Codebook with themes, their description, their appearance in only one or both focus groups and their frequency (extracted from NVivo 12).
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This group is characterized by a persistently disturbed eating behavior, which leads to changes in food intake, impaired physical health and psychosocial problems. According to the Diagnostic and Statistical Manual of mental disorders (DSM)-5, people with AN show a restrictive eating behavior, a body weight that is significantly too low for age, sex, and developmental trajectory, fear of gaining weight and a disturbance in the perception of one’s own body (body image disturbance) [1]. AN occurs in approximately 0.5% of the population, with women being affected about 10 times more often [2]. The risk of death in patients with AN is five times higher compared to people of the same age and gender [3]. The course of AN is often chronic and can lead to a permanent disability.
The eating and feeding disorders cluster further includes bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica and rumination disorder.
BN occurs in about 2% of the population with a male to female ratio of about 1:10 [2]. The main criteria for diagnosing BN are recurrent binge eating, compensatory behaviors and excessive concerns with body shape and weight [1]. BED is the most common eating disorder. It is about twice as common (approx. 4% of the population) as the BN, with the proportion of women in patients with BED being around 60% [2]. It is mainly characterized by binge eating without the use of compensation strategies [1]. ARFID is hallmarked by a restrictive eating pattern that leads to malnutrition; pica means the consumption of non-food; and rumination disorder features choking up and chewing food again. Within those eating disorders, clinical features may change over time, with some patients with AN changing to BN or BED. Therefore, we are dealing with a spectrum of eating disorders rather than well-defined disease entities [4].
According to the National Institute for Health and Care Excellence (NICE) [5], the main pillars of therapy for eating disorders such as AN are psychological therapy, diet counseling as well as weight and physical health monitoring. Additional therapies can be family therapy, occupational and art therapy. Despite the availability of these therapies, a recent study that examined acutely ill AN patients over 20 years showed that despite existing therapies, only about 30% recovered after about 10 years and only 60% after 20 years [6]. Thus, there is a demand for additional treatments, and music therapy could be such an additional approach.
In a recently conducted systematic review on the effects of music in people with or at risk for eating disorders, researchers found that the use of music as an adjunct treatment was beneficial in certain cases [7]. The review encompassed 16 studies and 3792 participants using music in an experimental or observational study. Important studies cited in this review found that listening to classical piano improved food consumption with inpatients with AN [8] and that a “vodcast” of visual images and soothing music favorably influenced eating behaviors in patients with AN [9].
Apart from music therapy, the role music as such plays in daily life is expansive. Essentially, all cultures produce and use music in some way. Whether that is listening to a favorite song or dancing at a wedding, music seems to have an expansive power of triggering an emotional response. It is used as a source of healing and can be used as of source of comfort for many. The value of music on a person’s life is dependent on the context with which they hear it, how much they engage with it and the feeling that it evokes when listening to it [10]. Music can have transformative effects on stress levels and the autonomic nervous system. For instance, studies have shown that listening to slow and smooth music reduces blood pressure and regulates breathing, in comparison to fast paced music which can lead to increased blood pressure [11]. Music has also been shown to influence neurotransmission such as the amount of dopamine release [12].
We sought to conduct a software-assisted qualitative analysis of two in-depth interviews performed during focus groups with people with AN to find out how they use music in daily life, how they talk about music, and what they think about the therapeutic application of music. We used this qualitative approach, because we wanted to identify and conceptualize aspects of the use of music which are important for them [13, 14, 15, 16].
Study participants: Six female patients between 22 and 49 years with AN were recruited at the inpatient eating disorders service at the Bethlem Royal Hospital and the outpatient eating disorders service at the Maudsley Hospital. Both hospitals are managed by the South London and Maudsley NHS Foundation trust (SLaM), London. Patients gave written informed content to participate in the focus groups. They also agreed that the focus group would be recorded and transcribed, the content analyzed, the results of this analysis harnessed for further service development and publication. They also agreed that their recorded and transcribed statements may be cited, potentially verbatim, in an anonymized way.
Study Design: Each patient took part in one of the two focus groups. The focus groups were advertised within both the inpatient and outpatient eating disorders units with posters including the information about the topic and the focus group’s research purpose. In preparation of the group, a questionnaire was devised containing 15 questions on listening to music, making music and music as a therapeutic strategy in order to guide the in-depth interviews (see Appendix). The focus groups were recorded, transcribed and subjected to thematic and content analysis [13, 14, 15, 16].
Procedure: For evaluation of the transcribed focus groups, we used the NVivo 12 software. NVivo is a qualitative data analysis computer software package for qualitative research on text-based information. It organizes and analyzes non-numerical or unstructured data and allows users to classify, sort and arrange information [17]. Using NVivo, themes were extracted, a word cloud developed, the most frequently used words, and the distribution of coded themes and references analyzed.
Following the transcription of both focus groups from audio recordings, a list of 14 themes were extracted from the data collected. Using Nvivo 12 software, the themes derived from both focus groups highlight the effects music has on the participants lives, the emotions experienced while listening to music, as well as the sentiments expressed about music therapy and its uses when treating their AN. The themes generated are as follows: Benefit of Music Therapy, Frequency (of music listening), Genre Listened To, How Music Makes You Feel, Importance of Music, Interest In Music Therapy, Music Dislikes, Music Making, Music Preference, Negative Emotion Elicited, Negative Memory Association, Neutral Emotion Elicited, Positive Emotion Elicited, and Positive Memory Association. Table 1 illustrates the codebook of the analysis along with the description of the theme, file number and number of references within the data.
