WHO scale for dehydration in children aged 1 month–5 years old.
\r\n\tIn sum, the book presents a reflective analysis of the pedagogical hubs for a changing world, considering the most fundamental areas of the current contingencies in education.
",isbn:"978-1-83968-793-8",printIsbn:"978-1-83968-792-1",pdfIsbn:"978-1-83968-794-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"b01f9136149277b7e4cbc1e52bce78ec",bookSignature:"Dr. María Jose Hernandez-Serrano",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10229.jpg",keywords:"Teacher Digital Competences, Flipped Learning, Online Resources Design, Neuroscientific Literacy (Myths), Emotions and Learning, Multisensory Stimulation, Citizen Skills, Violence Prevention, Moral Development, Universal Design for Learning, Sensitizing on Diversity, Supportive Strategies",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 14th 2020",dateEndSecondStepPublish:"October 12th 2020",dateEndThirdStepPublish:"December 11th 2020",dateEndFourthStepPublish:"March 1st 2021",dateEndFifthStepPublish:"April 30th 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Phil. Maria Jose Hernandez Serrano is a tenured lecturer in the Department of Theory and History of Education at the University of Salamanca, where she currently teaches on Teacher Education. She graduated in Social Education (2000) and Psycho-Pedagogy (2003) at the University of Salamanca. Then, she obtained her European Ph.D. in Education and Training in Virtual Environments by research with the University of Manchester, UK (2009).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"187893",title:"Dr.",name:"María Jose",middleName:null,surname:"Hernandez-Serrano",slug:"maria-jose-hernandez-serrano",fullName:"María Jose Hernandez-Serrano",profilePictureURL:"https://mts.intechopen.com/storage/users/187893/images/system/187893.jpg",biography:"DPhil Maria Jose Hernandez Serrano is a tenured Lecturer in the Department of Theory and History of Education at the University of Salamanca (Spain), where she currently teaches on Teacher Education. She graduated in Social Education (2000) and Psycho-Pedagogy (2003) at the University of Salamanca. Then, she obtained her European Ph.D. on Education and Training in Virtual Environments by research with the University of Manchester, UK (2009). She obtained a Visiting Scholar Postdoctoral Grant (of the British Academy, UK) at the Oxford Internet Institute of the University of Oxford (2011) and was granted with a postdoctoral research (in 2021) at London Birbeck University.\n \nShe is author of more than 20 research papers, and more than 35 book chapters (H Index 10). She is interested in the study of the educational process and the analysis of cognitive and affective processes in the context of neuroeducation and neurotechnologies, along with the study of social contingencies affecting the educational institutions and requiring new skills for educators.\n\nHer publications are mainly of the educational process mediated by technologies and digital competences. Currently, her new research interests are: the transdisciplinary application of the brain-based research to the educational context and virtual environments, and the neuropedagogical implications of the technologies on the development of the brain in younger students. Also, she is interested in the promotion of creative and critical uses of digital technologies, the emerging uses of social media and transmedia, and the informal learning through technologies.\n\nShe is a member of several research Networks and Scientific Committees in international journals on Educational Technologies and Educommunication, and collaborates as a reviewer in several prestigious journals (see public profile in Publons).\n\nUntil March 2010 she was in charge of the Adult University of Salamanca, by coordinating teaching activities of more than a thousand adult students. She currently is, since 2014, the Secretary of the Department of Theory and History of Education. Since 2015 she collaborates with the Council Educational Program by training teachers and families in the translation of advances from educational neuroscience.",institutionString:"University of Salamanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Salamanca",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"23",title:"Social Sciences",slug:"social-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"301331",firstName:"Mia",lastName:"Vulovic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/301331/images/8498_n.jpg",email:"mia.v@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6942",title:"Global Social Work",subtitle:"Cutting Edge Issues and Critical Reflections",isOpenForSubmission:!1,hash:"222c8a66edfc7a4a6537af7565bcb3de",slug:"global-social-work-cutting-edge-issues-and-critical-reflections",bookSignature:"Bala Raju Nikku",coverURL:"https://cdn.intechopen.com/books/images_new/6942.jpg",editedByType:"Edited by",editors:[{id:"263576",title:"Dr.",name:"Bala",surname:"Nikku",slug:"bala-nikku",fullName:"Bala Nikku"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"47145",title:"The Role of Capsaicin-Sensitive Afferent Nerves in Gastric Mucosal Protection Initiated Centrally or Peripherally under Experimental Conditions",doi:"10.5772/58573",slug:"the-role-of-capsaicin-sensitive-afferent-nerves-in-gastric-mucosal-protection-initiated-centrally-or",body:'How can gastric mucosa resist to wide variety of endogenous (e.g. acid, pepsin, H. pylori) and exogenous (bacterial products, NSAIDs, alcohol, cytotoxic agents) mucosal challenges? Or how can it be explained that while the incidence of mucosal injury related to acid secretion is about 20% of the population, everybody secretes acid throughout the life [1]? And how can be answered the classic question of Davenport: why the stomach does not digest itself [2]?
