Organizations involved in women’s health.
\r\n\tAssisted Reproductive Technologies (ART) is a key technology for treating infertility, which occurs in 10-15% of the general population in reproductive age. This has been one of the most tumultuously developing interdisciplinary technologies in medicine in recent decades. Thanks to in vitro methods, more than 5 million children were born in the whole world. For 40 years, the success rates of this treatment have increased many times, respectively in the first years from less than 10% to more than 50% in present days (in some groups of patients). The reason for this rapid increase is the introduction of new drugs and stimulation protocols, improvement of embryo culture media, and the use of new types of laboratory equipment that improve the conditions for embryo development. Last but not least, the introduction of modern genetic methods, as well as new gamete and tissue freezing techniques, has improved the methods' diagnostic and therapeutic capabilities.
",isbn:"978-1-80356-720-4",printIsbn:"978-1-80356-719-8",pdfIsbn:"978-1-80356-721-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"4a171468ca00ae2c47f7f5cd0f3b90a4",bookSignature:"Dr. Iavor K. Vladimirov",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11839.jpg",keywords:"Ovarian Reserve, Indication of ART Treatment, Stimulation Protocols, Monitoring of Ovarian Stimulation, Oocytes and Sperm Preparation, Manipulation Techniques, Surrogacy, Cross Border IVF Treatment, Preimplantation Genetic Testing, Endometrial Receptivity, Ethical aspects of ART, Ovarian Rejuvenation",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 24th 2022",dateEndSecondStepPublish:"June 7th 2022",dateEndThirdStepPublish:"August 6th 2022",dateEndFourthStepPublish:"October 25th 2022",dateEndFifthStepPublish:"December 24th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a month",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:'Dr. Vladimirov is the founder and medical director of the Sofia IVF Clinic. He is also one of the authors of the book "Theory about the Embryo Cryo-Treatment", the first theory that provides a scientific explanation for the high success rate in the use of frozen embryos.\r\nDr. Vladimirov introduces for the first time in Bulgaria the methods for Ovarian Reserve Assessment, In Vitro Maturation method,Determination of “implantation window” in the endometrium, using\r\nEndometrial Receptivity Analysis (ERA) test.',coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"253947",title:"Dr.",name:"Iavor K.",middleName:null,surname:"Vladimirov",slug:"iavor-k.-vladimirov",fullName:"Iavor K. Vladimirov",profilePictureURL:"https://mts.intechopen.com/storage/users/253947/images/system/253947.jpg",biography:"Dr. Iavor K. Vladimirov graduated in Medicine at the Sofia Medical University in 1990. In 1997 he became an Obstetrics and Gynaecology specialist. In 2003, he wrote a doctoral thesis on 'Diagnostic Testing to Assess the Ovarian Reserve of Infertile Women”, and obtained a Ph.D.\nDr. Vladimirov was, in the period between 2008 and 2010, a secretary of the Bulgarian Association of Sterility and Reproductive Health. \nHe hаѕ оvеr 25 уеаrѕ’ of ехреrіеnсе іn the аѕѕіѕtеd rерrоduсtіоn and іntrоduсеd the method of 'іn vіtrо mаturаtіоn” tо Вulgаrіа. Dr. Iavor Vladimirov іѕ thе fіrѕt Вulgаrіаn rерrоduсtіvе mеdісіnе ѕресіаlіѕt whо wоn оnе оf thе mоѕt рrеѕtіgіоuѕ аwаrd оf 'Тhе Society for Reproductive Endocrinology and Infertility” оf Тhе Аmеrісаn Ѕосіеtу fоr Rерrоduсtіvе Меdісіnе (АЅRМ) fоr уеаr 2016 and won the prestigious \\'Daniela Seizova - In the Name of Life\\' award in the category \\'Physician of 2016.\\' \nSince 2004 he is the Medical Director of the IVF unit in SBALAGRM – Sofia, Bulgaria.\nSince 2008 he is a Lector of the Faculty of Biology, Sofia University 'St. Kliment Ohridski”, Sofia, Bulgaria.",institutionString:"Sofia IVF clinic",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"453622",firstName:"Tea",lastName:"Jurcic",middleName:null,title:"Ms.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"tea@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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Therefore, obtaining reliable data depends on the researcher’s training, the experience and specialty of the medical treatment, the instruments used to obtain the information, and the degree of safety and security that the patient has both in the researcher and in the doctor.
The objective of clinical research is to obtain knowledge to incorporate it systematically in health policies. Specifically, research on women’s health began in 1990, when the Office of Research on Women’s Health (ORWH) promoted policies and funded research considering the influence of sex and gender on health. After, in 1991, the Women’s Health Initiative (WHI) announced, under which menopause was studied to understand the treatment of cardiovascular diseases, cancer, and osteoporosis. In addition to promoting research in women’s health methodologically, technically, and more recently, ethical aspects have been analyzed, in order to protect the patient’s safety, in the social, psychological, and biological spheres. With respect to medical care, the influence of the sex of treating doctor or nurse has been studied, but no differences were observed; on the contrary, there was only predisposition to give preferential treatment to a family member, when in a hypothetical situation, the life was in high risk. Despite the fact that each gender is characterized by a type of ethical reasoning, is based on caring/protection for women and justice for men. Finally, for the study and medical attention of women, various surveys have been developed, with the aim to evaluate a specific sign or symptom. This fact highlights the importance of studying and attending multidisciplinary to women, given the complexity and diversity of the signs and symptoms.
The application of ethical norms for the investigation and medical attention of women requires that doctors and nurses from their professional formation have to approach to this concept. So also, the political authorities and administrators of economic funds must know the transcendence of ethics in their fields of action.
Menopause is the permanent cessation of menorrhagia, due to ovarian dysfunction, which marks the end of the reproductive stage in a woman’s life and is characterized by low levels of estradiol and high concentrations of follicle-stimulating hormone and luteinizing hormone, although other complex changes have also been reported in systems such as immunological and nervous among others [1]. Hormonal changes begin about 3 years before menopause and continue for a similar period after menopause; in addition, there are metabolic disorders that induce characteristic signs and symptoms such as vasomotor and psychological, whose duration ranges from 3 months to 5 years after menopause [2]. Central obesity, dyslipidemia, sleep disorders, and high blood pressure, among others, are also identified [3, 4, 5].
Several symptoms have already been described widely; so here, only some will be described that require special mention given the complexity to diagnose or study them, or those of the major importance, or they have recent advances.
Sexual dysfunction: In general, menopause is usually perceived as a stage of decline, because signs and symptoms are accentuated with aging. One of the symptoms that usually cause embarrassment in female patient is the sexual dysfunction, which has a final result, the reduction of sexual desire [6]. The events that lead to this can be pathophysiological such as vulvar and vaginal atrophy and lubrication reduction or psychological, due to women who present low self-esteem. Sexual function in this stage is influenced by several factors, such as previous sexual activity, co-morbidities, cultural environment, mental illness, and ethnic origin; for example, the prevalence of sexual desire reduction has been described in 47, 54, 42, and 24% in English, Italian, French, and German menopausal women, respectively. It has also been pointed out that black and Latina women had greater sexual desire than white and Asian women at this stage. Although even women from the same country, but of different ethnic groups, tend to have a different prevalence of sexual dysfunction, as shown in a study carried out in ethnic groups from Iran, that study showed that the prevalence of sexual dysfunction was 75.3 in Arabs, 86.1 in Lors, and 83.2% in Persians [7]. Undoubtedly, the evaluation of the sexual function requires an ethical management by the treating medical personnel, since it must auscultate and interrogate the patient, without the woman feeling uncomfortable.