Themes | Description | Files | References |
---|---|---|---|
Benefit of music therapy | What are the benefits one associates with music therapy? | 2 | 9 |
Frequency | How often does one listen to music? | 2 | 13 |
Genre listened to | What type of music one listens to? | 2 | 10 |
How music makes you feel | What feelings does one experience because of music? | 1 | 22 |
Importance of music | What value does music have on one’s life? | 2 | 24 |
Interest in music therapy | Is there an interest in the therapeutic uses of music therapy as well as attending a music therapy session? | 2 | 9 |
Music dislikes | What music does one dislike? | 2 | 14 |
Music making | Playing an instrument, singing, recording, composition etc. | 2 | 6 |
Music preference | What does one prefer to listen to? (i.e. favorite artists, song, recording etc.) | 2 | 21 |
Negative emotion elicited | Is there a negative emotion associated with music? | 2 | 12 |
Negative memory association | Is there a negative memory associated with music? | 2 | 9 |
Neutral emotion elicited | Is there an indifference/ impartiality to music? | 2 | 6 |
Positive emotion elicited | Is there a positive emotion associated with music? | 2 | 28 |
Positive memory association | Is there a positive memory associated with music? | 2 | 24 |
Codebook with themes, their description, their appearance in only one or both focus groups and their frequency (extracted from NVivo 12).
A word cloud of the two interviews was developed of the 1000 most frequently used words throughout both focus groups to illustrate which words/phrases appeared most frequently throughout data collection. Words most frequently used are indicated by the larger text size. These include ‘music,’ ‘think,’ ‘listen,’ and ‘feel,’ suggesting that music elicits a thoughtful emotive reaction within individual participants (Figure 1). Music accounts for the most frequently used word amongst participants with a count of 378, while’ think’ had a count of 327 and ‘feel’ a count of 145 (Table 2).
Word cloud illustrating which words or phrases appeared most frequently throughout both focus groups.
Frequency rank | Word | Length | Count | Weighted percentage | Similar Words |
---|---|---|---|---|---|
1 | Music | 5 | 378 | 3.52% | Music, Musical, Music’s |
2 | Think | 5 | 327 | 3.04% | Think, Thinking |
3 | Listen | 6 | 226 | 2.10% | Listen, Listening, Listens |
4 | Really | 6 | 187 | 1.74% | Really |
5 | Feel | 4 | 145 | 1.35% | Feel, Feeling, Feelings, Feels |
6 | Play | 4 | 126 | 1.17% | Play, Played, Playful, Playing, Plays |
7 | Get | 3 | 118 | 1.10% | Get, Gets, Getting |
8 | Make | 4 | 115 | 1.07% | Make, Makes, Making |
9 | Song | 4 | 106 | 0.99% | Song, Songs |
10 | Words | 5 | 100 | 0.93% | Word, Words |
Top 10 most frequently used words including weighted percentages.
The individual themes coded with the greatest number of text segments by participants include Music Preference, Positive Emotion Elicited, Positive Memory Association, Importance of Music and How Music Makes You Feel (Figure 2).
Distribution of the frequency of themes coded from both focus group.
The themes were grouped into six main segments based on the content outlined by the participant in their responses: Music Therapy, Preference, Positives, Negatives, Neutrals, and Beliefs. The Positives grouping accounted for 25.1% of coded segments, while Preference and Beliefs accounted for 30.9 and 22.2%, respectively (Table 3).
Coded theme group | Number of coded references | Percentages of all coded references |
---|---|---|
Music therapy | 18 | 8.7 |
Preference | 64 | 30.9 |
Positives | 52 | 25.1 |
Negatives | 21 | 10.1 |
Neutrals | 6 | 3 |
Beliefs | 46 | 22.2 |
Coded references by group.
Throughout both focus groups, the most commonly shared themes represented positive associations with music, in the form of Positive Memory Associations (28 references) and Positive Emotion Elicited (24 references). A commonality that participants shared throughout the focus group discussions were the positive emotions that music makes them feel. One patient described music as “(it) can be a comfort; it can be something to move you up… (it’s) obviously something that’s a release of emotions…and it definitely cheers me up and makes me more determined and motivated”. This was a popular sentiment amongst and between the two focus groups, with one patient stating “(music) makes me feel good, content even.”
The importance of music was also a common theme for participants accounting for 24 references within the data. Patients discussed the uses of music within their day to day life and through their recovery process. One patient stated “(music) gives you space to kind of like describe stuff that you can’t necessarily put into words yourself,” and serves as an “incentive” or “motivator” throughout their recovery process.
The most commonly discussed themes fall under the Preference grouping with a total of 64 references throughout both focus groups. Accounting for 30.9% of the coded references, patients discussed their music preferences in great detail (Table 3). Patients listed the genres they listened to and how often they listened, if they participated in making music, and their music dislikes. Music preference accounted for 21 references within both focus groups where patients stated “classical” “pop” “soul” “literally anything” as the genre of choice as well as how they consume the music they listen to (“headphones,” “iPod,” “CD,” “radio”).
Neutral themes, defined as an indifference or impartiality to music, represented the smallest percent of coded references (3% of the coded data) (Table 3). However, Negative Emotion Elicited and Negative Memory Association accounted for 10.1% of all coded references (Table 3). Patients described music as channeling an emotion based on a certain song as well as having a negative memory linked to a piece of music. One patient describes a particularly sad event in their life that was tied to an artist, saying, “that would be with Frank Sinatra’s song, that was played at my Granddad’s funeral. So, again if I feel like I need to cry and let it all out… Ten out of ten it would make those tears fall.” Music seems to elicit an emotive reaction based on the participants life experience.
Music Therapy was discussed totaling 18 references throughout both focus groups (Figure 2). Patients were asked for their thoughts on music therapy, if music therapy can be helpful through their recovery process, as well as if they would be interested in attending a music therapy session. None of the patients had any experience with music therapy but all six of the patients unanimously agreed that they would be interested in attending a music therapy session.
There were nine references during the focus groups about the benefits of music therapy. One patient stated “I know it’s brilliant. And I know it could help me sort through a lot of issues,” while another stated its uses in a group setting with others undergoing treatment for their eating disorder, saying “…a lot of girls I was in daycare with, music was definitely a thing that we did a lot. So, I think that sort of being able to mingle with other people through the recovery process too, I think would be really, really helpful.” Overall, patients all seemed to have a strong connection with music, specifically throughout their recovery process and viewed music as an important tool for healing throughout their lives.