Though accumulating data strongly suggest an apparent redundancy in the processes of gastric mucosal defense, several mediators, mechanisms, structural elements involved in mucosal protection have been identified, the precious mechanism has not been completely clarified yet and incompletely understood.
The aim of present work is to give a short overview on the protective mechanism of gastric mucosal protection, particularly on capsaicin sensitive afferent pathways and mediators released from sensory nerve endings and play a role in maintaining gastric mucosal integrity.
Gastric mucosal defense to acid and other noxious stimulus involves both structural and functional components. Gastric mucosal barrier consists of the pre-epithelial mucus bicarbonate layer, an epithelial layer, and a post-epithelial layer. The pre-epithelial mucus bicarbonate layer consist of mucus gel, bicarbonat surfactant phospholipids, treofil peptides. Epithelial layer, and a post-epithelial layer involve blood vessels, non-epithelial cells and enteric nerves play a role in generation of different substances which are essential in maintaining mucosal integrity and gastric mucosal defense, e.g. bicarbonate, mucus, phospholipids, trefoil peptides, prostaglandins (PGs), heat shock proteins [reviews 3-5].
The pre-epitehlieal layer protects the gastric mucosa from microscopic damage. This layer consists of mucus gel, bicarbonate and surfactant phospholipids, which cover the mucosal surface. It retains bicarbonate secreted by surface epithelial cells to maintain a neutral microenvironment [5-7].
Trefoil factor family (TFF) proteins are able to enhance mucosal barrier functions by stabilizing the mucus gel and promoting epithelial restitution [8, 9]. These small protease-resistant proteins have been demonstrated to be protective demonstrated in various ulcer models [10, 11], the exact molecular mechanism has not been clarified yet.
Though the term „cytoprotection” has been used first by Chaudhury and Jacobson [12] the classic definition of cytoprotection derives from Robert et al [13]; they suggested that cytoprotection refers to protection of gastric mucosa against chemically/ physically-induced acute gastric ulceration in doses much smaller than that reduce gastric acid secretion. According to their results prostaglandins fulfilled this criteria. Later Lacy and Ito [14] reported that the superficial layer, that is supposed to be highly involved in maintenance of mucosal barrier, is not preserved during prostaglandin-induced protective processes; this was the main argue against the term “cytoprotection”.
Prostaglandins are synthesized from arachidonic acid by all nucleated cells, but the highest concentrations are found in gastrointestinal mucosa. Continuous synthesis of prostaglandins by gastrointestinal mucosa most likely represents a physiological process necessary to maintain cellular integrity and for this process prostaglandins serve as trophic factors [15, 16]. Subsequent studies proved that the maintenance of gastric mucosal blood flow and thus the prevention of ischemia are the key elements in the mucosal protective effect of prostaglandins [17]. Takeuchi et al. [18] suggested recently, that endogenous PGs also contribute to maintaining mucosal integrity after barrier disruption through an increase in mucosal blood flow, which occurs via sensory neurons by activation of the EP1 receptor.
Inhibition of leukocyte adherence to the vascular endothelium and inhibition of apoptosis are additional actions that can result in prevention of gastric mucosal damage [19].
Different prostaglandin receptors are involved in different processes resulting in mucosal defense. The effects of PGE2 on various gastric functions are mediated by different EP receptor subtypes; such as inhibition of acid secretion (EP3) and motility (EP1), stimulation of mucus secretion (EP4) and HCO3-secretion (EP1), and an increase in mucosal blood flow (EP2/EP4). However, the presence of EP1 receptors is essential to the protective action of PGE2 [20].
Nitric oxide (NO) is a freely diffusible molecule, synthetized from L-arginine by the enzyme NO synthase, exerts its biological action on vascular smooth muscle by stimulating soluble guanylate-cyclase and the subsequent formation of cyclic guanosine-monophosphate, which results in vasodilation.
NO has been shown to participate in the regulation of gastric mucosal microcirculation both under resting and stimulated conditions, since inhibition of NO synthase significantly reduced both the resting and the gastric acid-induced increased gastric mucosal blood flow [21, 22]. In addition, inhibition of NO synthase increases gastric mucosal injury [23, 24], and the constitutive isoform of NO synthase is important in maintaining gastric mucosal integrity [25].
NO mediates the mucosal vasodilatation and gastroprotective effect of calcitonin gene-related peptide (CGRP), which is released from nerve terminals of primary sensory neurons and plays a crucial role in gastric emergency system [26-28].