Osteoporosis: It is another important health problem in women postmenopausal, which usually occurs in the late phase but goes unnoticed because it is not painful or by patient’s ignorance. This pathology results from the decrease in estrogen production, reduced calcium resorption, increased urinary excretion, reduced vitamin D synthesis, as well as less formation of its active metabolites, decrease in the number of vitamin D receptors. The analysis of the quality of life of women with osteopenia or osteoporosis is important, as it can guide pharmacological and non-pharmacological strategies [8].
Obstructive sleep apnea: It is neither a symptom usually asked by doctors nor does the patient report having more episodes in this stage. However, clinical research found a higher prevalence after menopause, and even more, it has been proposed that it predisposes to enuresis, coronary risk, and cardiovascular disease. Enuresis, occurs during the apnea as a result of a negative pressure against the glottis, which causes cardiac distension and greater release of the atrial natriuretic peptide, which finally results in an increased urinary volume and, consequently, enuresis [9]. Then, the knowledge factors to obstructive sleep apnea can also control the enuresis, improve the quality of sleep, and reduce cardiac risk, the mood, and, in general, the well-being. Common risk factors for obstructive sleep apnea and enuresis have been reported, such as obesity, snoring, restless sleep, sleep fragmentation, daytime somnolence, and hypertension; this has not been found in postmenopausal women (Figure 1) [10].
Interrelationship between signs and symptoms with diseases observed during menopause and its stages.
As already mentioned, there are several condition factors of the presence and intensity of a certain symptom of menopause and therefore the type of treatment that they will receive to control them. Several studies indicate that among these factors are the psychological, cultural, and family factors, additionally to events that usually occur around the age of menopause [11].
Personality is part of the human being and is defined as the series of features or characteristics that induce the behavior of a person, in turn, allowing us to intuit the way of acting in a given situation. The personality is defined by traits such as neurosis, extroversion, openness to new experiences, kindness, and scrupulousness. The identification of this traits could guide the pharmacological and non-pharmacological strategies to reduce the anxiety and to improve the self-esteem and, with that, the self-care of the patient [12]. Of the different personality traits, the one that has been most related to the presence of vasomotor symptoms is the neurosis, since it predisposes anxiety, stress, hostility, impulsivity, low self-esteem, and depression, which in turn conditions feelings such as sadness, anger, and guilt. Although results of clinical studies in postmenopausal women are contradictory, for example, it has been reported that neurosis and anxiety are associated with physical symptoms; in contrast, in others, no correlation has been found with the number of hot flushes [13].
Another aspect that is not usually considered in the consultation is the possibility that the woman suffers some type of mistreatment (sexual, economical, or physical) which has been proven to diminish physical capacity functioning (Figure 2) [14].
Factors and events that influence the presentation of symptoms during menopause.
Many clinical research and medical care to postmenopausal patients has been focuses to treat diseases, uncomfortable symptoms, or family problems; without consider the advantages that menopause has; in example, there is no possibility of becoming pregnant, so, the women can enjoy their sexuality. Also, women can do activities that satisfy them [7].
The menopause is an opportunity to empower women. To achieve the above, it is necessary that the woman is better informed of physical and psychological changes she will undergo, of family and medical needs, as well as of the strategies she can carry out for her self-care [15]. Because approximately half of the world’s population is woman, and the life expectancy is greater than that of man, it can be intuited that women spend two thirds of their lives in postmenopausal, so their functional status must be preserved, since it will impact on the family, society, and itself. It is important to recognize those factors that hinder empowerment, for example, co-morbidities present before menopause, marital status, family network, and health centers that can be accessed.
Currently, campaigns have been implemented to prevent and treat osteoporosis: follow a healthy diet and promote moderate physical activity, stress management, interpersonal relationships, and group education, which will improve the quality of life. If menopause is accepted with the inherent changes, it will bring the woman to face this stage better; in contrast, it has been reported that women who do not accept this stage have more severe symptoms. In targeted studies, women in menopause have expressed that they need to be informed of this stage through different means [16].
Defining “ethics” or “ethical thinking” is complex and has basically focused on two approaches; one is based on care and prior experience, and the other is on justice, as outlined by Gilligan and Kohlberg, respectively. The first one is manifested by women, while the second one, by men which, of course, should not be generalized, but its foundation is derived from biological traits and the activity of each sex. For example, Gilligan proposes that women understand ethics, based on their role in the family and society, that is, in caring for and supporting family members equally and providing them with care, while men focus on ethics, according to the rights and obligations of people; this means that people should receive the just [17]. Both theories raise divergences and difficulties to define ethics and all the components that integrate it, even if there are different types of ethics (professional, economic, and government, among others).
Conduct clinical studies in doctors and nurses with a gender perspective, who provide medical attention is very important, given that they can influence the ethical treatment received by menopausal patients, who are in the stage of emotional and physiological susceptibility [18].
A study with doctors and nurses of both sexes was carried, to evaluate their impartial reasoning; starting from the assumption that women doctors and nurses have a partial thought (care orientation) and impartial men (focused on justice). The dilemmas presented situations of different severities and urgencies, whether the life of a relative was in danger or not. It was found that the response was partial, if the life of a relative was in danger, both in health professionals and in those who were not, while if it was a less serious situation that did not compromise life, the response was impartial, in both cases. In summary, what conditioned the response was the seriousness of the situation.
This ethical requirement for doctors has been diffused in several centuries and is raised in the “Hippocratic Oath,” which connects the responsibility of the doctor, with the result of his intervention. Subsequently, the principles of “first do no harm” and “beneficence and no maleficence” were included. Since then, several researchers have contributed to define “ethics and bioethics” as well as their scope. In 1979, Beauchamp and Childress concretized concepts and focused on “biomedical ethics.” On the other hand, in the Belmont report, “principlism” was defined, which focuses on respecting people with justice. In 1847, the American Medical Association began to define the doctors’ behavior [19].
In 1980, the teaching of bioethics was implemented in the undergraduate program and later in the specialties. Thus, the first thing that was emphasized was the basic concept of bioethics. Surgery residents surveyed indicated that they felt more confident to face ethical problems, after a training program. A study in pediatric residents indicated that they needed ethical training, especially to make the decision to give or take life support [20].
Several studies indicate that (1) medical women trained in ethics perceive more benefits than men and (2) student women focused more on psychosocial aspects and men were based on the rights of the patients. This shows that women are more based on abstract and personal principles, while men focused on responsibility, authority, and control. It is necessary to make a systematic analysis by the specialty and educational level, considering areas of special interest such as the role of bioethics and the conceptualization of justice, obtaining the informed consent of the patient or from a legal representative, facing the rejection of the signature of the said document, as well as obtaining it from people who speak different languages and care for special people or with a certain degree of vulnerability. Recognizing the training needs of the different specialties and taking into account the evolution of bioethics, better-oriented ethics programs can be designed.
A survey at the School of Medicine of the University of New Mexico to better understand these problems was conducted. The hypotheses were that (1) medical students and residents would support the need for more curricular attention to the principles of bioethics, the issues of informed consent, and the special needs of the population; (2) women would more strongly support these curricular needs; (3) residents of psychiatry would more strongly support curricular needs than other residents; and (4) there would be a greater perceived need in these curricular domains of ethics among apprentices who were in more advanced stages of training (Table 1) [21].
