadium alloy pulsatile, volume-displacement pumps. The modern LVAD era began with the introduction of the HeartMate X (vented electric) VE in 1998 [217]. These devices can provide excellent circulatory support and improve survival until heart transplantation. However, they have many application limitations, such as a large volume, an excessive surgical dissection, a large diameter driveline, a noisy pump operation, and particularly a limited mechanical durability. Other complications include bleeding, infections and thromboembolic events. During the succeeding decade, vast improvements in pump design resulted in a new crop of LVADs, whose attributes are transforming LVAD therapy into a kind of standard of care for end-stage heart failure [218]. LVAD therapy has now evolved into a solution which is strikingly superior to optimal medical therapy [219, 220].
It was reported that changes in the porous hydroxyapatite and Al oxide orbital implant densities may correspond to healing and maturation of soft tissues surrounding and penetrating the implants [221]. The thermal oxidation behavior of Al ion implanted Ti nitride films has been studied in dry oxygen atmosphere and found that Al implantation caused the oxidation rate of TiN films to slow down at the initial stage of oxidation [222]. Until recently, there is limited evidence regarding comparative effectiveness of various hip implant bearings, especially metal on metal or ceramic on ceramic implants compared with traditional metal on polyethylene or ceramic on polyethylene bearings [223].
For clinical applications, it is an important character that the metal devices do not cause mental or body uncomfortable reactions, such as delaminate or infiltrate ions to the surround tissues. For example, a defibrillator is a medical device that generates and delivers a shock to the heart of someone in cardiac arrest. Although this device can save lives, there are risks involved, for both the patient and the first responders. One risk associated with defibrillator use is that of burns. Certain transdermal medication patches contain aluminum backings, and when they come in contact with the defibrillator paddle, can cause minor burns to the patient. Accidental shocks to others can occur when first responders accidentally contact with the patient who is being defibrillated. The only objects that should touch the patient during treatment are the defibrillator paddles held by the administrator of the procedure. Sometimes internally implanted defibrillators discharge shocks when they are unnecessary. When this occurs, it can cause pain and promote a dangerous heart rhythm. In addition, the event can be emotionally disturbing and frightening. Doctor can recalibrate the device to minimize the risk of additional unnecessary shocks, and offer suggestions on how to manage these rare events [224].
A ceramic is an inorganic, nonmetallic solid material possessing strong mechanical properties prepared by the action of heat and subsequent cooling [30]. The uses of ceramics have been revolutionizing the biomedical field in deployment as implants for humans during the past three decades. In the search to improve the biocompatibility and mechanical strength of skeletal implant materials, attention has been directed towards the potential use of ceramic composites [225]. Since 1975 alumina ceramic has proven its bioinertness and have been accepted in biomedical applications, some alumina ceramic, such as Al2O3 has been characterized with high hardness and high abrasion resistance. Noiri and coworkers evaluated the biocompatibility of alumina-ceramic material histopathalogically for eight weeks by implanting in the eye sockets of albino rabbits with no signs of implant rejection or prolapse of the implanted pieces. After a period of four weeks of implantation, fibroblast proliferation and vascular invasion were noted. By the eighth week, tissue growth was observed in the pores of the implants [226].
Figure 11.
Scanning electron microscopy (SEM) images of SaOS-2 cells cultured for 48 h on micropatterned Ti (A-D) and diamond-like carbon (DLC) (E, F) surfaces. Large-sized (125 µm) squared (A) and circular (B) features facilitated the adhesion of several cells on one Ti island with the cells aligning themselves along the edges of the cell-friendly material. The cells adhering to mediumsized Ti islands no longer conformed strictly to the geometrical shape of the patterns (C) but particularly on circularly patterned surfaces, star-like cellular morphologies appeared (D). On small-sized inverse DLC samples, the cell bodies non-selectively covered large micro-patterned areas (E), but their filopodia clearly showed a preference for DLC trying to avoid bare Si circles (F) [222].
16. Conclusion remarks
Biocompatible is a vital important aspect for an implantable biomaterial. Among the numerous types of host responses to a broad spectrum of biomaterials, those with no adverse or negative effects, such as, fibrous encapsulation, osteolysis, hyperplasia, and inflammation are among the most expectant ones. As advances are made in biomaterial science and technology, new implants/medical devices will be continually explored, alternatives to conventional implants will become more and more effective, and hence more and more attractive. In an effort to provide the best clinical outcomes for the patients, we need to develop the best candidates with minimum invasive surgery times and unnecessary health risks. In the future, design and manufacture immuno or low-immuno implantable biomaterials according to or mimicking the patients’ own ingredients, such as blood components, ECMs, tissues and organs, will be possible. For an implantable biomaterial biocompatibility should be always put into the primary importance position no matter it is used as a temporary scaffold, a permanent template, or a drug delivery vihicle.
Acknowledgment
Work in the authors’ laboratory is supported by the State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology (No. 2012 - P03), the National Natural Science Foundation of China / the Research Grants Council of Hong Kong (NSFC/RGC, No. 50731160625), the National Natural Science Foundation of China (No. 81271665 & 30970748), the National High Tech 863 Grant (No. 2009AA043801), the Finland Distinguished Professor program (FiDiPro) of Tekes (No. 40041/10), and the Cross-Strait Tsinghua Cooperation Basic Research (No.2012THZ02-3).
