Biological and social risk factors of oral disease in old age.
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\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:"872",leadTitle:null,fullTitle:"Organic Pollutants Ten Years After the Stockholm Convention - Environmental and Analytical Update",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",reviewType:"peer-reviewed",abstract:"Ten years after coming into force of the Stockholm Convention on Persistent Organic Pollutants (POPs), a wide range of organic chemicals (industrial formulations, plant protection products, pharmaceuticals and personal care products, etc.) still poses the highest priority environmental hazard. The broadening of knowledge of organic pollutants (OPs) environmental fate and effects, as well as the decontamination techniques, is accompanied by an increase in significance of certain pollution sources (e.g. sewage sludge and dredged sediments application, textile industry), associated with a potential generation of new dangers for humans and natural ecosystems. The present book addresses these aspects, especially in the light of Organic Pollutants risk assessment as well as the practical application of novel analytical methods and techniques for removing OPs from the environment. 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After obtaining his PhD in 2005 at the University of Gdansk (Poland), he spent almost two years working for the Interdisciplinary Centre for Nanotoxicity (Jackson State University, Jackson, MS, USA) and the National Laboratory for Environmental Studies in Tsukuba, Japan (post-doctoral fellowship by the Japan Society for the Promotion of Science). His main area of interest is developing computational methods for assessing the human and environmental risk of novel chemicals. His accomplishments have been widely recognized. Tomasz Puzyn is an author of many contributions devoted to POPs/POPs-like chemicals risk assessment as well as QSAR modeling. In collaboration with Prof. Jerzy Leszczynski from the Interdisciplinary Centre for Nanotoxicity, he has developed the first Nano-QSAR models. The results were recently published in Nature Nanotechnology and Small journals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Gdańsk",institutionURL:null,country:{name:"Poland"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"124251",title:"Dr.",name:"Aleksandra",middleName:null,surname:"Mostrag",slug:"aleksandra-mostrag",fullName:"Aleksandra Mostrag",profilePictureURL:"https://mts.intechopen.com/storage/users/124251/images/system/124251.jpg",biography:"Aleksandra Mostrag-Szlichtyng is a Research Associate closely collaborating with Laboratory of Environmental Chemometrics at the University of Gdansk (Poland). Her scientific interests include applying and developing in silico tools for regulatory risk assessment of chemicals (particularly Organic and Persistent Organic Pollutants). She is an author of several contributions devoted to these issues. Aleksandra has acquired a diverse and in-depth knowledge in the fields of computational chemistry (University of Gdansk and Gdansk University of Technology, Poland) and computational toxicology (European Commission, Ispra, Italy). She cooperates with the Interdisciplinary Center for Nanotoxicity (Jackson State University, Jackson, MS, USA), the National Laboratory for Environmental Studies (Tsukuba, Japan), S-IN Soluzioni Informatiche (Vicenza, Italy) and the governmental Bureau for Chemical Substances (Poland). 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\r\n\tThere are many textbooks on international law, but these are generally written for students and legal academics and focus on the historical development of the various sub-fields of the discipline and on past judgments and decisions. This book adopts a different perspective: it is intended for practitioners, and these are numerous and varied. Apart from all those involved in diplomatic practice, they range from naval, coastguard, customs, and fisheries officers, to relief workers caring for refugees and following natural disasters, and many others. Everyone working on the ground needs practical advice, not history and caselaw. This book is therefore intended to be a practical handbook on a number of current and emerging themes in international law, focusing on the kinds of issues met in practice and describing what is legally and practically possible to address and resolve these issues. The individual authors are invited to use concrete examples or relevant scenarios to illustrate these problems and the processes required to achieve the desired practical and legal outcomes.
",isbn:"978-1-83768-054-2",printIsbn:"978-1-83768-053-5",pdfIsbn:"978-1-83768-055-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"c607e873911da868c0764770dc224313",bookSignature:"Dr. Michael Underdown",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11774.jpg",keywords:"Diplomatic Law, Consular Law, International Negotiations, Treaty Law, ICJ, International Arbitration, UNCLOS, Fisheries, ITLOS, Civil Aviation, Armed Warfare, Piracy, Smuggling, Human Rights",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 14th 2022",dateEndSecondStepPublish:"July 12th 2022",dateEndThirdStepPublish:"September 10th 2022",dateEndFourthStepPublish:"November 29th 2022",dateEndFifthStepPublish:"January 28th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"13 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"A well-known maritime and port lawyer and Oriental historian, with extensive international experience as a scholar, diplomat, and lawyer. Dr. Underdown was previously affiliated with Seoul National University as a visiting professor and Macquarie University as a research associate and is a member of the Royal Society of South Australia.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"478218",title:"Dr.",name:"Michael",middleName:null,surname:"Underdown",slug:"michael-underdown",fullName:"Michael Underdown",profilePictureURL:"https://mts.intechopen.com/storage/users/478218/images/system/478218.png",biography:"Professor Michael Underdown FRSSA is a professor at the Global Humanistic University in Curaçao and visiting professor at Jilin University and Northeast Normal University in China. He is also Adjunct Senior Research Fellow at Cairns Institute, James Cook University, Cairns. Professor Underdown studied Law and Oriental Studies in Australia, Belgium, Portugal and Germany and, in addition to academic appointments in Australia and New Zealand, has held research fellowships in the United Kingdom, Soviet Union, China and South Korea. He has ongoing research interests in law, history, philosophy, management and linguistics. He is admitted to the High Courts of Australia and New Zealand and has practised as both a solicitor and barrister, including as a Special Counsel at a “top tier” law firm. 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Parathyroid glands need to be examined in case of a diagnosed hyperparathyroidism as a part of preoperative localization of the abnormal glands. Hyperparathyroidism is characterized by elevated parathyroid hormone (PTH) levels in the blood. Due to the underlying cause, it can be divided into primary and secondary. The primary hyperparathyroidism (PHPT) is due to excessive production of PTH from one or more abnormal parathyroid glands. Secondary hyperparathyroidism (SHPT) is a result of hypocalcemia caused by other concomitant diseases (end stage kidney renal disease, etc.). In SHPT usually more than one parathyroid glands are affected. Considered rare disease in the past, the incidence of PHPT has changed dramatically during the last 30 years with the introduction of routine calcium measurements in clinical practice, and is now considered to be approximately 42 per 100,000 persons. Women are affected more frequently than men, in a ratio of approximately 3:1. PHPT occurs predominantly in individuals in their middle years with a peak incidence between ages 50 and 60 years and can reach 4 cases per 1000 persons in women after their 60s. At the time of diagnosis, most patients with PHPT do not have classic symptoms like osteitis fibrosa cystica, nephrocalcinosis, nephrolithiasis or other signs associated with the disease. Symptomatic PHPT is now exception rather than the rule, with more than three-fourths of patients having no symptoms making detected changes of the blood values of calcium, phosphorus and parathyroid hormone (PTH) to be the only reason for diagnosis [1, 2]. By far, the most common lesion found in patients with PHPT is the solitary parathyroid adenoma, occurring in 85–90% of patients, while in the rest 10–15% primary hyperplasia of the parathyroid glands is present [3]. In the past the standard surgical approach for PHPT was the bilateral four-gland parathyroid exploration with the removal of each gland which showed changes macroscopically. While in most of the patients with PHPT only one parathyroid gland is being affected, the above mentioned surgical approach is inappropriate in all cases. Unilateral approaches are appealing in a disease in which only a single gland is involved. So nowadays, the currently most widely used surgical approach is the minimally invasive parathyroidectomy which is connected with less postsurgical complications and shortens the time of operation [4]. To be successful this procedure needs to rely on a precise preoperative localization of the abnormal parathyroid glands. That is, why preoperative parathyroid imaging gained so large importance. The rationale for locating abnormal parathyroid glands prior to surgery is that they can be notoriously unpredictable in their location.