Organization | Aim |
---|---|
Women’s Health Initiative (WHI) | Was founded by the US National Institutes of Health (NIH) in 1991. This Initiative consisted of clinical trials and observational studies in order to conduct the main health issues causing morbidity and mortality in postmenopausal women |
Women’s Health Initiative Clinical Trial (WHICT) | This study was initiated in 1992 and concluded in 2007, in which the patient was included in a trial clinic or an observational study. Both focused to study the prevention of cancer, cardiovascular diseases, or osteoporosis |
Institute of Nutrition of Central America and Panama (INCAP) | Was constituted in 1949, under three principles:
|
National Research Ethics Service (NRES) | NRES is one of the functions of the Health Research Authority and is responsible for reviewing and supporting ethical research in the National Health Service “to guarantee the protection of the human rights, safety, dignity, and well-being of the participants in the research” |
Canadian Institutes of Health Research | Is the main federal agency for health research in Canada. It is constituted by 13 institutes, among which is the “Gender and Health” |
Office for Human Research Protections (OHRP) | The Office for Human Research Protections (OHRP) is responsible for protecting the rights and welfare of individuals who participate in research projects conducted under the authorization of the US Department of Health and Human Services (HHS) |
Council for International Organizations of Medical Sciences (CIOMS) | The Council for International Organizations of Medical Sciences was established in 1949 by the WHO and UNESCO, who are integrated international researchers, academies of science, and medical research councils. CIOMS promotes the public health, applying guides of health research, ethics, new products, and its security |
Canadian Medical Association (CMA) | CMA was founded in 1867, its members are volunteers, and doctors promote patient access to high-quality health services |
World Medical Association (WMA) | WMA was founded in 1947 and is formed by several millions of physicians and medical associations, promoting the medical care, ethics, and health education |
European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) | ESCEO was founded in 2005; it is a not-for-profit organization that meets clinical scientists who study bone, joint, and muscle disorders, as well as pharmaceutical industry |
Organizations involved in women’s health.
Among the diseases that affect menopausal women, there are some that are deserved to be explained with ethical focus, for example, osteoporosis, periodontal disease, and vaginal symptoms.
Osteoporosis is a disease that occurs in women in late postmenopausal; in fact, according to the National Osteoporosis Foundation, every second, a woman suffers a fracture due to osteoporosis, and even the risk for this disease is higher than for other gynecological cancers. Therefore, studies have been developed that measure the quality of life of these patients, who are determined by their degree of functionality. This has been confirmed in women with osteopenia and osteoporosis; since they have limited physical activity, they have altered the physical position, suffering, and pain, with mental and emotional alterations [22].
There are many approaches that have been given for the prevention, treatment, and study of osteoporosis. Primary prevention means promoting habits that encourage the formation of good quality bones; also, at this stage, the primary detection is carried out, and the modifiable risk factors are identified, or they can be reduced or eliminated. Secondary prevention implies the opportune diagnosis and its pharmacological and non-pharmacological treatment, before a fracture occurs. Tertiary prevention is directed to limit the damage by osteoporosis.
Vaginal symptoms: Like the vasomotor symptoms, the vaginal symptoms are frequent. The clinical evaluation of these manifestations is not easy, and validated questionnaires are required that can be understood and answered by the same patient, as well as being able to be applied in populations of different ethnic origins. For which, an instrument of 100 questions was developed, with a set of 100 structured items, which used ordered 5-point response options to assess the degree to which vaginal symptoms interfered with specific aspects of women’s daily activities, sexual function, emotional well-being, self-concept and body image, or interpersonal relationships. The aspects evaluated included sexual function, emotional well-being, the concept of self-perception, and personal interrelationships. According this questionnaire, the main symptoms were dryness, dyspareunia, and itching, and there was a lower prevalence of irritation and pain. The questionnaire was useful to evaluate the vaginal function, since it also evaluates feeling good, sexual function, and self-perception of the image [23].
Periodontal disease: A study carried out in postmenopausal women reported that 97% thought they had healthy gums, but when were evaluated, it was identified that 62% had at least one affected site, with the risk of losing a dental organ. In addition, women were unaware of the effects of periodontitis. Although women reported that they visited their dentist semiannually, in several teeth, the biofilm was observed, but in several teeth, biofilm was observed, which indicated a poor periodontal state; what makes us suppose is that they considered that they had healthy gums, because they did not present abscesses, a symptom that seems to be the best known, not considering important events such as the loss of periodontium and depth of probing. Periodontal disease is not well known among women, although they know the risk factors for developing caries, such as the infrequency of brushing, poor dental technique, and sugary foods. The study showed that most of the patients neither had knowledge about the risk factors nor of all the signs and symptoms, but once it was explained to them, they showed greater interest in self-care and assisted a periodic review by the specialist [24].
Physical activity: The index of healthy behavior considers four areas: healthy eating habits, preventive actions, positive mental attitude, and recreational activities. Using this instrument, a comparison was made between young and old women, in which it was found that the elderlies (between 56 and 69 years) have a high level of healthy behavior, although in a particular way the alimentary habits were similar and women with the higher educational level and who are divorced had more healthy habits. Women with some pathology had higher scores; this is expected, since they know that they have an illness and they understand that they must have more care and carry out actions that benefit their health and control the disease. On the other hand, women without pathologies had less healthy habits, a situation derived from their perception of their health, since they considered their health status as good. This type of instrument is of fundamental application in postmenopausal women, since it has been proven that a healthy state will condition symptoms of less intensity or frequency [25]. There are several survey questionnaires or scales to evaluate women’s health but, however, is not usually used all at the same time (Table 2).
Name | Symptoms evaluated | Score |
---|---|---|
Female Sexual Function Index (FSFI) [26] | Dimensions of sexual function in women | Range: 1.2–36 points ≤ 26.55 is classified as FSD |
Physical Function Scale (PFS) [27] | Physical function, social function, role limitations: physical problems, emotional problems, mental health, vitality, pain, and perception of general health | Range: 0–100 points High scores reflect better health status |
Center for Epidemiologic Studies Depression (CESD) Scale [28] | Depression, such as restless sleep, poor appetite, and feeling lonely | Range: 0–60 points High scores indicate greater depressive symptoms |
Epworth Sleepiness Scale [29] | Daytime sleepiness | Scores: 0–5 lower normal, 6–10 higher normal, 11–12 mild excessive, 13–15 moderate excessive, 16–24 severe excessive |
Pittsburgh Sleep Quality Index [30] | Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction | Range: 0–21 points < 5 have good sleep quality |
STOP-Bang Questionnaire [31] | Consists of yes/no responses: “Do you snore loudly?” “Do you often feel tired, fatigued, or sleepy during daytime?” “Has anyone observed you stop breathing during your sleep?” “Do you have or are you being treated for high blood pressure?” | Range: 0–8 points ≥3 suggest obstructive sleep apnea |
Charlson Comorbidity Index [32] | Categorize co-morbidities: each co-morbidity category has an associated weight (from 1 to 6) | 0 = no co-morbidity 3 = severe co-morbidities |
Dietary Inflammatory Index (DII) [33] | Related to the type of diet with the increase or decrease of inflammatory mediators IL − 1beta, IL-4, IL-6, IL-10, TNF-alfa, and PCR | -1 = pro-inflammatory foods 0 = they do not produce changes in inflammatory markers +1 = anti-inflammatory foods |
Day-to-Day Impact of Vaginal Aging (DIVA) [34] | Assessing the impact of vaginal dryness, soreness, itching, irritation, and pain on functioning and well-being | Range: 0–4 points Higher score indicates major symptoms |
Hospital Anxiety and Depression Scale (HADS) [35] | Depression and anxiety in hospitalized nonpsychiatric patients | Range: 0–42 points 0–7 normal 8–10 doubtful >11 clinic problem |
Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) [36] | Pain, physical function, social function, general perception of health, and mental function | Range: 1–5 points The highest score refers to the quality of worse life |
Health Behavior Inventory (HBI) [37] | Dietary self-management, preventive measures, healthy practices, and positive mental attitude | Range: 24–120 points The higher score indicates health behaviors |
Health Promoting Lifestyle Profile II (HPLP II) [38] | Health responsibility (HR), spiritual growth (SG), physical activity (PA), interpersonal relations (IR), nutrition (N), and stress management (SM) | Score: ≥2.50 is considered to be a positive response |
Neuroticism-Extroversion-Openness Five-Factor Inventory (NEO-FFI) [12] | The NEO-FFI is integrated by 60 items, which measures the five main domains (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) | Higher scores in neuroticism is related to severe menopausal symptoms |
Menopause-Specific Quality of Life Questionnaire (MENQOL) [39] | MENQOL evaluates the quality of life after menopause through: vasomotor, physical, psychosocial, sexual, and global quality of life question | Range: 0–6 points (0 none, 6 severe) |
Kupperman Index [40] | Hot flashes, paresthesia, insomnia, vertigo, nervousness, melancholia, weakness, arthralgia or myalgia, headache, palpitations, and formication | Scores: 15–20 = mild 20–35 = moderate >35 = severe |
Psychological General Well-Being Index [41] | Anxiety, depressed mood, positive well-being, self-control, general health, and vitality | Range: 0–100 points A high score is indicative of high levels of psychological well-being |
Hot Flash Related Daily Interference Scale (HFRDIS) [42] | Work, social activities, leisure activities, sleep, mood, concentration, relations with others, sexuality, and enjoyment of life | Range: 0–100 points High score indicates interference |
Menopause Rating Scale (MRS) [43] | Hot flushes, heart discomfort, sleep problems, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, dryness of vagina, joint, and muscular discomfort | Range: 9–21 points Higher score is related to more postmenopausal symptoms |
Questionnaires, survey and index used to evaluate women’s health.
