Summary of the studies done on the mediator-less
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"9444",leadTitle:null,fullTitle:"Ischemic Stroke",title:"Ischemic Stroke",subtitle:null,reviewType:"peer-reviewed",abstract:"Stroke continues to be a major public health issue. It is the third leading cause of death and disability across the globe. Its early identification and treatment along with prevention are major issues that confront a treating physician. We have understood the importance of early intervention and of the quote ‘time is brain’. Our endeavor now should be directed to the public at large and paramedics in particular. Although a stroke is a common condition, the availability of neurologists or stroke specialists is quite scarce. Today, management of a suspected case of stroke is done by a specialist team of medical and paramedical personnel. Advances in imaging, newer therapeutic agents, and endovascular management have revolutionized the management. Currently, we are witnessing a new era in the management of strokes and I am hopeful that continued research will get us to a satisfactory solution. This book along with another book from IntechOpen titled ‘Ischemic Stroke of Brain’ aims to improve the understanding of stroke medicine for postgraduate medical students in medicine and neurology who have an interest in stroke care.",isbn:"978-1-83962-395-0",printIsbn:"978-1-83962-394-3",pdfIsbn:"978-1-83962-396-7",doi:"10.5772/intechopen.86623",price:119,priceEur:129,priceUsd:155,slug:"ischemic-stroke",numberOfPages:130,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a24752137cbc5f228a3479e02a6a3d10",bookSignature:"Pratap Sanchetee",publishedDate:"March 24th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9444.jpg",numberOfDownloads:4349,numberOfWosCitations:0,numberOfCrossrefCitations:3,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:6,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:9,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 26th 2019",dateEndSecondStepPublish:"March 3rd 2020",dateEndThirdStepPublish:"May 2nd 2020",dateEndFourthStepPublish:"July 21st 2020",dateEndFifthStepPublish:"September 19th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"206518",title:"Dr.",name:"Pratap",middleName:null,surname:"Sanchetee",slug:"pratap-sanchetee",fullName:"Pratap Sanchetee",profilePictureURL:"https://mts.intechopen.com/storage/users/206518/images/system/206518.jpg",biography:"Dr. Pratap Sanchetee is a first batch alumnus of Dr. SN Medical College, Jodhpur, and achieved his MBBS in 1970. Subsequently, he received his MD diploma (Medicine) from the University of Rajasthan in 1974, and DM (Neurology) from the Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh in 1985. He served in the Armed Forces India as a Physician and Neurologist for 24 years and retired as Lt Col in 1998. From 1994 to 1998, he also served as an Associate Professor, Armed Forces Medical College, Pune. He was awarded Chief of Army Staff’s Commendation in 1980. Since 1998, he has been pursuing clinical practice in neurology at various hospitals at Jodhpur and at Guwahati Assam. He has been a Visiting Professor, Ph.D. guide, and advisor to Jain Visva Bharti University (JVBI) and Bhagwan Mahaveer International Research Centre (BMIRC), Ladnun, Rajasthan since 2009. He is a Director of Research at the Spiritual Training Research Foundation (STRF), Mumbai, India. His areas of active interest are the mind as an interface between soul and body, meditation and the brain, and delivery of neurology care in society. Dr. Sanchetee has a life membership of 9 national associations. He is the editor of four books and has published 112 original papers, chapters, and review articles in national and international journals. He is currently the Chairperson of the 'Tropical Neurology Subsection' of the Indian Academy of Neurology. He regularly participates in national and international conferences and presents academic papers. He was an executive editor of the Medical Journal Armed Forces India and Journal of Indian Academy of Geriatrics.",institutionString:"Sanchetee Hospital & Research Institute",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1056",title:"Neurology",slug:"neurology"}],chapters:[{id:"74822",title:"Current Trends in Stroke Rehabilitation",doi:"10.5772/intechopen.95576",slug:"current-trends-in-stroke-rehabilitation",totalDownloads:712,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Stroke remains a leading cause of adult disability. The social, physical and psychological consequences of stroke are devastating. With better understanding of causation and breakthrough advances in management, we are witnessing a greater population of stroke survivors with varying neurological and functional deficits. Poststroke rehabilitation is a multi-disciplinary and multi-modal endeavor and not a ‘one size fits all’ intervention. A combination of interventions may be better suited to treat motor and sensory impairments, cognitive problems and psychological issues. There is great interest in exploring novel rehabilitation technologies to augment conventional therapies to reduce neurological disability and improve function. Yoga and spirituality, though ancient practices, are finding a bigger role in field of rehabilitation. In spite of good potentials for recovery, these rehabilitative measures are underutilized and major barriers are limited availability, geographical distance, high cost and lack of awareness about its benefits. While conventional measures are well engraved, this article review the recent concepts in stroke rehabilitation.",signatures:"Pratap Sanchetee",downloadPdfUrl:"/chapter/pdf-download/74822",previewPdfUrl:"/chapter/pdf-preview/74822",authors:[{id:"206518",title:"Dr.",name:"Pratap",surname:"Sanchetee",slug:"pratap-sanchetee",fullName:"Pratap Sanchetee"}],corrections:null},{id:"72380",title:"Ischemic Stroke in Young Adults: Practical Diagnosis Guide",doi:"10.5772/intechopen.92671",slug:"ischemic-stroke-in-young-adults-practical-diagnosis-guide",totalDownloads:1017,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"With its increasing incidence in younger population and as a leading cause of disability, ischemic stroke represents a real public health problem. This chapter aims to evaluate the most common risk factors and causes for ischemic stroke in the young. Though some are identical to those found in older patients, most of them are specific to this population segment. Furthermore, another objective is to provide some guidance in approaching the case based on some important clinical clues. Due to the lack of universal management guidelines, it is up to the physician to judge the particularities of each case and to carry out the variety of investigations necessary for determining the cause.",signatures:"Diana Mihai, Florentina Cristina Plesa, Any Docu Axelerad, Alice Munteanu, Minerva Claudia Ghinescu and Carmen Adella Sirbu",downloadPdfUrl:"/chapter/pdf-download/72380",previewPdfUrl:"/chapter/pdf-preview/72380",authors:[{id:"318289",title:"Associate Prof.",name:"Carmen",surname:"Adella Sirbu",slug:"carmen-adella-sirbu",fullName:"Carmen Adella Sirbu"},{id:"318767",title:"Ms.",name:"Diana",surname:"Mihai",slug:"diana-mihai",fullName:"Diana Mihai"},{id:"320565",title:"Dr.",name:"Cristina Florentina",surname:"Plesa",slug:"cristina-florentina-plesa",fullName:"Cristina Florentina Plesa"},{id:"320566",title:"Dr.",name:"Any Docu",surname:"Axelerad",slug:"any-docu-axelerad",fullName:"Any Docu Axelerad"},{id:"320567",title:"Dr.",name:"Alice Elena",surname:"Munteanu",slug:"alice-elena-munteanu",fullName:"Alice Elena Munteanu"},{id:"320568",title:"Dr.",name:"Claudia Minerva",surname:"Ghinescu",slug:"claudia-minerva-ghinescu",fullName:"Claudia Minerva Ghinescu"}],corrections:null},{id:"72351",title:"Vascular Aphasias",doi:"10.5772/intechopen.92691",slug:"vascular-aphasias",totalDownloads:695,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Aphasia represents an acquired central disorder of language that impairs a person’s ability to understand and/or produce spoken and written language, caused by lesions situated usually in the dominant (left) cerebral hemisphere, in right-handed persons. Aphasia has a prevalence of 25–30% in acute ischemic stroke (vascular aphasia). It is considered as an important stroke severity marker, being associated with a higher risk of mortality, poor functional prognosis, and augmented risk of vascular dementia. The