Parathyroid glands differ in shape and size. Typically four glands are present and are located adjacent to the dorsal surface of the thyroid lobes-two upper and two lower pairs. Normal glands tend to be flat and oval and normal measurements are 3 × 5 × 7 mm [5]. The combined weight of all parathyroid glans is 90–130 mg and the superior glands are smaller than the inferior [6, 7]. Autopsy series demonstrate that four glands are found in 91% in subjects, five glands in 4%, and three glands in 5% [8]. Approximately 5% of humans have supernumerary (more than four) parathyroid glands [9]. Supernumerary glands are most commonly found within the thymus. Although gland distribution may deviate widely, the superior parathyroid glands, originating from the fourth pharyngeal pouch, are commonly found along the posterior surface of the upper two-thirds of the thyroid gland (92%). The inferior parathyroid glands have a more variable distribution than the superior ones. They originate from the third pharyngeal pouch together with the thymus. They migrate caudally until they reach the lower pole of the thyroid gland and 17% of them touch the inferior border of the thyroid gland, 26% are within the superior horn of the thymus, and 2% are in the mediastinal thymus [10]. The variable anatomic distribution makes the inferior glands more difficult to locate than the superior ones. Histologically parathyroid glands are made of chief, oxyphillic and transient oxyphillic cells mixed with fat tissue. Chief cells produce PTH. The oxyphillic cells which are rich of mitochondria are with poorly defined function [11].
The normal parathyroid glands cannot be visualized. The lack of the perfect imaging method for precise localization of parathyroid adenomas had led to search for an alternative imaging techniques. Ultrasonography (US) is one of the most widely used procedures. Because of the great anatomic variations of the parathyroid glands, their small sizes, the presence of more than one abnormal gland and the higher frequency of concomitant morphological changes of the thyroid gland, US proved to be specific but with low sensitivity. The success of US is highly operator dependent [12]. Rapid spiral thin-slice CT scanning of the neck and mediastinum with evaluation of axial, coronal and sagittal views can add much to the search for elusive parathyroid tissue [13]. MRI can also identify abnormal parathyroid tissue, but it is time consuming and expensive. It is also less sensitive than other modalities. It can nonetheless be useful when the search with the other noninvasive approaches has been unsuccessful. PET/CT can be used, but like MRI, it is expensive and does not have the kind of experiential basis that make it attractive. There are limiting data for using PET/CT in parathyroid imaging. PET with 18F-fluorodeoxyglucose (18F-FDG) was used with varying success. One study showed that 18F-FDG РЕТ was more sensitive but less specific than 99mTc-sestamibi SPECT [14]. Others reported very low sensitivity for detecting abnormal parathyroid glands [15]. Using РЕТ with 11C-methionine in parathyroid examination has been studied in some patients but because of the very short half-life of 11C-methionine, only 20 min its use is limited only to nuclear medicine centers located near to a cyclotron. There is a general consensus that the most sensitive and specific imaging modality, especially when it is combined with single-photon emission CT (SPECT) is the scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin.
Historically, the success of scintigraphy had been compromised by the failure of finding a pharmaceutical agent with specific topic accumulation in parathyroid glands and their close proximity to the thyroid gland. That is why to find a reliable method to differentiate both glands on scintigraphy was crucial. This was first achieved by a combined use of two radionuclides with different uptake in the thyroid and parathyroid cells. The latter allowed to perform a subtraction of the obtained images of both glands and to visualize only the abnormal parathyroid gland, but this proved to be time consuming and with greate radiation exposure to the patients. The first widely used radionuclide for detecting hyperfunctioning parathyroid glands during the 80s was 201Thallium chloride (201Tl). 201Tl chloride accumulates equally in thyroid and parathyroid cells. To make differentiation possible, its application was followed by an injection of 99mTc pertechnetate, with predominant thyroid uptake. Then 99mTc pertechnetate thyroid images were digitally subtracted from the images obtained with 201Tl chloride to allow visualization only of the parathyroid glands [16].
Introduced in clinical practice by Coakley et al. [17], the 99mTc-sestamibi scintigraphy significantly increased the role of preoperative scintigraphy in patients with hyperparathyroidism. Firstly used as a cardiotropic agent this radionuclide showed increased accumulation in a variety of benign and malignant tumors. 99mTc-sestamibi consists of lipophilic cationic molecules. After being intravenously injected these molecules distribute throughout the body accordingly to the local blood supply and by passive diffusion through cell’s membrane accumulate intracellularly into the mitochondria [18, 19]. Normally 99mTc-sestamibi distributes in parotid and submandibular salivary glands, thyroid gland, the heart and the liver, but not in normal parathyroid glands. Visualization of parathyroid adenomas and hyperplastic parathyroid glands depends on the presence of oxyphillic cells, which are rich of mitochondria. The cells of parathyroid adenomas have plenty of mitochondria [20], while the normal parathyroid cells do not [21]. The highest rates of uptake of 99mTc-sestamibi are seen in the solitary adenomas of the parathyroid glands [22]. Not only the amount of intracellular mitochondria is important but also the quantity of oxyphillic cells in the tumors. If the percentage of oxyphillic cells exceeded 25%, accumulation of 99mTc-sestamibi was observed in 78% of parathyroid adenomas. Also false negative results are possible if the oxyphillic cells do not content sufficient amount of mitochondria [23]. Accumulation of 99mTc-sestamibi into the cells also can be influenced by their metabolic activity, the weight and the size of the tumor. This new radionuclide rapidly replaced 201Tl chloride because it showed better quality of the images and higher sensitivity for detecting abnormal parathyroid glands, with less radiation exposure [24].
99mTc-tetrofosmin another myocardial perfusion agent was also used for visualizing parathyroid glands in scintigraphy, but the data for its use so far are limited. 99mTc-tetrofosmin shows some similarities with 99mTc-sestamibi although the way of accumulation is different and it is retained mainly in the cytosol rather than in the mitochondria of the target cells. When used for parathyroid scintigraphy 99mTc-tetrofosmin shows slower washout from the thyroid gland, which makes it unsuitable for single-isotope dual-phase scintigraphy [25]. Nevertheless its sensitivity increases when used in combination with SPECT. Several studies [26, 27] of the diagnostic value of 99mTc-tetrofosmin scintigraphy for topic localization of the hyperfunctioning parathyroid glands in patients with PHPT, showed that this method was useful for the clinical practice and that the accumulation of 99mTc-tetrofosmin depends on the weight of the tumor and the level of PTH.
Generally three protocols are most widely used: single-phase dual-isotope subtraction, dual-phase single-isotope and combination of both [28].
In single-phase dual-isotope modality two types of radiopharmaceuticals with different organ uptake are used. One isotope (99mTc-sestamibi or 99mTc-tetrofosmin) with equal thyroid and parathyroid glands accumulation and another (123I or 99mTc-pertechnetate) with predominant uptake in the thyroid gland are applied consecutively. The obtained images are digitally subtracted and if there is a residual radionuclide accumulation on the subtracted images a hyperfunctioning parathyroid gland can be suspected [28]. Disadvantages of this method are the use of two radionuclides, the necessity of full collaboration from the patient’s side to stay calm and motionless during the examination and the need of very precise positioning of the patient. In addition there is an increase possibility for the presence of artifacts on the subtracted images [29, 30].
The rationale of the single-isotope protocol is based upon the different washout periods of the radionuclide from the thyroid and parathyroid glands. In this method, after an injection of a single radionuclide, early (at 10–15 min) and late (at 1.5–3 h) images are obtained [28].
There are a very few studies directly comparing the results from single-isotope dual-phase modality with single-phase dual-isotope subtractional scintigraphy and the results are inconclusive [31, 32]. So far there is no clear confirmed advantages of one type over another.
No preliminary preparation of the patients before performing single isotope dual-phase scintigraphy is necessary. In subtractional modality some preliminary conditions should be followed such as: discontinuation of Levothyroxine or Iodine containing drugs minimum 20 days before the examination. A case history of every patient about the duration of the disease, any concomitant diseases and medications, especially drugs that could possibly interfere with the calcium-phosphate homeostasis, and family history should be taken.
99mTc-sestamibi and 99mTc-tetrofosmin: they are applied intravenously from 740 to 1110 MBq (20–30 mCi).
99mTc-pertechnetate has a half-life of 6 h and possesses energy of 140 keV. It is used for visualization of the thyroid gland because it accumulates in a functioning thyroid cells. Intravenously 99mTc-pertechnetate is applied form 74–350 MBq (2–10 mCi).