Since its inception in 1906, the Food and Drug Administration (FDA) has been committed to the health of women and stablished the Office of Women’s Health (FDA OWH) in 1994. The US Food and Drug Administration Guide developed a Guide for the Study and Evaluation of Gender Differences, which made it possible to include women in phase 1, 2, and 3 studies. Later, between 2002 and 2004, trials on hormone therapy were designed to test the effects of estradiol and combined estrogen/progesterone therapy on the prevention of cardiovascular diseases, fractures, and breast and colorectal cancer. The studies found that estradiol did not protect against cardiovascular disease and that the risks outweighed the benefits. In the year 2010, it was recognized that it was necessary to carry out research with female animals with a focus on the study of common diseases. Finally, the inadequate number of women included in clinical trials is noteworthy [44].
In that same year, the NIH Office of Research on Women’s Health proposed a strategic planning process with scientists, public policy experts, women’s health advocates, healthcare providers, elected officials, and the public to generate priorities research. In 2014, federal agencies collaborated with women’s health research. The NIH Office of Research on Women’s Health and the Office of Women’s Health of the FDA plan to collaborate on a national campaign to promote the importance of participation in clinical trials focusing on women; due to evidence of the effect of estrogen in the secondary prevention of coronary disease, published in
Three main reasons seem to explain the exclusion of women: (1) experimental exposition to risk during fertile years (2) erroneous perceptions that consider that women are less affected by certain disorders or health problems or that women respond to the same treatment as men; and (3) it is perceived that women provide complexity, increased cost, and the need for greater analytical capacity.
However, the Institute of Medicine concluded “being male or female is an important basic human variable that must be considered when designing and analyzing studies in all areas and at all levels of biomedicine and health-related research.” Until sex and gender differences are routinely investigated, there will be many opportunities to gain a better understanding of the pathogenesis of disease and human health.
Currently, the review of clinic protocols by the Research Ethics Committees (REC) is the key to the regulation of clinical research. The RECs have to comply with several requirements, such as (1) the minimum members is five; (2) membership must be diverse (by race, gender, cultural background, sensitivity to the problems of the community), with at least one scientist and one nonscientist [45]; (3) there are no rules about how fast decisions should be made or how many times you could apply; (4) the consequences of REC’s work for investigators or research funders, in terms of time or resources, were not a consideration of REC; (5) the scientific quality of a project is considered an ethical prerequisite; (6) the legality (to ensure that laws and other regulations are followed and the protection of institutes and responsible researchers); (7) the choice of researchers is determined by the professional location of the principal investigator, which a REC within the health institute could be chosen. The researchers did not choose the REC; (8) the REC had “responsibility of state public officials”; (9) transparency in the selection process to accept protocols; (10) compulsory education of REC members about ethical topics; (11) the variability in the work and decisions of REC had been recognized as a problem, but not solved; and (12) quality assurance investigation complicates the topic, but some defended the exemption from quality assurance studies of the ethical approval requirement.
Currently, it is recognized that health is fundamental to development of a society. Most studies describe the costs of poor health in women, particularly the costs of poor maternal health.
There are a lot of challenges that REC and national or international organizations have to solve, for example:
Girls from the United States exhibited physical signs of puberty by age 7.
Pollutants of land and livestock can impact on man’s reproductive abilities.
Good health among women is important for child development and the production of future human capital.
The mass and nonprofessional media can be the main source of knowledge about the symptoms and coping methods in postmenopausal women.
Determining the association of quality of life of the postmenopausal women with that of their spouses.
Promoting the health and health behavior must be a priority [11, 25, 46].
Menopause is a very important stage in a woman’s life, and the attention provided at this stage, whether for research or medical attention, must be carried out by personnel trained in ethics, because the woman is in the stage of major susceptibility; also, several symptoms can be confusing. Moreover, in medical consultation or the clinical studies, do not usually apply all the questionnaires, indexes, or scales, either due to lack of time or to focus on the main symptom, without considering that the symptom that was the reason for consultation may be the result of not treating other minor symptoms. The research clinic based on ethical principles will contribute to obtain specific and reliable results on women’s health.
The authors declare that there is no conflict of interest.
Central control of vocalization involves the activation of different interrelated brain structures in complex networks. Vocalization in mammals depends on a network originating in the laryngeal motor cortex, which projects to the mesencephalic Periaqueductal Gray Matter (PAG). The PAG modifies the activity of all pontomedullary structures responsible of generating all the laryngeal-respiratory motor patterns, necessary for vocal emission. These pontomedullary generators control the pattern and intensity of activation of respiratory, laryngeal, oropharyngeal, and craniofacial motor neurons [1].
Vocal emission involves the genesis of a precise and prolonged expiration that provides an adequate pressure/air flow component to generate a subglottic pressure compatible with vocalization. The nucleus ambiguus (nA), where laryngeal motor neurons are concentrated, is mainly responsible for this. All these regions present a high expression of the FOXP2 factor. FOXP2 is a transcription factor necessary for brain and lung development that is closely related to vocalization. Throughout the evolution of the human species, synaptic connectivity and plasticity in the circuits of the basal ganglia were increased, improving motor control and human cognitive and linguistic abilities [2].
Vocal fold abduction and adduction are known to be accomplished by two distinct populations of motor neurons located within the caudal third of the nA. It can be divided into three main parts: the compact formation (with motor neurons that innervate the esophagus), the semi-compact formation (with motor neurons that innervate the pharynx and the cricothyroid muscle of the larynx innervated by the superior laryngeal nerve) and the sparse formation (with motor neurons that innervate the laryngeal muscles except the cricothyroid) [3].