Protein and non-protein sulfhydryls were suggested also as endogenous protective compounds [29, 30], and it was raised that the maintenance of a critical level of non-protein sulfhydryls in the gastric mucosa is important for the gastroprotective action - besides nitric oxide [31].
H2S like NO, is an important gaseous mediator of gastric mucosal protection [32], and inhibition of endogenous H2S synthesis increases the susceptibility of the gastric mucosa to the damaging action of non-steroidal anti-inflammatory drugs (NSAIDs) [33]. On the other hand, exogenous H2S donors can increase the resistance of the gastric mucosa to injury induced by NSAIDs [34].
The gastroprotective effect of H2S involves several mechanisms, such as maintenance of gastric mucosal blood flow, stimulation of bicarbonate secretion, inhibition of pro-inflammatory cytokine expression/release stimulation of prostaglandin synthesis, reduced leukocyte-endothelial adherence, decreased reactive oxygen metabolite production and enhanced tissue repair [35].
Matrix metalloproteinases (MMPs) play a role both in the pathogenesis and in healing of peptic ulcers. These endopeptidases degrade extracellular matrix proteins and are essential for extracellular matrix remodeling and wound healing [36]. Experimentally their altered expression have been demonstrated in gastric ulcers induced by NSAIDs (indomethacin, naproxen) or ethanol [37, 38].
Noxious stimulus results in both generation of endogenous substance(s) that may counteract or attenuate the mucosal injury, and initiation of further protective mechanisms or formation of additional protective mediators that stimulate repair and restore mucosal integrity.
Early phase of mucosal lesions is characterized by decrease of mucosal blood flow and the consequent hypoxia. However, activation of hypoxia-inducible factor-1, in response to hypoxia, induces trefoil factor family (TFF) gene expression in rat and human gastric epithelial cells. The consequent production of TFF peptides augment surface mucous barrier functions (see above) and stimulate epithelial restitution by increasing mucosal blood flow, migration of cells and restoration of barrier function [39, 40].
Gastric mucosal injury is characterized by excessive production and/or decreased elimination of reactive oxygen species (ROS), that can induce tissue damage by promoting lipid peroxidation and increasing the production of inflammatory mediators and proinflammatory cytokines. Antioxidant enzymes, such as superoxide dismutase (SOD), catalase or glutathione are able to counteract the oxidative stress, for example, SOD converts superoxide radical anion (O2˙−) into less noxious hydrogen peroxide (H2O2) [39].
Heme oxygenase-1 (HO-1), the inducible form of heme oxygenase, also exerts cytoprotective effect and its generation may be induced by oxidative stress, inflammatory cytokines or heavy metals [40]. HO-1 catalyzes the oxidative degradation of the pro-oxidant heme to antioxidant and cytoprotective carbon monoxide and biliverdin [41, 42]. The activity of HO-1 is also increased during the healing of gastric ulcers, which indicates its involvement in the mucosal repair processes [43].
In addition, several genes, encoding peptides, are also upregulated after mucosal damage in the gastrointestinal mucosa and stimulate the repair process. Epidermal growth factor (EGF) a potent stimulant of growth and repair when infused systemically. It inhibits gastric acid secretion, and has a cytoprotective effect on the gastrointestinal mucosa. On the other hand, EGF is one of the main peptides secreted by repair lineages of the gastrointestinal tract [44]. Treofil factor family (TFF) has both cytoprotective and stimulant effect on repair. Three members (TFF1/pS2, TFF2/SP, and TFF3/ITF) of the family are present in human gastrointestinal mucosa. They are produced rapidly at sites of injury and stimulate the repair process. Exogenous TFF2/SP exerts a cytoprotective action in indomethacin-induced ulcer model in rats [45]. Transforming growth factor α (TGF-α) is normally trophic both in vitro in different cell lines and in vivo in the intestine of rats [46]. TGF-α decreased the gastric damage induced by ethanol or stress [47], and enhanced immunoreactive TGF-α was measured in gastric juice (within 30 minutes) following gastric instillation of hydrochloric acid. Transforming growth factor β (TGF-ß) is also involved in mucosal defense, but in contrast to other growth factors, it regulates the epithelial proliferation, it halts the proliferation of epithelial cells once they have left the crypts or glands. In addition, it is also a potent stimulant of cell migration [48-50]). Hepatocyte growth factor (HGF) is secreted as inactive precursor and than converted to an active form. HGF receptor was shown to be increased in the gastric mucosa after injury [51]. It was suggested that, the active HGF, produced in the stomach after injury, may stimulate the proliferation of gastric mucosal epithelial cells through increased number of HGF receptor. Basic fibroblast growth factor (bFGF) a potent stimulant of angiogenesis, and accelerates the healing of experimental gastric and duodenal ulcers in rats [52, 53]. In ulcerated human gastric mucosa, immunoreactive bFGF is upregulated [54], thought additional data suggest that bFGF mRNA expression is an early event after mucosal injury [55]. Platelet derived growth factor (PDGF) also stimulates angiogenesis. It was shown that PDGF (and bFGF) accelerated the healing of cysteamine induced duodenal ulcers in rats by stimulating angiogenesis and granulation tissue formation [56]. Furthermore, in experimental duodenal ulcer and colitis in rats (after a transitory reduction) of the concentrations of bFGF and PDGF increased in the healing phases both experimental lesions [57]. Vascular endothelial growth factor (VEGF) has dual role; in acute gastric ulcer it induced gastroprotective effect surprisingly by enhancing vascular permeability and the consequent perivascular dilution barrier towards gastric mucosal irritants [58]. On the other hand, in chronic duodenal ulcer VEGF stimulates granulation tissue formation and angiogenesis resulted in ulcer healing. In addition, upregulation of VEGF mRNA expression was observed after ethanol challenge [59].