99mTc-sestamibi accumulates in the thyroid and parathyroid glands, but the washout time from both glands differs, showing faster disappearing from the thyroid and retention in parathyroid cells. This allows successful visualization of pathologically changed parathyroid glands on the obtained later images—1.5–2 h after the injection of the radionuclide. This different retention time in both glands may be related to some down-regulation of the P-glycoprotein system in parathyroid adenomas, which delays washout of the nuclide [33]. Just the opposite, in parathyroid hyperplasia these so-called multidrug-related resistance molecules can be upregulated and can cause faster washout of 99mTc-sestamibi and lead to false negative results [34, 35].
To avoid this disadvantage and to improve sensitivity and specificity, the use of single-isotope dual phase (early and late) scintigraphy, based upon the suggestion that 99mTc-sestamibi is washed out faster from the thyroid gland than from the hyperfunctioning parathyroid cells, is recommended [36]. This single-isotope dual phase scintigraphy gained popularity due to its convenience. The fact that 99mTc-sestamibi can also be accumulated in solitary thyroid nodules diminishes the specificity of this procedure, especially in areas with higher incidence of nodular goiter [37, 38]. Some parathyroid adenomas also show rapid washout of 99mTc-sestamibi and make their visualization difficult by this procedure [39]. This led to an introduction of a modified protocol for subtractional scintigraphy by adding a second radionuclide with a preferential accumulation in the thyroid tissue.
99mTc-sestamibi scintigraphy is generally regarded to be the most sensitive and specific imaging modality especially when it is combined with other imaging procedures. The combination of US examination with dual-isotope 99mTc pertechnetate/99mTc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas leads to visualizing of the parathyroid adenomas in 95.2% of the cases (20 patients out of 21). Reaching such high diagnostic precision allows to minimize the extent of the surgical procedure and gives way to apply routinely and successfully minimally invasive parathyroidectomy only of the pathologically changed glands [40, 41].
Comparing different imaging methods,99mTc-sestamibi scintigraphy has higher sensitivity and specificity than US and CT in discovering adenomas of the parathyroid glands. With regards to the hyperplasia of the parathyroid glands 99mTc-sestamibi scintigraphy shows to be of less value [42, 43]. Hyperplastic parathyroid glands are visualized in 10–62.5% of the cases [44, 45]. In multiple endocrine neoplasia syndrome (MEN), where hyperplasia of the parathyroid glands is common, only 55% of the abnormal glands are seen on 99mTc-sestamibi scintigraphy [42, 46, 47]. 99mTc-sestamibi scintigraphy shows to be highly effective in discovering ectopic hyperfunctioning parathyroid glands, which in some studies, are observed in approximately 20% of the cases with PHPT and represent a diagnostic and therapeutic challenge [48]. Visualizing small parathyroid adenomas represents a specific problem. One study showed, that in surgically removed adenomas weighted less than 0.5 g, preoperative US was negative, but 99mTc-sestamibi scintigraphy discovered adenomas in 87% of cases and the combination with SPECT increased sensitivity to 95% [21].
In patients with SHPT, seems to have a direct correlation between 99mTc-sestamibi uptake with the blood level of parathyroid hormone and the phase of the cells’ cycles [49]. The lowest level of accumulation corresponds to G(0) phase and the highest to phase G(2) + S. No such correlation with the weight of the glands is found [49]. The fixation of the radionuclide depends on the functional status of the tissues, i.e., increased accumulation accompanies the cells’ active growing phase or is directly connected to the state of autonomy of the parathyroid cells [46].
The reason why not all pathologically changed parathyroid glands accumulate radionuclide remains unclear. This may be due to the different degree of activity and proliferation of the cells of the parathyroid adenomas. It was suggested that there is a relationship between nuclide accumulation and the degree of autonomy of the cells of the adenoma, i.e., the loss of the suppressive effect of calcium upon the secretion of the parathyroid hormone. The cells of the parathyroid adenomas and these of the hyperplastic glands show higher threshold for calcium suppression or have no threshold at all in comparison with the normal parathyroid cells. Due to this fact, these cells secrete more PTH for any given blood calcium level, show higher metabolic rate and capability to accumulate more 99mTc-sestamibi. Hyperplastic parathyroid glands are to some extent with preserved functional regulation, respond to the normal suppressive stimuluses, have lower metabolic rate and accumulate less of the radionuclide.
Due to its higher affinity to the parathyroid adenomas, 99mTc-sestamibi scintigraphy was used in cases of relapse of the hyperparathyroidism after parathyroidectomy or after autotransplantation of parathyroid glands.
Nowadays, there are several imaging methods for discovering hyperplastic parathyroid glands. The results so far are inconclusive. The dual-phase 99mTc-sestamibi scintigraphy in preoperative localization of the hyperplastic parathyroid glands in patients with profound secondary hyperparathyroidism do not show high sensitivity, but is of help to discriminate between patients with nodular and diffuse hyperplasia [50].
The role of 99mTc-sestamibi scintigraphy in patients with end-stage renal disease and secondary hyperparathyroidism is still unclear. The uptake of 99mTc-sestamibi can be suppressed by the use of calcitriol in these patients. In one study [51] 99mTc-sestamibi scintigraphy managed to visualize 1 or more (maximum 3) parathyroid glands in most, but not in all patients on hemodialysis with PHT levels above 600 pg/ml. Performing suppressive test with calcitriol (2 mg of calcitriol applied i.v. after each hemodialysis for two consecutive weeks) showed suppression of 99mTc-sestamibi uptake at least in one parathyroid gland in 57% of the cases and full suppression in all glands in 36%. The basal level of PHT or its lowering after this test showed to be of no predictive value for the suppression of 99mTc-sestamibi uptake in the parathyroid glands. Because of its lower sensitivity, the 99mTc-sestamibi scintigraphy was found to be of limited value in preoperative evaluation in uremic patients with secondary hyperparathyroidism, but its significance grew up in localizing hyperfunctioning glands left after the first operation [51].
Single-isotope dual phase 99mTc-sestamibi scintigraphy is easily performed, and needs only application of 99mTc-sestamibi. After injection of the radiopharmaceutical, early (10–15 min), and late planar (1,5–3 h) images are obtained (Figures 1 and 2).
Single-isotope dual-phase scintigraphy with 99mTc-sestamibi. The late image (120 min) shows a focus of a residual activity (arrow), caudally of the right thyroid lobe consistent with adenoma of the right lower parathyroid gland.
Single-isotope dual-phase scintigraphy with 99mTc-sestamibi. On the early images (20 min) relatively diffuse uptake in the area of the thyroid gland and a focus of increased accumulation of the radionuclide (thin arrow), caudally of the left thyroid lobe are seen. On the late phase images (120 min) only a focus of a residual activity (thick arrow), caudally of the left thyroid lobe is visualized-suggesting adenoma of the lower left parathyroid gland.
In some cases, the obtained early and late images show no signs of abnormal accumulation of radionuclide, but when combined with SPECT, than adenomas located at the back of the thyroid gland become visible (Figure 3a and b).
(a) Single-isotope dual-phase scintigraphy with 99mTc-sestamibi. Early planar images show diffuse uptake in the thyroid gland. Late planar images show no sign of a focus of residual activity in the neck area or mediastinum. (b) (The same patient) 99mTc-sestamibi SPECT images show an area of a residual activity, located dorsally and caudally of the left thyroid lobe (arrows) suspicious for a parathyroid adenoma.
So, the combination of a single-isotope dual-phase scintigraphy with 99mTc-sestamibi with SPECT can be of great help.
During many years in the past, two-dimensional images have been obtained, mainly AP-images, and rarely this was combined with lateral and oblique images [52, 53].
SPECT has gained more importance, because it gives three-dimensional images. There are accumulating data from the literature, that it improves sensitivity for discovering and localizing the hyperfunctioning parathyroid glands [54, 55]. The main reason for this is the improved contrast resolution of SPECT (Figure 4).
Early 99mTc-sestamibi SPECT images showing an area of radionuclide accumulation (arrows), located dorsally and caudally of the left thyroid lobe.
