\r\n\tThe human microbiota consists of a wide variety of bacteria, viruses, fungi, and other single-celled animals that live in the body while microbiome is the name given to all of the genes inside these microbial cells. Recently, there has been renewed interest in the role played by microbiota and microbiome in both human health and human disease. A correct equilibrium between the human host and their microorganisms is important for an appropriate physiological function.
\r\n\tMicroorganisms have evolved alongside humans and form an integral part of life, carrying out a range of vital functions. They are implicated in both health and disease, and research has found links between bacterial populations, whether normal or disturbed, and the following diseases: asthma, cancer, diabetes, obesity, heart disease and, neurological and neurodegenerative diseases.
\r\n\tThe chapters of this book aim to present outstanding research on biochemical, genetics, clinical, molecular and behavioral fields about microbiota-gut-brain axis with emphasis in how neuropeptides such as brain derived factor (BDNF), substance P, calcitonin gene-related peptide and neuropeptide Y (NPY), vasoactive intestinal polypeptide, somatostatin and corticotropin-releasing factor are also likely to play a role in the bidirectional gut-brain communication. In this capacity they may influence the activity of the gastrointestinal microbiota and its interaction with the gut-brain axis.
\r\n\tIt will be shown evidence that neuropeptides represents a challenge in understanding the complex interactions between gut and brain. Although their precise role in the microbiota-gut-brain axis has not yet been defined, neuropeptides play an important role in this respect. For instance, a growing field of work is implicating the microbiota-microbiome in a variety of psychological processes and neuropsychiatric disorders. These include mood and anxiety disorders, neurodevelopmental disorders such as autism spectrum disorder and schizophrenia, and even neurodegenerative disorders such as Alzheimer’s and Parkinson’s diseases. These brain disturbances have been linked to molecular and biochemical alterations in the course of neurodevelopment so, the research in this area has established different approaches (nutritional, immunological, energy homeostasis), to find the role played by the gut microbiota-microbiome in the etiology of the aforementioned brain disorders.
The radial forearm flap is the most commonly used technique for phalloplasty. The goals of penile construction in a transgender man are to decrease the patient’s gender incongruence, obviate the use of an external prosthesis, give the patient the ability to orgasm, and to urinate through the constructed phallus if desired. Urethral strictures and fistulas are common complications following a phalloplasty with urethral lengthening that may be mitigated with a two-stage technique that utilizes a mucosa-only prelaminated neourethra. Sources of the mucosa may include vaginal and oral mucosa and less commonly, uterine, bladder, and colonic mucosa.
Transition of the trans man genitalia is commonly performed in multiple stages including a hysterectomy and oophorectomy primarily and if desired, followed by a vaginectomy with urethral diversion to the perineum or lengthening with a phalloplasty, scrotoplasty, and glansplasty. The ovaries may be preserved at the time of hysterectomy for possible egg preservation. If the decision is made to preserve the ovaries, it is crucial for the patient to be monitored for abnormalities through yearly routine surveillance.
First stage surgery may consist of a hysterectomy and oophorectomy (if not done prior) along with a vaginectomy with urethra lengthening using an anteriorly based vaginal flap with labia minora tissues along with prelamination of the nondominant radial forearm flap using vaginal mucosa, buccal mucosa, and less common skin grafts.
Second stage surgery, which commonly occurs 2–3 months following the first stage, consists of tubularization of the radial forearm tissue with free flap transfer, microvascular anastomosis, neurotization, urethroplasty, scrotoplasty, and glansplasty.
Given the large cutaneous surface of a native male phallus, autologous construction of a neophallus commonly will necessitate a large cutaneous donor site. Flaps, such as the tube-in-tube radial forearm flap, latissimus dorsi flap, scapular flap, deltoid flap, abdominal pedicled flap, and anterolateral thigh (ALT) flaps have all been used for phalloplasty [1]. Though many techniques have been described, the radial forearm free flap (RFFF) remains the most common for phalloplasty due to its long, reliable vascular pedicle, multiple nerve innervations for anastomosis to the recipient site, and pliability of the tissue facilitating eventual implant placement [2]. In addition, the radial forearm flap has a lower urethral and flap loss complication rate compared to the anterolateral thigh flap [3]. Harvest allows for simultaneous operative sites at the pelvis, upper extremity, and oral region if buccal mucosa is needed. This ability allows for decreased operative time, which can last from 5–12 hours. The RFFF technique makes it possible for patients to fulfill their desires of standing micturition, aesthetic acceptability, and erogenous and tactile sensation.
Erectile rigidity is another commonly reported goal of phalloplasty. To achieve an erection, radial bone can be utilized as an osteocutaneous flap at the time of neophallus creation, or a patient can opt to undergo insertion of a semirigid or hydraulic prosthesis at least 1 year after phalloplasty. It should be noted, however, that our practice prefers to no longer perform the osteocutaneous RFFF due to dyspareunia experienced by the patient post-surgery. This is due to the anchoring of the radius bone at the pubic symphysis. Additionally, most centers report a 30%+ extrusion rate necessitating implant removal at 2–3 years, and reoperation rates reach 100% at 5 years (Figure 1) [4]. There is a significant risk of complications following placement of penile prosthesis including mechanical failure, infection, and mal-positioning. It is critical to have a plastic surgeon trained in microvascular surgery present during the placement of the penile implant as the vascular pedicle may be readily injured during the dissection and subsequent dilation process required for placement of the cylinders. It is critical to avoid multiple passing of the dilators so that devascularization of the phallus does not ensue.
Radius bone exposure following radial forearm osteocutaneous flap phalloplasty.
Adding to the complexity of phalloplasty is the creation of a functional penile urethra. The urethra after neophallus construction can be divided into distinct segments, from proximal to distal: native (female) urethra, fixed or lengthened urethra, the anastomotic urethra, penile shaft urethra, and external meatus. The fixed urethra is the portion of the urethra formed after lengthening the native urethra via local vaginal or labial flaps, extragenital flaps, and grafts of skin or mucosa (Figure 2). The phallic urethra can be constructed by prelamination, tube-in-tube techniques, or pedicle flaps [2].
Patient 3 months following urethral lengthening using labia minora and anterior vaginal wall flaps.
The preoperative assessment begins with a physical examination. The patient is assessed for adequate perfusion to the lower extremities. Ideally, the patient should have a palpable pedal pulse bilaterally. If perfusion is in question especially when dealing with patients with peripheral arterial disease, one can obtain noninvasive studies such as arterial duplex or plethysmography to determine which side to use. Preoperative vein mapping can be performed to assess for deep venous thrombosis as well as the caliber and quality of the great saphenous vein. Ideally, the great saphenous vein should be 2.5–3 mm and free of sclerosis.
A branch of the profunda femoris artery is an option for inflow. The perfusion to the thigh is robust thus a branch of the profunda femoris artery can typically be sacrificed without significantly affecting thigh perfusion. To expose the profunda femoris artery, a longitudinal skin incision is made in the thigh overlying the femoral arteries. The femoral bifurcation is identified and the superficial femoral artery is preserved. The main trunk of the profunda femoris artery is identified and preserved. There are tributary branches of the profunda femoris vein that are ligated to facilitate exposure and hemostasis. The branches of the profunda femoris artery are identified and circumferentially dissected. Typically, the ascending branch is of adequate caliber and length to be used for the inflow. If this branch is not long enough or the caliber is too small, the remaining branches of the profunda can be explored.
An alternative source of inflow can be the superficial femoral artery or the common femoral artery. The great saphenous vein can be used as a conduit. An oblique incision is made in the medial groin overlying the femoral artery bifurcation as well as the saphenofemoral junction. The saphenous vein is identified first and preserved. The superficial femoral artery is then exposed that lies medial to the femoral vein. The artery is sequentially dissected and controlled, and the skin incision is extended distally along the course of the saphenous vein. The length of the vein needed to perform the loop transposition varies by patient. The length required can be estimated with a free tie. Ideally, the loop graft needs to be able to reach the pubis when is oriented medially. Once the saphenous vein is exposed, it is circumferentially dissected and its tributary branches are ligated and divided. Careful attention needs to be made when ligating the branches too close to the vein as it may cause stenosis. The saphenous vein is then transected distally, and the distal end is ligated. The vein is then cannulated and distended with heparinized saline solution. Any defects are identified and repaired. When the vein is distended, it is marked for orientation. To perform the loop configuration, the distal end of the vein is swung in a counterclockwise fashion toward the femoral artery. The patient is systemically heparinized. The femoral artery was clamped proximally and distally and an arteriotomy is made using 11 blades and then lengthened with Potts scissors. Alternatively, an aortic punch device can be used to enlarge the arteriotomy to the desired size. The anastomosis should be approximately 4 mm. An end-to-side anastomosis was performed between the femoral artery and the saphenous vein paying careful attention to maintaining the orientation of the vein to avoid twisting and kinking. Just prior to completing the last few sutures of the anastomosis, the femoral artery is forward and back-bled. The lumen of the artery and vein are flushed with heparinized saline solution to flush any thrombus. Once the anastomosis is completed, the clamps are released. The loop graft is assessed for orientation and flow. The patient’s leg and foot also need to be assessed to ensure there are no changes to baseline perfusion. One can expect a weak pulse and a thrill when palpating the graft. A Doppler can also be used to assess the presence of flow. If the loop graft is kinked or twisted, it may thrombose. When the loop graft is ready to be used, it is transected in the middle; the proximal end is the arterial inflow and the distal end is the venous outflow.