Key Laboratory for Advanced Materials Processing Technology, Ministry of Education & Center of Organ Manufacturing, Department of Mechanical Engineering, Tsinghua University, Beijing, P.R. China
Business Innovation Technology (BIT) Research Centre, School of Science and Technology, Aalto University, Aalto, Finland
State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology, Wuhan, P.R. China
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1. Introduction
Approximate methods of analytical modeling (MAM) of the wideband stochastic processes (StP) in stochastic differential systems with unsolved derivatives (SDS USD) based on normal approximate method (NAM), orthogonal expansions method, and quasi moment methods are developed in [1, 2]. For stochastic integrodifferential systems with unsolved derivatives reducible to SDS corresponding equations for MAM are given in [3, 4]. In [3, 4], problems of mean square (m.s.) synthesis of normal (Gaussian) estimators (filters, extrapolators, etc.) were firstly stated and solved in [1, 2, 3, 4]. Results presented in [1, 2, 3, 4] are valid for smooth (in m.s. sense) functions in SDS USD. For unsmooth functions in SDS USD theory of normal filtering and extrapolation is developed in [5].
Let us present an overview and generalization of [1, 2, 3, 4, 5] for linear and nonlinear regression models. Section 2 is developed to normal analytical modeling algorithms. Normal linear filtering and extrapolation algorithms are given in Sections 3 and 4. Linear modeling and estimation algorithms for SDS USD with multiplicated (parametric) noises are presented in Section 5. Normal nonlinear algorithms for filtering and extrapolation are described in Section 6. Section 7 contains two illustrative examples. In Section 8, main conclusions and some generalizations are given.
2. Normal modeling
Different types of SDS USD arise in problems of analytical modeling and estimator design for stochastic nonlinear dynamical systems when it is possible to neglect higher-order time derivatives [1, 2, 3].
First-order SDS USD is described by the following scalar equation:
φ=φtXtẊtUt=0,E1
where Xt and Ẋt are scalar state variable and its time derivative; Ut is noise vector StP dimUt=nU; nonlinear function φ admits regression approximation [6, 7, 8].
For vector SDS USD, we have the following vector equation:
φ¯=φ¯tXtX¯tUt=0.E2
Here X¯t being vector of derivatives till l order
X¯t=ẊtT…Xtl−1TT;E3
Ut being autocorrelated noise vector defined by linear vector equation:
U̇t=a0tU+a1tUt+btUVt,E4
where dimXt=nX;dimUt=nU; Vt is white noise, dimVt=nV;dima0tU=nU×1;dimatU=nU×nU;dimbtU=nU×nV. Further, we consider the Wiener white noise W0t with matrix intensity v0=v0t and the mixed Wiener-Poisson white noise [9, 10, 11, 12, 13]:
Vt=Ẇt,Wt=W0t+∫R0qcρP0tdρ,E5
vt=v0tW+∫R0qcρcρTvPtρdρ.E6
Here, dimcρ=dimW0t=nV; stochastic Ito integrals are taken in R0q (R0q with pricked origin).
As it is known [6, 7, 8], a deterministic model for real StP defined by Y=φZ at Z=XTX¯TUTT in (2) is given by the formula
ŷz=EYz,ŷz∈ΨE7
at accuracy criterion
εz=∑p=1nYEŷp−Yp2z,p=1…nY.E8
Class of functions ψ∈Ψ represents linear functional space satisfying the following necessary and sufficient conditions:
trE[ŷz−Y]ψzT=0.E9
For linear shifted and unshifted regression models, we have two known models:
where Ez,Γz,Kz being first and second moments for given one-dimensional distribution.
For Eq. (2), linear regression model takes the Booton form
φ̂=φ̂0+k1φXt+k2φX¯t+k3φUt=0,E12
where φ̂0, k1,2,3φ being regressors depending on φ and joint distribution of StP Xt,X¯t,Ut. After Eq. (12) differentiation till the l−1 order, we get the following set of l−1 equations:
φ̂̇t=0,…,φ̂tl−1=0.E13
At algebraic solvability condition of linear Eqs. (12) and (13), we reduce SDS USD to SDS of the following form:
Ẋt=A0+A1Xt+A2Ut,E14
where A0,A1,A2 are expressed in terms φ̂0, k1,2,3φdetk2φ−1≠0 and indirectly depends on statistical characteristics of Xt, its derivatives and noise Ut. For combined vector XtTUtT=Y˜t we have equation:
Y˜̇t=B0+B1Y˜t+B2Vt,Yt0=Y0,E15
Its one and second probabilistic moments satisfy the following equations [12, 13, 14]:
Y˜̇t=B0+B1Y˜t+B2Vt,Yt0=Y0,E16
ĖtY˜=B0+B1EtY˜,Et0Y˜=E0Y˜,E17
K̇tY˜=B1KtY˜+KtY˜B1T+B2vB2T,K̇t0Y˜=K0Y˜,E18
∂KY˜t1t2∂t2=KY˜t1t2B1t2T,KY˜t1t1=Kt1Y˜E19
where EtY˜=EY˜t, KtY˜=EY˜t−E˜tYY˜t−E˜tYT, t1>t2. So, we get two proposals.
Proposal 1. Let vector non-Gaussian SDS USD(2)satisfy conditions:
vector functionsφinEq. (2)admit m.s. regression of linear classΨ;
linearEqs. (12)and(13)are solvable regards all derivatives tilll−1order.
Then SDS USD may be reduced to parametrized SDE. First and second moments of joint vectorY˜t=XtTUtTTsatisfyEqs. (16)–(19).
Proposal 2. For normal joint distributionN=NEtYKtYof vector variables inEqs. (16)–(19)it is necessary in equations of Theorem 1 to put
So for Kazakov regression, Eqs. (21)–(24) are the basis of Proposal 3.