In previous work by our research group, the activity of the laryngeal motor neurons of nA and the reflex mechanisms involved in respiratory laryngeal responses have been characterized, suggesting that the parabrachial complex (PBc) and the A5 region (A5) have a role in modifying the activity of laryngeal motoneurones localized in the nA and accordingly the striated laryngeal muscles of the upper airway [4, 5] (Figure 1). Pontomedullary respiratory nuclei: PBc, A5, the nucleus of the solitary tract (NTS), nA and retroambiguous nuclei (nRA), paraambiguous (nPA) and retrofacial (nRF) integrate inputs from central and peripheral receptors and from superior structures to produce changes in the basic respiratory rhythm (eupnea). These changes are a prerequisite for survival (for example, tachypnea associated with the defense reaction, which increases the supply of oxygen preparing to fight or defend, or the response of gasping reset in the event of intense anxiety with respiratory alkalosis). But these changes in respiration are also necessary to maintain a constant expiratory flow that allows vocalization. It is known that Periaqueductal Gray Matter (PAG) is a key point in coordinating the efferent activity from limbic, cortico-prefrontal and cingulate afferents, modifying the activity of all these mesencephalic-pontomedullary nuclei [2].
Laryngeal and respiratory responses to electrical stimulation in the medial (a) and lateral (b) parabrachial nucleus and (c) to glutamate microinjection in the A5 region. Phrenic nerve discharge, respiratory airflow, pleural pressure, subglottic pressure and integrated phrenic nerve discharge showing an expiratory facilitatory response with an increase of subglottic pressure during electrical stimulation (20 mA, 0.4-ms pulses, 50 Hz for 5 s) in the medial parabrachial nucleus, an inspiratory facilitatory response with the decrease of subglottic pressure during electrical stimulation (10 mA, 0.4-ms pulses, 50 Hz for 5 s) in the lateral parabrachial nucleus and an expiratory facilitatory response with an increase of subglottic pressure during a glutamate injection (10 nl over 5 s) in the A5 region. The arrow shows the onset of injection.
The PAG presents a large number of afferences. The most important have their origin from the prefrontal cortex, amygdala and hypothalamus. Its efferent projections to different pontine nuclei allow it to coordinate different patterns of cardiorespiratory and motor responses depending on the type of stimulus. Other functions of PAG include thermoregulation, participation in wakefulness and sleep mechanisms, or modulation of neuropathic pain or urination. At the clinical level, we know that its activity is modified in different neurodegenerative processes such as Alzheimer’s and multisystemic atrophy [6, 7, 8, 9].
All these higher structures that project to the PAG integrate visual, auditory and somatosensory information in the context of basic mechanisms for survival, maintaining an efferent tone on the PAG which, in turn, projects on the pontomedullary respiratory nuclei involved in respiratory rhythmogenesis to change from eupnea to a rhythm adapted to vocalization or growling. Specifically, the nRA is the perfect target to convert passive breathing into active breathing to generate motor activities that produce changes in abdominal pressure, in addition to modifying the activity of the motor neurons that are located in the nA and that control the caliber of the pharynx and larynx [10, 11]. Stimulation of PAG and nRA is known to produce vocalization [12] and lesions in PAG cause mutism in animals and humans [13, 14] and vocalization and problems in the production of voice when lesions occur in nRA [15]. However, the electrophysiological influence of PAG on these pontomedullary nuclei has not yet been described.
Regarding the studies of the pathways that participate in voluntary and involuntary vocalizations, there is a model that explains vocal control that includes two hierarchically organized pathways. Involuntary vocalizations are innate and require a different control mechanism than that which dominates voluntary vocalizations or speech [16, 17]. These emotional expressions, such as crying or laughing, are directed by the emotional system, made up of specific pathways that target the brain stem and spinal cord [18, 19]. Specifically, research carried out with the squirrel monkey has determined that the system includes: the cingulate gyrus, the PAG, and various pontine and medullary nuclei [20, 21, 22, 23, 24].
The PAG receives projections from the upper limbic regions and from cortical areas such as the anterior cingulate gyrus, insula, and orbitofrontal cortex. In addition, it maintains connections with the caudal part of the nRA. The nRA has direct access to the motor neurons involved in vocalization, that is, it controls the motor neuron groups that innervate the soft palate, pharynx, and larynx, as well as the diaphragm, intercostal, abdominal, and pelvic muscles. Its final objective is to control/modify the intra-abdominal, intrathoracic and subglottic pressure, the control of which is essential to generate vocalization.
In primates, vocalizations, in addition to activation of the PAG, can be produced by electrical stimulation of the hypothalamus [20, 25, 26], amygdala [20], bed nucleus of the stria terminalis [22], orbitofrontal cortex [27] and anterior cingulate gyrus [28], since all these regions have a strong connection with the PAG [29, 30, 31, 32, 33]. The only necessary condition is that the PAG was intact [13, 34, 35].
On the contrary, if areas that are not connected with the PAG, such as the motor or premotor cortex, are stimulated, no vocalizations are produced [36, 37]. These results emphasize the essential role of the PAG in the production of vocalization in primates as well as in humans. This coordinating role in the generation of vocalization is also demonstrated by the fact that the activation of the caudal levels of the PAG can generate partial vocalizations through its connection with the nRA [10, 38, 39].
In summary, the input of the stimulus occurs in the primary integrating center of vocalizations (VOC). Next, the superior temporal gyrus, the supplementary motor area and the insula, will be in charge of modulating the stimulus. Once the output from the VOC is produced, the stimulus can be directed to the corticobulbar pathway and cerebellum directly or, on the contrary, it can go from the cingulate gyrus, the PAG, the pons, until reaching the reticular area of the medulla; which has access to the nA ipsilaterally and contralaterally [40]. On the other hand, the voluntary production of voice in human beings consists of a sound modulation of sound. This production depends directly on the laryngeal motor cortex, that is, the production of voluntary vocal emissions in humans, requires the activation of this cortex, located in the dorsal portion of the ventral zone of the primary motor cortex, and its direct connection with the laryngeal motor neurons of the nA, which are in charge of controlling the laryngeal muscles for the emission of learned vocal patterns [41].
However, it has been shown that during speech emissions there is a joint activation of the voluntary and involuntary system [19]. An involuntary activation of the path takes place automatically to give the vocal emissions the appropriate emotional character. Therefore, stimulation of the pathway that originates in the primary motor cortex and runs through the PAG and nRA is required; in addition to the activation of the pathway that goes from the laryngeal motor cortex directly to the corticomedullary fibers, which will activate the motor neurons of the face, mouth, tongue, larynx and pharynx, to control the production of words and phrases.
Finally, vocal control will depend on the primary motor area, a bilateral structure that is responsible for laryngeal control and orofacial musculature [42], in addition to the activation of the superior temporal gyrus to compensate for alterations in the auditory feedback of the tone used during phonation. Likewise, two feedback loops are put into operation that provide the motor cortex with the information necessary to carry out motor commands for phonation. One of these loops includes the basal ganglia, while the other involves the cerebellum. However, these structures seem unnecessary for the production of innate vocal patterns [43, 44].
Therefore, we see that emotional emissions in humans require bilateral activation of the laryngeal motor cortex (Figure 2) [45]. Furthermore, the system for the production of speech involves a predominant activation of the left hemisphere, including the superior temporal gyrus, the anterior insula, the basal ganglia, and the cerebellum. For this production, the activity of the cingulate gyrus and the PAG is also necessary, in variable degrees, to associate the emotional character with the vocal production.
Scheme of squirrel monkey brain coronal section showing the voluntary and involuntary pathways controlling the larynx.
Other intermediate structures project both to the laryngeal motor cortex and the nA. One of these structures is PBc, cited above [46]. Neuronal unit recording experiments demonstrate the presence of neuronal activity during vocalization [47], suggesting that this nucleus is involved in laryngeal motor coordination as an intermediate nucleus of proprioceptive information between the cortex and the nA. In addition, recent work has shown that both cPB and PAG have high immunoreactivity to the expression of the FOXP2 gene, demonstrating that both regions are primarily involved in modulating the expiratory flow necessary for the production of the sound and voice [2].