99mTc-tetrofosmin, another myocardial perfusion agent, is also used for parathyroid scintigraphy, but there are limited data in the literature for its use. Several studies [26, 27] assess the diagnostic value of 99mTc-tetrofosmin scintigraphy for topic localization of the hyperfunctioning parathyroid glands in patients with PHPT. They show that this method was useful for the clinical practice and that the accumulation of 99mTc-tetrofosmin depended on the weight of the tumor and the level of PTH. The early images (15th min) prove to be better than the late ones (120th min). 99mTc-tetrofosmin is washed out more slowly from the thyroid gland than 99mTc-sestamibi but both radionuclides give better results in comparison with 99mTc-pertechnetate/201Tl-substractional technique [56]. 99mTc-tetrofosmin looks promising alternative of 99mTc-sestamibi with similar properties and capabilities of localizing parathyroid adenomas.
Dual-isotope substractional scintigraphy with 99mTc-tetrofosmin/99mTc-pertechnetate and SPECT represent highly sensitive method for localization of parathyroid adenomas and their combination can further improve the diagnostic precision [57]. 99mTc-tetrofosmin, like 99mTc-sestamibi is not perfect for localization of hyperplastic parathyroid glands in patients with SHPT, because of its lower sensitivity [56]. 99mTc-tetrofosmin has some similarities with 99mTc-sestamibi, but its mechanism of accumulation in the cells is different. In contrast with 99mTc-sestamibi, which accumulation depends on mitochondria’s membrane potential, retention of 99mTc-tetrofosmin depends mainly on cell’s membrane potential [25]. 99mTc-tetrofosmin, shows slower wash out from the thyroid on the late planar images (120 min). This leads to the necessity to obtain additional later planar images—between 150 and 160 min. This slower wash out makes 99mTc-tetrofosmin to be unsuitable for performing single-isotope, dual-phase scintigraphy [25]. To avoid misleading, because of prolonged retention of the radiopharmaceutical in the thyroid adenomas, an US examination should be performed, especially in iodine deficient areas [56].
Figure 5 is presented a single-isotope dual-phase scintigraphy with 99mTc-tetrofosmin, combined with SPECT in a patient with PHPT.
(a) Early phase image (20 min) shows an intense uptake of the radionuclide at the lower part of the right thyroid lobe, which activity is still present on the late image (120 min) (arrows) and (b) (same patient) SPECT images showing an intense uptake dorsally and caudally of the right thyroid lob (arrow), suggestive for adenoma of the right lower parathyroid gland.
In 99mTc-tetrofosmin scintigraphy early images at 20th min show better quality than the later ones at 120th min (Figure 6a–c).
(a) Single-isotope dual-phase scintigraphy with 99mTc-tetrofosmin. Early planar images (20 min) are with better quality, (b) (same patient) single-isotope dual-phase scintigraphy with 99mTc-tetrofosmin and (c) 99mTc-tetrofosmin SPECT images—an area (arroes) with high uptake located dorsally of the lower right lobe is seen, consistent with adenoma of the right lower parathyroid gland.
Late planar images (120 min)—negative scan.
In this case, early SPECT gives opportunity to visualize adenomas, which were not seen on the late planar images, which is probably due to the rapid wash out of the radiopharmaceutical from some adenomas, as well as to the small sizes of the adenomas. When combined with SPECT, dual-phase scintigraphy with 99mTc-tetrofosmin can detect adenomas with rapid wash out of the radiopharmaceuticals.
The single isotope dual-phase scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin could miss parathyroid adenomas with rapid washout of the radionuclide. The combination with early SPECT improves sensitivity.
The single isotope dual-phase scintigraphy with 99mTc-tetrofosmin in patients with PHPT and SHPT is with less sensitivity and specificity, because of the poor quality of the obtained images and slower washout of the radionuclide from the thyroid gland.
SPECT combined with single-isotope scintigraphy and subtractional methods for visualization of hyperfunctioning parathyroid adenomas in patients with PHPT and SHPT is a reliable additional modality. It does not cause additional and unnecessary exposure of the patients to the gamma-rays and can increase sensitivity.
The rationale that stands behind dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi, is that 99mTc-sestamibi accumulates in both, thyroid gland and hyperfunctioning parathyroid glands, while 99mTc-pertechnetate uptakes only in the thyroid. First thyroid specific radionuclide 99mTc-pertechnetate is injected and at 30th min images are obtained. Afterwards, while the patient is still under the detector, second radionuclide 99mTc sestamibi with dual accumulation is applied and a second set of images on the 20th min are obtained. Later images are subtracted digitally from the first set of images and if a focus of residual activity on the subtractional images is detected, a hyperfunctioning parathyroid gland is supposed. The combination with early SPECT can improve sensitivity (Figure 7a and b).
(а) Dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi. Upper image on the left-image of thyroid gland obtained with 99mTc-pertehnetat. Upper image on the right an image obtained with 99mTc sestamibi (arrow). Lower image. Subtractional image showing a focus of a residual activity (arrow) in upper back part of the left thyroid lobe consistent with left parathyroid adenoma and (b) (same patient) dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi. Early SPECT images showing an area of intense uptake located dorsally and cranially of the left thyroid lobe.
The subtraction could be of help, when the patients had undergone surgery of the thyroid, but some thyroid parenchyma is still present. This method is important in the presence of more than one abnormal parathyroid gland.
Dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi combined with SPECT in a 51 years old man with MEN-type 1 syndrome—pheochromocytoma, parathyroid adenoma and prolactinoma, who had previously undergone thyroid (subtotal thyroidectomy) and parathyroid (left upper parathyroid gland) surgery. Subtractional images (Figure 8a) and early SPECT images (Figure 8b) show two areas of intense uptake located below the remnants of the both thyroid lobes. SPECT images show that the lesion below the right thyroid lobe was located also adjacent to the back part of the right thyroid lobe.
(а) Dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi. Subtractional image showing two areas of intense uptake consistent with two parathyroid adenomas and (b) SPECT images showing an area of intense uptake located dorsally and caudally of the right thyroid lobe.
In some cases, obtaining late images could also be of help. Combining dual-isotope, 99mTc-pertehnetat/99mTc sestamibi, subtractional scintigraphy with SPECT, and also recording late planar images on the 120th min (late phase) would improve sensitivity (Figures 9 and 10).
(а) Dual-isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi. Subtractional image showing no residual activity in the areas of the neck and chest and (b) late planar images showing a residual activity (arrow) in the middle of the left thyroid lobe, consistent with left parathyroid adenoma.
(а) Dual-isotope subtractional method with 99mTc-pertehnetat/99mTc-tetrofosmin. The upper row: on the left image of the thyroid gland with 99mTc-pertehnetat and on the right image of the parathyroid gland with 99mTc-tetrofosmin (arrow). The lower row shows subtractional image representing adenoma of left parathyroid gland and (b) dual-isotope subtractional method with 99mTc-pertehnetat/99mTc-tetrofosmin early SPECT images showing an area of hyper fixation, located caudally of the left thyroid lobe.
Dual isotope subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi or 99mTc-pertehnetat/99mTc-tetrofosmin allows visualization of abnormal parathyroid glands after subtraction is performed, even on the early obtained images. This helps to shorten the time of examination to 80–90 min and is of great use in the postsurgical follow up and when more than one abnormal gland is present.
Disadvantages of the subtractional scintigraphy with 99mTc-pertehnetat/99mTc sestamibi or 99mTc-pertehnetat/99mTc-tetrofosmin are: necessity of applying of two radionuclides, the need of very precise positioning of the patients in this dual phase method requiring full collaboration from patient’s side and the probability of the presence of artifacts in the obtained images.
Secondary hyperparathyroidism is characterized with hyperplasia of parathyroid glands, because it is caused by longstanding uncontrolled hypocalcemia, which leads to a profound overstimulation of a previously normal parathyroid glands. Over time this overstimulation causes hyperplasia and eventually adenomatous changes (tertiary hyperparathyroidism) of the parathyroid glands with PTH levels far more exceeding those observed in PHPT (Figure 11). Nevertheless, hyperplastic parathyroid glands usually show faster wash out of the radionuclides in comparison to solitary adenomas, which makes them more difficult to be visualized with scintigraphy (Figure 12). Negative scans, may be associated with the possible suppression of the accumulation of radiopharmaceuticals in the parathyroid cells as a result of the concomitant calcitriol intake. The use of calcium channel blockers may affect the uptake of 99mTc-sestamibi by parathyroid cells and reduce the sensitivity of the method. A study found that negative scans are twice as likely in patients taking calcium antagonists than those who do not take these medications (OR2, 88.95% CI, 1.03–8.10, p 0.045) [58]. So, adding the poor general condition of the patients, pathologically changed parathyroid glands are more difficult to be localized in SHPT than in PHPT.