The regression Eyz and its m.s. estimator ŷz represent deterministic regression model. So to obtain a stochastic regression model, it is sufficient to represent Y in the form Y=Eyz+Y\' or Y=ŷz+Y\'\', where Y\',Y\'\' being some random variables. For finding a deterministic linear regression model, it is sufficient to know the mathematical expectations Ez,Ey and covariance matrices Kz,Kyz. In the case of a stochastic linear regression model, it is necessary to know the distribution of Y for any z or at list its regression ŷz and covariance matrix Kyz (coinciding with the covariance matrices KY\'z or KY\'\'z). A more general problem of the best m.s. approximation of the regression by a finite linear combination of given functions χ1z,…,χNz is reduced to the problem of the best approximation to the regression, as any linear combination of the functions χ1z,…,χNz represents a linear function of variables z1=χ1z,…,zNz=χNz. Corresponding models based on m.s. optimal regression are given in [7].
In the general case, we have the following vector equation:
Żt=azZtt+bzZttVt,E30
where Vt being defined by Eqs. (5) and (6). Functions az=azZtt and bz=bzZtt are composed on the basis of Eq. (2) after nonlinear regression approximation φ̂t=∑jcjχZt and Eq. (13).
According to normal approximation method (NAM), we have for Eq. (30) the following equations for normal modeling [9, 10, 11, 12]:
where EN being symbol of normal mathematical expectation.
3. Normal linear filtering
In filtering SDS USD problems, we use two types of equations: reduced SDE USD for vector state variables Xt and equation for vector observation variables Yt and Ẏt≡Zt.
Consider SDS USD Eq. (2) reducible to SDE Eq. (3.9) at conditions of Theorem 1. We introduce new variables putting Xt≡Y˜t,
Ẋt=A0t+A1tXt+A2tV1t.E39
Let the observation vector variable Yt satisfy the following linear equations:
Zt=Ẏt=B0t+B1tXt+B2tV2t.E40
where V1t and V2t are normal white noises with matrix v1t=v01 and v2t=v02 intensities.
Equations of Kalman-Bucy filter in case of Eqs. (39) and (40) for the Gaussian white noises are as follows [12, 13, 14]:
X̂̇t=A0+A1X̂t+βtZt−B0+B1X̂t.E41
βt=RtB1tTv2t−1,detv2t≠0.E42
Ṙt=A1tRt+RtA1tT+v1t−βtv2tβtTE43
at corresponding initial conditions. Rt being m.s. covariance matrix error, βt being gain coefficient. So, we have the following result.
Proposal 4. Let:
USD are reducible to SDS according to Proposal 2 or Proposal 3;
Then equations for m.s. normal filtering have the generalized Kalman-Bucy filter of the form(41)–(43).
4. Normal linear extrapolation
Using equations of linear m.s. extrapolation for time interval Δ [12, 13, 14] we get the following equations for the generalized Kalman–Bucy extrapolator:
X̂̇t+Δt∣t=A1X̂t+Δt∣tΔ>0E44
with initial condition
X̂t+Δt∣tΔ=0=X̂t.E45
For the initial time moment t and for the final time moment t+Δ according to Eq. (44), we get
where utτ being the fundamental solution of equation u̇t=A1tut at condition utt=I. For conditional mathematical expectation relatively Yt0t in Eq. (46), we get m.s. estimate future state Xt+Δ
In this case, error covariance matrix Rt+Δt∣t satisfies the following equation:
Ṙt+Δt∣t=a1Rt+Δ∣t+Rt+Δ∣ta1T+ψv0ψT.E48
At initial condition
Rt+Δ∣tΔ=0=Rt.E49
Hence, the error matrix Rt is known from Proposal 4. So, we have the following proposition.
Proposal 5. At conditions of Proposal 4 m.s. normal extrapolationX̂t+Δt∣tis defined byEqs. (47)–(49).
This extrapolator presents a sequel connection m.s. filter with gain ut+Δt, summator ut+ΔtX̂t∣t and integral term ∫tt+Δut+ΔτA0τdτ. The accuracy of extrapolation is estimated according to Eqs. (48) and (49).
5. Linear modeling and estimation in SDS USD with multiplicated noises
Let us consider vector Eqs. (2)–(6) for the multiplicative Gaussian noises:
φ=φẊtXtVt=φ1Ẋtt+φ20t∑h=1nXφ2htXhVt=0.E50
Here, dimXt=dimẊt=nX, dimφ=nX, φ1 being nonlinear vector function of vector argument Ẋt admitting linear regression
φ1Ẋtt≈φ11Ẋt,φ11=φ11EtẊKtẊt.E51
Here, φ11 being matrix of regressors; V1t being vector Gaussian white noise, dimVt=nV with matrix intensity v=v0t. In this case, Eqs. (50) and (51) at condition detφ11≠0 may be resolved relatively Ẋt
Ẋt=B0+B1Xt+B2+∑r=1nXB3rXrtVt,E52
where B0,B1,B2,B3r depend upon regressors φ11. Using [9, 10, 11, 12], we get equations for mathematical expectations. EtX, covariance matrix KtX, and matrix of covariance functions KXt1t2:
Here KtX=KrstX; KXt1t2=KrsXt1t2. So for MAM in nonstationary regimes, we have Eqs. (54) and (55) Proposal 6. In stationary case Eqs. (54) and (55) we get the following finite set of equations for E∗ and K∗ (Proposal 7):
For calculating (62) we need to find mathematical expectation EtQ, covariance matrix KtQ of combined vector Qt=X1…XnXY1…YnYT and error X˜t,X˜t=X˜t−Xt covariance matrix Rt using equations
Equations (70)–(72) define normal linear Pugachev extrapolator for SDS USD reduced to SDS (Proposal 9).