Complications of urinary stricture and fistula are prevalent. Variations of urethral lengthening techniques among centers have resulted from attempts to improve upon urologic complication rates, which range from 33 to 77% in large case series [5]. Urethral cutaneous fistulas following surgery may range from 22 to 75% [6]. Fistulas occur most commonly at or just proximal to the anastomosis between the phallic urethra and fixed urethra due to vascular insufficiency of the flap and decreased lumen of the phallic urethra. Rates of urethral strictures in female-to-male phalloplasty recipients range from 11 to 74% [7, 8, 9]. Since the plastic surgeon alone is not trained in the management of urethral strictures or fistulas, we believe it is essential to have a qualified reconstructive urologist involved in the management of these complications to optimize patient care.
The radial forearm flap may allow the patient to have penetrative sexual intercourse, has minimal donor site scarring, results in a cosmetically acceptable phallus, has tactile and erogenous sensitivity, and potentially creates a competent neourethra that allows for standing urination. These ideal characteristics, described by Hage et al, are mostly met by the RFFF (radial forearm free flap) [10].
Recognizing that urethral strictures and fistulas remain the most challenging complication we face, we have been able to decrease their occurrence with a staged technique. We have found that the radial forearm tube-within-a-tube technique not only requires electrolysis of the forearm to avoid hair growth within the urethra—a common cause of stricture—but also requires a larger donor site since flap skin is used to create the urethra. Minimizing the donor site and decreasing stricture rates have encouraged us to continue the two-stage technique with mucosal prelamination, which more closely mimics native urethra mucosa (Figure 3).
Cystoscopy of prelaminated neourethra prior to stage 2 phalloplasty revealing mucosa which mimics that of native urethral mucosa.
Given the potential morbidity associated with the complex phalloplasty procedure, an adequate preoperative evaluation is essential. The need for gender dysphoria evaluation and medical clearance is unique to this patient population. Gender identity disorder or gender incongruence is classified by the International Classification of Disease Manual as ICD-10-CM F64.9. The DSM-5 defines gender dysphoria as an incongruity between the patient’s experienced and expressed gender and their assigned gender, which causes clinically significant distress lasting at least 6 months, however, this has often lasted nearly the individual’s entire life [11]. According to the World Professional Association for Transgender Health (WPATH), a psychological evaluation and two letters recommending gender affirmation surgery from two psychiatrists or licensed mental health therapists, who independently assessed the patient, are required for the removal of reproductive organs and/or phalloplasty [12]. In addition, the patient must have taken hormone replacement therapy and lived as their true gender for at least 1 year. These prerequisites are not only required by most insurance companies for authorization of the procedure but also ensure that patients have a realistic understanding of the procedure and serve to minimize disappointment and patient regret.
The importance of a thorough preoperative psychosocial evaluation cannot be overstated. Adequate social support is encouraged to facilitate a successful recovery. The patient should be informed to expect frequent postoperative visits 1–2 months following surgery and should understand that the operation will impact their ability to work for 4–6 weeks. The surgeon should remain involved in all stages of the preoperative evaluation by corresponding with the patient’s mental health provider and urogynecologist.
A clear and candid discussion regarding the patient’s desired goals from surgery, including the length and circumference of the neophallus, allows the surgeon to determine whether expectations are realistic given the patient’s anatomy. The limitations, functional outcomes, recovery, risk of complications, timing of procedures, and cost of each surgery should be honestly discussed with the patient.
It is critical to accurately document current medications, including antiplatelet agents and hormones, in addition to the patient’s smoking history. Androgens such as testosterone must be discontinued 2 weeks prior to surgery to reduce the risk of thrombosis, and smoking cessation is required 4 weeks prior to surgery and up to 4 weeks after to ensure proper healing. Specific information regarding prior infections helps in selecting postoperative antibiotics, as postsurgical infection will delay healing and increase morbidity.
The microsurgical component of RFFF phalloplasty requires additional preoperative evaluation. Adequate recipient vessels will be needed for the microsurgical construction. If arterial inflow from the thigh will be used then pedal vessels should be assessed for adequate inflow. The abdominal wall should be examined for prior incisions particularly if the inferior epigastric vessels will be used as recipient’s vessels. We have used the inferior epigastric artery, descending branch of the lateral femoral circumflex or on occasion arterio-venous loops for recipient arteries and the inferior epigastric vein or saphenous veins for recipient venous outflow.
Allen’s test of the patient’s nondominant hand confirms that harvest of the RFFF flap will not compromise the blood supply to the hand. If the results of Allen’s test are poor, that is, the hand remains cool and pale after the release of ulnar artery occlusion, using another donor site should be considered or the dominant forearm. In addition, sensitive tattoos of the proposed forearm should be evaluated. Patients who live in cold climates may need reconstitution of their arterial anatomy with vein grafts after flap harvest.
Prior to surgery, it is also vital to assess patient sensation to determine if orgasm can be achieved through clitoral stimulation. The dorsal clitoral nerve (Figure 4), ilioinguinal nerve, and genitofemoral nerve co-apted to the medial and lateral antebrachial cutaneous nerves will provide both erogenous and protective sensation to the neophallus. If a patient has difficulty achieving orgasm prior to surgery, it is unlikely that the patient will be able to after surgery.
Clitoral nerves are exposed as recipient’s nerves at stage 2 RFFF phalloplasty.
It should also be noted that part of the patient population has forearm tattoos that will affect the cosmesis of the neophallus. Patient preference will dictate whether the presence of forearm tattoos on the neophallus is acceptable. Clear expectations should be set with the patient regarding the forearm donor site scar, which may be perceived as a stigma, however, we argue the scar is more acceptable than the anterolateral thigh flap scar (Figure 5).
Patient with urethral and flap-related complications following ALT phalloplasty from an outlying institution.
In our practice, we construct the penile urethra by forearm prelamination with mucosa, which obviates the need for forearm depilation (as would be the case in a tube-within-a-tube technique). The native urethra is a fibromuscular tube lined by urothelium, columnar epithelium, and nonkeratinizing squamous epithelium. Mucosal grafts have greater homology to the native urethra as they are also composed of nonkeratinized epithelium, which has led to less scar contracture and subsequent urethral strictures and fistulas following neourethral construction [1].
Prior to phalloplasty, a patient should have had a hysterectomy and oophorectomy. If he has not yet had these procedures, it is possible to have them performed during the first stage of our approach to staged phalloplasty. We have found that uterine mucosa is readily available if the patient is undergoing hysterectomy in the same operative setting as phalloplasty, and can be used to construct a patent, functional penile urethra [1]. If a patient is interested in egg harvesting prior to oophorectomy, this is performed before definitive and irreversible hysterectomy and oophorectomy.
The current sequence of surgery in our practice is first a subcutaneous mastectomy, followed by a hysterectomy and oophorectomy combined with a vaginectomy, scrotoplasty, and reconstruction of the horizontal part of the urethra, and later the actual phalloplasty.
We have found our two-stage technique allows for a urethral conduit which mimics that of a native urethra with no hair growth while minimizing the donor site on the forearm. Our decreased stricture rate has encouraged us to continue the use of this technique in patients pursuing phalloplasty with urethral lengthening.
The main procedures are as follows:
Vaginectomy with the harvest of vaginal mucosa tissue (combined with hysterectomy and oophorectomy if not already performed)—Procedure performed concurrently by urogynecologist or gynecologic oncologist
Urethral lengthening utilizing labia minora flaps and anteriorly based vaginal mucosa flap harvested at the time of vaginectomy
Occasional harvest of buccal mucosa if required for neo-urethra
Radial forearm flap elevation ulnarly for flap urethra prelamination
IV antibiotics against gram-positive, gram-negative organisms and anaerobes are administered to the patient 1 hour prior to incision.