In this study, we conducted a software-assisted qualitative study exploring people with AN’s attitudes toward music, music therapy, and the uses of music throughout their life, treatment and recovery. The results of the study point to a promising potential for the varied uses of music throughout the recovery process for eating disorders. Patients were questioned in focus groups concerning the uses of music in their day to day life and as a therapeutic strategy. Responses were analyzed with NVivo 12 qualitative software for recurring themes throughout the discussions.
The most prevalent theme throughout the focus groups involved positive expressions and positive memory associations related to music. This theme occurred in ~25% of the data and totaled 52/207 of all of the coded themes (Table 3). This suggests patients have pleasant feelings about music and associate good things that have happened in their lives along with musical experiences. The importance of music was the second most common theme accounting for 24 references throughout the focus groups (Figure 2). Patients described the effect music had on their day to day life, with regulating emotions and providing an outlet of peace through their recovery process, suggesting that it was the study participants’ opinion that music could be used to improve their mental state throughout their recovery.
Negative feelings and negative memories associated with music accounted for only ~10% of all of the references from both focus groups (Table 3). Patients discussed how music they dislike can make them feel low in mood and also described negative memories linked to a certain genre or song. This suggests music can influence mood not only positively but negatively as well.
The final main result concerns the potential uses of music as a therapeutic adjunct to their treatment. When asked about music therapy, 6/6 patients stated they were interested in attending a music therapy session; in addition, all patients expressed that they see benefit in using music therapy as an adjunct to their current treatment for their eating disorder. This suggests music could be helpful for patients in the treatment of AN.
In previous studies on the use of music in eating disorder treatment, researchers found that patients with AN managed to eat more when listening to classical piano music and had a significant reduction in postprandial anxiety when participating and music therapy; listening to a violin concerto by Mozart induced the recall of autobiographical memories in patients with BN and reduced body width estimation [7, 8, 9, 18, 19, 20]. These previous findings align with the results of our current research as patients described that when listening to their favorite music, they generally feel happier and more positive. In addition, patients expressed their interest in attending music therapy citing the potential benefits it could have in their own life specifically with their treatment of their AN.
In other studies, however, negative symptoms presented when patients watched music videos. More specifically, researchers found that watching music videos was associated with an increase in body dissatisfaction [21], and sexually objectifying videos were associated with increased perception of body size in young women with suffering from low self-esteem [22]. In our study, we found that patients who listened to music outside their usual preference or that they did not like, as a result, had negative emotional reactions (i.e. crying, dissociation). This aligns with the previous findings suggesting that while music not only can produce positive side effects, it can also produce negatives as well [7].
Our study has several limitations. The number of participants (N = 6) was small. All study participants suffered from AN. Due to the small sample size, we could not differentiate between the subtypes of AN (restricting vs. binge eating/purging), length of illness duration and their stage of recovery. Our sample was ethnically homogeneous with only white Caucasian participants, and all patients were female. Thus, the results are not generalizable to other ethnic groups or males. From our perspective, the lack of generalizability is a main problem of research in the area of music therapy for people with eating disorders, and specifically AN. Even though there is plenty of case studies (for a comprehensive review and further literature see [23]), randomized controlled trials (RCT) are scarce [7].
AN is one of several eating disorders. As we have explained in the introduction, eating disorders are not distinct entities, but should rather be seen as symptom clusters within a spectrum of serious problems related to body image disturbance, disordered eating and their physical and psychosocial consequences. Therefore, it might be worth investigating, whether our findings can be reproduced and confirmed in people with BN, BED, ARFID or other eating disorders.
Taken together, our analysis shows that people with AN connect music mainly with positive emotions and memories. Therefore, music may be used more frequently and more extensively in psychological therapies as a tool to modulate emotions. As patients would welcome music therapy as an adjunct treatment option during inpatient or outpatient treatment, therapist might think about including music therapy into their overall treatment concept. However, quantitative research in bigger patient samples and RCTs will be necessary to verify these results.
Based on the current study and previous publications on music and music therapy in people with AN, the following preliminary conclusions can be drawn:
Music elicits mainly positive emotions and memories in people with AN.
Music is an integral and important part of life.
Music can help with recovery, overcome anxieties and improve eating.
People with AN would like to be offered music therapy as an adjunct to their usual treatment.
Music may be used as a tool to provoke emotions during psychotherapy.
Music may also elicit negative feelings and memories.
Watching sexually objectifying music videos can increase body dissatisfaction and the perception of body size in vulnerable people.
The MSc Mental Health Studies Programme, Institute of Psychiatry, Psychology and Neuroscience, King’s College London funded the publication costs of this book chapter. Hubertus Himmerich has received salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London.
The authors declare no conflict of interest.
How do you find listening to music?
What impact does listening to your favorite music have on your body and brain?
How often do you listen to music?
What type of music do you prefer to listen to?
Genre, style
Instrumental, vocals, both
Stimulating, relaxing
How do you prefer to listen to music?
Recordings, live music
TV, radio, DVD, CD, MP3
How often do you listen to something that is not your usual preference?
How does listening to music relate to your emotions?
Can you name of experience where music made you feel happy or sad?
Is there a time in your life that you connect a certain situation with a specific song?
How does it make you feel, if you have to listen to music you do not like?
Have you played, or do you play an instrument or sing?
Singing alone/in a choir
Play instrument alone/in a band/in an orchestra
How could listening to music be helpful to cope with difficult emotions or problems in your life?
Do you feel that there could be an effect of music in your life?
Do you have any experience with music therapy?
Would you attend a music therapy session?
The authors thank all six patients who took part in the focus group. They would also like to express their gratitude to Caroline Norton and to Zoe Vazquez-Sanchez for supporting the focus groups in the Maudsley and the Bethlem Royal Hospital.
Techniques in cataract surgery have been dramatically progressing over the past half-century with associated improvements in outcomes and safety [1, 2]. Manual phacoemulsification remains the most popular technique in developed countries, representing about 90% of procedures [3]. Although a number of recent developments have occurred in intraocular lens technology, the basic phacoemulsification procedure has remained unchanged over the past 20 years [4, 5].