6. Normal nonlinear filtering and extrapolation
Let us consider SDS (2) reducible to SDS and fully observable measuring system described by the following equations:
Ẋt=aXtYtαt+bXtYtαtV0,E73
Zt=Ẏt=a1XtYtt+b1XtYttV0.E74
Here, a,a1,b,b1 being known functions of mentioned variable; α being vector of parameters in Eq. (73); V0 being normal white noise with intensity matrix v0=v0t.
Using the theory of normal nonlinear suboptimal filtering [10, 11, 12], we get the following equations for X̂t and Rt:
where ar being r th element of line-matrix a1T−â1Tb1ν0b1T−1; bkr being element of k th line and r th column of the matrix b1ν0b1T; br being the rth column of the matrix b1ν0b1Tb1ν0b1T−1, br=b1r…bprr=1,n1¯.
Hence, if the function a1 is linear in Xt and function b does not depend on Xt all matrices ρr=0 and Eq. (76) does not contain Ẏt (Section 3).
Analogously Section 6 we get from [12] corresponding equations of normal conditionally optimal (Pugachev) extrapolator for reduced equations
Ẋt=aXtYtt+bXttV1,E84
Zt=Ẏt=a1XtYtt+b1XtYttV2,E85
where V1 and V2 are normal independent white noises.
7. Examples
Let us consider scalar system
φẊtXt≡φ1Ẋt+φ2Xt+U1t=0E86
U̇1t=α10+α11U1t+β1V1t.E87
Here, Xt,Ẋt being state variable and its time derivative; U1t being scalar stochastic disturbance; V1t being scalar normal white noise with intensity v1t; φ1 and φ2 being nonlinear functions; α10,α11,β1 being constant parameters. After regression linearization of nonlinear functions, we have
φ1≈φ10+kẊφ1Ẋt0,φ2≈φ20+kXφ2Xt0.E88
At condition kẊφ≠0 we get from (86) and (88) equations for mathematical expectation mtX=EXt and centered Xt0=Xt−mtX:
Coefficients of statistical linearization for typical nonlinear functions [12, 13, 14].
Let us consider normal scalar system
F≡ΦẊt+atXt+ut=0.E104
Нere random function admits Pugachev normalization
ΦẊt≈Φ0+kΦẊt0+ΔΦt0,E105
where ΔΦt0 being normal StP satisfying equation of forming filter
Δ̇Φt0=atΔΦΔΦt0+btΔΦVt.E106
Note that functions Φt0 and kΦ depend on EtΦ̇ and DtΦ̇. Equations (104) and (105) are decomposing on two equations. First equation at condition kΦ≠0 is as follows:
Φ0+atEtX+ut=0,Φ0=kΦ0EtẊ.E107
Second equation at condition kΦ≠0 is as follows: kΦẊt0+ΔΦt0+atXt0=0 may be presented as
Ẋt0=atkΦ−1Xt0−kΦ−1ΔΦt0.E108
Equations (106) and (108) for Zt0=Xt0ΔΦt0T leads to the following vector equation for covariance matrix
K̇tZ=AKtZ+KtZAT+BνVBT,E109
where A=−atkΦ−1−kΦ−10aΔΦ,B=0bΔΦ. Eqs. (107) and (109) give the following final relations:
Models of various types of SDS USD arise in problems of analytical modeling and estimation (filtering, extrapolation, etc.) for control stochastic systems, when it is possible to neglect higher-order time derivatives. Linear and nonlinear methodological and algorithmic support of analytical modeling, filtering, and extrapolation for SDS USD is developed. The methodology is based on the reduction of SDS USD to SDS by means of linear and nonlinear regression models. Special attention is paid to SDS USD with multiplicative (parametric) noises. Examples illustrating methodology are presented. The described results may be generalized for systems with stochastically unsolved derivatives and stochastic integrodifferential systems reducible to the differential.
Acknowledgments
The author is grateful to experts for their appropriate and constructive suggestions to improve this template. Research is supported by the Russian Academy of Sciences (Project-AAAA-A19-119001990037-5). Also, the author is much obliged to Mrs. Irina Sinitsyna and Mrs. Helen Fedotova for translation and manuscript preparation.