In one of the latest works carried out by our research group, we have demonstrated that the column corresponding to the dorsolateral PAG is involved in the control of defense response [48, 49], which is associated with tachycardia, hypertension and redistribution of blood flow. This sympathetic response is mediated by the rostro-ventrolateral medulla (RVLM), which, in turn, activates sympathetic preganglionic neurons present in the intermediolateral column of the spinal cord. These projections are ultimately responsible for the sudden increase in blood pressure. It is also known that the increase in blood pressure is produced by indirect activation of the RVLM by other less studied pathways [50, 51, 52].
The dorsolateral PAG does not have direct connections with the RVLM but has very dense connections (afferents and efferents), with the hypothalamic area responsible for the activation of the RVLM during the defense response. We know that the cardiorespiratory activity of dorsolateral PAG neurons depends on the activity of these hypothalamic neurons [52, 53]. Likewise, our group has shown that there are functional connections from this hypothalamic area and other pons structures such as the parabrachial complex (cPB) [54, 55] and A5 area [56, 57]. Both regions are rich in FOXP2 expression. Our research group has shown the importance of the interrelation between some of these hypothalamic-midbrain and pontomedullary structures involved in cardiorespiratory control. More specifically, we have focused on the analysis of these interactions by analyzing the defense response evoked from specific areas of the hypothalamus (dorsomedial hypothalamic area and perifornical area (DMH-PeF)) [54, 55, 56, 57] and midbrain (PAG) (Figures 3 and 4) [48, 49].
Extracellular recordings of two putative cells were recorded from the A5 region. (A) Silent neuron (upper trace, 4 superimposed sweeps) with constant-latency responses to HDA stimulation (lower trace). The cell was demonstrated to be orthodromically activated from the HDA. (B) Silent neuron (upper trace, 4 superimposed sweeps). The lower trace shows constant latency responses (4 superimposed sweeps) to the dlPAG stimulation.
Instantaneous respiratory rate (upper trace), respiratory flow, pleural pressure, instantaneous heart rate and blood pressure in a spontaneously breathing rat, showing the cardiorespiratory response evoked on PAG (upper figures) or HDA (lower figures) stimulation before [A, a] and after [B, b] the microinjection of muscimol (50 nl over 5 s) in the A5 region. The arrows indicate show the onset of the HDA/PAG electrical stimulation.
Originally, the stimulation of these areas evokes a series of cardiorespiratory and autonomic changes that characterize the defense response [58]. The defense response prepares the animal for situations environmental stresses that require a rapid locomotor response characterized hemodynamically by hypertension, tachycardia and redistribution of blood flow from abdominal and visceral areas to the skeletal muscles of the extremities. Additionally, this response is accompanied by mydriasis, increases in respiratory rate and tidal volume and vocalization [56].
Recent publications propose DMH-PeF as one of the main areas of the hypothalamus that generate the defense response carried by the PAG [59]. Disinhibition of DMH-PeF after microinjection of bicuculin (GABA receptor antagonist) produces an increase in renal sympathetic activity and blood pressure that has been attributed to the activation of neurons in RVLM [60, 61]. The administration of bicuculin also produces an increase in heart rate, which decreases between 30 and 50% due to the inhibition of Rafe Pallidus with muscimol [62, 63, 64]. In addition, there is morphological evidence of projections from the DMH to the Rafe Pallidus [65]. The results seem to show that the pressor and tachycardia cardiovascular responses, typical of stress, evoked from this region, including in the DMH-PeF, would present two descending routes, one responsible for the increase in blood pressure, via RVLM, and the other responsible for the increase in heart rate, via Pale Rallidus. Both responses use the PAG as an intermediate station [60].
In previous studies, we have characterized the activity of laryngeal nA motor neurons and the reflex mechanisms involved in respiratory laryngeal responses. We have also described the existence of a network of hypothalamic-midbrain-pontomedullary nuclei that modulate the cardiorespiratory responses produced to certain types of stress. Bearing this in mind and knowing that many of these structures express FOXP2 and participate in vocalization processes, the limited number of existing publications that study the electrophysiological relationships between the neural circuits involved in the control of laryngeal activity is striking.
Recently, we have been able to carry out a series of preliminary experiments with the techniques that we had been using for years and that we are taking up again. The results of this previous approach include the “in vivo” recording of laryngeal motor neurons and the recording of subglottic pressure and laryngeal resistance using the technique of “isolated glottis in situ” and the analysis of the changes that occur in these parameters. During electrical stimulation of the study areas. These works have led to two publications in international congress proceedings; [66] in Proc Physiol Soc 43, PC208 and [67] in J Physiol Biochem, 74 (Suppl 1) and two communications presented at the SENC Congress in Santiago de Compostela (2019), concluding that not also PAG but CnF seem to modify the activity of laryngeal motoneurons.
Therefore, all these central structures described have in common the fact that they convey cardiorespiratory responses to environmental stress and support vocalization. Recent studies show that the laryngeal microstructure and its innervation undergo the same changes during development in rodents and humans [68] and that the central circuits responsible for vocalization present an overactivity in certain speech disorders of central origin such as spasmodic dysphonia due to laryngeal dystonia [69].
Laryngeal respiratory apnea is frequently a particularly serious clinical manifestation, as occurs in newborn apnea or central sleep apneas, caused by immaturity or abnormalities of central respiratory control in these individuals, causing an exaggerated response of the respiratory system, the laryngeal adduction reflex [70].
Furthermore, it is also known that spasmodic dysphonia, a focal form of dystonia, is a neurological alteration of the voice that manifests with involuntary “spasms” of the vocal cords, which result in speech interruptions and affect the quality of the voice. The two recognized types of spasmodic dysphonia are adductor spasmodic dysphonia (intermittent excessive closure of the vocal cords) and abductor spasmodic dysphonia (prolonged opening of the vocal cords). The cause of spasmodic dysphonia is unknown, although there is some consensus that behind it there is an alteration of the central nervous system, especially at the level of motor control. Specifically, alterations have been described in the circuit of the ganglia of the base, cerebellum and sensorimotor cortex, and structural alterations in the corticobulbar and corticospinal tracts, which are the nerve tracts that come into contact with the bulbar neurons responsible for phonation [69]. A better description and knowledge of the individual contribution of each of the nuclei that make up this hypothalamic-midbrain network on the central control of laryngeal motor neurons, would allow a better understanding not only of normal phonatory control, but would also contribute to a better understanding of the central alterations produced in this type of dystonia as well as in other disorders at the vocal level.
Paradoxical laryngeal adduction movements are characterized by adduction or approximation of the vocal cords during the respiratory cycle (especially during the inspiratory phase), which causes airway obstruction at the laryngeal level. The resulting dyspnoea and stridor are frequently confused with asthma, but do not respond to treatment with steroids and bronchodilators, since the glottic narrowing is independent of the caliber of the bronchial lumen. The origin of this intermittent interruption of transglottic airflow due to paradoxical laryngeal adduction remains to be elucidated. It has been linked to laryngeal irritation from agents such as gastroesophageal reflux or acute severe stress [71].
On the other hand, the pressor response and tachycardia associated with the stimulation of the DMH-PeF and PAG, mediated by the cPB nuclei and A5 Area, are of immediate interest for the knowledge of certain types of hypertensions classified clinically as “essential”. We believe that knowledge of the mechanisms involved in the inhibition of the baroreceptor reflex, which could mediate this type of hypertension, will allow us to provide new data that will contribute to better explaining the mechanisms of neuronal interactions between the hypothalamic-midbrain regions and the pontomedullary cardiorespiratory and laryngeal control centers implicated in this type of pathology.