“Femto” is a prefix of the International System of Units that stands for 10−15, a millionth of a billionth. The femtosecond laser consists of a solid-state laser source that emits impulses of a wavelength close to the infrared spectrum with a duration measurement in femtoseconds. Its emission frequency is 10,000 pulses per second of monochromatic light. Corneal flap creation during laser in situ keratomileusis (LASIK) is the most common use of this laser [6, 7]. The latest innovation is its use in cataract surgery, called FLACS (femto laser-assisted cataract surgery) [8, 9]. The recent introduction of femtosecond laser to cataract surgery, by Nagy et al. in 2008, and its Food and Drug Administration (FDA) approval in 2010 represents a potentially significant advancement in cataract technology, with expectations of greater safety and better visual outcomes [10, 11, 12].
The femtosecond laser has a similar action to the
Laser | Wavelength (nm) | Effect on tissue |
---|---|---|
Carbon dioxide | 10600, far infrared | Photothermal |
Nd:YAG | 1064, near infrared | Photodisruption |
Femtosecond | 1053, near infrared | Photodisruption |
Krypton | 647-531, visible light | Photochemical coagulation |
Argon | 614-488, visible light | Photochemical coagulation |
Excimer | 193, far ultraviolet | Photoablation |
Use of lasers in ophthalmology.
Photodisruption starts with a process called laser induced optical break-down (LIOB), which occurs when conditions of high frequency laser pulses are highly focused with short duration and applied through a small beam laser diameter [13]. The LIOB generates a high-intensity electrical field. The laser pulses cause ionization, meaning the breaking of the bonds between electrons and atomic nuclei, which is responsible for a cavitation bubble phenomenon, related to the expansion of this plasma consisting of ions [14]. This plasma complex will tend to expand at supersonic speed, separating tissue in its path, rapidly losing energy and vaporizing tiny quantities of corneal tissue. The cavitation bubble consists of CO2, N2 and H2O molecules, which are absorbed by the corneal pump mechanism or eliminated when the corneal flap is raised or the eye opened [15]. These ultrafast pulses are too brief to transfer heat and generate inflammation to the tissue, and therefore are considered particularly adapted to cleave tissue. Hundreds of thousands of adjacent pulses can shape uniform horizontal, vertical or oblique cut surfaces. The pulses are always emitted from the deepest targeted layers of the cornea toward the most superficial ones, to avoid the generated cavitation bubbles from stopping laser pulses focused on the underlying layers. One of fundamental requirement for femtolaser intervention is corneal transparency, allowing precise focus of the laser spots and energy delivery.
The femtosecond laser used in cataract surgery has been specifically developed for the following surgical steps: main and accessory corneal incisions, capsulorhexis, lens fragmentation, and optional arcuate incisions for intraoperative correction of astigmatism. The depth of treatment can reach 8 mm, from the corneal epithelium to lens posterior capsule. The pulsed energy used by a femtosecond laser for cataract surgery is on a scale of microjoules (μJ) and 15 μJ is the maximum energy of pulses.
Five FLACS devices are currently available:
LenSx (Alcon LenSx, Inc., Aliso Viejo, CA, USA)
LensAR (LENSAR, Inc., Winter Park, FL, USA)
Catalys (OptiMedica, Abbott Medical Optics, Santa Clara, CA, USA)
Victus (Technolas Perfect Vision and Bausch and Lomb, Rochester, NY, USA)
LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland)
The laser programming consists in individual steps: (1) customize the treatment with the graphic user interface, (2) dock with patient interface, (3) image via OCT scan, (4) analyze the image and (5) treat with the femtosecond laser. These functions are clustered on a computer supplied with the femtosecond laser (and the patient bed, depending on the device). The association of the femtosecond laser, the graphic user interface, the docking system, and the OCT scan constitutes the femtolaser platform. Femtolaser platforms are quite similar to each other and are fitted either with an optical coherence tomography (OCT) imaging system or a Scheimpflug camera to guide the laser beam to the target. Recording of patient data and customized profiles are made through the touchscreen monitor. Platforms differ in step order, docking interface, lens fragmentation patterns and speed of action (Table 2). The environmental needs for the laser system are crucial to provide reproducible procedures. The space in the operative room must be considered as the devices occupies between 2 and 3 m3 (except the LDV Z8, which is a smaller portable device) and must be near to the phacoemulsifier. Table 3 summarizes these requirements.
LenSx | LensAR | Catalys | Victus | LDV Z8 | |
---|---|---|---|---|---|
Alcon | LensAR | AMO | Bausch & Lomb, Technolas | Ziemer | |
Room size (m) | 3.4 × 4.3 | 4.57 × 4.57 | 3.04 × 3.35 | 3.4 × 3.7 | No specific needs |
Laser size (h × l × p, m) | Screen: 1.22 × 0.76 × 0.61; laser: 0.51 × 0.58 × 0.20 | 1.65 × 1.97 × 0.8 | 1.15 × 1.64 × 0.84 | 1.67 × 2.1 × 0.82 | 1.4 × 1 × 0.6 |
Docking | Curved applanation lens | Fluid-fill suction ring | Fluid-fill suction ring | Curved applanation lens | Fluid-fill suction ring + curved applanation lens |
Imaging | HD-OCT | HD-OCT + Scheimpflug camera | HD-OCT | HD-OCT | HD-OCT |
Included bed | No | No | Yes | Yes | No |
Corneal refractive procedure | Yes | No | No | Yes | Yes |
FLACS platforms available.
Operating temperature of the environment | 18–24°C |
Operating humidity | 30–65% |
24-hour air conditioning system sterility | |
Class A operating room (minor surgery under topical or local anesthesia) | |
Handwashing facilities | |
Smooth and washable floors |
Environmental requirements for the laser system set-up space.