Single-isotope, dual-phase scintigraphy with 99mTc-sestamibi in a patient with secondary hyperparathyroidism. The late phase (120 min) show a focus of residual activity (arrow)—consistent with parathyroid adenoma (probably tertiary hyperparathyroidism).
(а) Single-isotope, dual-phase scintigraphy with 99mTc-tetrofosmin in a patient with secondary hyperparathyroidism. Early (20 min) and late (120 min) images show no focus of a residual activity in the area of neck and mediastinum and (b) (same patient) early SPECT images showing an area of nuclide accumulation caudally of the left thyroid lobe, suspicious for parathyroid adenoma.
The visualization of abnormal parathyroid glands is difficult due to their variations in number and localization. Noninvasive parathyroid imaging studies include 99mTc-sestamibi scintigraphy, ultrasonography, computed tomography scanning, magnetic resonance imaging, and positron emission tomography. There is a general consensus that the most sensitive and specific imaging modality is the scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin. 99mTc-sestamibi scintigraphy significantly increases the role of preoperative scintigraphy in patients with hyperparathyroidism and allows unilateral surgical approach with minimally invasive parathyroidectomy to be used. Generally three protocols with the use of two radiopharmaceuticals, 99mTc-sestamibi or 99mTc-tetrofosmin, are most widely applied: single-phase dual-isotope subtraction, dual-phase single-isotope and combination of both. Each one of them has specific advantages and disadvantages. While, single parathyroid adenomas are localized with greater precision, hyperfunctioning parathyroid hyperplastic cells represent a real challenge to the imaging modalities.
Several factors can influence the radionuclide uptake in pathologically changed parathyroid cells:
biochemical factors
Total calcium levels—higher preoperative calcium levels are more frequently seen in patients with positive scans.
Parathyroid hormone levels.
A significant correlation between radiopharmaceutical uptake and preoperative levels of PTH is observed. As higher PTH is, as higher is the possibility for positive scans.
Vitamin D levels.
Patents with vitamin D deficiency are more likely to have positive scans.
Suboptimal levels of vitamin D, can stimulate the growth of the parathyroid adenomas independently from hypocalcemia and 1,25-dihydroxyvitamin D3 deficit can change the set-point of calcium suppressive effect upon PTH secretion [59].
Calcium-channel blockers.
The use of calcium-channel blockers can influence the uptake of the radiopharmaceutical in the parathyroid cells diminishing the sensitivity of the method.
biological factors
Size—although considered to be very important, it is not the only determining factor.
Type of cells of the parathyroid adenoma—because oxyphilic cells contain more mitochondria, they uptake radionuclides to a larger extent.
P glycoprotein and MDR gene products.
Uptake of 99mТс-sestamibi and 99mТс-tetrofosmin in the cells of the parathyroid adenomas depends on the activity of the P glycoprotein coded by MDR gene, which is functioning as an ATP dependent efflux pump, protecting against accumulation of lipophilic cationic radiopharmaceuticals, including 99mТс-tetrofosmin [60]. The expression of P glycoprotein in the parathyroid adenomas appears to be important factor determining radiopharmaceutical uptake. In one study 71% (10 out of 14) of adenomas with high P glycoprotein membrane activity have shown negative scans, 70% (45 out of 64) with negative P glycoprotein expression (р = 0.006) have shown positive scans [61].
Population aging is a human success story. A reason to celebrate the triumph of public health, medical advancement, and economic and social development over the diseases, injuries and early deaths that have limited human life spans throughout history. Globally, there were 703 million people aged 65 and over in 2019. In the next three decades, the number of older people in the world is projected to double, reaching more than 1.5 billion in 2050. All regions will see an increase in the size of their older population between 2019 and 2050.
There are not only improvements in life expectancy at birth, but also even faster improvements in life expectancy at later ages. Globally, a 65-year-old could expect to live 17 more years in 2015-2020 and 19 more years by 2045-2050 [1]. The World Health Organization (WHO) notes that life expectancy in older age is increasing at a much faster rate in high-income countries than in lower-resource settings conditions. See Figure 1 [2].
Changes in life expectancy from 1950, with projections until the year 2050, by region of the WHO and worldwide [
This demographic transition is a major challenge for health authorities around the world, particularly as disease patterns will change at the same time. With age, the risk of losing years of healthy life is compounded by low individual resistance, poor nutritional status, chronic diseases, and adverse socio-environmental conditions [3]. Responding to this challenge requires the whole society.
One of the most important strategies we have to control and lessen the danger that this represents is the promotion of health. Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the largest growth in the older adult population is taking place in the world [4]. All these efforts to keep away older people from suffering and physical, emotional and social limitations as a result of disease must include the maintenance of oral health.
In the last decades of the 20th century and the beginning of the 21st, a global agenda has been disseminated on the implementation of public policies that reduce the burden of disease in the older adults. For example, since 1995, in response to the global challenges of population aging, the WHO launched a program on aging and health. This was designed to promote knowledge about health care in old age through specific research and training activities, information dissemination, and policy development.
In 1998 in the World Health Report, WHO reported the need to strengthen health promotion among older people. The health implications of aging should be better clarified and understood. Later, in 2000, WHO reiterated the priority of older people’s health through the “Aging and Life Cycle” program, which focused on the concept of “active aging”. In 2002, WHO published a document entitled “Active Aging: A Policy Framework”, which outlines essential approaches to achieving healthy aging. The proposed policy framework was based on three basic pillars: health, social participation and security [4].
The WHO in its report on aging and health, 2015, emphasized: “Oral health is a crucial and often neglected area of healthy aging” [5].
In this regard, oral health is a key component in maintaining and promoting a healthy body and a high quality of life [6]. The growing body of scientific evidence confirms that good oral health is integral and essential to a person’s overall health. Oral health and disease are closely related to health and disease in general. Unfortunately, older people are representative of a vulnerable population group that suffers heavily from oral diseases.
Given the comorbidities associated with the chronic disease profiles of older people, poor oral health further compromises healthy aging. The literature consistently describes oral health as a significant determinant of an individual’s quality of life [7].
Health authorities around the world now face a growing public health problem, including an increasing burden of oral disease among older people. Globally, poor oral health in this age group has been shown particularly in high levels of tooth loss, decay tooth, periodontal disease, xerostomia, and oral cancer [2].
In oral health, global inequalities persist both within and between regions and societies and undermine the fabric, productivity and quality of life of many communities of the world [8]. Despite advances in prevention, restorative techniques, and dental materials, tooth loss remains a reality in both industrialized and developing countries [9]. While there have been significant improvements in oral health in the last 30 years, inequalities persist and a marked social gradient in oral health is observed similar to that of general health [8].
According to the WHO Oral Health Database, high levels of decay tooth are found in national surveys of older people; regionally, the average number of teeth affected by decay varies from an average of 9 teeth in the countries of the African region to an average of 24 teeth in Europe. In all regions, the experience of decay tooth in older people led to tooth loss, while the number of teeth treated after decay is quite limited, especially in the countries of the African region.
Regarding periodontitis, globally, surveys have reported that the percentage of older people with deep periodontal pockets is within the range of 5–30%. Data from Madagascar reported that 17.1% of people aged 65 to 74 had superficial or deep periodontal pockets, while these conditions were observed in 55.5% of Chinese older adults [10].
Poor oral health negatively affects the daily performance of older people, this condition can lead to reduced chewing performance, limited food choices, weight loss, poor communication, low self-esteem and well-being. Obviously, these conditions influence the quality of life. The increase in life expectancy without a better quality of life has a direct impact on government spending on health, and is becoming a key public health problem in the most developed countries. It will also be of great concern to developing countries and countries with high population density and emerging economies, such as China and India [2].
At all ages, a healthy natural dentition and a pleasant dental appearance contribute to quality of life. Bad breath and tooth decay can promote social isolation, limit participation in social activities, and influence our judgments about personality traits [9].
Older people in good health can contribute to society, their families, their communities and economic productivity through formal or informal channels, e.g. through volunteer work, etc. [11]. Searching for effective, systematic and wide-ranging interdisciplinary solutions aimed at the current and future burden of oral diseases in our older people will be a great challenge and opportunity in the 21st century [6].