assessment of aphasias in clinical practice is based on classical analysis of oral production and comprehension. The language disturbances are frequently combined into aphasic syndromes which are components of different vascular syndromes that may evolve/involve rapidly at the acute stage of ischemic stroke. The main determinant of the type of vascular aphasia is the infarct location (especially left middle cerebral artery territory). Recent studies at the hyperacute stage of ischemic stroke have observed features of aphasia, have reanalyzed its neuroanatomy using new imaging techniques, and have shown that aphasias have a parallel course to that of cortico-subcortical hypoperfusion. Thus, the reversal of hypoperfusion, following recanalization (spontaneous or secondary to thrombolysis or thrombectomy), is associated with resolution of aphasia. Speech therapy is needed as soon as permitted by clinical condition.",signatures:"Dragoș Cătălin Jianu, Silviana Nina Jianu, Ligia Petrica, Traian Flavius Dan and Georgiana Munteanu",downloadPdfUrl:"/chapter/pdf-download/72351",previewPdfUrl:"/chapter/pdf-preview/72351",authors:[{id:"45925",title:"Prof.",name:"Dragoș",surname:"Cătălin Jianu",slug:"dragos-catalin-jianu",fullName:"Dragoș Cătălin Jianu"},{id:"55071",title:"Dr.",name:"Silviana Nina",surname:"Jianu",slug:"silviana-nina-jianu",fullName:"Silviana Nina Jianu"},{id:"241849",title:"Dr.",name:"Traian Flavius",surname:"Dan",slug:"traian-flavius-dan",fullName:"Traian Flavius Dan"},{id:"241852",title:"Dr.",name:"Georgiana",surname:"Munteanu",slug:"georgiana-munteanu",fullName:"Georgiana Munteanu"},{id:"318785",title:"Prof.",name:"Ligia",surname:"Petrica",slug:"ligia-petrica",fullName:"Ligia Petrica"}],corrections:null},{id:"72708",title:"Telestroke: A New Paradigm",doi:"10.5772/intechopen.92831",slug:"telestroke-a-new-paradigm",totalDownloads:633,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Stroke is one of the leading causes of death and disability across the world. With the development of new modalities of treatment, including the use of intravenous tissue plasminogen activator and mechanical thrombectomy, clinical outcomes have improved in patients with acute ischemic strokes. However, these interventions are time dependent, and there exists a great disparity between the rural and urban parts of the world in terms of the availability of neurologists and these lifesaving treatment options. Telestroke networks utilize digital technology for two-way, high-resolution video teleconferencing to help abate these disparities by bringing safe, efficient, and cost-effective care to underserved communities in the United States and around the world.",signatures:"Rohan Sharma, Krishna Nalleballe, Nidhi Kapoor, Vasuki Dandu, Karthika Veerapaneni, Sisira Yadala, Madhu Jasti, Suman Siddamreddy, Sanjeeva Onteddu and Aliza Brown",downloadPdfUrl:"/chapter/pdf-download/72708",previewPdfUrl:"/chapter/pdf-preview/72708",authors:[{id:"319857",title:"Ph.D.",name:"Aliza",surname:"Brown",slug:"aliza-brown",fullName:"Aliza Brown"},{id:"319923",title:"Dr.",name:"Krishna",surname:"Nalleballe",slug:"krishna-nalleballe",fullName:"Krishna Nalleballe"},{id:"320987",title:"Dr.",name:"Rohan",surname:"Sharma",slug:"rohan-sharma",fullName:"Rohan Sharma"},{id:"320988",title:"Dr.",name:"Nidhi",surname:"Kapoor",slug:"nidhi-kapoor",fullName:"Nidhi Kapoor"},{id:"320989",title:"Dr.",name:"Karthika",surname:"Veerapaneni",slug:"karthika-veerapaneni",fullName:"Karthika Veerapaneni"},{id:"320990",title:"Dr.",name:"Sisira",surname:"Yadala",slug:"sisira-yadala",fullName:"Sisira Yadala"},{id:"320991",title:"Dr.",name:"Sanjeeva",surname:"Onteddu",slug:"sanjeeva-onteddu",fullName:"Sanjeeva Onteddu"},{id:"320992",title:"Dr.",name:"Vasuki",surname:"Dandu",slug:"vasuki-dandu",fullName:"Vasuki Dandu"},{id:"320994",title:"Dr.",name:"Madhu",surname:"Jasti",slug:"madhu-jasti",fullName:"Madhu Jasti"},{id:"320995",title:"Dr.",name:"Suman",surname:"Siddamreddy",slug:"suman-siddamreddy",fullName:"Suman Siddamreddy"}],corrections:null},{id:"72501",title:"The Treatment of Acute Stroke",doi:"10.5772/intechopen.92763",slug:"the-treatment-of-acute-stroke",totalDownloads:669,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Stroke is a major public health issue, because of its high incidence rate, high case fatality rate, risk of residual physical and neuropsychological disabilities, and direct and indirect costs. Many strokes are preventable and treatable in the acute stage, provided that patients are admitted soon enough. The term stroke covers a wide range of heterogeneous disorders, depending on the severity of the clinical presentation, from transient deficits to severe cases with coma and early death; the underlying mechanism, i.e., cerebral ischemia, parenchymal hemorrhage, subdural hemorrhage, or subarachnoid hemorrhage (SAH); and the cause, i.e., atherosclerosis, cardioembolism, small-vessel occlusion, rare vasculopathies and undetermined causes in cerebral ischemia, or vascular malformations, cerebral amyloid angiopathies, small-vessel diseases, rare vasculopathies and undetermined causes in parenchymal hemorrhages. This chapter will focus only on acute cerebral ischemia and parenchymal hemorrhage. We will cover the general assessment of stroke patients, the complications that can occur in the acute stage, the treatment of acute stroke, and finally a few situations that require specific managements and where evidence-based data are scarce.",signatures:"Irina Alexandrovna Savvina and Anna Olegovna Petrova",downloadPdfUrl:"/chapter/pdf-download/72501",previewPdfUrl:"/chapter/pdf-preview/72501",authors:[{id:"318757",title:"Associate Prof.",name:"Irina Alexandrovna",surname:"Savvina",slug:"irina-alexandrovna-savvina",fullName:"Irina Alexandrovna Savvina"},{id:"319118",title:"Dr.",name:"Anna Olegovna",surname:"Petrova",slug:"anna-olegovna-petrova",fullName:"Anna Olegovna Petrova"}],corrections:null},{id:"70917",title:"Vinpocetine and Ischemic Stroke",doi:"10.5772/intechopen.90551",slug:"vinpocetine-and-ischemic-stroke",totalDownloads:624,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Vinpocetine (VPN) is a synthetic ethyl-ester derivative of the alkaloid apovincamine from Vinca minor leaves. VPN is a selective inhibitor of phosphodiesterase type 1 (PDE1) has potential neurological effects through inhibition of voltage gated sodium channel and reduction of neuronal calcium influx. VPN have noteworthy antioxidant, anti-inflammatory and anti-apoptotic effects with inhibitory effect on glial and astrocyte cells during and following ischemic stroke (IS). VPN is effective as an adjuvant therapy in the management of epilepsy; it reduces seizure frequency by 50% in a dose of 2 mg/kg/day. VPN improves psychomotor performances through modulation of brain monoamine pathway mainly on dopamine and serotonin, which play an integral role in attenuation of depressive symptoms. VPN recover cognitive functions and spatial memory through inhibition of hippocampal and cortical PDE-1with augmentation of cAMP/cGMP ratio, enhancement of cholinergic neurotransmission and inhibition of neuronal inflammatory mediators. Therefore, VPN is an effective agent in the management of ischemic stroke and plays an integral role in the prevention and attenuation of post-stroke epilepsy, depression and cognitive deficit through direct cAMP/cGMP-dependent pathway or indirectly through anti-inflammatory and anti-oxidant effects.",signatures:"Hayder M. Al-kuraishy and Ali I. Al-Gareeb",downloadPdfUrl:"/chapter/pdf-download/70917",previewPdfUrl:"/chapter/pdf-preview/70917",authors:[{id:"306350",title:"Prof.",name:"Hayder M.",surname:"Al-kuraishy",slug:"hayder-m.-al-kuraishy",fullName:"Hayder M. 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Microbial production of energy and/or chemicals from renewable carbohydrate feedstocks, and other organic-based wastes such as wastewater, is an attractive alternative to the current common fossil fuels. Microbial fuel cells (MFCs) are among the fast-growing microbial electrochemical systems (MESs) that offer a promising way for simultaneous wastewater treatment and electricity production [1–3]. Although MFCs showed promising features such as simultaneous wastewater treatment and electricity generation, low sludge production, wide range of substrates and operating at room temperature, the low power output and high cost especially that of the Pt cathode are the main challenges facing their commercialization [4–6].