Docking the eye to the system means connecting the eye to the laser. This is done via a patient interface. The patient interface utilizes suction to stabilize the eye and maintain a clear optical pathway for imaging and laser delivery. The goal during suction is to obtain a clear and stable image during the laser treatment while controlling the increased intra ocular pressure and the image quality. Each platform has a specific patient interface, for example, with the Catalys, docking is accomplished with a liquid filled interface which allowed a good cornea visualization during docking. The LenSx uses a curved applanated interface, which can create posterior corneal folds which can interfere with the ability to image and cut tissue effectively. Optimal docking is achieved when there is a symmetric scleral show.
The LenSX laser is a standard unit that does not require external connections to water or gas. Recent updates have changed the diameter of the patient-interface, now called SoftFit PI, which allowed a 20% reduction in intraocular pressure (IOP), providing less discomfort for the patient (Figure 1). The SoftFit® interface has a soft lens insert in the interface that allows the reduction of corneal folds during the docking, and a better delivery of the laser beam [16]. The integrated anterior segment optical coherence tomography OCT provides real-time scanning from the corneal epithelium to the posterior lens capsule with a high-resolution video. This imaging system is able to either take a single OCT snapshot, or produce live continuous OCT images (Figures 2–4). Thanks to live OCT, surgeons can immediately check if the patient’s positioning is adequate, reducing the risk of tilt during the docking procedure.
LensX docking system, SofFit® interface.
LensX capsulotomy procedure.
LensX incisions procedure.
Free floating continuous, curvilinear, and circular capsulotomy with LensX.
The LENSAR docking system is a noncontact disposable fluid filled patient. The suction ring is low pressure, which decreases the frequency of subconjunctival hemorrhages and minimizes the risk of high intraocular pressure. The system includes a Scheimpflug three-dimensional confocal system combined with a laser biometric system allowing scans of the anterior segment at varying speeds. The depth-of-field imaging is enhanced compared with OCT technology. The nuclear fragmentation consists of radial sections or concentric cylindrical cuts and allows cubic, spherical or pie-cut patterns. The system is also able to detect and compensate for tilt (Figure 5).
LensAR lens fragmentation patterns.
The docking system, called “Liquid Optics®,” includes two parts: one is fitted to the patient by suction and the second couples to the first cone to the console of the Catalys optics system. The suction ring, which is filled with a balanced saline solution (BSS), requires a vacuum that does not exceed 15 mm Hg. The OCT images are guided through a continuous optical system. The system software identifies the ocular surfaces, reconstructs areas to be excluded from laser treatment and customizes the treatment according to the observed structures.
The patterns of lens fragmentation are wide and allow control of grid spacing (from 100 to 2000 μm) (Figures 6–9).
Catalys device.
Liquid optics® Interface.
Per-operative CATALYS visualization.
Laser treatment with CATALYS.
The VICTUS system currently uses two components for laser docking: a low-pressure silicone suction ring and a curved interface cone. Adaptation of the curved interface cone is controlled by intelligent sensors, which change pressure levels exerted on the eye depending on the treatment. The image capturing system is a spectral-domain OCT that takes real-time images and identifies anterior segment structures. The surgeon can manually locate the area of photodisruption in the nucleus and its distance to the posterior capsule.
Flaps in refractive corneal procedures and incisions are also possible, making it a versatile femtosecond laser system. The laser source operates at 80 kHz for the FLACS procedure. The optical-acoustic-modulator included allows modulation in the laser pulses’ frequency: it can change from 80 kHz for the FLACS procedure to 160 kHz for the LASIK-flap procedure (Figures 10–12).
VICTUS device.
VICTUS docking system.
VICTUS laser treatment with free floating capsulotomy.
The device is the first mobile cataract femtosecond laser that can be easily suit in the operating room. Ziemer has developed a liquid-filled nonapplanating interface which adheres to the eye with minimal suction and thus avoids corneal folds. The FEMTO LDV Z8 employs a combination of two imaging systems for real-time visual control of the docking process and of the positioning of dissections: the TopView®, a high-definition camera which provides visual control of the alignment of the patient interface to the eye and a proprietary OCT system, operating in the near-infrared range (Figures 13–15) [17]. It obtained FDA approval for FLACS in 2016.
LDV Z8 device.
LDV Z8 procedure and incisions.
Eye after LDV Z8 procedure.
Proper docking requires cooperation from the patient. The liquid interface has advantages of causing less tissue distortion and minimal increase in intraocular pressure as well as less mean eye movement during capsulotomy. The cornea should be well centered in the patient interface before docking to avoid misalignment of corneal incisions. Apart from the transient learning curve, docking may cause subconjunctival hemorrhage [18]. The estimated incidence of this side effect is 34% and significantly decreased using the liquid interface device with lower suction pressure, and shorter treatment time [19].
The capsulotomy cut opens the lens’s anterior capsule in a continuous, curvilinear, and circular fashion with high precision to improve safety during intraocular maneuvers. We advise to choose a 5.2 mm diameter capsulotomy, with a delta up at 400 μm and a delta down of 350 μm. The energy recommended is 15 μJ, with a 4 μm spot separation and a 3 μm layer separation. Laser capsulotomies have been shown to be better centered than manual continuous curvilinear capsulorhexis (CCC), with highly predictable sizes [20, 21, 22].
The surgeon defines the pattern, the length, and the number of cuts. The energy level, the anterior and posterior lens capsule parameters, pattern separation and the primary incision angle have to be specified. Then, the nucleus can be easily split.
It is possible to correct a small amount of astigmatism (<1.5 D) with arcuate incisions (AI) [23]. Nomograms can facilitate surgical planning by determining the proper treatment for an intended correction [24]. Arcuate incisions can be left unopened until the postoperative period depending on the postoperative refractive error [25].
All corneal incisions are placed just inside the limbus. The real-time anterior segment imaging provides the peripheral corneal thickness at the location of the incision during the procedure. We recommend a 2.2 mm three planes (90°/11°/90°) main incision at 135° and a one plane 1.2 mm incision at 5° for the side-port incision. The spot the layer separation should be 4 μm with an energy level of 5.5 μJ.
After removing the docking system, next steps are similar to manual phacoemulsification. The cortex aspiration can be tricky because the femtosecond laser cut it just below the capsulotomy. If the irrigation/aspiration probe is not sufficient, a Simcoe cannula can be used. To help, the cortex may be washed with a 25G syringe full of balanced salt solution.