The first stage entails flap prelamination during which the radial forearm flap is designed and the neourethra is formed using autologous tissue; mucosa is preferentially used in our practice. The markings for the planned flap are determined preoperatively following a normal Allen’s test on the patient’s nondominant upper extremity, ensuring that the patient’s hand can be perfused with the ulnar artery alone. The flap is elevated from the ulnar to radial direction in the supra-fascial plane to allow placement of the neourethra.
Prelamination of the patient’s eventual penile urethra is performed by grafting vaginal, and/or buccal mucosa in a suprafascial plane of the donor volar and ulnar forearm. The vaginal mucosa is harvested during the vaginectomy for the creation of the neourethra. We lengthen the native female urethra using labia minora tissues and an anterior pedicled vaginal flap. If a hysterectomy has not already been performed, it can be performed during this stage to provide additional mucosal tissue for the neourethra. The buccal mucosa is also harvested at this time if necessary (Figures 6 and 7). To allow for irrigation of the entire prelaminated neourethra, holes are cut into a 24-French Foley. After mucosal harvest, the mucosal grafts are cleansed with a betadine and normal saline solution and then sewed around the holed catheter construct, exteriorizing the sub-mucosal surface using a running, locking suture. Placing this construct lengthwise in the subcutaneous forearm (suprafascial plane) allows for the creation of a tubular graft, which will become the penile neourethra of the eventual phalloplasty. The patient is then immobilized in a splint for several days. Irrigation of the prelaminated flap is then performed twice daily beginning 1 week after surgery, a practice continued until flap transfer to prevent infection.
Markings of buccal mucosal graft. Avoid injury to Stenson’s duct.
Vaginal and buccal mucosa with mucosal surface toward the foley catheter in preparation for tubularization around the catheter.
Creating the urethra with mucosal tissue and not using forearm tissue decreases the width of the flap skin paddle compared to the traditional tube-within-a-tube urethra and yields a more aesthetically acceptable donor site scar. With this method, the patient can place his upper extremity across his chest with the flexor aspect against the chest and the scar will not be visible (Figure 8). Furthermore, with this technique, the patient does not need to undergo costly depilation treatments as there will be no hair growth within the urethra. Prelamination can also be completed with a skin graft from the thigh or abdomen when mucosal tissue is inadequate in patients who have undergone metoidioplasty with vaginectomy, however, this may lead to increased stricture rates.
Patient following staged radial forearm flap harvest revealing limited donor site secondary due to prelamination of the urethra.
Approximately 8–12 weeks after the first stage flap prelamination, creation of the neophallus can be performed. Although allowing more time between stages may be favorable, we have found that 8 weeks is long enough to achieve successful wound healing and favorable results and is a time frame that is tolerable for our patients [1].
One hour before incision is made, antibiotics against gram-positive, gram-negative, and anaerobic organisms should be intravenously administered to the patient. A tourniquet is used for flap harvest, in addition to a hand table. Separate surgical set-ups are used for the pelvic area and upper extremity to avoid cross-contamination. Two surgical teams can work simultaneously—one team performs the RFFF harvest and the second team performs the dissection of the recipient’s vessels (inferior epigastric artery and vein and/or descending branch of the lateral circumflex artery and saphenous vein), recipient nerves, preparation of the urethra for anastomosis and scrotoplasty.
The design of the radial forearm flap was defined in the first stage. A marking pen is used to delineate the dimensions of the flap, which will commonly measure 5.5–7.5 inches in length and 5.5–6.5 inches in width. Whereas the flap was elevated in the suprafascial plane for prelamination at Stage I, the flap is now elevated in the subfascial plane to avoid injury to the neourethra. The dissection begins on the ulnar side of the forearm and proceeds to the flexor carpi radialis and brachioradialis tendons for the RFFF harvest. The medial and lateral antebrachial cutaneous nerves are preserved during dissection of the radial forearm flap for coaptation to one dorsal nerve of the clitoris end-to-side for erogenous sensation and the ilioinguinal or genitofemoral nerve for tactile sensation. The radial artery and venae comitantes are ligated distally and proximally dissected for vascular anastomosis. Prior to distal ligation, the artery may be temporarily clamped to ensure blood flow to the hand. The basilic and/or cephalic veins are preserved and dissected with the flap. While the RFFF remains connected to its inherent blood supply, the flap is tubed into a phallus and sutured so that the neourethra is buried within the tubed phallus (Figure 9).
Tubed radial forearm flap at the donor site with the prelaminated urethra.
Using a modification of Monstrey’s scrotoplasty technique, the clitoris is dissected free from the lengthened urethra and denuded of skin [13]. The clitoral hood skin is removed and used for the coronaplasty using a technique described by Gottlieb [14] (Figure 10). The recipient arteries harvested for the vascular anastomoses are either the inferior epigastric artery or the descending branch of the lateral femoral circumflex artery. Of note, once we switched to using the descending branch of the lateral femoral circumflex artery as our recipient artery, we no longer had re-open procedures due to vascular compromise [2]. The thigh incision made for the lateral femoral circumflex is also used for the harvest of the great saphenous vein (Figure 11). Since we use the greater saphenous veins as recipient veins for the radial forearm flap, the proximal incision made to harvest the greater saphenous vein is also used for the gracilis muscle harvest. The distal free end of the muscle, harvested via a separate distal incision, is delivered through the proximal incision. Undermining of the soft tissues is performed from the proximal thigh incision to the level of the midline groin defect where the urethral anastomosis is to be performed.
Trans male patient during the harvest of clitoral (or T-dick) hood skin for coronaplasty using Gottlieb technique.
Descending branch of the lateral femoral circumflex artery as recipient artery and saphenous vein as recipient artery in preparation for free flap phalloplasty.
After vessel preparation with a microscope and confirming adequate outflow from the descending branch of the lateral femoral circumflex artery and inflow from the great saphenous vein, the RFFF is transferred to the pubic area. The forearm donor site can be covered with either an autologous split-thickness skin graft or the surgeon can apply a dermal substitute that can be grafted later. The first maneuver is to place the foley catheter, which is located in the neourethra, directly into the patient’s bladder. Absorbable sutures are used for the urethral anastomosis in two layers, which is the first anastomosis performed (Figure 12).
First of two-layered urethral anastomosis in staged radial forearm flap phalloplasty.
The arterial, venous, and neural anastomoses are performed next in that order and are all hand-sewn using 9-0 nylon suture with the aid of an operative microscope. The radial artery is connected end-to-end to the descending branch of the lateral circumflex artery. The venous anastomosis is performed between the cephalic or basilic vein and the greater saphenous vein. A second venous anastomosis can be performed between a radial venous comitante vein with the contralateral greater saphenous vein. Two to three nerve anastomoses may also be performed. The medial and lateral antebrachial cutaneous nerves are anastomosed end-to-end to the ilioinguinal nerves and to one of the dorsal clitoral nerves end-to-side. The ilioinguinal nerve is commonly found exiting the external inguinal ring. A cadaver nerve graft may be used as an interposition nerve graft when needed.
The gracilis muscle may be harvested in a minimally invasive fashion and wrapped around the urethral anastomosis, avoiding compression of the vascular pedicle, to provide vascularity to a minimally vascular urethral anastomosis (Figure 13). This maneuver also provides bulk to the neo-scrotum often obviating the need for scrotal implants. At our institution, we have been able to minimize urethral fistula rates using a gracliis muscle flap to augment the urethral anastomosis [15].
Gracilis muscle harvest via minimally invasive approach prior to alpha wrap around the urethral anastomosis.
A suprapubic tube is placed and used for urinary diversion if needed during urinary training of the neo-phallus.
Upon closure of all incisions, a Norfolk coronaplasty is performed with either a skin graft or labial graft obtained from the clitoral hood region by denuding the clitoris before transposition (Figure 10) [16].
Following surgery, patients are transferred to the intensive care unit for flap monitoring and will remain on strict bed rest for a minimum of 3 days. An implantable Doppler device has been very helpful in flap monitoring. Prophylaxis for microvascular thrombosis is typically subcutaneous heparin and aspirin. Strict monitoring of the free tissue transfer is performed by the intensive care unit and resident staff [17]. Patients whose forearm donor site was first covered with a dermal substitute are taken back to the operating room for definitive coverage with a skin graft after 2 weeks. Several days later the patient may be discharged home with both a penile catheter and suprapubic catheter (Figure 14). A pericatheter retrograde cystourethrogram can be planned 12 weeks post-surgery. If there is no extravasation of dye, indicating that there is no urinary fistula, the foley catheter can be removed and the suprapubic catheter can be clamped (Figure 15). Patients are encouraged to urinate through their neophallus with the suprapubic catheter clamped. We then check for residual urine in the bladder using a bladder scan if necessary. If the patient is successfully able to urinate from the phallus and adequately empty the bladder for several days the suprapubic tube can be discontinued.