Goals in dentistry cannot be achieved solely on the basis of providing clinical treatment alone. As for any age, health promotion and self-managed disease prevention measures are important to achieve better oral health outcomes. Health promotion interventions are key to improving oral health in old age, as it encourages older people to be proactive about their health [11].
Through the Ottawa Charter, WHO, 1986, health promotion was defined as: “the process of allowing people to increase control over their health and improve it”. To achieve a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment [12].
Failure to prevent or control the progression of oral disease can increase the risk of adverse health outcomes. A recent systematic review in Cochrane found evidence that periodontal disease treatment improved metabolic control among people with type 2 diabetes. Also, it was shown that better care of oral hygiene can prevent respiratory infections and death from pneumonia. in older people in hospitals and nursing homes. Furthermore, frequent tooth brushing was reported to be associated with lower levels of cardiovascular disease [13].
The literature also indicates that health promotion activities should include the active participation of stakeholders in their planning, implementation, and evaluation. This will ensure that health promotion activities are based on the target group’s own goals and needs.
Greater efforts should be made to identify opportunities for health promotion activities and the development of community models that encourage older people to improve and maintain their oral health. Ignoring health promotion and disease prevention opportunities in these groups is unfair and can increase inequalities in health standards [11].
Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the world’s largest population growth is taking place [3].
Health literacy, which is within the framework of health promotion and preventive strategies, is necessary to counter oral diseases. Health literacy has been defined as “the cognitive and social skills that determine people’s motivation and ability to access, understand, and use information in a way that promotes and maintains good health.” In the case of older people, it is important to take into account, in addition to health literacy, functional literacy. Health professionals should consider literacy difficulties among older people than younger adults, if they associate aging with visual and/or cognitive impairments, or think that older cohorts had more likely to have missed school as children. Therefore, they need to provide clear or improved oral instruction to older people [14].
In recent years, the WHO developed a series of essential principles for the prevention of oral and general diseases and the quality of life, which must be followed by all actors involved in the health care of older people. In the report on health in the world of 2015, the strengthening of health promotion and the creation of healthy environments adapted to the older adults are highlighted in the first place. Promote a healthy diet and nutrition, especially less sugar consumption and increased consumption of fruits and vegetables, in accordance with the “WHO Global Strategy on Diet, Physical Activity and Health, and Reduction of Malnutrition.”
One of the most relevant recommendations of this report is to emphasize the importance of educating caregivers about oral health knowledge, to dependent older people, in addition to involving their families, it is extended to independent older adults. As well as, to “other important people”, which can be interpreted as the entire team that cares for older people. A relevant point is to ask that care models be developed thinking of older people with primary oral health care capacity. As well as, nursing homes and institutions for dependent older people in order to meet the needs of the many people neglected.
On the other hand, the economic cost of treatments is identified as a barrier to oral health care in older people. So it is requested to improve social security for this age group, and to establish health care financially fair mouthpiece for the older adults. Attention is paid to evidence-based medicine, and this report calls for the implementation of national evidence-based public health programs to achieve better oral health, general health, and quality of life. Finally, within these principles of the WHO, the surveillance of the oral health of the older adults and important risk factors is recommended [10].
Meeting the oral health needs of the growing older population will require a diverse and capable dental workforce. A two-pronged approach is required, focusing both on (a) new entrants to the profession through dental schools and (b) existing dentists. The latter will be achieved through the continuing professional development of most dentists, but there will also be a greater need for postgraduate education and training. Undergraduate education is the hotbed of conscientious professionals, so it is important to place appropriate emphasis on oral health care for older patients in the undergraduate curriculum [15].
In this regard, the group made up of The common Task and Finish of the European College of Gerodontology (ECG) and the European Society of Geriatric Medicine (EUGMS), proposes a series of educational training actions aimed at dentists, and non-dentists in order to improve dental care for the older adults. They call this strategy “Educational Action Plans”, and which in our opinion are of such importance for the prevention of oral diseases in older adults that we underline them.
According to this proposal, educational action plans should involve dental and non-dental health care providers, giving them the opportunity for interprofessional training, practical training and improvement of attitudes towards the promotion of oral health. Better training for dental professionals in oral care for frail dependent older people.
Non-dental health professionals should receive education at the undergraduate, graduate and specialty levels, in the evaluation and promotion of oral health. This includes physicians, nurses, nursing assistants, physical therapists, occupational therapists, medical assistants, pharmacists, dietitians and others. It is proposed that these health providers should recognize oral health as part of multimorbidity. Also relate medication to the impact on oral health, initially assess oral health status, and demonstrate oral hygiene measures for the older adults and their caregivers. All this by developing strategies to overcome barriers to maintaining oral health and access to dental care, deciding when to refer to the dentist, and supporting collaborative practice [16, 17].
As the population ages, one of the main challenges for the future will be to translate existing knowledge and strong experiences in disease prevention and health promotion into appropriate programs [3]. Educational interventions on oral health in older people have shown their potential benefit to improve the level of knowledge and their application in preventive oral care measures. The most remarkable result to emerge from the data is the significant decrease in the O’Leary index and in the index of tongue coating [18].
Educational interventions have shown to significantly reduce the number of plaque-covered teeth and improve prosthetic hygiene in older people who require the care of a home health nurse. However, multiple approaches based on individual needs are required to improve the oral health of vulnerable older people, including integrating preventive dental care into the daily care plan carried out by home care nurses. It is important to consider the functional capacity and cognitive function of the older adult, as it has been associated with poorer oral hygiene [19]. Oral hygiene education programs for institutionalized older people caregivers have shown a positive impact on improving this condition of residents. The ratio of residents to caregivers should be considered, as it could play an important role in the provision of oral hygiene services, and has received little attention in the literature [20].
Unfortunately, oral health competence and attitudes towards oral care have been reported to be inadequate in nursing home care. Poor oral health has been reported for people most dependent on care, showing the need for preventive actions [21].
Considering only biological factors as the cause of oral diseases is not enough to explain the social differences in oral health. Consequently, addressing these factors alone, has led to reductionist approaches to prevention and treatment. Unfortunately there is a lack a sound theoretical basis and which, in general, have also failed to reduce the burden of oral diseases, and oral health inequalities [22].
In this regard, as reported by Link & Phelan, 1995, it is necessary to “contextualize risk factors” and understand the “fundamental social causes” of the disease. “Contextualize” risk factors based on the individual means that it is required (1) use an interpretive framework to understand why people become exposed to risk or protective factors and (2) determine the social conditions under which individual risk factors are related to disease [23].
In the case of oral health, there is considerable evidence of the influence of the social gradient on the oral health status of individuals. We know that many oral diseases are associated with socioeconomic status, which is linked to family income, educational level, employment status, housing, physical health, and mental health [23].
The fundamental social causes of disease essentially involve the resources that determine the degree to which people can avoid the risks of morbidity and mortality. Resources broadly can include money, knowledge, power, prestige, and the types of interpersonal resources incorporated into the concepts of social support and social network. Variables examined by medical sociologists and social epidemiologists, such as race/ethnicity and gender, are linked to resources such as money, power, prestige and/or social connection that should be considered as possible root causes of the disease [24].
Oral diseases share the same determinants and risk factors as the major Non-communicable Diseases (NCDs), which include heart disease, cancer, chronic obstructive pulmonary disease, diabetes, dementia, and stroke [23]. For NCDs, risk factors have been identified and many are related to lifestyle. Risk reduction is associated with smoking cessation, diet control (including reducing excessive consumption of calories, saturated fat and salt), moderate alcohol consumption, and exercise. Furthermore, many of these risk factors are important for the development of oral diseases. Table 1, resumes both biological and social risk factors [25].
Biological risk factors | Social risk factors |
---|---|
Interaction between the microbial plaque and the host’s immune response Aging of oral tissues: Changes in the healing capacity of cells and tissues | Related to lifestyle: Smoking, alcohol consumption, Diet: excessive consumption of carbohydrates |
Decreased salivary gland secretion; xerostomia | Socioeconomic status |
Medical conditions: Disabling musculoskeletal disease Cognitive and functional impairment Frailty syndrome Depression | Educational level |
Ethnicity and gender |
Biological and social risk factors of oral disease in old age.