Sudden suction break can occur in less than 2% of cases, but did not lead to further complications as laser treatment can be started over (Table 4) [19]. Most important factors to prevent it are precise patient interface placement and good preoperative anesthesia. Hard headrest avoids the head from being pushed down during insertion of the patient interface and reduces the risk for suction loss.
Conjunctival hemorrhage | 34% | |
Pupillary constriction | 19% | |
Suction break | 2% | |
Capsule complications | 2% | |
Posterior rupture | 0.53–1.9% | |
Anterior tear | 0.02% | |
Block syndrome | 0.001% | |
Endothelial damages | 0.002% | |
Wrong corneal incison localization | 0.002% |
Rate of complications.
The incidence of pupillary constriction is 19% and arises during the first steps of the femtolaser procedure [19]. The laser application itself can cause pupillary miosis. Bubble formation in the anterior chamber releases small amounts of free radicals and prostaglandins that can trigger pupillary constriction. Highly myopic eyes and eyes with pseudoexfoliation syndrome are prone to a miotic reaction after femtosecond laser treatment. Intracameral epinephrine before lens removal can help enlarge the pupil and facilitate the surgery [26]. Iris hooks, retractors or a Malyugin ring can be placed after the laser procedure if miosis results. In a case of insufficient mydriasis and an ectopic pupil, Malyugin et al. have developed a surgical technique that combines use of an iris hook and a pupil expansion ring followed by FLACS [27]. Prophylaxis may be an adapted management of the procedure. If the patient is operated immediately after the femtolaser, the prostaglandins released hardly have the time to have effect on the sphincter pupillae. Moreover, pupil dilatation should start 1 hour before, with more frequent instillation of mydriatics.
A recent meta-analysis shows that the number of anterior capsule and posterior capsule tears for both FLACS and manual phacoemulsification cataract surgery are low, around 0.02% [2]. Tilt, improper docking, loss of suction, corneal folds, and imaging or programming errors can cause partial a capsulotomy. Capsule tags and bridges are usually harmless if they are detected early [28]. The crucial step for capsulotomy removal is to follow the line of the femtosecond laser cut. The absence of a gutter and the presence of bubbles trapped under the capsulotomy cut are signs that help the surgeon identify minor remaining capsule attachments. The surgeon should never pull toward the center of the micro adhesion area because it can cause tags which may run out toward the periphery during hydrodissection or phacoemulsification. One should detach it capsule circumferentially following the contour of the capsulotomy. As small tags can be difficult to see, pulling out the entire anterior capsule with sudden movement is not recommended.
When an anterior capsule tear occurs, the surgeon should perform a very gentle hydrodissection and the canula should be placed 90 degrees from the tear. Avoiding the area of the anterior capsule tear and nucleus rotation is highly advised. During IOL implantation, the leading haptic should be kept away from the tear line.
Capsular block syndrome (CBS) is a rare (0.001%) but serious complication [19]. If hydrodissection with a high-speed influx of fluid is performed, the gas contained in the nucleus cannot access to the anterior chamber, creating an acute intra-capsular high pressure. The subsequent capsular high pressure may lead to a posterior capsular rupture with dropped nucleus. The main signs are the quick constriction of the iris, iris prolapse through the main incision, wrinkling of the capsule and tilting of the lens. Surgeons should be aware of this complication and avoid it by releasing the gas and decompressing the capsular bag before starting hydrodissection. The nucleus may be gently rocked to allow this gas to be burped out. This rock’n roll technique allows air bubbles to leave the crystalline lens. When the gas bubbles leave the intralenticular plane toward the anterior chamber or leave the eye completely, there is no further danger of CBS or posterior capsular rupture.
Half of posterior capsular tears and lens dislocations are caused by posterior extension of an anterior radial tear. It is imperative that the notches at the anterior capsular margin are recognized and managed during the capsulotomy removal. Completing nuclear fracture centrally to allow any retrolenticular gas to escape is advised. In case of posterior capsular rupture, the management should be the same as during a manual phacoemulsification.
In the first studies, the capsular complication rate during the learning curve (first 200 FLACS procedures) was 7.5% and then decreased to 0.62% (consecutive 1300 cases) [29, 30]. The overall incidence of posterior capsular tears was 3.5% and that of posterior lens dislocation was 2% [30]. In more recent studies, posterior capsular tears have been reported to vary between 0.53 and 1.9%, whereas the incidence of a dropped nucleus has been reported to be between 0.1 and 0.12% [31]. The debate is ongoing: in a recent meta-analysis, Day et al., including 1700 eyes, found that FLACS did not significantly lower the rate of posterior capsular rupture, which was very low in both the FLACS group and manual phacoemulsification group [2]. Though, Popovic et al., including 15,000 eyes, showed that FLACS was associated with higher rates of posterior capsular tears (risk ratio 3.73, p < 0.05) [32]. In both studies, the incidence was very low (0.02%) [32]. FLACS might be safer than manual phacoemulsification: lately, Scott et al published the first study with a statistically significant decrease of vitreous loss rate in the FLACS group compared with manual phacoemulsification group (0.65 vs. 1.65%) with a decrease in the individual surgeon’s vitreous loss rate [29].
Endothelial damage during capsulotomy should be considered as a serious complication of femtosecond laser treatment. This complication was likely caused by the lack of an integrated OCT system with the first devices. Highly hyperopic eyes with a shallow anterior chamber require closer attention to avoid endothelial cuts. In the published cases, the overall incidence was very low (0.002%) and there were no long-term visual consequences of this complication although the endothelial incision line could be observed 1 year after surgery [19].
During corneal wound creation with the femtosecond laser system, if the wound is too central, it can cause surgically induced astigmatism. On the opposite, if the wound is too peripheral, it cannot be opened. Since real-time OCT devices allow visual control of the procedure, the incidence of this complication has dramatically decreased to become very rare (0.002%) [32].