In MFCs, the exo-electrogenic microorganisms act as biocatalysts in anaerobic oxidation of the organic materials that exist in different wastes, liberating electrons that can be collected by a conductive electrode, i.e., anode, generating an external power-producing circuit, and protons transferred through an electrolyte to a cathode surface. At the cathode, electrons react with protons and oxygen producing water [7–9]. The exo-electrogenic microorganisms that can be used in MFCs can be a prokaryote or eukaryote. Although prokaryotic microorganisms showed promising results in the MFCs and a lot of research has been carried out using them due to their ease in the electron transfer mechanism, yeast, as a eukaryote, attracted researchers’ attention and was extensively studied as a biocatalyst in MFCs [4–6].
Microbial electrochemical systems (MESs) are innovative technology, recently implemented for numerous applications [10–15] such as (i) the simultaneous wastewater treatment and electricity production by MFCs, (ii) bio-hydrogen and/or other chemical production by microbial electrolysis cells (MECs), (iii) water desalination by microbial dialysis cells (MDCs) and (iv) electricity production in sediments or plant MFCs.
In case of MFCs, microorganisms oxidize organic matter, producing electrons that travel through a series of respiratory enzymes in the cell and make energy for the cell in the form of ATP. The electrons are then released to a terminal electron acceptor (TEA) that becomes reduced. Many TEAs such as oxygen, nitrate, sulfate and others readily diffuse into the cell where they accept electrons forming products that can diffuse out of the cell. However, it is now known that some microorganisms can transfer electrons exogenously (i.e., outside the cell) to a TEA such as metal oxides like iron oxide. This is the case of bacteria called exo-electrogens, which can be used to produce electricity in MFC [16].
Figure 1 shows a schematic diagram of an air-cathode MFC that consists of anode and cathode electrodes separated by a separator (if needed). The anode compartment composed of anode and carbon source (organic materials), with or without exogenous mediator. At the cathode, an electron acceptor (O2 from air) reacts with protons that pass from the anode to the cathode through the electrolyte, and the electrons produce water.
A schematic diagram showing the main components of an air-cathode MFC.
Anode material is considered as an important parameter that affects the performance of MFCs. The anode of the MFCs should have high electrical, mechanical and chemical stability, be biocompatible and have high surface area [20]. Carbon materials (conventional and nonconventional) are the best materials that are applied as anode in the MFCs showing high power output. The conventional carbon materials such as carbon paper, carbon cloth, carbon brush and carbon felt, and the nonconventional ones such as carbon nanotubes (CNTs), carbon nanofibers and graphene have been extensively applied in MFCs. Little work have been carried out using noncarbonaceous materials such as stainless steel, gold and titanium [17–19], which showed a lower performance compared to that obtained in case of using carbon.
Cathode material has a significant impact on the overall cell voltage and it should have a high redox potential. Carbon materials such as carbon paper and carbon cloth modified with high active catalyst such as Pt catalyst are among the most common cathodes of the MFCs [20]. Although modifying the carbon cloth and/or carbon paper with Pt significantly decreased the oxygen reduction activation energy and increased the reaction rate, the high cost and scarcity of the Pt are the main challenges facing the application of such cathode. Recently, a wide range of non–Pt-based catalysts were investigated as cathodes in MFCs and showed promising results that gave them a potential to replace Pt catalyst in the near future such as carbon nitrogen alloys and metal carbides [18, 20–29].
As anode is working under anaerobic conditions, while cathode is working under aerobic conditions, the addition of separator with high ionic conductivity and low permeability could improve the MFC performance [30]. A large number of separators have been extensively studied in MFCs such as anion and cation exchange membranes, salt bridge, glass fibers, microfiltration membrane, porous fabrics, and coarse-pore filters [31–37]. It is worth mentioning that some MFCs showed better performance even without using the separator [3].
Microorganisms are generally divided into two main categories, prokaryotes and eukaryotes. Prokaryotes are simpler (no distinct nucleus) and smaller in size (around 1 μ in diameter) compared to eukaryotes that have larger size (5–10 μ or more) and are complex (possessing a distinct nucleus and subcellular organelles such as plastids and mitochondria) [4, 6]. All microorganisms that are capable of exo-cellular electron transfer (exo-electrogens) can be effectively used in MFCs without adding soluble exogenous mediators [4, 22, 30–38].
The possible electron transfer mechanisms in MFCs are shown in Figure 2 and can be summarized in the following:
Direct electron transfer (DET) whether by direct cell attachment or through nanowires (pili)
DET requires a direct contact between the anode surface and the outer membrane of the microorganism. Pili are nanowires that are formed out to connect the microorganism’s membrane to the anode surface. The merits of the pili formation that multiple layers biofilm microorganisms can participate in the electron transfer while bulk ones do not participate in the electron transfer [4, 39–43].
Indirect electron transfer through external or internal mediators
In this type, a redox active material (mediator) is responsible for the electron transfer between the microorganism and the anode surface. This redox can either be exerted naturally by the microorganisms (internal) or can be added from outside (external). These mediators whether internal or external will be responsible for the electron transfer from the bulk microorganisms to the anode surface. The electron transfer in the mediated electron transfer is higher than that in the DET [4, 44–51].
Schematic diagram showing different electron transfer mechanisms in MFCs.
Internal mediators have several advantages over the external ones such as they are cheap as they are exerted by the microorganism and have no toxic effect on the microorganism. Figure 3 shows a schematic diagram of the disadvantages of external mediators and some types of the internal and external mediators.
External and internal mediators in MFCs.
Several external mediators have been investigated in MFCs such as methylene blue (MB), methyl red, methanyl yellow, methyl orange, bromocresol purple, bromocresol green (BcG), romothymol blue, bromophenol blue, Congo red, cresol red, eriochrome black T, murexide, neutral red (NR), yeast extract, etc.
Yeast is a eukaryote with cell compartmentalization and has more complicated architecture compared to prokaryotes. Yeast is considered as an ideal biocatalyst for microbial fuel cell applications as most strains are nonpathogens, can metabolize wide range of substrates, are robust, and are easily handled. The bio-catalytic activity of the yeast would be related to the existence of different natural electron shuttles, mediators, such as azurin, ferredoxin and cytochromes, which could be used by redox enzymes for electron transfer from the yeast cells to the anode surface. This is in addition to the high extent of proteins in the yeast cell membrane, which is an important characteristic of electroactive species [4, 6]. Yeast cells also have a thick (100–200 nm) cell wall constructed of polysaccharides and proteins [43, 52]. Yeast cytochromes are located in the mitochondria, and transmembrane proteins (tPMETs) are located in the cell membrane, which are enclosed by the cell wall. Hence, to obtain an electrochemical response from the yeast cells, it has been assumed that a mediator must traverse the cell wall and interact with the membrane and/or internal redox sites such as NAD+/NADH [41, 42], or that the response originates from the soluble electroactive species exported from the cell [4, 45].