During the last two decades, Health Sciences research has evolved from a purely biological perspective towards a biopsychosocial model of health and disease. As a result, it has been found that there is a relationship between voice disorders and neuro-vegetative responses associated with emotional responses, mainly those related to anxiety and stress. These responses are generated by the activation of the hypothalamic defense areas and are carried by the PAG and pontomedullary structures such as the PBc and A5. The emotional response intervenes, along with other psychological factors, on the tone of the laryngeal muscles causing spasmodic dysphonia or laryngeal dysphonia. This occurs because the laryngeal muscles appear to be extremely sensitive to emotional stress generated by anxiety, anger, irritability, impatience, frustration, and depression, which can lead to spasmodic dysphonia or laryngeal dystonia [69]. Along these lines, Demmink-Geertman et al. [72] confirmed that, due to the characteristics of the higher pitch of the female voice, this effect is greater in women of all ages and that, above all, it affects professionals who use the voice as a means of work. This fundamentally affects women involved in teaching tasks. Only in Andalusia, the number of teachers is 132,985, and in Spain, they exceed 750,000, of which 71.9% are women. The percentage is particularly relevant in early childhood (97.6%), special (81.7%) and primary (81.4%) education. At least 21% have vocal involvement and 15.8% of sick leave is due to voice problems (FETE-UGT 2019 teaching report). Knowing the pathophysiology of the mechanisms by which stress produces alterations in the functionality of the vocal cords would allow the development of adequate treatments for these pathological processes.
Therefore, new contributions are needed to add new perspectives to a series of pathologies that are related to mechanisms that have their origin in these hypothalamic-midbrain regions, such as the so-called central apneas associated with hypertension [70], apneas associated with sudden death infantile syndrome [73], paradoxical laryngeal adduction movements [71] and muscular tension dysphonia secondary to stress [74].
The study was supported by a program grant Junta de Andalucía, Group n° CTS-156, Spain.
The authors declare that they have no conflict of interest.
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Integrity - We are consistent and dependable, always striving for precision and accuracy in the true spirit of science.
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\n\nIntechOpen is a dynamic, vibrant company, where exceptional people are achieving great things. We offer a creative, dedicated, committed, and passionate environment but never lose sight of the fact that science and discovery is exciting and rewarding. We constantly strive to ensure that members of our community can work, travel, meet world-renowned researchers and grow their own career and develop their own experiences.
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Fleming and Gordon M. Harrington",authors:[{id:"47432",title:"Dr.",name:"Richard M.",middleName:null,surname:"Fleming",slug:"richard-m.-fleming",fullName:"Richard M. Fleming"},{id:"112635",title:"Prof.",name:"Gordon M.",middleName:null,surname:"Harrington",slug:"gordon-m.-harrington",fullName:"Gordon M. Harrington"}]},{id:"52656",doi:"10.5772/64781",title:"Assessment of Right Ventricle by Echocardiogram",slug:"assessment-of-right-ventricle-by-echocardiogram",totalDownloads:2276,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Assessment of right ventricular (RV) function is important to ascertain clinical outcome in patients with symptoms of right ventricular failure manifested as lower extremity swelling and abdominal congestion. RV function is not routinely assessed and reported in clinical practice. Unlike the bullet‐shaped left ventricle (LV), RV has a complex geometry with a triangular shape. RV is further divided into the inlet, trabecular apex, and infundibulum or conus. RV evaluation involves quantifying afterload and preload, assessing the mechanism and severity of tricuspid regurgitation (TR), and quantitative evaluation of RV performance. For quantification of RV size and function, we can use intravenous contrast for endocardial tracing of RV border to measure RV dimensions, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), Doppler index of myocardial performance (Tei index or myocardial performance index), pulsed wave or color Doppler tissue imaging systolic velocity [s'], or strain imaging. For qualitative evaluation of RV, the RV size is compared to the LV size in parasternal, short axis, and subcostal projections.",book:{id:"5166",slug:"echocardiography-in-heart-failure-and-cardiac-electrophysiology",title:"Echocardiography in Heart Failure and Cardiac Electrophysiology",fullTitle:"Echocardiography in Heart Failure and Cardiac Electrophysiology"},signatures:"Gunjan Choudhary, Arushi A. Malik, Dwight Stapleton and Pratap\nC. Reddy",authors:[{id:"183647",title:"Dr.",name:"Gunjan",middleName:null,surname:"Choudhary",slug:"gunjan-choudhary",fullName:"Gunjan Choudhary"},{id:"192261",title:"Dr.",name:"Arushi A",middleName:null,surname:"Malik",slug:"arushi-a-malik",fullName:"Arushi A Malik"},{id:"192262",title:"Dr.",name:"Dwight",middleName:null,surname:"Stapleton",slug:"dwight-stapleton",fullName:"Dwight Stapleton"},{id:"192263",title:"Dr.",name:"Pratap C",middleName:null,surname:"Reddy",slug:"pratap-c-reddy",fullName:"Pratap C Reddy"}]},{id:"43925",doi:"10.5772/56118",title:"History of Antimicrobial Prophylaxis Protocols for Infective Endocarditis Secondary to Dental Procedures",slug:"history-of-antimicrobial-prophylaxis-protocols-for-infective-endocarditis-secondary-to-dental-proced",totalDownloads:2136,totalCrossrefCites:3,totalDimensionsCites:4,abstract:null,book:{id:"3381",slug:"recent-advances-in-infective-endocarditis",title:"Recent Advances in Infective Endocarditis",fullTitle:"Recent Advances in Infective Endocarditis"},signatures:"Inmaculada Tomás and Maximiliano Álvarez-Fernández",authors:[{id:"70085",title:"Dr.",name:"Inmaculada",middleName:null,surname:"Tomás-Carmona",slug:"inmaculada-tomas-carmona",fullName:"Inmaculada Tomás-Carmona"},{id:"149434",title:"Dr.",name:"Maximiliano",middleName:null,surname:"Álvarez-Fernández",slug:"maximiliano-alvarez-fernandez",fullName:"Maximiliano Álvarez-Fernández"}]},{id:"16134",doi:"10.5772/24458",title:"Tissue Doppler in Ischemic Heart Disease",slug:"tissue-doppler-in-ischemic-heart-disease",totalDownloads:3313,totalCrossrefCites:3,totalDimensionsCites:4,abstract:null,book:{id:"344",slug:"establishing-better-standards-of-care-in-doppler-echocardiography-computed-tomography-and-nuclear-cardiology",title:"Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology",fullTitle:"Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology"},signatures:"Ola Gjesdal and Thor Edvardsen",authors:[{id:"40027",title:"Prof.",name:"Thor",middleName:null,surname:"Edvardsen",slug:"thor-edvardsen",fullName:"Thor Edvardsen"},{id:"58106",title:"Dr.",name:"Ola",middleName:null,surname:"Gjesdal",slug:"ola-gjesdal",fullName:"Ola Gjesdal"}]}],mostDownloadedChaptersLast30Days:[{id:"51931",title:"Speckle-Tracking Imaging, Principles and Clinical Applications: A Review for Clinical Cardiologists",slug:"speckle-tracking-imaging-principles-and-clinical-applications-a-review-for-clinical-cardiologists",totalDownloads:4607,totalCrossrefCites:8,totalDimensionsCites:11,abstract:"Evaluation of myocardial mechanics, although complex, has now entered the clinical arena, thanks to the introduction of bedside imaging techniques, such as speckle-tracking echocardiography.",book:{id:"5166",slug:"echocardiography-in-heart-failure-and-cardiac-electrophysiology",title:"Echocardiography in Heart Failure and Cardiac Electrophysiology",fullTitle:"Echocardiography in Heart Failure and Cardiac Electrophysiology"},signatures:"Iacopo Fabiani, Nicola Riccardo Pugliese, Veronica Santini, Lorenzo\nConte and Vitantonio Di Bello",authors:[{id:"184730",title:"Prof.",name:"Vitantonio",middleName:null,surname:"Di Bello",slug:"vitantonio-di-bello",fullName:"Vitantonio Di Bello"},{id:"184733",title:"Dr.",name:"Iacopo",middleName:null,surname:"Fabiani",slug:"iacopo-fabiani",fullName:"Iacopo Fabiani"},{id:"184734",title:"Dr.",name:"Nicola Riccardo",middleName:null,surname:"Pugliese",slug:"nicola-riccardo-pugliese",fullName:"Nicola Riccardo Pugliese"},{id:"184736",title:"Dr.",name:"Lorenzo",middleName:null,surname:"Conte",slug:"lorenzo-conte",fullName:"Lorenzo Conte"},{id:"185432",title:"Dr.",name:"Santini",middleName:null,surname:"Veronica",slug:"santini-veronica",fullName:"Santini Veronica"}]},{id:"16137",title:"Doppler Contrast Echocardiography",slug:"doppler-contrast-echocardiography",totalDownloads:2925,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"344",slug:"establishing-better-standards-of-care-in-doppler-echocardiography-computed-tomography-and-nuclear-cardiology",title:"Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology",fullTitle:"Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology"},signatures:"Vincent L. Sorrell and Sachin Kumar",authors:[{id:"62264",title:"Dr.",name:"Vincent L.",middleName:null,surname:"Sorrell",slug:"vincent-l.