In our experience, with the new platforms, all capsulotomies are complete and we have not seen capsular tears. Depending of the device, the docking is relatively easy. The Catalys device, with its Liquid Optic Interface allows for easy docking without posterior corneal folds. Laser induced miosis can be managed by adding 0.5% tropicamide drops in the liquid filled into the patient interface. We have not seen capsular blockage syndrome as we gently rock the nucleus to remove the gas bubbles trapped into the capsule before performing hydrodissection. We recommend the hydrodissection to be soft but complete. Phacoemulsification is easier after laser treatment but should be performed cautiously by the beginner. All the fragment patterns among the different devices effectively cut the nucleus and allow for easy disassembly. The ice-cube pattern available with the Victus is for us the more efficient pattern, as the surgeon only has to separate the first ice cubes to quickly remove all the nucleus.
TIPS FOR SUCCESS
|
In conclusion, FLACS increases the ease and predictability of the steps involved in cataract surgery but has a surgical learning curve and most of the complications occur during the first 100 procedures [19]. Greater surgeon experience and improved technology are associated with a significant reduction in complications. Most complications are predictable and largely preventable.
By using a laser to fragment the crystalline lens, less US energy is required to complete its removal. The reduction in the effective phako time can reach 70% and zero phacoemulsification time is possible in nearly 50% of operations [13].
Lower endothelial cell loss with the laser-assisted procedure compared with the manual phacoemulsification has been reported in the early post-operative state due to the reduction of EPT, with the LensX, the LensAR, the Catalys, and the Victus platforms [33].
The clinical comparative studies performed on a selected series of cases have failed to demonstrate any statistical significance of FLACS versus conventional phacoemulsification surgery concerning the visual outcomes, the intraocular lens power predictability, the corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA). Some studies reported better CDVA, UDVA and intraocular lens power predictability for FLACS, while others have reported no differences. In all cases, the 12-month post-operative visual acuity is high. The mean CDVA was 0.03 logMAR, range of −0.08 to 0.05 logMAR [2, 13, 32]. Superiority of UDVA in has been reported at 2 hours, 3 days, and 1 week postoperatively. After 1 month and later, no statistically significant differences between groups are shown [16]. The mean long-term UDVA was 0.13 logMAR, range 0.07 to 0.23 [32, 34].
Two studies demonstrated that postoperative aqueous flare was significantly greater in eyes that had undergone manual cataract surgery at 1 day and at 4 weeks postoperatively than in eyes after FLACS [35, 36] without significant differences regarding retinal thickness after 3 months.
Compared with manual capsulorhexis, there is evidence of advantages with FLACS by obtaining a more precise shape and size of capsulotomy [22]. This should be associated with a better intraocular lens centration, and then potentially less intraocular lens tilt. However, femtosecond laser capsulotomy shape changes over time and does not improve visual acuity compared with the manual procedure [37].
Clinical cystoid macular edema (CME) after cataract surgery, manual or FLACS, remains a rare complication with a prevalence lower than 2% [2]. The peri-operative use of nonsteroidal drops may interfere with the CME rate. Endophthalmitis, expulsive hemorrhage and retinal detachment are rarer complications, estimated at less than 0.1% [38]. No difference between manual phacoemulsification and femtosecond procedures has been described.
The FLACS procedure induces a transient increase of intra-ocular pressure (IOP), during the suction phase, higher with flat and curved applanating contact interfaces compared with the fluid-filled interface. In the 2 years follow-up, no significant elevated IOP was observed after FLACS [39].
In summary, the rate of intra-operative and post-operative complications remains low, less than 2% and not statistically different between FLACS and manual phacoemulsification [40]. Although anterior and posterior capsule tears could have been a concern, the safety of FLACS and phacoemulsification cataract surgery seems equal, considering all complications.
Costs related to FLACS have been much higher than with the conventional procedure so far. It can represent a barrier to wider acceptance by surgeons and clinical centers. This may be difficulty to adopt as more functional benefits have not been yet clearly established with this new technology. An extra-cost of approximately USD 500 to USD 600 per operated eye is associated with FLACS (approximately USD 400,000 for the device, plus USD 150 to 300 for disposables per procedure). However, these elements may vary dramatically among different countries. If FLACS becomes more common in cataract surgery, these costs should decrease. Moreover, sharing a femtolaser platform between several surgeons and/or for several refractive procedures are also a current option to reduce costs [41].
Advantages of FLACS over manual phacoemulsification are its precision and predictability regarding the capsulotomy size and centration, corneal wound construction, and nucleus fragmentation [42]. It may be helpful in difficult situations such as pediatric cataracts white or subluxated cataracts. Even if the total energy delivered in the anterior chamber appears lower than during manual phacoemulsification, there is no strong evidence of difference in term of endothelial cell loss between the procedures. The FLACS procedure requires more operating room space as well as increase in operating time. The treatment can also lead to miosis. Altogether, there is no evidence of superior post-operative visual acuity with FLACS, whereas the costs associated with FLACS platforms are currently higher than with manual surgery. Future research on outcomes will help clarify if the increased costs can be supported by evidence of visual and clinical superiority of FLACS.
The femtosecond laser cataract can be considered a young technology still in significant progress, compared with phacoemulsification, a very mature procedure, which has evolved for decades and has reached a very high level. Each year, companies offer new software evolving to a more user-friendly interface and more efficient versions. Progress is expected in the miniaturization of lasers, making them more moveable. New lenses may be specially designed, based on its perfect laser rhexis and would open a new refractive era, giving significant advantages to the laser procedure. The cost effectiveness is still questioned; many countries cannot afford or consider adopting this technology yet. If adequate improvements are achieved in the “FLACS of the future,” this technique may become the gold standard one day.
The authors have no financial interests.