Trans man following Stage II phalloplasty revealing suprapubic tube and penile foley catheter.
Pericatheter retrograde cystourethrogram 8 weeks following second stage phalloplasty operation in trans man. The study reveals no contrast extravasation indicating no fistula and no stricture noted.
If the patient desires, he can tattoo the glans and shaft of the neophallus for aesthetic enhancement, which is ideally performed before full tactile sensation has been achieved (typically 1-year postop). Similarly, the donor site can be tattooed to avoid the stigmata of a skin graft (Figure 16).
RFFF donor site with tattoo concealment.
Since the RFFF phalloplasty lacks bone, it may be too soft to allow for penetrative intercourse. Implantation of an erectile prosthesis is a definitive procedure, that may be performed after 8–12 months when tactile sensation is achieved at least ¾ distally of the penile shaft. A simple Tinel sign is often used to assess postoperative tactile sensation in the neo-phallus postoperatively. Both malleable dual or single cylinder penile prostheses or inflatable prostheses may be used for the erectile device commonly anchored to the ischial tuberosities. We strongly recommend plastic surgery involvement in placement of the prosthesis since knowledge of the location and preservation of the neo-phallus vascular supply is critical to successful placement. More technical details of the neo-phallus implant placement will be discussed in a separate chapter. Prior to implant placement, as the patient is awaiting neural sensation, patients may have successful penetrative intercourse by using an elastic 3M Coban wrap and a condom.
It is important that the patient is aware of the potential complications that may occur following surgery, included in the informed consent. Some complications may include partial or total flap loss, hematoma at the donor or recipient site, an insensate flap, anorgasmia, skin graft loss, chronic pain, numbness, urinary complications, hypertrophic scarring, infection, cold intolerance, vascular compromise, abdominal wall weakness or hernia, implant infection or malfunction, dyspareunia, tendon exposure, limited hand function, and persistent gender dysphoria.
Urethral fistulas and strictures are common untoward events following phalloplasty in the transgender male and may prevent the patient from voiding while standing. A meta-analysis of 665 patients drawn from 11 studies found that an average of 0.51 strictures and/or fistulas can be expected per free forearm flap phalloplasty [17]. The published rate of urologic complications following penile reconstruction ranges from 23 to 75% [18, 19]. The subsequent management of urethral fistulas and strictures can be challenging. Initially, conservative measures such as periodic urethral dilatation or internal urethrotomy can be employed as temporizing measures prior to definitive surgical management.
Most urethral fistulas occur at the anastomosis between the fixed urethra and phallic urethra, and often can occur proximal to a concomitant stricture. The techniques for fistula repair described are the simple fistula repair, the use of local tissue transfer, two-stage procedures with use of mesh graft, bladder, or buccal mucosa [20]. When the fistula is small with substantial overlying tissue, spontaneous resolution is likely. However, when a urethrocutaneous fistula is large and superficial, the abovementioned surgical repair is necessary.
Urethral strictures also primarily occur at the anastomotic urethra. The keystone surgical procedures for urethral stricture include urethroplasty (excision and primary anastomosis) and staged Johanson-type urethroplasty with additional skin grafts, preferentially buccal mucosa [21]. Surgical approaches are customized to the length of the stricture. A patient who has both a urethral fistula and stricture should have both problems addressed at the same time.
There are many variations of urethroplasty available owing to the considerable heterogeneity of phallic and neourethral construction techniques. Well-vascularized local flaps are utilized when available, as well as buccal mucosal grafts. A patient who has undergone several urethral fistula and/or stricture repair attempts will have progressively fewer options for reconstruction. At our institution, we have significantly decreased our fistula rates in transgender male phalloplasty by augmenting the paucity of vascularized tissue at this anastomosis using a pedicled gracilis flap at the time of flap transfer [15]. Prelamination with mucosal grafts may also decrease urethral stenosis and fistula formation [2].
The goals of phalloplasty include a sensate, cosmetically acceptable phallus with an incorporated neourethra, and the ability to place an implantable penile prosthesis to allow rigidity for penetrative intercourse. In the majority of cases, phalloplasty is the final stage of treatment for gender dysphoria.
While other donor sites may be used, the radial forearm free flap is a favorable technique due to its high vascularity, adequate sensation, sufficient tissue pliability, and good cosmetic outcome. We have found that our two-stage technique allows for a neourethra, which mimics a native urethra with no hair growth, while minimizing the donor site on the forearm compared to the previously used skin for a tube-within-a-tube radial forearm flap technique. Using a pre-laminated urethra our patients do not need to undergo electrolysis since the urethra is not created from forearm tissue, so we do not have the risk of hair growth in the urethra and its associated complications. Our decreased stricture rate has encouraged us to continue the use of this technique in patients pursuing phalloplasty with urethral lengthening. Although there have not been any blinded, randomized controlled trials comparing single-stage to two-stage phalloplasty, we believe that prelamination using mucosa for the construction of the trans male phallus urethra is a worthwhile technique that has demonstrated a reduction in the prevalence of complications with this already very challenging procedure.
The authors declare no conflict of interest.
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",metaTitle:"Publish a Whole Book",metaDescription:"At IntechOpen, we not only specialize in the publication of book chapters as part of our Edited Volumes, but also the publication and dissemination of long form manuscripts, known as monographs. Monographs allow authors to focus on presenting a single subject or a specific aspect of that subject and publish their research at length.\n\nPerhaps you have an area of research that does not fit within a previously defined IntechOpen project, but rather need help in publishing your individual research? Publishing your IntechOpen book in the form of a long form monograph is a great alternative.",metaKeywords:null,canonicalURL:"/page/publish-a-whole-book",contentRaw:'[{"type":"htmlEditorComponent","content":"MONOGRAPH - LONG FORM MANUSCRIPT
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\\n\\nIntechOpen has collaborated with Enago, through its sister brand, Ulatus, which is one of the world’s leading providers of book translation services. The services are designed to convey the essence of your work to readers from across the globe in a language they understand. Enago’s expert translators incorporate cultural nuances in translations to make the content relevant for local audiences while retaining the original meaning and style. Enago translators are equipped to handle all complex and multiple overlapping themes encompassed in a single book and their high degree of linguistic and subject expertise enables them to deliver a superior quality output.
\\n\\nIntechOpen Authors that wish to use this service will receive a 20% discount on all translation services. To find out more information or obtain a quote, please visit: https://www.enago.com/intech.
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\n\n*The price does not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate applied in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT by providing us with their VAT registration number. This is made possible by the EU reverse charge method.
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\n\nIntechOpen has collaborated with Enago, through its sister brand, Ulatus, which is one of the world’s leading providers of book translation services. The services are designed to convey the essence of your work to readers from across the globe in a language they understand. Enago’s expert translators incorporate cultural nuances in translations to make the content relevant for local audiences while retaining the original meaning and style. Enago translators are equipped to handle all complex and multiple overlapping themes encompassed in a single book and their high degree of linguistic and subject expertise enables them to deliver a superior quality output.
\n\nIntechOpen Authors that wish to use this service will receive a 20% discount on all translation services. To find out more information or obtain a quote, please visit: https://www.enago.com/intech.
\n\nFUNDING
\n\nWe feel that financial barriers should never prevent researchers from publishing their work. Please consult our Open Access Funding page to explore funding opportunities and learn more about how you can finance your IntechOpen publication.
\n\nBENEFITS
\n\nPUBLISHING PROCESS STEPS
\n\nFor a complete overview of all publishing process steps and descriptions, go to How Open Access Publishing Works.
\n\nSEND YOUR PROPOSAL
\n\nIf you are interested in publishing your book with IntechOpen, please submit your book proposal by completing the Publishing Proposal Form.
\n\nNot sure if this is the right option for you? Please refer back to the main Publish with IntechOpen page or feel free to contact us directly at book.department@intechopen.com.