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Methodological and algorithmic support of analytical modeling, filtering, and extrapolation for SDS USD is developed. The methodology is based on the reduction of SDS USD to SDS by means of linear and nonlinear regression models. Two examples that are illustrating stochastic aspects of methodology are presented. Special attention is paid to SDS USD with multiplicative (parametric) noises.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79114",risUrl:"/chapter/ris/79114",signatures:"Igor N. Sinitsyn",book:{id:"10821",type:"book",title:"Automation and Control - Theories and Applications",subtitle:null,fullTitle:"Automation and Control - Theories and Applications",slug:null,publishedDate:null,bookSignature:"Prof. Elmer P. Dadios",coverURL:"https://cdn.intechopen.com/books/images_new/10821.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-174-4",printIsbn:"978-1-83969-173-7",pdfIsbn:"978-1-83969-211-6",isAvailableForWebshopOrdering:!0,editors:[{id:"111683",title:"Prof.",name:"Elmer",middleName:"P.",surname:"Dadios",slug:"elmer-dadios",fullName:"Elmer Dadios"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"301200",title:"Dr.",name:"Igor N.",middleName:null,surname:"Sinitsyn",fullName:"Igor N. Sinitsyn",slug:"igor-n.-sinitsyn",email:"efedotova@ipiran.ru",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Normal modeling",level:"1"},{id:"sec_3",title:"3. Normal linear filtering",level:"1"},{id:"sec_4",title:"4. Normal linear extrapolation",level:"1"},{id:"sec_5",title:"5. Linear modeling and estimation in SDS USD with multiplicated noises",level:"1"},{id:"sec_6",title:"6. Normal nonlinear filtering and extrapolation",level:"1"},{id:"sec_7",title:"7. Examples",level:"1"},{id:"sec_8",title:"8. Conclusion",level:"1"},{id:"sec_9",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Sinitsyn IN. Analytical modeling of wide band processes in stochastic systems with unsolved derivatives. Informatics and its Applications. 2017;11(1):2-12. (in Russian)'},{id:"B2",body:'Sinitsyn IN. Parametric analytical modeling of processes in stochastic systems with unsolved derivatives. Systems and Means of Informatics. 2017;27(1):21-45. (in Russian)'},{id:"B3",body:'Sinitsyn IN. Normal suboptimal filters for stochastic systems with unsolved derivatives. Informatics and its Applications. 2021;15(1):3-10. (in Russian)'},{id:"B4",body:'Sinitsyn IN. Analytical modeling and filtering in integrodifferential systems with unsolved derivatives. Systems and Means of Informatics. 2021;31(1):37-56. (in Russian)'},{id:"B5",body:'Sinitsyn IN. Analytical modeling and estimation of normal processes defined by stochastic differential equations with unsolved derivatives. Mathematics and Statistics Research. 2021. (in print)'},{id:"B6",body:'Pugachev VS. Theory of Random Functions and its Application to Control Problems. Pergamon Press; 1965. p. 833'},{id:"B7",body:'Pugachev VS. Probability Theory and Mathematical Statistics for Engineers. Pergamon Press; 1984. p. 450'},{id:"B8",body:'Pugachev VS, Sinitsyn IN. Lectures on Functional Analysis and Applications. Singapore: World Scientific; 1999. p. 730'},{id:"B9",body:'Pugachev VS, Sinitsyn IN. Stochastic Differential Systems. Analysis and Filtering. Chichester: John Wiley & Sons; 1987. p. 549'},{id:"B10",body:'Pugachev VS, Sinitsyn IN. Theory of Stochastic Systems. 2nd ed. Moscow: TORUS Press; 2001. p. 1000. (in Russian)'},{id:"B11",body:'Pugachev VS, Sinitsyn IN. Stochastic Systems. Theory and Applications. Singapore: World Scientific; 2001. p. 908'},{id:"B12",body:'Sinitsyn IN. Kalman and Pugachev Filters. 2nd ed. Logos: Moscow; 2007. p. 772. (in Russian)'},{id:"B13",body:'Socha L. Linearization Methods for Stochastic Dynamic Systems, Lect Notes Phys. 730. Springer; 2008. p. 383'},{id:"B14",body:'Sinitsyn IN. Normalization of systems with stochastically unsolved derivatives. Informatics and its Applications. 2021. (in print, in Russian)'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Igor N. Sinitsyn",address:"sinitsin@dol.ru",affiliation:'
Federal Research Center “Computer Science and Control” of Russian Academy of Sciences, Russia
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Research evidence shows that children who are healthy are at a low risk for school problems than students who are unhealthy. Students with good health tend to perform better in school than those with poor health. Problems that emanate from poor health include a higher probability of school failure, poor levels of concentration, grade retention and dropout. However, health is a complex and elusive concept and its definition is often shrouded by assumptions and limitations. Therefore, the relationship between health and student achievement is often complex. The concept of health has been evolving over time, cutting across multiple disciplines. Of late, there has been a focus on achieving not only health but total well-being. Schools have been challenged to promote student health by providing favourable environments, policies, support services and information-based interventions. Schools should develop integrated health interventions because of their proven effectiveness in promoting healthy lifestyles among students. This chapter critically examines the concept of health and establishes the connection between health and achievement. The chapter also proposes health interventions that are effective in influencing academic achievement.