The electron transfer during the metabolism of the organic materials in the yeast cell is shown in Figure 4. Electrons liberate during the oxidation of the substrate into pyruvate in the glycolysis process, which takes place in the cytosol of the cell. These electrons received by the NAD+ forming NADH, which is recycled through its oxidation by the liberation of the electrons to the anode surface whether directly through the tPMETs or through the mediator to form NAD+ again — cycle of NADH to NAD+. In mitochondria, oxidation of pyruvate into organic acids is associated with the liberation of the electrons that are received by the NAD+ forming NADH, which in turn are oxidized by releasing electrons to the mediator to form the NAD+ again. The reduced form of the mediator lost electrons to the anode surface to complete the cycle [38, 46].
Schematic diagram shows the possible electrons’ origin and transfer of yeast cells to MFC.
Several yeast strains have been studied as biocatalysts in MFC with or without external mediator such as
Baker’s yeast (
Mediator-less MFCs are those that operate without the addition of any external mediator. Sayed et al. [6] studied the mechanism by which
The OCV and the electrode potentials vs. time of the MFC using carbon paper (CP) as the anode material. (a) Without filtration and (b) with filtration [
The i-V and i-p curves measured before and after the replacements of the anolyte solution [
The same conclusions for the direct electron transfer and no role of the mediator in the electron transfer of the
In another study, the performance of air-cathode MFC using
Although
Anode modification [42].
Immobilization of the yeast cells on carbon nanotube [43].
Yeast surface display of dehydrogenases [52].
The electrical conductivity of the anode plays an important role in the performance of the MFCs. The effect of the modification of carbon paper with thin layer of different transition metals, i.e., cobalt and gold, on the performance of air-cathode MFCs using
The i-t measurements at 0.2 V for a mediator-less yeast-based MFC using nonmodified (NME) carbon paper and Co, 30 nm, modified one [
Ref. | Max. power | Anode chamber (WV) | Separator | Cathode | Anode material | Carbon source | MFC type | ||
---|---|---|---|---|---|---|---|---|---|
mW/m2 | mW/m3 | Electron acceptor | Electrode | ||||||
6 | 3. | 17 | 84 mL (70 mL WV) | NRE 212 | O2 (air) | Pt/C over carbon paper | Carbon paper | Glucose | Air cathode |
42 | 12.9 | (70 mL WV) | Nafion 117 | O2 (air) | Pt/C over carbon paper | Carbon paper | Glucose | Air cathode | |
20.2 | Co sputtered carbon paper | ||||||||
2 | Au-sputtered carbon paper | ||||||||
38 | 25.51 | 350 mL (320 mL WV) | Nafion 117 | O2 (air) | Graphite plate | Graphite plate | Synthetic wastewater | Air cathode | |
52 | 2.7 | 8–10 mL (5 mL WV) | Nafion 117 | O2 (air) | A graphite plate | A graphite plate/MWCNT | Lactose | Dual chamber | |
2.8 | d-glucose | ||||||||
33 | lactose | ||||||||
46 | 40 | 500 mL | Nafion 117 | Potassium ferricyanide | Reticulated Vitreous carbon | Reticulated Vitreous carbon | Glucose | Dual chamber | |
47 | 28 | 850 mL (760 mL WV) | Nafion 117 | - | Graphite plates | Graphite plates | Glucose | Dual chamber |
Summary of the studies done on the mediator-less
The electron transfer of
The performance of
Several studies have been carried out to enhance the electron transfer through the addition of an external mediator. A candidate external mediator must satisfy several requirements such as being electrochemically active, fast release of electrons on the electrode surface, biocompatible to the microorganisms, soluble and chemically stable in the anolyte media, easily penetrate the cell membrane, and has a prober redox potential that is sufficiently positive to provide fast electron transfer from microorganisms to the anode while not too strong to avoid a big loss of potential [2, 14, 16]. Different mediators such as MB, NR, thionine, yeast extract, and others enhanced the electron transfer in
Ref. | Max. power | Mediator | Anode chamber (WV) | Separator | Cathode | Anode material | Carbon source | MFC type | ||
---|---|---|---|---|---|---|---|---|---|---|
mW/m2 | mW/m3 | Electron acceptor | Electrode | |||||||
59 | 22 | 850 × 103 | 2-hydroxy-1,4- naphthoquinone | WV, 7.5 cm3 | Gore-Tex, 30 μm | K3[Fe(CN)6] | Carbon rods | Carbon rods and carbon fiber bundles | Glucose | Dual-chamber |
50 | 80 | MB | (70 mL WV) | Nafion 117 | O2 (air) | Pt/C over carbon paper | Carbon paper | Glucose | Air cathode | |
148 | Co-sputtered carbon paper | |||||||||
120 | Au-sputtered carbon paper | |||||||||
45 | 150 | MB | 10 mL | Nafion | Potassium ferricyanide | Carbon felt | Carbon felt | Glucose | Dual chamber | |
46 | 146.71 ± 7.7 | MB | 500 mL | Nafion 117 | Potassium ferricyanide | Reticulated vitreous carbon | Reticulated vitreous carbon | Glucose | Dual chamber | |
52 | 39 | MB (0.1 M) | 25 mL | O2 (air) | Pt/C over carbon cloth | Graphite plate | d-xylose | Air cathode | ||
31 | d-glucose | |||||||||
32 | l-arabinose | |||||||||
22 | d-cellobiose | |||||||||
14 | d-galactose | |||||||||
44 | 400 | MB | 32 mL | Nafion 115 | Reticulated vitreous carbon | Reticulated vitreous carbon | Dextrose | Dual chamber | ||
80 | NR | |||||||||
500 | MB &NR | |||||||||
45 | 1500 | MB | 10 mL | Nafion | Potassium ferricyanide | Carbon felt, | Carbon felt | Glucose | Dual chamber MFC | |
46 | 145 | MB | 500 mL | Nafion 117 | Potassium ferricyanide | Reticulated vitreous carbon, | Reticulated vitreous carbon | Glucose | Dual chamber MFC | |
47 | 850 mL (760 mL WV) | Nafion 117 | - | Graphite plates | Graphite plates | Dual chamber | ||||
51 | 36 | 36 | YE | 70 mL WV | Nafion 117 | Pt/C over carbon paper | Carbon paper | Glucose | Air cathode | |
70 | Au-plated carbon paper |
Summary of the studies done on the mediated
Using copper electrodes and a sulfonated polyether ether ketone (SPEEK) as proton exchange membrane, Permana et al. [48] studied the performance of dual chamber
The effect of the anode modification on the performance of the mediated
The i-V and i-p curves of the yeast-based MFC with 0.1 mM MB using nonmodified carbon paper, and Co30 and Au30 as anodes [
MB was also used in air-cathode MFC that used modified
Compared to MB, NR showed promising results in a two-compartment
Thionine is another mediator that worked effectively in
Yeast extract, which is one of the main components of the biological cultivating media, was effectively used as a mediator in
The effect of the yeast extract (YE) addition to
The effect of the yeast extract (YE) addition on
Ref. | Max. power | Electron transfer mechanism | Anode chamber (WV) | Separator | Cathode | Anode material | Carbon source | MFC type | |||
---|---|---|---|---|---|---|---|---|---|---|---|
mW/m2 | mW/m3 | Mediator less | Mediator | Electron acceptor | Electrode | ||||||
53 | 60 | Mediator less | 100 mL | Salt bridge | Potassium ferricyanide | Graphite rods, | Graphite rods | Fructose, | Dual chamber | ||
180 | Mediator less | YPfru | |||||||||
185 | MB | Fructose | |||||||||
54 | 640 | MB | 13 mL | Nafion 117 | Potassium ferricyanide | Carbon felt | Carbon felt | YPfru | Two chamber | ||
55 | 36 | Mediator less | 13 mL | Nafion 117 | Potassium ferricyanide | Carbon felt | Carbon felt NME | Fructose | Dual chamber | ||
720 | Ni-nanomodified carbon felts galvanostatic pulse deposition (GME) | ||||||||||
56 | 390 | Mediator less | 13 mL | Nafion 117 | Potassium ferricyanide | Carbon felt | Ni-nanomodified carbon felts potentiostatic pulse technique (PME) | Fructose | Dual chamber | ||
83 | NiFe(g.) | ||||||||||
93 | NiFe(p.) | ||||||||||
155 | NiFeP(g.) |
Summary of the studies done on the
The effect of the mediator type, i.e., bromocresol green (BcG), bromocresol purple, romothymol blue, bromophenol blue, Congo red, cresol red, eosin, eriochrome black T, methyl red, methanyl yellow, MB, methyl orange, murexide and NR on the performance of
The performance of
The catalytic activity of
The electron transfer pathways between the cytosolic redox enzymes of
The biocatalytic activity of the nonconventional yeast
Kaneshiro et al. [59] have investigated the catalytic activity of six different yeast strains in a dual chamber MFC with glucose as the substrate including
A novel yeast-based MFC stack that composed of 4 units of total capacity of 1840 mL was designed and operated using glucose as the carbon source, graphite plates as the electrodes and Nafion 117 as the separator [63]. The stack was operated under continuous mode with a hydraulic retention time of 6.7 h. Single cell and cells connected in parallel and/or series connections were investigated to achieve the best operating conditions. A maximum current of 6447 mA/m2 and maximum power of 2003 mW/m2 were obtained. A Columbic efficiency of 22% was obtained in the parallel connection. Figure 11 showed that the stack could be operated for more than 3 days with stable voltage and power output. The results obtained in this study proved the potential of yeast for scaling up. Table 4 showed summary of the materials and operating conditions used in the stack.