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the physiology reproductive tract, through hormonal imbalance, decreased oocyte quality and poor semen quality, and decreased embryo development and survival. Heat stress decreases the secretion of luteinizing hormone and estradiol resulting in reduced length and intensity of estrus expression, increased incidence of anoestrus and silent heat in farm animals. Oocytes exposed to thermal stress lose its competence for fertilization and development into the blastocyst stage, which results in decreased fertility because of the production of poor quality oocytes and embryos. Furthermore, low progesterone secretion limits the endometrial functions, and subsequently embryo development. In addition, the increased secretion of endometrial prostaglandin F2 alpha during heat stress threatens the maintenance of pregnancy. In general, the percentage of conception rate was found to be reduced by 4.6% for each unit increase in temperature humidity index (THI) above 70, and heat stress during pregnancy further slows down the growth of the foetus and results in lower birth weight. In tropical and subtropical regions, during hot days, the testicular temperature may increase and impair both the spermatogenic cycle and semen quality, which culminates in decreased bull fertility. The effects of heat stress on livestock can be minimized via adapting suitable scientific strategies comprising physical modifications of the environment, nutritional management and genetic development of breeds that are less sensitive to heat stress. In addition, the summer infertility may be countered through advanced reproductive technologies involving hormonal treatments, timed artificial insemination and embryo transfer, which may enhance the chances for establishing pregnancy in farm animals.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Govindan Krishnan, Madiajagan Bagath, Prathap Pragna,\nMallenahally Kusha Vidya, Joy Aleena, Payyanakkal Ravindranathan\nArchana, Veerasamy Sejian and Raghavendra Bhatta",authors:[{id:"89780",title:"Dr.",name:"Veerasamy",middleName:null,surname:"Sejian",slug:"veerasamy-sejian",fullName:"Veerasamy Sejian"},{id:"177210",title:"Dr.",name:"Raghavendra",middleName:null,surname:"Bhatta",slug:"raghavendra-bhatta",fullName:"Raghavendra Bhatta"},{id:"177220",title:"Dr.",name:"M",middleName:null,surname:"Bagath",slug:"m-bagath",fullName:"M Bagath"},{id:"201967",title:"Dr.",name:"Govindan",middleName:null,surname:"Krishnan",slug:"govindan-krishnan",fullName:"Govindan Krishnan"},{id:"201968",title:"Ms.",name:"Archana",middleName:null,surname:"Pr",slug:"archana-pr",fullName:"Archana Pr"},{id:"201969",title:"Ms.",name:"Pragna",middleName:null,surname:"Prathap",slug:"pragna-prathap",fullName:"Pragna Prathap"},{id:"201970",title:"Ms.",name:"Aleena",middleName:null,surname:"Joy",slug:"aleena-joy",fullName:"Aleena Joy"},{id:"201971",title:"Dr.",name:"Vidya",middleName:null,surname:"Mk",slug:"vidya-mk",fullName:"Vidya Mk"}]},{id:"55006",doi:"10.5772/intechopen.68650",title:"Immunocastration as Alternative to Surgical Castration in Pigs",slug:"immunocastration-as-alternative-to-surgical-castration-in-pigs",totalDownloads:1881,totalCrossrefCites:9,totalDimensionsCites:19,abstract:"Surgical castration of piglets is a routine practice in pig production used to prevent the incidence of boar taint of pig meat, which may develop in entire male pigs as they reach puberty. This practice is being presently questioned in the European Union, and there is a strong initiative to end it. The initiative is presently voluntary; however, key stakeholders of European pig production sector have signed a declaration, and the actions undertaken by them already affect the business. Before such new concepts in pig production can be implemented, alternative solutions are needed, one of them being immunocastration. The present chapter will thus focus on the presentation of immunocastration as one of the promising alternatives to surgical castration. Theoretical and practical aspects of immunocastration in pig production will be described, and the advantages and disadvantages of this alternative will be summarised. Physiological principles of immunocastration and impacts on metabolism, growth performance, body composition and meat quality will be described and aspects of public acceptability reviewed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Marjeta Čandek-Potokar, Martin Škrlep and Galia Zamaratskaia",authors:[{id:"23161",title:"Dr.",name:"Marjeta",middleName:null,surname:"Čandek-Potokar",slug:"marjeta-candek-potokar",fullName:"Marjeta Čandek-Potokar"},{id:"198220",title:"Dr.",name:"Martin",middleName:null,surname:"Škrlep",slug:"martin-skrlep",fullName:"Martin Škrlep"},{id:"198221",title:"Prof.",name:"Galia",middleName:null,surname:"Zamaratskaia",slug:"galia-zamaratskaia",fullName:"Galia Zamaratskaia"}]},{id:"55696",doi:"10.5772/intechopen.69444",title:"Estrus Cycle Monitoring in Wild Mammals: Challenges and Perspectives",slug:"estrus-cycle-monitoring-in-wild-mammals-challenges-and-perspectives",totalDownloads:1854,totalCrossrefCites:0,totalDimensionsCites:6,abstract:"The knowledge of reproductive physiology is of paramount importance to guide reproductive management and to make possible future application of assisted reproduction techniques (ARTs) aiming ex situ conservation of wild mammals. Nevertheless, information on the basic reproductive aspects of wild mammals remain scarce, and appropriate management practices have not yet been developed for all the species. This chapter discusses the methods most currently used for reproductive monitoring in wild females. Additionally, the difficulties regarding their use in different species and the possibilities of these procedures in captivity or in free-living mammals are addressed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Alexandre R. Silva, Nei Moreira, Alexsandra F. Pereira, Gislayne C.X.\nPeixoto, Keilla M. Maia, Lívia B. Campos and Alana A. Borges",authors:[{id:"90066",title:"Dr.",name:"Alexandre",middleName:"Rodrigues",surname:"Silva",slug:"alexandre-silva",fullName:"Alexandre Silva"},{id:"177090",title:"Dr.",name:"Alexsandra Fernandes",middleName:null,surname:"Pereira",slug:"alexsandra-fernandes-pereira",fullName:"Alexsandra Fernandes Pereira"},{id:"177093",title:"MSc.",name:"Gislayne Christianne Xavier",middleName:null,surname:"Peixoto",slug:"gislayne-christianne-xavier-peixoto",fullName:"Gislayne Christianne Xavier Peixoto"},{id:"198314",title:"Prof.",name:"Nei",middleName:null,surname:"Moreira",slug:"nei-moreira",fullName:"Nei Moreira"},{id:"198315",title:"MSc.",name:"Keilla Moreira",middleName:null,surname:"Maia",slug:"keilla-moreira-maia",fullName:"Keilla Moreira Maia"},{id:"198316",title:"MSc.",name:"Lívia Batista",middleName:null,surname:"Campos",slug:"livia-batista-campos",fullName:"Lívia Batista Campos"},{id:"198317",title:"MSc.",name:"Alana Azevedo",middleName:null,surname:"Borges",slug:"alana-azevedo-borges",fullName:"Alana Azevedo Borges"}]},{id:"56522",doi:"10.5772/intechopen.69549",title:"Role of Melatonin in Reproductive Seasonality in Buffaloes",slug:"role-of-melatonin-in-reproductive-seasonality-in-buffaloes",totalDownloads:1727,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Buffaloes are characterized by seasonal reproductive activity. Anestrus buffalo heifers and lactating buffaloes were used to study the effect of melatonin treatment on the resumption of ovarian activity during out-of-breeding season. Buffaloes of treated group were injected or implanted with melatonin (18 mg melatonin/50 kg body weight). Using CIDR-eCG protocol preceded with melatonin successfully achieved estrus behavior and induced conception rate during out-of-breeding season. Furthermore, the reproductive performance of buffaloes during out-of-breeding season was clearly improved by melatonin implantation in conjunction with CIDR-eCG protocol due to the luteotrophic effect of melatonin expressed as increasing diameter of CL (corpus luteum) and progesterone concentration. This improvement resulted in greater values of conception rate, in melatonin implanted compared to not implanted buffaloes. Melatonin implantation in anestrus buffalo heifers increased the diameter of largest follicles and melatonin concentration but progesterone and luteinizing hormone (LH) concentrations were decreased. In addition, melatonin implantation in anestrus lactating buffaloes increased the SOD (superoxide dismutase) enzyme activity. Sustained release of exogenous melatonin significantly protects against oxidative stress while increasing beneficial total antioxidant capacity (TAC) concentration in summer-stressed anestrus buffaloes. Melatonin implantation in conjunction with CIDR-eCG protocol successfully improved some blood metabolites, in anestrus buffalo heifers during out-of-breeding season under tropical conditions.