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Thomas Matingwina",authors:[{id:"227293",title:"Ph.D.",name:"Thomas",middleName:null,surname:"Matingwina",slug:"thomas-matingwina",fullName:"Thomas Matingwina"}]},{id:"63876",doi:"10.5772/intechopen.79938",title:"The Importance of Mindfulness in the Achievement of Optimal Functioning: Conceptualization for Research Development",slug:"the-importance-of-mindfulness-in-the-achievement-of-optimal-functioning-conceptualization-for-resear",totalDownloads:914,totalCrossrefCites:0,totalDimensionsCites:7,abstract:"The concept of ‘optimal functioning’ has emerged as a major line of research development in educational psychology. Optimal functioning, which reflects the paradigm of positive psychology, is concerned with a person’s achievement of maximization in his/her functioning, whether it is mental, cognitive, emotional, or social. This inquiry places strong emphasis on importance of flourishing, happiness, and the proactivity of human endeavors. An important question then for consideration, from this testament, is how researchers optimize the achievement of optimal functioning. We have recently made progress by focusing on empirical research development and methodological conceptualizations into the study of optimization. Our conceptualizations, collectively, contend that there are psychological, educational, and psychosocial variables that operate as sources of ‘energization’, which then stimulate the buoyancy of motivation, personal resolve, effective functioning, strength, and effort expenditure. Energization, in its totality, from our postulation, may then arouse, intensify, and sustain a person’s internal state of functioning. Our cross-institutional, cross-cultural research collaboration (e.g., Australia, Malaysia, and Taiwan), to date, has considered one notably construct that could serve as a source of internal energization for the achievement of functioning: mindfulness. We strongly believe that the totality of mindfulness, positive in nature, could play a central role in the psychological processes of human agency.",book:{id:"7698",slug:"educational-psychology-between-certitudes-and-uncertainties",title:"Educational Psychology",fullTitle:"Educational Psychology - Between Certitudes and Uncertainties"},signatures:"Huy P. Phan, Hui-Wen Wang, Jen-Hwa Shih, Sheng-Ying Shi, Ruey-Yih Lin and Bing H. Ngu",authors:null},{id:"58183",doi:"10.5772/intechopen.71842",title:"Influence of Drugs on Cognitive Functions",slug:"influence-of-drugs-on-cognitive-functions",totalDownloads:2138,totalCrossrefCites:5,totalDimensionsCites:5,abstract:"Disorders related to the misuse of certain drugs represent not only a worldwide public health problem, but also an economic and social issue. Adolescents and children represent the most vulnerable population for drug consumption and addiction. At this early stage in life, a crucial phase of the neurodevelopmental process, substance abuse can induce brain plasticity mechanisms that may produce long-lasting changes in neural circuitry and ultimately behavior. One of the consequences of these changes is the impairment of cognitive functions, with academic negative impact in the acquisition of new knowledge. In this chapter, we will describe the effects of illicit substances of abuse, both stimulants and depressants as well as prescription drug misuse and its influence of on learning and memory processes. Recent evidence on the new so-called smart drugs is also discussed.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Claudia Juárez-Portilla, Tania Molina-Jiménez, Jean-Pascal Morin,\nGabriel Roldán-Roldán and Rossana Citlali Zepeda",authors:[{id:"219266",title:"Dr.",name:"Rossana C",middleName:null,surname:"Zepeda",slug:"rossana-c-zepeda",fullName:"Rossana C Zepeda"},{id:"219492",title:"Dr.",name:"Claudia",middleName:null,surname:"Juárez-Portilla",slug:"claudia-juarez-portilla",fullName:"Claudia Juárez-Portilla"},{id:"219493",title:"Dr.",name:"Tania",middleName:null,surname:"Molina-Jiménez",slug:"tania-molina-jimenez",fullName:"Tania Molina-Jiménez"},{id:"219494",title:"Dr.",name:"Gabriel",middleName:null,surname:"Roldán-Roldán",slug:"gabriel-roldan-roldan",fullName:"Gabriel Roldán-Roldán"},{id:"220789",title:"Dr.",name:"Jean-Pascal",middleName:null,surname:"Morin",slug:"jean-pascal-morin",fullName:"Jean-Pascal Morin"}]},{id:"59046",doi:"10.5772/intechopen.72566",title:"Stress and Cognition: Psychological Basis and Support Resources",slug:"stress-and-cognition-psychological-basis-and-support-resources",totalDownloads:1621,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Executive functions are processes that help in tasks such as reasoning, planning, troubleshooting, and management of the individual’s own life. A consequence of the specific connections of stress is that executive functions tend to be interrupted when the stimulation load is so big that the individual becomes stressed. The level of cellular stress becomes evident with the increase of cortisol. Cellular processes such as inflammation, proliferation/death, and oxidative stress have been shown in murine models resembling cognitive impairment in humans. This impairment translates into behavioral changes, loss of memory, inability for decision-making, and attention problems. The incorporation of factors, such as drug use and bullying, promotes the impairment of executive functions. Resorting to strategies, such as exercising, environmental enrichment, and changes in the diet, constitutes an excellent aid in the promotion of academic achievement. In this chapter, we discuss the impact of stress on cognitive executive functions associated with academic achievement and also suggest strategies to reduce the impact of stressing factors.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Tamara Cibrian-Llanderal, Montserrat Melgarejo-Gutierrez and\nDaniel Hernandez-Baltazar",authors:[{id:"209886",title:"Dr.",name:"Tamara",middleName:null,surname:"Cibrian-Llanderal",slug:"tamara-cibrian-llanderal",fullName:"Tamara Cibrian-Llanderal"},{id:"210172",title:"Dr.",name:"Montserrat",middleName:null,surname:"Melgarejo-Gutierrez",slug:"montserrat-melgarejo-gutierrez",fullName:"Montserrat Melgarejo-Gutierrez"},{id:"210173",title:"Dr.",name:"Daniel",middleName:null,surname:"Hernandez-Baltazar",slug:"daniel-hernandez-baltazar",fullName:"Daniel Hernandez-Baltazar"}]}],mostDownloadedChaptersLast30Days:[{id:"70837",title:"Identifying and Remediating Dyslexia in Kindergarten and the Foundation Year",slug:"identifying-and-remediating-dyslexia-in-kindergarten-and-the-foundation-year",totalDownloads:925,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Dyslexia is a learning disability found across the ability range. It is an unexpected failure to learn to read and spell despite conventional classroom instruction. It is usually identified at about 7 years of age or beyond when the dyslexic fails to learn to read. The incidence varies in different countries in different languages and with teaching methods. This research presents a new method for the identification of dyslexia by the Reception or Kindergarten teacher as part of everyday teaching. The method uses a child’s