Close circuit voltage and produced power from staked MFC at parallel mode with 1 KΩ resistances in external circuit for 148 h [
MFC material | Plexiglas |
MFC type | MFCs stack composed of 4 anodes and 3 cathodes compartments |
Anode | Graphite plates, size of 40 × 60 × 1.2 mm |
Cathode | Graphite plates, size of 40 × 60 × 1.2 mm |
Membrane | Nafion 117.32 cm2 |
Catholyte | Potassium permanganate (400 μmol/L) |
Anode media | Yeast ( |
Fuel | Glucose, 30 g/L |
Anode chamber (volume) | 460 mL |
Working volume | 350 mL |
Current collector | Copper wire |
Mode | Continuous up flow mode |
HRT | 6.7 h |
A summary of the stack materials and operating conditions.
Yeast is successfully used as a biocatalyst in MFC, which exhibits different electron transfer mechanisms according to its strains. In
Chronic liver disease is a major health problem worldwide. This situation is generated by a wide range of chronic liver injuries such as chronic viral hepatitis, chronic alcohol abuse, non-alcoholic fatty liver disease, autoimmune hepatitis, primary biliary cirrhosis, and other less frequent causes. Regardless of the liver disease etiology, a common pathway of fibrosis is set up, which progresses and leads to liver cirrhosis that may be complicated by portal hypertension, liver failure, and hepatocellular carcinoma.
The evaluation of patients with chronic liver disease must be as simple as possible, cost efficient, and easily repeatable. While the liver biopsy is still considered the gold standard for liver fibrosis evaluation, due to its shortcomings (invasiveness, potential complications, inter-/intra-observer variability, sampling error) [1, 2, 3] scientific and practical interest has focused on the development of noninvasive techniques for the diagnosis of liver fibrosis.
Elastography can be used to assess liver fibrosis noninvasively. It measures the tissue behavior when mechanical stress is applied, either using ultrasound (ultrasound-based elastography) or magnetic resonance (magnetic resonance elastography).
Ultrasound elastography is perhaps the most important breakthrough in the evolution of ultrasound in the last 20 years. The basic idea behind liver elastography is that the elasticity of the tissue examined offers information on liver health. A stiffer liver tissue usually indicates the presence of chronic liver disease.
Mainly, most liver ultrasound elastography techniques are based on the principle of measuring the speed of the shear wave that propagates through the liver which is influenced by the stiffness of the tissue. The speed of the shear wave is proportional to the tissue stiffness. Basically, the stiffer the liver, the faster the shear wave will propagate through the liver.
The value of ultrasound-based elastography for staging chronic liver disease has been established by numerous studies [4, 5, 6, 7]. Moreover, its value for evaluating and predicting chronic liver disease complications (portal hypertension, hepatocellular carcinoma) has been also proven in different studies [8, 9, 10].
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) have issued guidelines and recommendations on the clinical use of ultrasound-based elastography and describe in detail their basic principles [11, 12, 13].
This chapter focuses on the basic principles of elastography, which is an important aspect for every clinician or practitioner who is performing or learning liver elastography. Moreover, clinical features such as the examination techniques of different liver elastography methods and the factors that influence the liver elastography results are described and discussed.
Elastography assesses tissue elasticity, which is the tendency of tissue to resist deformation with an applied force or to resume its original form after removal of the force. Elastography can be considered a type of remote palpation that allows the measurement and display of the biomechanical properties in a tissue that acts against the shear deformation. Shear deformation is generated by applying a force either to a single location or broadly across the body surface. A force can be applied by vibrating the body surface that produces a natural internal physiological motion or using the ultrasound transducer to create focused acoustic radiation force at controlled depths [13, 14].
All ultrasound-based elastography methods use ultrasound to measure the tissue shear deformations resulting from an applied force. The type of force applied can be quasi-static or dynamic. Quasi-static forces do not allow the acquiring of images that are quantitative for tissue properties. Dynamic forces allow the quantification of the tissue properties. They include impulses that can be produced mechanically at the body surface or by acoustic radiation force impulse at controlled depths.
According to the EFSUMB guidelines [11], elastography techniques can be classified according to how the displacement data are shown. Three options are available as follows:
Display of displacement without further processing. This type of displacement is used in acoustic radiation force impulse (ARFI) imaging, which allows a quantitative measurement (units of μm), and the image displayed is scaled between bright (soft tissue) and dark (hard tissue). This technique is not used for liver elastography measurements.
Display of tissue strain or strain rate, which is calculated from the spatial gradient of displacement or velocity. This type of displacement works according to Hooke’s law, which states that E = σ/ε, where stress is the applied force per unit area and strain is the change in length of the tissue divided by its original length. If the stress (not known in strain module) is assumed to be the same for all image locations, an image of strain can be thought of as an inverse relative to Young’s modulus map. Strain is a quantitative measurement (%) and image brightness is typically scaled between bright (soft) and dark (hard).
Display of shear wave speed, which is calculated by measuring the arrival time of a shear wave at different locations in the tissue. This is possible only when the force is applied dynamically. Shear wave speed may be displayed in units of m/s. Alternatively, it may be converted to either Young’s modulus E or shear modulus G, which are expressed in units of kilopascal (kPa). These elastography techniques are called shear wave elastography (SWE) and include transient elastography (TE), point shear wave elastography (pSWE), and multidimensional shear wave elastography (2D-SWE and 3D-SWE).
For liver applications, elastography methods that display the shear wave speed are the most commonly used in practice, followed by strain and displacement imaging (for liver lesions), which are less frequently used. The elastography methods integrated into clinical practice for the liver are described in Table 1.
Strain/displacement techniques | Strain elastography |
---|---|
Shear wave elastography techniques | Transient elastography Point shear wave elastography Multidimensional shear wave elastography (2D-SWE and 3D-SWE) |
Elastography methods used for the liver.
Strain elastography is the most widely implemented elastography method on commercial systems; however, it is the least used technique for liver applications. The force used in strain elastography is either produced with the ultrasound probe or due to the internal physiological motion. The axial displacement images are calculated using radiofrequency echo correlation tracking or Doppler processing, which converts the axial displacement images into strain images [14, 15]. Excitation with manual pressure measures elasticity in superficial tissues. A disadvantage of this excitation method is that manual stress is not efficiently transmitted to deeper tissues. Excitation from natural physiologic motion, such as cardiac pulsation and respiration, is another mechanism of generating tissue stress. Deep organs, such as the liver or the kidney, can be assessed with this method [14, 15].