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Tamer Awad Ramadan",authors:[{id:"197651",title:"Dr.",name:"Tamer",middleName:"Awad",surname:"Ramadan",slug:"tamer-ramadan",fullName:"Tamer Ramadan"}]},{id:"54974",doi:"10.5772/intechopen.68651",title:"Markers for Sperm Freezability and Relevance of Transcriptome Studies in Semen Cryopreservation: A Review",slug:"markers-for-sperm-freezability-and-relevance-of-transcriptome-studies-in-semen-cryopreservation-a-re",totalDownloads:1590,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"Advances in sperm assessment techniques have offered new perspectives to improve the technology of semen cryopreservation. This review addresses some recent achievements in the proteomics of seminal plasma and spermatozoa and exemplifies its importance as markers for sperm fertility following cryopreservation. Recent advances in transcriptome studies on sperm RNA-Seq data have generated new information aimed to unravel the physiological roles of RNAs in the sperm-egg fertilization processes and their associations with male fertility. The relevance of the sperm freezability markers and the potential associations of RNA-profiling sequences with the sperm biological functions have been discussed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Leyland Fraser",authors:[{id:"199650",title:"Dr.",name:"Leyland",middleName:null,surname:"Fraser",slug:"leyland-fraser",fullName:"Leyland Fraser"}]}],mostDownloadedChaptersLast30Days:[{id:"79344",title:"Epidemiology of Bovine Mastitis and Its Diagnosis, Prevention, and Control",slug:"epidemiology-of-bovine-mastitis-and-its-diagnosis-prevention-and-control",totalDownloads:252,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Mastitis is an inflammation of mammary glands that is prevalent in dairy bovines. It causes a significant proportion of economic losses to the dairy farmers in India. Cattle and buffalo farming contribute significantly to the economy of the state. Various infectious agents such as bacteria, fungi, and algae may cause mastitis. Hence, it is essential to understand the etiological agents and predisposing factors that lead to mastitis in susceptible bovine populations in Madhya Pradesh state so that appropriate prevention and control strategies can be implemented. In this chapter, epidemiology, diagnosis, prevention, and control measures of mastitis in general and in India, the state of Madhya Pradesh, in particular, will be presented.",book:{id:"10589",slug:"mastitis-in-dairy-cattle-sheep-and-goats",title:"Mastitis in Dairy Cattle, Sheep and Goats",fullTitle:"Mastitis in Dairy Cattle, Sheep and Goats"},signatures:"S.D. Audarya, D. Chhabra, R. Sharda, R. Gangil, R. Sikrodia, J. Jogi and N. Shrivastava",authors:[{id:"291434",title:"Dr.",name:"N.",middleName:null,surname:"Shrivastav",slug:"n.-shrivastav",fullName:"N. Shrivastav"},{id:"317236",title:"Dr.",name:"S.D.",middleName:null,surname:"Audarya",slug:"s.d.-audarya",fullName:"S.D. Audarya"},{id:"344698",title:"Dr.",name:"D.",middleName:null,surname:"Chhabra",slug:"d.-chhabra",fullName:"D. Chhabra"},{id:"344699",title:"Dr.",name:"R.",middleName:null,surname:"Sharda",slug:"r.-sharda",fullName:"R. Sharda"},{id:"344700",title:"Dr.",name:"R.",middleName:null,surname:"Gangil",slug:"r.-gangil",fullName:"R. Gangil"},{id:"344702",title:"Dr.",name:"R.",middleName:null,surname:"Sikrodia",slug:"r.-sikrodia",fullName:"R. Sikrodia"},{id:"344703",title:"Dr.",name:"J.",middleName:null,surname:"Jogi",slug:"j.-jogi",fullName:"J. Jogi"}]},{id:"55696",title:"Estrus Cycle Monitoring in Wild Mammals: Challenges and Perspectives",slug:"estrus-cycle-monitoring-in-wild-mammals-challenges-and-perspectives",totalDownloads:1854,totalCrossrefCites:0,totalDimensionsCites:6,abstract:"The knowledge of reproductive physiology is of paramount importance to guide reproductive management and to make possible future application of assisted reproduction techniques (ARTs) aiming ex situ conservation of wild mammals. Nevertheless, information on the basic reproductive aspects of wild mammals remain scarce, and appropriate management practices have not yet been developed for all the species. This chapter discusses the methods most currently used for reproductive monitoring in wild females. Additionally, the difficulties regarding their use in different species and the possibilities of these procedures in captivity or in free-living mammals are addressed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Alexandre R. Silva, Nei Moreira, Alexsandra F. Pereira, Gislayne C.X.\nPeixoto, Keilla M. Maia, Lívia B. Campos and Alana A. Borges",authors:[{id:"90066",title:"Dr.",name:"Alexandre",middleName:"Rodrigues",surname:"Silva",slug:"alexandre-silva",fullName:"Alexandre Silva"},{id:"177090",title:"Dr.",name:"Alexsandra Fernandes",middleName:null,surname:"Pereira",slug:"alexsandra-fernandes-pereira",fullName:"Alexsandra Fernandes Pereira"},{id:"177093",title:"MSc.",name:"Gislayne Christianne Xavier",middleName:null,surname:"Peixoto",slug:"gislayne-christianne-xavier-peixoto",fullName:"Gislayne Christianne Xavier Peixoto"},{id:"198314",title:"Prof.",name:"Nei",middleName:null,surname:"Moreira",slug:"nei-moreira",fullName:"Nei Moreira"},{id:"198315",title:"MSc.",name:"Keilla Moreira",middleName:null,surname:"Maia",slug:"keilla-moreira-maia",fullName:"Keilla Moreira Maia"},{id:"198316",title:"MSc.",name:"Lívia Batista",middleName:null,surname:"Campos",slug:"livia-batista-campos",fullName:"Lívia Batista Campos"},{id:"198317",title:"MSc.",name:"Alana Azevedo",middleName:null,surname:"Borges",slug:"alana-azevedo-borges",fullName:"Alana Azevedo Borges"}]},{id:"76529",title:"Mastitis in Small Ruminants",slug:"mastitis-in-small-ruminants",totalDownloads:175,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Bacterial mastitis in small ruminants is a complex disease, with massive economic loss in dairy sheep/goat industry due to poor productivity. The current mastitis prevention strategy relies on culling of infected ewes or does and or the use of antimicrobial agents to eliminate the bacterial infection. This has a potential risk for developing antibiotic resistant bacteria, posing human health risk from consumption of raw sheep or goat dairy products. Existing experimental and licensed vaccines on the market are ineffective against reducing the risk of mastitis in herds or flocks. Raising the needs for development of improved vaccines against mastitis for use in sheep and goats. This review examines, current understanding of the pathological processes and immunological responses against bacterial mastitis, using S. aureus as an example. By highlighting the protective defense mechanism induced in the udder against S. aureus mastitis. Based on evidence from published studies on pathological process and protective immune response mechanism, the need for improved vaccines for prevention of mastitis in small ruminant is highlighted and the development of a vaccine capable of enhancing immune response mechanism, that reduce the establishment of intramammary infection through induction of local IgA, IgG2 and Th17 immune responses is proposed.",book:{id:"10589",slug:"mastitis-in-dairy-cattle-sheep-and-goats",title:"Mastitis in Dairy Cattle, Sheep and Goats",fullTitle:"Mastitis in Dairy Cattle, Sheep and Goats"},signatures:"Christine T. Mwenge Kahinda",authors:[{id:"335924",title:"Dr.",name:"Christine T.",middleName:"Christine",surname:"Mwenge Kahinda",slug:"christine-t.-mwenge-kahinda",fullName:"Christine T. Mwenge Kahinda"}]},{id:"55491",title:"Mitigation of the Heat Stress Impact in Livestock Reproduction",slug:"mitigation-of-the-heat-stress-impact-in-livestock-reproduction",totalDownloads:4255,totalCrossrefCites:9,totalDimensionsCites:23,abstract:"Heat stress affects the fertility and reproductive livestock performance by compromising the physiology reproductive tract, through hormonal imbalance, decreased oocyte quality and poor semen quality, and decreased embryo development and survival. Heat stress decreases the secretion of luteinizing hormone and estradiol resulting in reduced length and intensity of estrus expression, increased incidence of anoestrus and silent heat in farm animals. Oocytes exposed to thermal stress lose its competence for fertilization and development into the blastocyst stage, which results in decreased fertility because of the production of poor quality oocytes and embryos. Furthermore, low progesterone secretion limits the endometrial functions, and subsequently embryo development. In addition, the increased secretion of endometrial prostaglandin F2 alpha during heat stress threatens the maintenance of pregnancy. In general, the percentage of conception rate was found to be reduced by 4.6% for each unit increase in temperature humidity index (THI) above 70, and heat stress during pregnancy further slows down the growth of the foetus and results in lower birth weight. In tropical and subtropical regions, during hot days, the testicular temperature may increase and impair both the spermatogenic cycle and semen quality, which culminates in decreased bull fertility. The effects of heat stress on livestock can be minimized via adapting suitable scientific strategies comprising physical modifications of the environment, nutritional management and genetic development of breeds that are less sensitive to heat stress. In addition, the summer infertility may be countered through advanced reproductive technologies involving hormonal treatments, timed artificial insemination and embryo transfer, which may enhance the chances for establishing pregnancy in farm animals.