-sorrell",fullName:"Vincent L. Sorrell"},{id:"62565",title:"Dr.",name:"Sachin",middleName:null,surname:"Kumar",slug:"sachin-kumar",fullName:"Sachin Kumar"}]},{id:"52583",title:"Role of Echocardiography in the Critically Ill Patients",slug:"role-of-echocardiography-in-the-critically-ill-patients",totalDownloads:2401,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Since its inception in 1950s, echocardiography has evolved significantly. Its role has expanded beyond cardiology into operating theaters, intensive care units, and emergency departments. It is an easy, inexpensive, noninvasive, and portable technique, which can be rapidly performed at bedside. It is devoid of complications and, for the most part, universally available. This review focuses on growing importance of echocardiography for critically ill patients in the intensive care and high dependency unit settings including indications, modalities, measurements, and therapeutic impact. Literature review of echocardiography use for the cardiovascular assessment of the critically ill patients was done and various indications are discussed including appropriate use scores. Methods being used include transthoracic and transesophageal echo with various modes. This does include assessment of volume status of the hemodynamically unstable patients, myocardial function, global left ventricular systolic function, regional wall motion abnormalities, cardiac output, cardiac tamponade, valvular function, left ventricular outflow obstruction, and right ventricular function. Other diagnostic assessments include aortic dissection, thromboembolisms, pleural effusions, and septal defects. Echocardiography is now considered as an indispensable tool for diagnosis and management including hemodynamic monitoring in critically ill patients. It provides advantages including noninvasiveness and real-time anatomical and functional assessment of the cardiovascular system.",book:{id:"5166",slug:"echocardiography-in-heart-failure-and-cardiac-electrophysiology",title:"Echocardiography in Heart Failure and Cardiac Electrophysiology",fullTitle:"Echocardiography in Heart Failure and Cardiac Electrophysiology"},signatures:"Manivannan Veerasamy",authors:[{id:"185477",title:"Dr.",name:"Manivannan",middleName:null,surname:"Veerasamy",slug:"manivannan-veerasamy",fullName:"Manivannan Veerasamy"}]},{id:"51873",title:"Noninvasive Measurement of Pulmonary Capillary Wedge Pressure by Speckle Tracking Echocardiography",slug:"noninvasive-measurement-of-pulmonary-capillary-wedge-pressure-by-speckle-tracking-echocardiography",totalDownloads:1616,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The severity of left-sided heart failure can be evaluated by pulmonary capillary wedge pressure (PCWP) because PCWP reflects left ventricular (LV) filling pressure. Owing to developments in echocardiographic technology, speckle tracking echocardiography (STE) has allowed automatic construction of time-left atrial (LA) volume (LAV) curves. Thus, we developed a novel index based on a combination of LAV and LA function that would estimate PCWP using STE. The following regression equation described the relationship between PCWP that was obtained by right-heart catheterization and active LAEF/minimum LAV index (volume was indexed to body surface area: LAVI) in the patients with sinus rhythm: PCWP = 10.8–12.4 [log10 (active LAEF/minimum LAVI)] (r = −0.86, p <0.001) (measurements from the apical 4-chamber view). We defined this index [log10 (active LAEF/minimum LAVI)] as the kinetics-tracking index (KT index). The PCWP estimated by the KT index (ePCWP) had a strong correlation with PCWP obtained by right-heart catheterization (r = 0.92, p <0.001). The ePCWP measured by STE could be a useful parameter to improve clinical outcomes in patients with heart failure.",book:{id:"5166",slug:"echocardiography-in-heart-failure-and-cardiac-electrophysiology",title:"Echocardiography in Heart Failure and Cardiac Electrophysiology",fullTitle:"Echocardiography in Heart Failure and Cardiac Electrophysiology"},signatures:"Masanori Kawasaki",authors:[{id:"50603",title:"Dr.",name:"Masanori",middleName:null,surname:"Kawasaki",slug:"masanori-kawasaki",fullName:"Masanori Kawasaki"}]},{id:"51894",title:"Multimodality Echocardiographic Assessment of Patients Undergoing Atrial Fibrillation Ablation",slug:"multimodality-echocardiographic-assessment-of-patients-undergoing-atrial-fibrillation-ablation",totalDownloads:1989,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Atrial fibrillation (AF) is most common sustained arrhythmia in clinical practice. The new treatment standard in paroxysmal and persistent AF is the catheter ablation. Echocardiography plays a key role in risk stratification and management of patients with AF and is critical in the assessment of candidates for AF ablation, providing both anatomic and hemodynamic information. Echocardiography is crucial for patient selection, preprocedural left atrial appendage thrombus excluding, intraprocedural guidance, and detection and monitoring for early and late ablation related complications. Transthoracic echocardiography allows rapid and comprehensive assessment of cardiac anatomical structure and function. Transoesophageal echocardiography also provides accurate information about the presence of a thrombus in the atria and thromboembolic risk, making safe the ablation procedure by immediately detection of the complications related procedure. Intracardiac echocardiography has emerged as a popular and useful tool in the everyday practice of interventional electrophysiology, being very useful only during the ablation procedure. This paper presents the role of echocardiography in all these steps concerning AF ablation procedure, and also (1) delineates the role of echocardiographic techniques in guiding the procedure, (2) discusses the critical echocardiographic aspects of this procedure, and (3) underlines the strengths and limitations of various echocardiographic modalities.",book:{id:"5166",slug:"echocardiography-in-heart-failure-and-cardiac-electrophysiology",title:"Echocardiography in Heart Failure and Cardiac Electrophysiology",fullTitle:"Echocardiography in Heart Failure and Cardiac Electrophysiology"},signatures:"Mariana Floria and Maria Daniela Tanase",authors:[{id:"185089",title:"Dr.",name:"Tanase",middleName:null,surname:"Daniela Maria",slug:"tanase-daniela-maria",fullName:"Tanase Daniela Maria"},{id:"185115",title:"Dr.",name:"Mariana",middleName:null,surname:"Floria",slug:"mariana-floria",fullName:"Mariana Floria"}]}],onlineFirstChaptersFilter:{topicId:"982",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters: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:133,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:107,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:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"June 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"3",title:"Bacterial Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/3.jpg",isOpenForSubmission:!1,editor:null,editorTwo:null,editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. 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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:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. 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His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. 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