Strain elastography is a semi-quantitative method for tissue elastic property analysis, which has not demonstrated high accuracy for liver applications.
TE has been designed only for liver elasticity measurement. It uses an automated piston, which is also a disk-shaped ultrasound transducer, that applies a low-frequency (50 Hz) mechanical push to the body surface with controlled applied force [16]. A transient shear wave is created that propagates into the tissue. The shear wave propagation velocity is proportional to tissue stiffness, which increases with fibrosis [17]. TE measures tissue stiffness over a 1 cm diameter and 4 cm length region of tissue, which is 100 times larger than those evaluated with liver biopsy. The transient shear wave deformation is propagated at a constant speed, for 4 cm, and measured by a straight line automatically displayed in a displacement M-mode shown in the result (Figure 1) [11]. If the pulse is not transmitted and recorded successfully, the software does not provide a reading. Transient elastography is marketed under the trade name FibroScan®. Stiffness values are presented in kPa. Controlled attenuation parameter (CAP) is a technology that quantifies liver steatosis by measuring the energy loss as the sound wave passes through the medium. Total attenuation at 3.5 MHz is expressed in dB/m, and steatosis is estimated using the same radiofrequency data as elastography, in the same location that stiffness is measured [18]. A schematic representation of the basic principle of TE is presented in Figure 2.
Transient elastography (TE) and controlled attenuation parameter (CAP) with the Fibroscan® device. Sample display showing the echo M-scan on the left, single-line amplitude A-scan in the middle, and the displacement M-mode after a vibration-controlled impulse push on the surface on the right. Numeric values for CAP are displayed on the left side (db/m) and for TE on the right side (kPa).
Schematic representation of the principle of transient elastography. A mechanically induced impulse at the tissue surface with an A-mode transducer produces an axial shear wave pulse. The measured shear wave speed is proportional to the fibrosis.
Applying an ARFI at a controlled depth within a tissue generates a shear wave that propagates away from the pushing beam’s axis and focal point (Figure 3). Its average speed of propagation from the focal point positioned on one lateral boundary of a measurement region of interest (ROI) to another on the opposite lateral boundary of the ROI may be measured by detecting its time of arrival at that point, relative to that of the ARFI [14]. Ultrasound imaging is used to guide placement of the ROI; however, no elasticity images are produced (Figure 4). First introduced by Siemens, pSWE is available on different commercial systems from different vendors (e.g., Philips, Samsung, Hitachi, Esaote). The results can be expressed either in m/s or in kPa.
Schematic representation of the principle of point shear wave elastography (pSWE). An ultrasound-induced focused radiation force impulse is produced at a controlled depth generating a lateral shear wave in a region of interest (ROI). The measured shear wave speed represents tissue stiffness.
Point shear wave elastography (pSWE) implemented on virtual touch quantification (VTQ) from Siemens (4a), ElastPQ from Philips (4b), and S-Shearwave from Samsung (4c). A region of interest (ROI) is placed 1–2 cm below the liver capsule for liver stiffness assessment.
In this technique, acoustic radiation force impulse is used to create tissue displacement at multiple points (Figure 5). By placing the ARFI focus at multiple sequential locations and, at each, detecting the shear wave speed and arrival time, quantitative images of the shear wave speed can be produced [13, 14]. A large quantitative color-coded elasticity map (elastogram) is presented, which can be overlaid on the B-mode image or displayed separately, side by side (Figure 6). In addition to the visual impression of the elastogram against a color scale, a quantitative measurement can be obtained by placing smaller ROIs (measurement boxes) inside the elastogram. The result of one measurement is displayed usually as the mean and standard deviation either in m/s as shear wave propagation speed or in Young’s modulus in kPa (Figure 6).
Schematic representation of the principle of 2D shear wave elastography (2D-SWE). Multiple ultrasound-induced ARFI lines create transverse shear waves that produce quantitative images of their speed.
2D shear wave elastography (2D-SWE) implemented by SuperSonic imagine (6a) and General Electric (6b). The elastogram, which is superimposed on the B-mode image, is placed 1–2 cm below the liver capsule. A circular ROI is placed inside the elastogram for tissue stiffness measurements. A color-coded scaled quality map (6b left image) can be available for guiding the measurement placement. The result is expressed in kPa and m/s.
This technique is available on multiple ultrasound systems including SuperSonic Imagine, GE Healthcare, Canon, Philips, Siemens, Mindray.
All elastography methods follow an evaluation technique that enables a good approach toward the liver parenchyma. The patients will be positioned in a supine position with their right arm in maximal abduction in order to widen the intercostal spaces thus offering a better view of the right liver lobe. The measurements from the left liver lobe are not recommended due to higher values and significant variability. A minimum training is required that one may perform liver stiffness measurements, and the acquisition itself will take usually less than 5 minutes. Patients should be in fasting condition (for at least 3 hours) and rest for a minimum of 10 minutes prior to the evaluation. When scanning for the ultrasound section, large vessels and artifacts should be avoided in both A-mode (TE) and B-mode image (pSWE and 2D-SWE) as well as deep inspiratory movements [12, 19, 20]. A dedicated ultrasound gel is used as an interface between the probe and the patient’s skin.
For the TE technique, the transducer is placed between the 9th and 11th right intercostal spaces in order to penetrate at least 4 cm thickness of liver parenchyma. The device offers an A-mode image that will assist the examiner to choose the best section into the liver. TE probe will transmit a mechanical impulse to the liver through a special piston (cylinder-shaped) that will apply a controlled force and thus will generate an elastic share wave. The probe is able to detect the velocity of the shear wave propagation into the liver reflecting the liver stiffness. Measurements are expressed in kilopascals with a range between 1.5 and 75 kPa. If the system detects errors in the acquisition process, it will automatically discard the measurement. At the end of the examination, the median of 10 measurements is displayed as well with the quality parameters (IQR, SR) [12, 19, 20]. For more accurate evaluations, manufacturers provided M, XL, and S probes that are recommended in order to overcome the confounding factor of obesity and thoracic circumference variations [20]. Studies demonstrated that at least 100 measurements are needed for training for one to achieve reliable results and 500 for expert level [21, 22]. It is also a reproducible method with an excellent intra- and interobserver agreement [23].
pSWE is a different method integrated into an ultrasound machine that evaluates liver fibrosis by noninvasive means. The acoustic “push” of the probe will generate share waves that will be transferred to liver parenchyma. Being an ultrasound-assisted method, ultrasound experience plays an important role in performing reliably the technique; even so, the reproducibility of the method is excellent [20, 24]. Using this technique, ascites is not a barrier for liver stiffness measurement. The probe, as in TE, should be placed in the right intercostal spaces in order to depict full liver tissue, without large vessels or other structures. Following, ROI should be set at depths between 1 and 6 cm beneath the liver capsule, ideally at 1–2 cm or 2–3 cm [25]. Special attention should be given to breathing oscillations and to cardiac cycles, patients should hold their breath for a few seconds during the acquisition, and the operator should choose a fair distance from the heart when selecting the ultrasound section and the ROI. However, no elastogram is provided by pSWE. Ten valid measurements are recommended and the result (the median of the measurements) is shown in m/s or kPa. Quality parameters such as IQR/M and standard deviation (SD) are used to optimize the performance of the method [11, 26].
As in the other methods, 2D-SWE uses a section through the right live lobe free of large vessels and other structures that need a steady image in order to make the acquisition. Patients should hold their breath for 4 to 5 seconds or even longer so that the high frame rate should record the tissue displacement of the share wave propagation into the color-coded box. Tissue displacement by the share waves is displayed by a color-coded map; thus, the technique offers both quantitative and qualitative assessments of the tissue stiffness. The colored box should be positioned at least 1–2 cm below the liver capsule but not deeper than 7 cm into the liver parenchyma [27]. The ROI will express the results as the mean value and standard deviation in kPa or in m/s. The biggest advantage that this method is offering is the fact that it evaluates a larger area of the liver parenchyma (up to 10 cm2). Usually, stiffer tissue will be depicted in red and softer tissue in blue. The operator should obtain as many elastogram loops to which in post-processing will select the ROI for LSM acquisition on the most homogeneous elastogram [26]. A minimum ultrasound training (>300) is necessary to be able to achieve good elastograms [28]. Recommended quality criteria are the IQR/M and measurement depth < 5.6 cm as quality technical [11, 29]. The median of at least three measurements should be used when performing LSM, but the examiner can choose between 3 and 15 measurements [30, 31, 32]. Even though it is a reproducible method [33], the inter- and intra-observer agreement in patients might be slightly inferior to pSWE [34, 35].