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Govindan Krishnan, Madiajagan Bagath, Prathap Pragna,\nMallenahally Kusha Vidya, Joy Aleena, Payyanakkal Ravindranathan\nArchana, Veerasamy Sejian and Raghavendra Bhatta",authors:[{id:"89780",title:"Dr.",name:"Veerasamy",middleName:null,surname:"Sejian",slug:"veerasamy-sejian",fullName:"Veerasamy Sejian"},{id:"177210",title:"Dr.",name:"Raghavendra",middleName:null,surname:"Bhatta",slug:"raghavendra-bhatta",fullName:"Raghavendra Bhatta"},{id:"177220",title:"Dr.",name:"M",middleName:null,surname:"Bagath",slug:"m-bagath",fullName:"M Bagath"},{id:"201967",title:"Dr.",name:"Govindan",middleName:null,surname:"Krishnan",slug:"govindan-krishnan",fullName:"Govindan Krishnan"},{id:"201968",title:"Ms.",name:"Archana",middleName:null,surname:"Pr",slug:"archana-pr",fullName:"Archana Pr"},{id:"201969",title:"Ms.",name:"Pragna",middleName:null,surname:"Prathap",slug:"pragna-prathap",fullName:"Pragna Prathap"},{id:"201970",title:"Ms.",name:"Aleena",middleName:null,surname:"Joy",slug:"aleena-joy",fullName:"Aleena Joy"},{id:"201971",title:"Dr.",name:"Vidya",middleName:null,surname:"Mk",slug:"vidya-mk",fullName:"Vidya Mk"}]},{id:"79839",title:"Antimicrobial Usage for the Management of Mastitis in the USA: Impacts on Antimicrobial Resistance and Potential Alternative Approaches",slug:"antimicrobial-usage-for-the-management-of-mastitis-in-the-usa-impacts-on-antimicrobial-resistance-an",totalDownloads:151,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Mastitis is the most frequently diagnosed disease of dairy cattle responsible for the reduction in milk quantity and quality and major economic losses. Dairy farmers use antibiotics for the prevention and treatment of mastitis. Frequent antimicrobial usage (AMU) undeniably increased antimicrobial resistance (AMR) in bacteria from dairy farms. Antimicrobial-resistant bacteria (ARB) from dairy farms can spread to humans directly through contact with carrier animals or indirectly through the consumption of raw milk or undercooked meat from culled dairy cows. Indirect spread from dairy farms to humans can also be through dairy manure fertilized vegetables or run-off waters from dairy farms to the environment. The most frequently used antibiotics in dairy farms are medically important and high-priority classes of antibiotics. As a result, dairy farms are considered one of the potential reservoirs of ARB and antimicrobial resistance genes (ARGs). To mitigate the rise of ARB in dairy farms, reducing AMU by adopting one or more of alternative disease control methods such as good herd health management, selective dry-cow therapy, probiotics, and others is critically important. This chapter is a concise review of the effects of antimicrobials usage to control mastitis in dairy cattle farms and its potential impact on human health.",book:{id:"10589",slug:"mastitis-in-dairy-cattle-sheep-and-goats",title:"Mastitis in Dairy Cattle, Sheep and Goats",fullTitle:"Mastitis in Dairy Cattle, Sheep and Goats"},signatures:"Benti D. Gelalcha, Getahun E. Agga and Oudessa Kerro Dego",authors:[{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego"},{id:"332974",title:"Ph.D. Student",name:"Benti D.",middleName:"Deresa",surname:"Gelalcha",slug:"benti-d.-gelalcha",fullName:"Benti D. 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",coverUrl:"https://cdn.intechopen.com/series/covers/22.jpg",latestPublicationDate:"May 18th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"356540",title:"Prof.",name:"Taufiq",middleName:null,surname:"Choudhry",slug:"taufiq-choudhry",fullName:"Taufiq Choudhry",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000036X2hvQAC/Profile_Picture_2022-03-14T08:58:03.jpg",biography:"Prof. Choudhry holds a BSc degree in Economics from the University of Iowa, as well as a Masters and Ph.D. in Applied Economics from Clemson University, USA. In January 2006, he became a Professor of Finance at the University of Southampton Business School. He was previously a Professor of Finance at the University of Bradford Management School. He has over 80 articles published in international finance and economics journals. His research interests and specialties include financial econometrics, financial economics, international economics and finance, housing markets, financial markets, among others.",institutionString:null,institution:{name:"University of Southampton",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"86",title:"Business and Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/86.jpg",isOpenForSubmission:!0,editor:{id:"128342",title:"Prof.",name:"Vito",middleName:null,surname:"Bobek",slug:"vito-bobek",fullName:"Vito Bobek",profilePictureURL:"https://mts.intechopen.com/storage/users/128342/images/system/128342.jpg",biography:"Dr. Vito Bobek works as an international management professor at the University of Applied Sciences FH Joanneum, Graz, Austria. He has published more than 400 works in his academic career and visited twenty-two universities worldwide as a visiting professor. Dr. Bobek is a member of the editorial boards of six international journals and a member of the Strategic Council of the Minister of Foreign Affairs of the Republic of Slovenia. He has a long history in academia, consulting, and entrepreneurship. His own consulting firm, Palemid, has managed twenty significant projects, such as Cooperation Program Interreg V-A (Slovenia-Austria) and Capacity Building for the Serbian Chamber of Enforcement Agents. He has also participated in many international projects in Italy, Germany, Great Britain, the United States, Spain, Turkey, France, Romania, Croatia, Montenegro, Malaysia, and China. Dr. Bobek is also a co-founder of the Academy of Regional Management in Slovenia.",institutionString:"Universities of Applied Sciences FH Joanneum, Austria",institution:null},editorTwo:{id:"293992",title:"Dr.",name:"Tatjana",middleName:null,surname:"Horvat",slug:"tatjana-horvat",fullName:"Tatjana Horvat",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hXb0hQAC/Profile_Picture_1642419002203",biography:"Tatjana Horvat works as a professor for accountant and auditing at the University of Primorska, Slovenia. She is a Certified State Internal Auditor (licensed by Ministry of Finance RS) and Certified Internal Auditor for Business Sector and Certified accountant (licensed by Slovenian Institute of Auditors). At the Ministry of Justice of Slovenia, she is a member of examination boards for court expert candidates and judicial appraisers in the following areas: economy/finance, valuation of companies, banking, and forensic investigation of economic operations/accounting. At the leading business newspaper Finance in Slovenia (Swedish ownership), she is the editor and head of the area for business, finance, tax-related articles, and educational programs.",institutionString:null,institution:{name:"University of Primorska",institutionURL:null,country:{name:"Slovenia"}}},editorThree:null},{id:"87",title:"Economics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/87.jpg",isOpenForSubmission:!0,editor:{id:"327730",title:"Prof.",name:"Jaime",middleName:null,surname:"Ortiz",slug:"jaime-ortiz",fullName:"Jaime Ortiz",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002zaOKZQA2/Profile_Picture_1642145584421",biography:"Dr. Jaime Ortiz holds degrees from Chile, the Netherlands, and the United States. He has held tenured faculty, distinguished professorship, and executive leadership appointments in several universities around the world. 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His teaching interests revolve around global economies and markets while his research focuses on topics related to development and growth, global business decisions, and the economics of technical innovation.",institutionString:null,institution:{name:"University of Houston",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},{id:"88",title:"Marketing",coverUrl:"https://cdn.intechopen.com/series_topics/covers/88.jpg",isOpenForSubmission:!1,editor:null,editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:1,paginationItems:[{id:"81831",title:"Deep Network Model and Regression Analysis using OLS Method for Predicting Lung Vital Capacity",doi:"10.5772/intechopen.104737",signatures:"Harun Sümbül",slug:"deep-network-model-and-regression-analysis-using-ols-method-for-predicting-lung-vital-capacity",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Decision Science - Recent Advances and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11604.jpg",subseries:{id:"86",title:"Business and Management"}}}]},overviewPagePublishedBooks:{paginationCount:1,paginationItems:[{type:"book",id:"11392",title:"Leadership in a Changing World",subtitle:"A Multidimensional Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11392.jpg",slug:"leadership-in-a-changing-world-a-multidimensional-perspective",publishedDate:"May 11th 2022",editedByType:"Edited by",bookSignature:"Muhammad Mohiuddin, Bilal Khalid, Md. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. 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He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNVJQA4/Profile_Picture_2022-03-07T13:23:04.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. degree from Integral University. Currently, he’s working as an Assistant Professor of Pharmaceutics in the Faculty of Pharmacy, Integral University. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than 32 original articles published in reputed journals, 3 edited books, 5 book chapters, and a number of scientific articles published in ‘Ingredients South Asia Magazine’ and ‘QualPharma Magazine’. He is a member of the American Association for Cancer Research, International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs that aim to provide practical solutions to current healthcare problems.