freeform writing and a checklist that identifies a critical borderline point that must be reached if the child is to become literate. In order to overcome any difficulty, a specific intervention was identified and a training technique was introduced in a Reception Year cohort (N = 175 children). It was based upon previous research that found dyslexia was caused by a unique deficit that prevented them from developing early phonological awareness in the normal course of learning. The intervention strategy also enabled disadvantaged learners to catch up with more advantaged peers and close the 11-month learning gap found in the national statistics. Their Key stage 1 school SATs showed 30% uplift 3 years later.",book:{id:"9451",slug:"learning-disabilities-neurological-bases-clinical-features-and-strategies-of-intervention",title:"Learning Disabilities",fullTitle:"Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention"},signatures:"Diane Montgomery",authors:[{id:"85131",title:"Prof.",name:"Diane",middleName:null,surname:"Montgomery",slug:"diane-montgomery",fullName:"Diane Montgomery"}]},{id:"58763",title:"Stress in Nursing University Students and Mental Health",slug:"stress-in-nursing-university-students-and-mental-health",totalDownloads:2408,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Stress is a physiological response that impacts the cognitive, emotional, behavioral, and social components. It also involves the adaptation of the organism, the coping resources, and the environment. In young people, stress can be triggered by social interactions or school requirements. This chapter is a narrative review analyzing scientific bibliography from the main databases (NIH, Scielo, Redalyc) that explored the main stressors and their effects on nursing students. These stressors include the care of patients, assignments and workloads, academic evaluations, and negative or hostile social interactions. Data include the deleterious effects of stress in nursing students as anxiety, depression, inhibiting learning, and burnout, which negatively impact their academic development and health. Finally, some interventions to reduce the impact of stress are discussed. Conclusion: Stress responses in nursing students vary in duration and intensity during their academic training; final effects depend on the coping mechanisms, individual resources, and hospital environment. The effects of stress on nursing students impact on academic performance but could also trigger several psychiatric disorders as depression or anxiety, as well as other associated problems such as sleep disorders, alcohol, and psychoactive drug consumption, which in the short and long term may affect the patient care.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Frank Pulido-Criollo, Jonathan Cueto-Escobedo and Gabriel Guillén-\nRuiz",authors:[{id:"175891",title:"MSc.",name:"Frank",middleName:null,surname:"Pulido-Criollo",slug:"frank-pulido-criollo",fullName:"Frank Pulido-Criollo"},{id:"199455",title:"Dr.",name:"Jonathan",middleName:null,surname:"Cueto-Escobedo",slug:"jonathan-cueto-escobedo",fullName:"Jonathan Cueto-Escobedo"},{id:"218681",title:"Dr.",name:"Gabriel",middleName:null,surname:"Guillén-Ruiz",slug:"gabriel-guillen-ruiz",fullName:"Gabriel Guillén-Ruiz"}]},{id:"62994",title:"Health, Academic Achievement and School-Based Interventions",slug:"health-academic-achievement-and-school-based-interventions",totalDownloads:2459,totalCrossrefCites:6,totalDimensionsCites:9,abstract:"There is a statistically significant relationship between health and academic achievement. Research evidence shows that children who are healthy are at a low risk for school problems than students who are unhealthy. Students with good health tend to perform better in school than those with poor health. Problems that emanate from poor health include a higher probability of school failure, poor levels of concentration, grade retention and dropout. However, health is a complex and elusive concept and its definition is often shrouded by assumptions and limitations. Therefore, the relationship between health and student achievement is often complex. The concept of health has been evolving over time, cutting across multiple disciplines. Of late, there has been a focus on achieving not only health but total well-being. Schools have been challenged to promote student health by providing favourable environments, policies, support services and information-based interventions. Schools should develop integrated health interventions because of their proven effectiveness in promoting healthy lifestyles among students. This chapter critically examines the concept of health and establishes the connection between health and achievement. The chapter also proposes health interventions that are effective in influencing academic achievement.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Thomas Matingwina",authors:[{id:"227293",title:"Ph.D.",name:"Thomas",middleName:null,surname:"Matingwina",slug:"thomas-matingwina",fullName:"Thomas Matingwina"}]},{id:"60102",title:"Bullying in School",slug:"bullying-in-school",totalDownloads:3848,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Bullying in school is a significant problem worldwide and is one of the most common antisocial behaviors among adolescents and children. Despite implementing anti-bullying prevention programs in almost every school within the United States, Europe, and some initiatives in low-income countries, yet bullying is more pervasive problems in schools than any other problems. This chapter provides a review of research and evidence on school bullying: understanding the definition of bullying in school, and the size of the problem, the consequences of bullying, academic correlations, who is at risk, students’ perceptions of bullying and the evidence school-based programs to reduce and prevent bullying.