SE, offered by the Hitachi system (HI-RTE) [36], uses a regular ultrasound transducer that has embedded the SE module in it. It needs a good echoic window for the SE system to work properly; thus, a good ultrasound section is mandatory. The probe will generate echo signals under mild tissue compression and by this will produce a real-time elasticity image by overlapping a colored map on the B-mode image [37, 38]. It has all the advantages of the B-mode imaging and the examination approach will be as for the rest of the techniques with the patient in dorsal decubitus with the right arm in maximal abduction and a short breath hold when the acquisition is made, ascites and high BMI not being a contraindication for this method. However, the method is mainly used as a qualitative evaluation. Results will be displayed as blue for stiffer tissue and in red for soft tissue. Several methods have been developed in order to quantitatively assess tissue stiffness such as Elastic Ratio, Elastic Index, Elasticity Score, and Liver Fibrosis Index but without a proven consistency. The examiner must have ultrasound skills and special training is necessary for ROI setting and probe adjustment for homogeneous compression/relaxation index [20, 38]. Even though experience plays a role in SE, studies [39, 40] demonstrated that SE has a good and very good intra- and inter-observer variability and is a reproducible method.
When measuring liver stiffness with ultrasound-based elastography, we have to acknowledge some factors that can influence the results. Some of the factors are related to a physiological state, and some are linked to pathology. Hepatic inflammation with a threshold of ASAT and/or ALAT >5 times the normal value, hepatic congestion, cholestasis, acute hepatitis, and infiltrative liver disease are known to increase liver stiffness [20]. It is also known that food intake and physical activity can falsely increase LSM; thus, a minimum of 2 hours fasting and resting for 10 minutes before the examination are recommended [20, 41, 42]. Confounding factors of the SWE according to their method are depicted in Figure 7.
Associated confounding factors in ultrasound-based liver elastography.
Besides BMI, TE results can be influenced by increased transaminase, cholestasis, hepatic congestion, infiltrative liver disease, food intake, and heavy alcohol consumption. Several limitations of TE that are worth mentioning are the contraindication of LSM in patients with ascites and the lack of B-mode imaging [26, 46].
Ultrasound-based liver elastography confounding factors are described in Figure 7.
Ultrasound elastography comprises a set of techniques that noninvasively measure tissue stiffness. In this chapter, we have provided a brief introduction into the physical concepts of liver elastography and discussed several aspects important for clinical practice. In conclusion, elastography techniques that measure the shear wave speed are the most appropriate for liver applications. The liver elastography examination technique is standardized and co-founding factors need to be taken into consideration before performing liver stiffness measurements.
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In this chapter, the current status of ergonomics in laparoscopy, laparoendoscopic single‐site surgery (LESS), and robot‐assisted surgery will be reviewed. Ergonomic guidelines for laparoscopic surgical practice and methods for ergonomic assessment in surgery will be described. Results will be based on the scientific literature and our experience. Results showed that the surgeon's posture during laparoscopic surgery is mainly affected by the static body postures, the height of the operating table, the design of the surgical instruments, the position of the main screen, and the use of foot pedals. Ergonomics during the laparoscopic surgical practice is related to the level of experience. Better ergonomic conditions entail an improvement in task performance. Laparoscopic instruments with axial handle lead to a more ergonomic posture for the wrist compared to a ring handle. LESS is physically more demanding than conventional and hybrid approaches, requiring greater level of muscular activity in the back and arm muscles, but better wrist position compared with traditional laparoscopy. Physical and cognitive ergonomics with robotic assistance were significantly less challenging when compared to conventional laparoscopic surgery.",book:{id:"5390",slug:"laparoscopic-surgery",title:"Laparoscopic Surgery",fullTitle:"Laparoscopic Surgery"},signatures:"Francisco M. Sánchez-Margallo and Juan A. Sánchez-Margallo",authors:[{id:"14715",title:"Prof.",name:"Francisco M.",middleName:null,surname:"Sánchez-Margallo",slug:"francisco-m.-sanchez-margallo",fullName:"Francisco M. Sánchez-Margallo"},{id:"188738",title:"Dr.",name:"Juan A.",middleName:null,surname:"Sánchez Margallo",slug:"juan-a.-sanchez-margallo",fullName:"Juan A. Sánchez Margallo"},{id:"188740",title:"Dr.",name:"Javier",middleName:null,surname:"Hermoso De Mendoza",slug:"javier-hermoso-de-mendoza",fullName:"Javier Hermoso De Mendoza"}]},{id:"59483",doi:"10.5772/intechopen.74117",title:"Handheld Devices for Laparoscopic Surgery",slug:"handheld-devices-for-laparoscopic-surgery",totalDownloads:1280,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulating instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative functionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics.",book:{id:"6360",slug:"new-horizons-in-laparoscopic-surgery",title:"New Horizons in Laparoscopic Surgery",fullTitle:"New Horizons in Laparoscopic Surgery"},signatures:"Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo and Amir\nSzold",authors:[{id:"14715",title:"Prof.",name:"Francisco M.",middleName:null,surname:"Sánchez-Margallo",slug:"francisco-m.-sanchez-margallo",fullName:"Francisco M. Sánchez-Margallo"},{id:"188738",title:"Dr.",name:"Juan A.",middleName:null,surname:"Sánchez Margallo",slug:"juan-a.-sanchez-margallo",fullName:"Juan A. Sánchez Margallo"},{id:"214776",title:"Dr.",name:"Amir",middleName:null,surname:"Szold",slug:"amir-szold",fullName:"Amir Szold"}]},{id:"21003",doi:"10.5772/18033",title:"Risks Associated with Laparoscopic Surgery",slug:"risks-associated-with-laparoscopic-surgery",totalDownloads:16659,totalCrossrefCites:4,totalDimensionsCites:6,abstract:null,book:{id:"1041",slug:"advanced-laparoscopy",title:"Advanced Laparoscopy",fullTitle:"Advanced Laparoscopy"},signatures:"Tülün Öztürk",authors:[{id:"30184",title:"Prof.",name:"Tulun",middleName:null,surname:"Ozturk",slug:"tulun-ozturk",fullName:"Tulun Ozturk"}]},{id:"21013",doi:"10.5772/20516",title:"Port-Site Metastasis Following Laparoscopic Surgery",slug:"port-site-metastasis-following-laparoscopic-surgery",totalDownloads:3946,totalCrossrefCites:1,totalDimensionsCites:5,abstract:null,book:{id:"1041",slug:"advanced-laparoscopy",title:"Advanced Laparoscopy",fullTitle:"Advanced Laparoscopy"},signatures:"Terence C. Chua, Tristan D. Yan, David L. Morris and Paul H. Sugarbaker",authors:[{id:"39316",title:"Dr.",name:"Paul",middleName:null,surname:"Sugarbaker",slug:"paul-sugarbaker",fullName:"Paul Sugarbaker"},{id:"63672",title:"Prof.",name:"David",middleName:"Lawson",surname:"Morris",slug:"david-morris",fullName:"David Morris"},{id:"97099",title:"Dr.",name:"Terence",middleName:null,surname:"Chua",slug:"terence-chua",fullName:"Terence Chua"},{id:"97100",title:"Dr.",name:"Tristan",middleName:null,surname:"Yan",slug:"tristan-yan",fullName:"Tristan Yan"}]},{id:"46621",doi:"10.5772/58533",title:"History of the Inguinal Hernia Repair",slug:"history-of-the-inguinal-hernia-repair",totalDownloads:4886,totalCrossrefCites:3,totalDimensionsCites:4,abstract:null,book:{id:"3818",slug:"inguinal-hernia",title:"Inguinal Hernia",fullTitle:"Inguinal Hernia"},signatures:"Andrzej