It is important to recognize that in the older adults, there are risk factors, biological and social that favor the prevalence of oral pathologies such as tooth decay and chronic periodontitis [26]. These diseases continue to appear in old age. Global data indicate that the incidence of untreated tooth decay shows an upward trend after age 60. It was suggested that this was due to the development of root decay among older people. Similarly, periodontal diseases and their sequelae are highly prevalent among older people. The age-standardized prevalence and incidence of severe periodontitis showed a slight increase worldwide during 1990-2010, with a peak incidence in the fourth decade of life [27].
From a biological perspective, the etiology of periodontal disease has consistently been related to the interaction between the microbial plaque and the host’s immune response. Previous research shown, although periodontal conditions are initiated by dental plaque, the perpetuation of inflammation and the severity and progression of the disease depend on the effectiveness of the innate immune response to the bacterial biofilm. For its part, tooth decay is an essentially diet-mediated disease, in which host factors such as immune components in the microbial biofilm and saliva contribute to its progression [22].
Age can affect both oral diseases directly. When analyzing national studies of older people from the USA and Germany to observe, among other issues, the vulnerability to periodontitis and tooth decay in this population. The results showed that changes in susceptibility to periodontitis with age could be explained by exposure to pro-inflammatory conditions and changes in the healing capacity of cells and tissues [26].
The greater severity of periodontal diseases with age has been related to the length of time that periodontal tissues have been exposed to dentogingival plaque and is considered to reflect the accumulated oral history of the individual. However, the susceptibility of the periodontium to microbial plate induced periodontal degradation can be influenced by the aging process or by health problems specific to the aging patient. Differences in eating habits, increased flow of gingival exudate from the inflamed gum, and possible age-related changes in salivary gland secretions can similarly alter the conditions for growth and multiplication of microorganisms in the biofilm [28].
On the other hand, due to accumulated periodontal destruction, the number of surfaces at risk of tooth decay increases. The sequelae of restorative treatment contribute to an increased susceptibility to tooth decay development. Risk indicators for root decay include tooth decay experience, number of surfaces at risk, and poor oral hygiene [26].
With regard to tooth decay and the immune system and the impact of aging, a systematic review showed that studies are still in an early stage. A small number of studies have reported components of innate and adaptive immunity that affect the composition of dental saliva and biofilms with possible impacts on caries progression. Some conclusions could, at this stage, be considered more theoretical [29].
The general health of older people involves a variety of medical, cognitive and functional conditions and/or limitations that can have a direct effect on the onset and progression of oral diseases. And, by extension, the self-sufficiency of older people with respect to the performance of oral hygiene and the search for timely professional dental care [27].
In general, obtaining medical or dental care is known to be a problem for many older people with impaired functional status, especially those who are homebound or reside in long-term care facilities. People with disabling musculoskeletal conditions are likely to be among those affected in this way.
It is estimated that 10% of the world’s population aged 60 years or older have significant clinical problems attributable to osteoarthritis, a condition that is associated with joint pain, limited movement and sensation and occurs most frequently in the knee, hip and joints of the hands [30]. While the prevalence of rheumatoid arthritis is lower, it also affects a large number of people and is associated with aging [31].
Many people with these conditions, osteoarthritis and arthritis in the hands, cannot maintain proper oral hygiene, causing plaque and stone buildup, increasing the likelihood of tooth decay and periodontal disease. The limitation of mobility resulting from these diseases, particularly in the lower extremities, makes it difficult for those affected to visit dental offices for both routine hygiene and treatment [32].
Although cognitive impairment has not yet met the diagnostic criteria for dementia, people with mild cognitive impairment have been found to have poorer oral hygiene, a high gingivitis score, and more impaired root surfaces than those with intact cognition [33]. Tooth loss was reported to be independently associated with the development of cognitive impairment among older people living in the community. This finding supports the hypothesis that tooth loss may be a predictor or risk factor for cognitive decline [34].
Frail older patients in hospitals and long-term care homes, who depend on others for oral hygiene care, are at risk of poor health due to impaired functional and cognitive abilities. They are at high risk for tooth decay because foods containing sugar and refined carbohydrates remain in contact with the teeth for long periods between brushing [35].
One of the oral conditions that affect the quality of life of the older adults is xerostomia. A high prevalence of xerostomia and hypofunction of the salivary glands has been found in vulnerable older people. Etiologic factors include polypharmacy (especially with antihypertensives, antidepressants, and antipsychotics), poor general health, female sex, and advanced age. People with dry mouth require preventive measures against the consequences of the absence of saliva, including tooth decay, periodontal disease, and candidiasis [36].
Older people with depressive symptoms are less likely to make self-care, including oral hygiene and preventive dental care, a priority - many older people experience a chronic course of depressive symptoms. Depression in old age and depressive symptoms may be associated with poor nutrition, decreased salivary flow, distorted taste, increased oral lactobacillus counts, dental caries, advanced periodontal disease, and oral discomfort [37]. Older people with tooth loss were shown to be at increased risk of depressive symptoms [38].
Oral cancer poses a great threat to the health of adults and the older adults in high- and low-income countries [36]. Oral cavity cancer can be easily prevented and treated if it is diagnosed early [39].
It includes cancer of the lip, oral cavity, and pharynx, and is the eighth most common cancer worldwide. Incidence and mortality rates are higher in men than in women. The prevalence increases with advancing age, and oral cancer is of particular concern among people over 65 years of age. Variations between countries are attributable to differences in risk profiles and the availability and accessibility of health services, among others [36].
Oropharyngeal cancers, a subset of head and neck cancers, have the human papillomavirus (HPV) as a major risk factor. Modifiable lifestyle behaviors, such as smoking and alcohol use, are implicated in the etiology of oral cavity cancers. Previous studies demonstrated that smoking was associated with a 2-fold increased likelihood of oral cavity cancers among those who had never drunk alcohol and binge drinking was associated with a higher likelihood of oral cancers among those who never had they had smoked [40].
Other risk factors are the consumption of betel quid and areca nuts, poor oral hygiene, poor nutrition, a weakened immune system, genetic and immune predisposition. In most cases, it is preceded by visible painless changes in the mouth known as precancerous lesions, such as a whitish (leukoplakia) or reddish (erythroplastic) discoloration of the mucosa, an ulcer, or a swelling. The self-examination of the mouth serves for prevention and early detection. It is an easy to perform, non-invasive method, and low-cost [39].
In the context of social determinants in health, as mentioned above, these have a significant influence on health inequalities. It will modulate people’s health and disease during the life course. Returning to the concept of the WHO [41], which defines them as “the combination of the social conditions in which the individual is born, grows and the ages that affect his health”. Cueto et al. [42] in a deeper analysis revealed two edges in this matter. In first place, older adults linked to work have less of time to go to a dentist appointment. They commonly attend when there is an emergency or pain that affects their job performance or social life. On the other hand, the older adults that are unemployed, or not perceive a pension are more likely to suffer damage to their health by the psychic instability that this condition entails, leading to a deterioration of their oral health.
An unhealthy lifestyle appears to be the most relevant SDH in older adults [43].
Kuh and Ben-Shlomo [44] defined life-course epidemiology as the “study of long-term effects on chronic disease risk of physical and social exposures during gestation, childhood, adolescence, young adulthood and later adult life”. In other words, it links exposure to risk factors and consequences by considering the importance of the duration and timing of the development of the illness.
The sum in the biological systems could be influenced by independent and individual exhibitions. Specifically, the person is vulnerable to the risk factors, a series of separated situations at different phases of life and this combination increases the illness risk in later life. This is the “
As stated by the WHO [45] clinically, oral diseases are caused by bad oral habits such as poor oral hygiene, high consumption of sugars, the use and abuse of alcohol and tobacco and a lack of fluoride. Moreover, it is well known that oral illnesses share behavioral risks with non-communicable diseases. For instance, a diet high in added sugars is the principal cause of dental decay and it is related to obesity and overweight.
Heilmann et al. [46] proposed a theoretical framework for oral health. In which they integrated a life course perspective, with the models of the social determinants of oral health illness and their effect on the usual risk factors that link general health and oral health. The model highlights the significance of socioeconomic factors in the infancy and adulthood, like as education and salary. These elements are affected by economic, political and social variables at the societal level. In this sense, the model shows the degree in which infancy socioeconomic status will influence adulthood socioeconomic status. For example, the advancement of dental decay over the course of life follows different patterns directions, to be specific caries levels calculated at one age predicts dental caries levels al later ages.