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Nahla Mansour Al-Ali and Khulood K. Shattnawi",authors:[{id:"228887",title:"Associate Prof.",name:"Nahla",middleName:null,surname:"Al Ali",slug:"nahla-al-ali",fullName:"Nahla Al Ali"},{id:"238157",title:"Dr.",name:"Khulood",middleName:null,surname:"Shattnawi",slug:"khulood-shattnawi",fullName:"Khulood Shattnawi"}]},{id:"58183",title:"Influence of Drugs on Cognitive Functions",slug:"influence-of-drugs-on-cognitive-functions",totalDownloads:2138,totalCrossrefCites:5,totalDimensionsCites:5,abstract:"Disorders related to the misuse of certain drugs represent not only a worldwide public health problem, but also an economic and social issue. Adolescents and children represent the most vulnerable population for drug consumption and addiction. At this early stage in life, a crucial phase of the neurodevelopmental process, substance abuse can induce brain plasticity mechanisms that may produce long-lasting changes in neural circuitry and ultimately behavior. One of the consequences of these changes is the impairment of cognitive functions, with academic negative impact in the acquisition of new knowledge. In this chapter, we will describe the effects of illicit substances of abuse, both stimulants and depressants as well as prescription drug misuse and its influence of on learning and memory processes. Recent evidence on the new so-called smart drugs is also discussed.",book:{id:"6225",slug:"health-and-academic-achievement",title:"Health and Academic Achievement",fullTitle:"Health and Academic Achievement"},signatures:"Claudia Juárez-Portilla, Tania Molina-Jiménez, Jean-Pascal Morin,\nGabriel Roldán-Roldán and Rossana Citlali Zepeda",authors:[{id:"219266",title:"Dr.",name:"Rossana C",middleName:null,surname:"Zepeda",slug:"rossana-c-zepeda",fullName:"Rossana C Zepeda"},{id:"219492",title:"Dr.",name:"Claudia",middleName:null,surname:"Juárez-Portilla",slug:"claudia-juarez-portilla",fullName:"Claudia Juárez-Portilla"},{id:"219493",title:"Dr.",name:"Tania",middleName:null,surname:"Molina-Jiménez",slug:"tania-molina-jimenez",fullName:"Tania Molina-Jiménez"},{id:"219494",title:"Dr.",name:"Gabriel",middleName:null,surname:"Roldán-Roldán",slug:"gabriel-roldan-roldan",fullName:"Gabriel Roldán-Roldán"},{id:"220789",title:"Dr.",name:"Jean-Pascal",middleName:null,surname:"Morin",slug:"jean-pascal-morin",fullName:"Jean-Pascal Morin"}]}],onlineFirstChaptersFilter:{topicId:"266",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n
\r\n\t
\r\n
\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"April 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. In 2017, Usha was awarded the Marquis Who’s Who Lifetime Achiever Award.",institutionString:null,institution:{name:"RMIT University",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:5,paginationItems:[{id:"91",title:"Sustainable Economy and Fair Society",coverUrl:"https://cdn.intechopen.com/series_topics/covers/91.jpg",isOpenForSubmission:!0,editor:{id:"181603",title:"Dr.",name:"Antonella",middleName:null,surname:"Petrillo",slug:"antonella-petrillo",fullName:"Antonella Petrillo",profilePictureURL:"https://mts.intechopen.com/storage/users/181603/images/system/181603.jpg",biography:"Antonella Petrillo is a Professor at the Department of Engineering of the University of Naples “Parthenope”, Italy. She received her Ph.D. in Mechanical Engineering from the University of Cassino. Her research interests include multi-criteria decision analysis, industrial plant, logistics, manufacturing and safety. She serves as an Associate Editor for the International Journal of the Analytic Hierarchy Process. She is a member of AHP Academy and a member of several editorial boards. She has over 160 Scientific Publications in International Journals and Conferences and she is the author of 5 books on Innovation and Decision Making in Industrial Applications and Engineering.",institutionString:null,institution:{name:"Parthenope University of Naples",institutionURL:null,country:{name:"Italy"}}},editorTwo:null,editorThree:null},{id:"92",title:"Health and Wellbeing",coverUrl:"https://cdn.intechopen.com/series_topics/covers/92.jpg",isOpenForSubmission:!0,editor:{id:"348225",title:"Prof.",name:"Ann",middleName:null,surname:"Hemingway",slug:"ann-hemingway",fullName:"Ann Hemingway",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035LZFoQAO/Profile_Picture_2022-04-11T14:55:40.jpg",biography:"Professor Hemingway is a public health researcher, Bournemouth University, undertaking international and UK research focused on reducing inequalities in health outcomes for marginalised and excluded populations and more recently focused on equine assisted interventions.",institutionString:null,institution:{name:"Bournemouth University",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},{id:"93",title:"Inclusivity and Social Equity",coverUrl:"https://cdn.intechopen.com/series_topics/covers/93.jpg",isOpenForSubmission:!0,editor:{id:"210060",title:"Prof. Dr.",name:"Ebba",middleName:null,surname:"Ossiannilsson",slug:"ebba-ossiannilsson",fullName:"Ebba Ossiannilsson",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6LkBQAU/Profile_Picture_2022-02-28T13:31:48.png",biography:'Professor Dr. Ebba Ossiannilsson is an independent researcher, expert, consultant, quality auditor and influencer in the fields of open, flexible online and distance learning (OFDL) and the "new normal". Her focus is on quality, innovation, leadership, and personalised learning. She works primarily at the strategic and policy levels, both nationally and internationally, and with key international organisations. She is committed to promoting and improving OFDL in the context of SDG4 and the future of education. Ossiannilsson has more than 20 years of experience in her current field, but more than 40 years in the education sector. She works as a reviewer and expert for the European Commission and collaborates with the Joint Research Centre for Quality in Open Education. Ossiannilsson also collaborates with ITCILO and ICoBC (International Council on Badges and Credentials). She is a member of the ICDE Board of Directors and has previously served on the boards of EDEN and EUCEN. Ossiannilsson is a quality expert and reviewer for ICDE, EDEN and the EADTU. She chairs the ICDE OER Advocacy Committee and is a member of the ICDE Quality Network. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Infectious Diseases",id:"6"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",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. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/436653",hash:"",query:{},params:{id:"436653"},fullPath:"/profiles/436653",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var m;(m=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(m)}()