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Most smart home systems are controlled by smartphones and microcontrollers. A smartphone application is used to control and monitor home functions using wireless communication techniques. We explore the concept of smart home with the integration of IoT services and cloud computing to it, by embedding intelligence into sensors and actuators, networking of smart things using the corresponding technology, facilitating interactions with smart things using cloud computing for easy access in different locations, increasing computation power, storage space and improving data exchange efficiency. In this chapter we present a composition of three components to build a robust approach of an advanced smart home concept and implementation.",book:{id:"7602",slug:"internet-of-things-iot-for-automated-and-smart-applications",title:"Internet of Things (IoT) for Automated and Smart Applications",fullTitle:"Internet of Things (IoT) for Automated and Smart Applications"},signatures:"Menachem Domb",authors:[{id:"222778",title:"Prof.",name:"Menachem",middleName:null,surname:"Domb",slug:"menachem-domb",fullName:"Menachem Domb"}]},{id:"62481",title:"Blockchain and Digital Currency in the World of Finance",slug:"blockchain-and-digital-currency-in-the-world-of-finance",totalDownloads:2009,totalCrossrefCites:4,totalDimensionsCites:5,abstract:"High-tech enables payment evolution and global competition. The ambiguities surrounding of the digital currency still leave enough space for the analysis of its unreserved acceptance, trust and anticipation, which are the main driver for the spread of the network. Banks should carefully consider the technology underlying these cryptocurrencies as a potential generic new way of transferring ownership of the value over the long term. The chapter provides an analysis of the use of cryptocurrencies in general, especially Bitcoin as the technology adoption in the presence of network externalities. The objective attitude is the future of the digital currency in the moment is still unsolved issue due to the existence of “critical mass”. Further, the chapter explores financial privacy which is very sensitive issue in using digital currency (or cryptocurrency) and discuss about private choices versus political rules. The research has shown that the future of cryptocurrencies can be bright if some institutional-formal conditions are met due to the fact that success evolution of e-money requires building safety payments through three criteria–standardization, compatibility and innovation.",book:{id:"7228",slug:"blockchain-and-cryptocurrencies",title:"Blockchain and Cryptocurrencies",fullTitle:"Blockchain and Cryptocurrencies"},signatures:"Tatjana Boshkov",authors:[{id:"246137",title:"Ph.D.",name:"Tatjana",middleName:null,surname:"Boshkov",slug:"tatjana-boshkov",fullName:"Tatjana Boshkov"}]},{id:"38793",title:"Overview of Wireless Sensor Network",slug:"overview-of-wireless-sensor-network",totalDownloads:12434,totalCrossrefCites:62,totalDimensionsCites:84,abstract:null,book:{id:"2211",slug:"wireless-sensor-networks-technology-and-protocols",title:"Wireless Sensor Networks",fullTitle:"Wireless Sensor Networks - Technology and Protocols"},signatures:"M.A. Matin and M.M. Islam",authors:[{id:"12623",title:"Prof.",name:"Mohammad Abdul",middleName:"A",surname:"Matin",slug:"mohammad-abdul-matin",fullName:"Mohammad Abdul Matin"}]},{id:"66938",title:"An Overview of Wireless Mesh Networks",slug:"an-overview-of-wireless-mesh-networks",totalDownloads:1672,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Wireless mesh networks (WMNs) are communication networks which comprise radio nodes in which nodes are arranged in a mesh topology. Mesh topology is an interconnection of all nodes connected with all other nodes in the network. The network includes devices like nodes, clients, routers, gateways, etc. As the nodes are fully connected, mesh networks are usually less mobile as rerouting is less difficult in predicting the reroute results in delay in data transmission. Mesh clients can be of any wireless devices like cell phones, laptops, etc. The gateways which act as forwarding nodes may not be connected with the Internet. As different devices come under a single network, it is also referred as mesh cloud. WMN is self-healable. It works better with various different networks which include cellular networks and IEEE 802.11, 802.15, and 802.16 as well. WMN is flexible to work with more than one protocol. This chapter gives architecture, layer functionalities, and applications.",book:{id:"7322",slug:"wireless-mesh-networks-security-architectures-and-protocols",title:"Wireless Mesh Networks",fullTitle:"Wireless Mesh Networks - Security, Architectures and Protocols"},signatures:"J. Rejina Parvin",authors:null},{id:"63090",title:"Cryptocurrency Returns",slug:"cryptocurrency-returns",totalDownloads:1450,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"One of the most significant innovations in the world of finance has been the creation and evolvement of cryptocurrencies. These digital means of exchange have been the focus of extensive news coverage, especially the Bitcoin, with a primary focus on the tremendous potential return and the high level of accompanying risk. In this chapter, we examine the risk-return pattern for an array of cryptocurrencies, contrasting the pattern with those of conventional currency and equity investments. We find the measures of cryptocurrency returns and risk to be a very high multiple of those of conventional investments, and the pattern is determined to be robust relative to the time frame. Consequently, cryptocurrencies are determined to provide an alternative to investors that involves tremendously high risk and return.",book:{id:"7228",slug:"blockchain-and-cryptocurrencies",title:"Blockchain and Cryptocurrencies",fullTitle:"Blockchain and Cryptocurrencies"},signatures:"Mike Cudd, Kristen Ritterbush, Marcelo Eduardo and Chris Smith",authors:[{id:"254939",title:"Dr.",name:"Mike",middleName:null,surname:"Cudd",slug:"mike-cudd",fullName:"Mike Cudd"}]}],onlineFirstChaptersFilter:{topicId:"88",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"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. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 29th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:32,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9759",title:"Vitamin E in Health and Disease",subtitle:"Interactions, Diseases and Health Aspects",coverURL:"https://cdn.intechopen.com/books/images_new/9759.jpg",slug:"vitamin-e-in-health-and-disease-interactions-diseases-and-health-aspects",publishedDate:"October 6th 2021",editedByType:"Edited by",bookSignature:"Pınar Erkekoglu and Júlia Scherer Santos",hash:"6c3ddcc13626110de289b57f2516ac8f",volumeInSeries:22,fullTitle:"Vitamin E in Health and Disease - Interactions, Diseases and Health Aspects",editors:[{id:"109978",title:"Prof.",name:"Pınar",middleName:null,surname:"Erkekoğlu",slug:"pinar-erkekoglu",fullName:"Pınar Erkekoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.jpg",institutionString:"Hacettepe University",institution:{name:"Hacettepe University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:13}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:8},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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