In 2010, Sheiham and Sabbah [47] reported in their study that the presence of caries in the infancy is a strongly precursor of caries in permanent dentition. Likewise, Hallet and O’Rourke [48] the incidence and severity of dental decay in the primary dentition is linked to the individual, together with socio-economic aspects just as income and maternal education.
However, this is not particularly surprising given the fact that the most significant outcome of enamel defects is a high susceptibility to dental decay. Seen from the
Caries and periodontal disease are thus more common than other chronic health conditions and increase in older age. Good oral health is an important aspect of general health and wellbeing contributing to self-esteem, dignity, social integration and nutrition.
Aging is a physiological process that affects in unique ways to each person. It is influenced by different factors such as social, economic, environmental conditions and lifestyle of the individual developed through the course of life. It represents a challenge for the professional due to the oral cavity is the first place of the body where the signs of the nutritional deficiencies are manifested clinically [50].
According to the WHO [51] malnutrition refers to “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients”. Who enlists some of the causes that lead to malnutrition in older adults. See Figure 2.
Oral health and nutrition risk factors enlisted by the WHO [
It is important to highlight the fact that polypharmacy, chronic diseases and aspects associated to mental health also affect the nutritional status, circumstances that are frequently present in older adults. Poor oral health conditions in this group are associated with discomfort, pain and a reduced appetite, which lead to an inappropriate selection of aliment, with a low or none nutritional content. There is a reduced intake of harder foods, fruits, proteins, vegetables, fiber, vitamins and minerals and a high intake of cholesterol and saturated fat, which alters the nutritional status [52].
Dental loss is related to the reduction of masticatory ability, affecting the maximal biting force and leading to problems in bolus formation. As the number of teeth present in mouth diminishes, the bolus size increases, generating a swallowing dysfunction. This decline can impact seriously in older adult’s health, resulting in of chronic disease like cardiovascular problems, diabetes, frailty, sarcopenia and an increased risk of malnutrition [53]. This last condition increases the risk of oral infections.
Frailty is defined as a state, highly prevalent in older adults, of diminished functional reserves that lead to an increased vulnerability to stressors and adverse health results. It includes falls, reduced strength, mortality, growing dependency, a reduced ability to recover from tension situations and increased health care usage [54]. When taking care for frail people is important to be aware of seemingly minor issues. Clegg et al. [55] declared “an apparently small insult (e.g. a new drug; “minor” infection; or “minor” surgery) results in a dramatic and disproportionate change in health state: from independent to dependent; mobile to immobile; postural stability to falling; lucid to delirious”.
As mentioned by Castrejón-Pérez et al. [56] the relation that lies between oral health and frailty is considerable and it comes from different pathways:
nutritional, as dentition impact the nutritional status
biological, through the relation with chronical inflammatory answer in the body
psychological, by the impact of oral health on depression and self-esteem.
Hakeem et al. [54] study demonstrated that frailty index was associated with periodontal disease and tooth loss in older adults. Poor nutritional status contributes to the progression of many morbidities involved in the complex and multiple etiology of frailty. This low nutritional intake leads older adults to an increased risk of oxidative stress, malnutrition, inflammation and frailty. There is a strong association between oral health and frailty. This last condition affects the oral status through loss of functions, which guide older adults to complications to take care of their oral hygiene and access to dental services [57].
The concept of vulnerability can be described as that subject who will not necessarily experience damage, but who is in fact more susceptible since it has higher inequalities. This condition is specially associated with individual and community situations and contexts. Aging involves an augmented risk for the development of vulnerability, since it is a process of variations that influence on life and health conditions of the individual [58].
Vulnerable groups commonly experience barriers to access oral health and are affected by oral diseases. The World Dental Federation [FDI] made a classification of this barriers [59]. See Table 2.
Main causes | Examples |
---|---|
Individuals themselves | Low income, lack of perceived need, psychological reasons such as fear and anxiety |
Dental profession | Lack of sensitivity or compassion to patient’s attitude, inappropriate work team resources, difficult location access |
Society | Lack of public support to healthy attitudes, low support for research and inadequate dental health work team planning |
Barriers for access on oral health services.
On a previous study, we found some different barriers that affect how older adults take care of their health. Lack of time, was reported as the main concern. Older adults sometimes have up to three jobs, because of their working record, since they do not count with a pension. Another example of lack of time is that some older adults (e.g. wife, mother) are caregivers of their partner or parents and therefore no time left for themselves. This is more rooted in women as part of the sociocultural inheritance and traditions; women are more tended to be a caregiver, which affects their social life and self-esteem, increasing stress factors and physical and mental fatigue.
On the other hand, education plays an important role too. Even knowing the consequences of not having good habits, older adults let the time go by without receiving oral health attention and only assist to the dentist in case of an emergency and when the pain is unbearable [60].
Moreover, is important to identify that some subjects experience accumulative challenges as they relate to simultaneous vulnerable groups. For example, an unemployed adult with physical disabilities living in a non-urban community, from a native group. In this way, more efforts are needed to facilitate access for this groups and specially be focused in address the complicated nature of the barriers meted [61].
As mentioned by the WHO, healthy aging is described as “the process of fostering and maintaining the functional capacity that enables well-being in old age. Functional capacity consists of having the attributes that allow all people to be and do what is important to them” [62]. Oral health is an important element of healthy aging as the mouth influences the whole body through the course of life. A healthy mouth contributes to good nutrition, promotes a safer swallowing and prevents infections [63].
Poor oral health conditions could be inescapable in the aging process, but through prevention, patient care and education, these objectives can be achieved. Therefore, professional clinicians and researchers should work together to develop behavioral interventions for the promotion of dental health in family, community and health care settings [64].
A growing body of literature has analyzed that keeping a healthy natural dentition in old age has many benefits including the psychosocial, functional and structural point of view. Knowing this, the goals of mouth healthcare should be targeted to treat and prevent oral infection, promote oral health related to quality of life and give the resources to restore oral health function where necessary and guarantee an acceptable dental appearance [9].
Among the great challenges that humanity is facing, there is the aging population. Promoting healthy aging is a task of the whole society. Oral health is part of general health, and participates in a relevant way in the quality of life. Proper oral health promotion activities are essential to protect the oral health of the population.
Understanding the pathways through which social determinants and biological risk factors interact over the life course and shape oral health inequalities can help achieve healthy aging.
Oral health care for older people should begin with interprofessional education, and the exchange between different health care providers for older people should be expanded. The older person, and their family, should be included. Knowing the risks involved in oral diseases allows us to prevent them.
The authors declare no conflict of interest.
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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. 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In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. 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Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9759",title:"Vitamin E in Health and Disease",subtitle:"Interactions, Diseases and Health Aspects",coverURL:"https://cdn.intechopen.com/books/images_new/9759.jpg",slug:"vitamin-e-in-health-and-disease-interactions-diseases-and-health-aspects",publishedDate:"October 6th 2021",editedByType:"Edited by",bookSignature:"Pınar Erkekoglu and Júlia Scherer Santos",hash:"6c3ddcc13626110de289b57f2516ac8f",volumeInSeries:22,fullTitle:"Vitamin E in Health and Disease - Interactions, Diseases and Health Aspects",editors:[{id:"109978",title:"Prof.",name:"Pınar",middleName:null,surname:"Erkekoğlu",slug:"pinar-erkekoglu",fullName:"Pınar Erkekoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.jpg",institutionString:"Hacettepe University",institution:{name:"Hacettepe University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:13}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:8},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"1",type:"subseries",title:"Oral Health",keywords:"Oral health, Dental care, Diagnosis, Diagnostic imaging, Early diagnosis, Oral cancer, Conservative treatment, Epidemiology, Comprehensive dental care, Complementary therapies, Holistic health",scope:"
\r\n This topic aims to provide a comprehensive overview of the latest trends in Oral Health based on recent scientific evidence. Subjects will include an overview of oral diseases and infections, systemic diseases affecting the oral cavity, prevention, diagnosis, treatment, epidemiology, as well as current clinical recommendations for the management of oral, dental, and periodontal diseases.
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