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}},{id:"226275",title:"Ph.D.",name:"Metin",middleName:null,surname:"Budak",slug:"metin-budak",fullName:"Metin Budak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226275/images/system/226275.jfif",biography:"Metin Budak, MSc, PhD is an Assistant Professor at Trakya University, Faculty of Medicine. He has been Head of the Molecular Research Lab at Prof. Mirko Tos Ear and Hearing Research Center since 2018. His specializations are biophysics, epigenetics, genetics, and methylation mechanisms. He has published around 25 peer-reviewed papers, 2 book chapters, and 28 abstracts. He is a member of the Clinical Research Ethics Committee and Quantification and Consideration Committee of Medicine Faculty. His research area is the role of methylation during gene transcription, chromatin packages DNA within the cell and DNA repair, replication, recombination, and gene transcription. His research focuses on how the cell overcomes chromatin structure and methylation to allow access to the underlying DNA and enable normal cellular function.",institutionString:"Trakya University",institution:{name:"Trakya University",country:{name:"Turkey"}}},{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",biography:"Anca Pantea Stoian is a specialist in diabetes, nutrition, and metabolic diseases as well as health food hygiene. She also has competency in general ultrasonography.\n\nShe is an associate professor in the Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. She has been chief of the Hygiene Department, Faculty of Dentistry, at the same university since 2019. Her interests include micro and macrovascular complications in diabetes and new therapies. Her research activities focus on nutritional intervention in chronic pathology, as well as cardio-renal-metabolic risk assessment, and diabetes in cancer. She is currently engaged in developing new therapies and technological tools for screening, prevention, and patient education in diabetes. \n\nShe is a member of the European Association for the Study of Diabetes, Cardiometabolic Academy, CEDA, Romanian Society of Diabetes, Nutrition and Metabolic Diseases, Romanian Diabetes Federation, and Association for Renal Metabolic and Nutrition studies. She has authored or co-authored 160 papers in national and international peer-reviewed journals.",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",country:{name:"Romania"}}},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279792/images/system/279792.jpg",biography:"Graduate and master in Biology from the University of Coimbra.\n\nI am a research fellow at the Macroalgae Laboratory Unit, in the MARE-UC – Marine and Environmental Sciences Centre of the University of Coimbra. My principal function is the collection, extraction and purification of macroalgae compounds, chemical and bioactive characterization of the compounds and algae extracts and development of new methodologies in marine biotechnology area. \nI am associated in two projects: one consists on discovery of natural compounds for oncobiology. The other project is the about the natural compounds/products for agricultural area.\n\nPublications:\nCotas, J.; Figueirinha, A.; Pereira, L.; Batista, T. 2018. An analysis of the effects of salinity on Fucus ceranoides (Ochrophyta, Phaeophyceae), in the Mondego River (Portugal). Journal of Oceanology and Limnology. in press. DOI: 10.1007/s00343-019-8111-3",institutionString:"Faculty of Sciences and Technology of University of Coimbra",institution:null},{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279788/images/system/279788.jpg",biography:"Leonel Pereira has an undergraduate degree in Biology, a Ph.D. in Biology (specialty in Cell Biology), and a Habilitation degree in Biosciences (specialization in Biotechnology) from the Faculty of Science and Technology, University of Coimbra, Portugal, where he is currently a professor. In addition to teaching at this university, he is an integrated researcher at the Marine and Environmental Sciences Center (MARE), Portugal. His interests include marine biodiversity (algae), marine biotechnology (algae bioactive compounds), and marine ecology (environmental assessment). Since 2008, he has been the author and editor of the electronic publication MACOI – Portuguese Seaweeds Website (www.seaweeds.uc.pt). He is also a member of the editorial boards of several scientific journals. Dr. Pereira has edited or authored more than 20 books, 100 journal articles, and 45 book chapters. He has given more than 100 lectures and oral communications at various national and international scientific events. He is the coordinator of several national and international research projects. In 1998, he received the Francisco de Holanda Award (Honorable Mention) and, more recently, the Mar Rei D. Carlos award (18th edition). He is also a winner of the 2016 CHOICE Award for an outstanding academic title for his book Edible Seaweeds of the World. In 2020, Dr. Pereira received an Honorable Mention for the Impact of International Publications from the Web of Science",institutionString:"University of Coimbra",institution:{name:"University of Coimbra",country:{name:"Portugal"}}},{id:"61946",title:"Dr.",name:"Carol",middleName:null,surname:"Bernstein",slug:"carol-bernstein",fullName:"Carol Bernstein",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61946/images/system/61946.jpg",biography:"Carol Bernstein received her PhD in Genetics from the University of California (Davis). She was a faculty member at the University of Arizona College of Medicine for 43 years, retiring in 2011. Her research interests focus on DNA damage and its underlying role in sex, aging and in the early steps of initiation and progression to cancer. In her research, she had used organisms including bacteriophage T4, Neurospora crassa, Schizosaccharomyces pombe and mice, as well as human cells and tissues. She authored or co-authored more than 140 scientific publications, including articles in major peer reviewed journals, book chapters, invited reviews and one book.",institutionString:"University of Arizona",institution:{name:"University of Arizona",country:{name:"United States of America"}}},{id:"182258",title:"Dr.",name:"Ademar",middleName:"Pereira",surname:"Serra",slug:"ademar-serra",fullName:"Ademar Serra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/182258/images/system/182258.jpeg",biography:"Dr. Serra studied Agronomy on Universidade Federal de Mato Grosso do Sul (UFMS) (2005). He received master degree in Agronomy, Crop Science (Soil fertility and plant nutrition) (2007) by Universidade Federal da Grande Dourados (UFGD), and PhD in agronomy (Soil fertility and plant nutrition) (2011) from Universidade Federal da Grande Dourados / Escola Superior de Agricultura Luiz de Queiroz (UFGD/ESALQ-USP). Dr. Serra is currently working at Brazilian Agricultural Research Corporation (EMBRAPA). His research focus is on mineral nutrition of plants, crop science and soil science. Dr. Serra\\'s current projects are soil organic matter, soil phosphorus fractions, compositional nutrient diagnosis (CND) and isometric log ratio (ilr) transformation in compositional data analysis.",institutionString:"Brazilian Agricultural Research Corporation",institution:{name:"Brazilian Agricultural Research Corporation",country:{name:"Brazil"}}}]}},subseries:{item:{id:"28",type:"subseries",title:"Animal Reproductive Biology and Technology",keywords:"Animal Reproduction, Artificial Insemination, Embryos, Cryopreservation, Conservation, Breeding, Epigenetics",scope:"The advances of knowledge on animal reproductive biology and technologies revolutionized livestock production. Artificial insemination, for example, was the first technology applied on a large scale, initially in dairy cattle and afterward applied to other species. Nowadays, embryo production and transfer are used commercially along with other technologies to modulate epigenetic regulation. Gene editing is also emerging as an innovative tool. This topic will discuss the potential use of these techniques, novel strategies, and lines of research in progress in the fields mentioned above.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11417,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). She is the head of the Reproduction and Embryology Laboratories and was lecturer of Reproduction and Reproductive Biotechnologies at Veterinary Medicine Faculty. She has over 25 years of experience working in reproductive biology and biotechnology areas with a special emphasis on embryo and gamete cryopreservation, for research and animal genetic resources conservation, leading research projects with several peer-reviewed papers. Rosa Pereira is member of the ERFP-FAO Ex situ Working Group and of the Management Commission of the Portuguese Animal Germplasm Bank.",institutionString:"The National Institute for Agricultural and Veterinary Research. 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\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
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",annualVolume:11967,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",editor:{id:"137040",title:"Prof.",name:"Jose",middleName:null,surname:"Navarro-Pedreño",fullName:"Jose Navarro-Pedreño",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRAXrQAO/Profile_Picture_2022-03-09T15:50:19.jpg",institutionString:"Miguel Hernández University of Elche, Spain",institution:null},editorTwo:null,editorThree:null,editorialBoard:[{id:"177015",title:"Prof.",name:"Elke Jurandy",middleName:null,surname:"Bran Nogueira Cardoso",fullName:"Elke Jurandy Bran Nogueira Cardoso",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGxzQAG/Profile_Picture_2022-03-25T08:32:33.jpg",institutionString:"Universidade de São Paulo, Brazil",institution:null},{id:"211260",title:"Dr.",name:"Sandra",middleName:null,surname:"Ricart",fullName:"Sandra Ricart",profilePictureURL:"https://mts.intechopen.com/storage/users/211260/images/system/211260.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}}]},{id:"40",title:"Ecosystems and Biodiversity",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive species, Destruction of habitats, Overexploitation of natural resources, Pollution, Global warming, Conservation of natural spaces, Bioremediation",scope:"