L. Komorowski",authors:[{id:"169228",title:"Dr.",name:"Andrzej",middleName:null,surname:"Komorowski",slug:"andrzej-komorowski",fullName:"Andrzej Komorowski"}]}],mostDownloadedChaptersLast30Days:[{id:"53643",title:"The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity",slug:"the-evolution-of-minimally-invasive-techniques-in-restoration-of-colonic-continuity",totalDownloads:2174,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Restoration of bowel continuity after Hartmann’s procedure is considered technically challenging and is associated with high morbidity and mortality. This is the main reason why restoration of intestinal continuity is often not attempted. Over the past decade, considerable international experience has gained on this topic with new minimally invasive techniques being developed. This review details the evolution of minimally invasive techniques in restoration of colonic continuity after Hartmann’s procedure. A comprehensive search of PubMed and Embase was done. Different restoration modalities were included. Eight studies, from six different countries, in which multiport laparoscopic restoration of continuity was compared to conventional open restoration of bowel continuity, were included. In the total of 254 patients, continuity was restored laparoscopically compared with 255 patients in which continuity was performed in open fashion. Restoration of bowel continuity via trephine access was also reported; three studies including 37 patients were included in this review. Single-port restoration of bowel continuity after Hartmann’s procedure is a natural evolution of multiport laparoscopy and trephine access. Six studies reporting on single-port reversal of Hartmann’s procedure were included with a total of 75 patients. Single-port access in combination with a transanal approach has also been reported; however, data are extremely limited as there is only one study in the published literature. Success of restoration of bowel continuity with less morbidity and mortality has been demonstrated throughout the evolution of the different surgical techniques. In this review advantages of different approaches for restoration of bowel continuity after Hartmann’s procedure are discussed. Furthermore, surgical techniques are described, pictorial guides are added for some techniques, and flowcharts are given for easy use during clinical decision-making.",book:{id:"5390",slug:"laparoscopic-surgery",title:"Laparoscopic Surgery",fullTitle:"Laparoscopic Surgery"},signatures:"Stefan H.E.M. Clermonts, Laurents P.S. Stassen and David D.E.\nZimmerman",authors:[{id:"187504",title:"Dr.",name:"David",middleName:null,surname:"Zimmerman",slug:"david-zimmerman",fullName:"David Zimmerman"},{id:"194463",title:"Dr.",name:"Stefan",middleName:null,surname:"Clermonts",slug:"stefan-clermonts",fullName:"Stefan Clermonts"},{id:"194464",title:"Prof.",name:"Laurents",middleName:null,surname:"Stassen",slug:"laurents-stassen",fullName:"Laurents Stassen"}]},{id:"60143",title:"Total Laparoscopic Hysterectomy",slug:"total-laparoscopic-hysterectomy",totalDownloads:1295,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The applications of minimally invasive pelvic surgery continue to grow. This chapter focuses primarily on the preoperative evaluation, surgical technique and post-operative care of total laparoscopic hysterectomy. Since laparoscopic assisted vaginal hysterectomy is a slight modification of the procedure it is not being discussed separately. The major physiologic obstacles to safe laparoscopy include pregnancy, increased intra cranial pressure, abnormalities of cardiac output and gaseous exchange in the lung, chronic liver diseases and coagulation disorders. In a redo surgery there may be problems of laparoscopic port entry.",book:{id:"6360",slug:"new-horizons-in-laparoscopic-surgery",title:"New Horizons in Laparoscopic Surgery",fullTitle:"New Horizons in Laparoscopic Surgery"},signatures:"Nidhi Sharma and Vanusha Selvin",authors:[{id:"220214",title:"Prof.",name:"Nidhi",middleName:null,surname:"Sharma",slug:"nidhi-sharma",fullName:"Nidhi Sharma"},{id:"225521",title:"Dr.",name:"Vanusha",middleName:null,surname:"Selvin",slug:"vanusha-selvin",fullName:"Vanusha Selvin"}]},{id:"56017",title:"Surgical Anatomy of the Groin",slug:"surgical-anatomy-of-the-groin",totalDownloads:2541,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Most surgeons are familiar with the inguinal anatomy from the anterior perspective. With the advent of laparoscopic techniques for inguinal hernia repair, it became important to understand the inguinal anatomy from the preperitoneal view for a posterior approach to the inguinal region. The purpose of this chapter is to describe the anatomic landmarks of the groin region.",book:{id:"5928",slug:"hernia",title:"Hernia",fullTitle:"Hernia"},signatures:"Kamer Tomaoglu",authors:[{id:"201271",title:"M.D.",name:"Kamer",middleName:null,surname:"Tomaoglu",slug:"kamer-tomaoglu",fullName:"Kamer Tomaoglu"}]},{id:"21003",title:"Risks Associated with Laparoscopic Surgery",slug:"risks-associated-with-laparoscopic-surgery",totalDownloads:16659,totalCrossrefCites:4,totalDimensionsCites:6,abstract:null,book:{id:"1041",slug:"advanced-laparoscopy",title:"Advanced Laparoscopy",fullTitle:"Advanced Laparoscopy"},signatures:"Tülün Öztürk",authors:[{id:"30184",title:"Prof.",name:"Tulun",middleName:null,surname:"Ozturk",slug:"tulun-ozturk",fullName:"Tulun Ozturk"}]},{id:"56039",title:"Congenital Diaphragmatic Hernia",slug:"congenital-diaphragmatic-hernia",totalDownloads:2578,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Despite advances in neonatal and surgical care, the management of congenital diaphragmatic hernia (CDH) remains challenging with no definitive standard treatment guidelines. Several centers report mortality rates as low as 20%, but if extracorporeal membrane oxygenation (ECMO) support is required, the mortality rate rises to 50%. The disease severity is related to the degree of pulmonary hypoplasia and pulmonary hypertension that occurs with CDH. Both conditions decrease the infant’s ability to ventilate and oxygenate adequately at delivery. These physiologic conditions that impair gas exchange are the important determinants of morbidity and mortality in CDH infants. Presently, delivery of infants with CDH is recommended close to term gestation. The focus of care includes gentle ventilation, hemodynamic monitoring, and treatment of pulmonary hypertension followed by surgery for the defect. Extracorporeal membrane oxygenation (ECMO) is considered after failure of conventional medical management for infants ≥ 34 weeks’ gestation or with weight >2 kg and no associated major lethal anomalies. This chapter discusses long‐term follow‐up recommendations for survivors, which should involve a multidisciplinary approach, as there are many surgical and nonsurgical consequences to the disease process. Clinical strategies that address these multifaceted aspects of care, from prenatal to long‐term follow‐up, may further reduce the high mortality rate for these infants.",book:{id:"5928",slug:"hernia",title:"Hernia",fullTitle:"Hernia"},signatures:"Joanne Baerg, Arul Thirumoorthi and Rajaie Hazboun",authors:[{id:"178844",title:"Dr.",name:"Joanne",middleName:null,surname:"Baerg",slug:"joanne-baerg",fullName:"Joanne Baerg"},{id:"180308",title:"Dr.",name:"Arul",middleName:null,surname:"Thirumoorthi",slug:"arul-thirumoorthi",fullName:"Arul Thirumoorthi"},{id:"206025",title:"Dr.",name:"Rajaie",middleName:null,surname:"Hazboun",slug:"rajaie-hazboun",fullName:"Rajaie Hazboun"}]}],onlineFirstChaptersFilter:{topicId:"1146",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:31,numberOfPublishedChapters:314,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:18,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:14,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. 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