When the gastric epithelium is exposed to acid back diffusion or any irritant, one of the most rapid and important responses is an increase in mucosal blood flow. The aim of this hyperemic response is to remove, dilute and buffer any back-diffusing injurious agent or acid. This response is mediated by primary sensory afferent neurons, namely if the mucosal barrier is disturbed or disrupted in the presence of luminal acid, the acid reaching the lamina propria stimulates spinal afferents. This stimulation will initiate the efferent-like function of primary afferents resulting in CGRP and NO formation and release that induces a prompt hyperaemia in the gastro-duodenal mucosa and bicarbonate (HCO3−) secretion [60-68].
Afferent neurons have a basic role in regulation of gastrointestinal functions, and also in gastric mucosal defense. Beside intrinsic sensory neurons which have their cell body within the gastrointestinal tract and originate in the myenteric or submucosal plexus, there are two groups of extrinsic sensory neurons: vagal and spinal afferents. 75-90% of the axons in vagus nerve are afferent fibers [69], and 9% of these afferent fibres are the capsaicin-sensitive afferent nerves [70], that originate in the jugular and nodose ganglia and project to medullary brain stem. The spinal afferents have their cell body in dorsal root ganglia and reach the stomach via spinal and splanchnic nerves.
The first evidence that suggested the prominent role of sensory nerves in gastric mucosal resistance was obtained by experiments when ablation of sensory nerve was shown to result in aggravation of mucosal lesions induced by hydrochloric acid, aspirin, indomethacin [review 71]. Moreover, Szolcsányi and Barthó described that stimulation of afferent nerves by capsaicin resulted in mucosal protection against acid induced mucosal injury [63, 71]. The role of sensory nerves in gastric mucosal defense was confirmed by the findings that capsaicin induces gastroprotective action following intragastric administration, both in experimental animals [71, 72] and in humans [73].
The protective action of capsaicin is due to its stimulatory effect on capsaicin-sensitive primary afferent neurons, since defunctionalisation of afferent neurons by high parenteral dose of capsaicin [74] abolished the gastroprotective effect of capsaicin [67, 71].
The action of capsaicin is mediated by capsaicin receptor which was cloned and named as transient receptor potential vanilloid-1 (TRVP1) [75], the specific sensor for capsaicin [76-79].
In the gastrointestinal tract, TRPV1 can be identified in intrinsic enteric neurons, extrinsic sensory neurons, epithelial and endocrine cells [80-84].
The acid-evoked hyperemia in the esophageal and duodenal mucosa is inhibited by the TRPV1 antagonist capsazepine or sensory denervation, suggesting that acid activates TRPV1 on sensory nerve fibers [85, 86]. As a result, activation of TRPV1-positive sensory nerve fibers are able to protect the esophageal, gastric and intestinal mucosa from a variety of injurious by stimulating mucosal microcirculation [61].
Apart from signaling to the CNS, TRPV1-expressing sensory nerve fibers when activated, peptide transmitters, such as CGRP, somatostatin and the tachykinins substance P (SP) and neurokinin, as well as well as nitrogen oxide (NO) and /or ATP can be released from the peripheral nerve endings of afferents nerves and can influence the gastrointestinal function [61, 87-89]. Peptide mediators of TRPV1-positive afferent neurons may induce wide variety of actions.
CGRP and substance P fibers innervate the mucosal and submucosal microvasculature [78, 90]. CGRP in rat stomach are located exclusively in extrinsic afferent fibers, most if not all, in spinal sensory afferent neurons [91-93]. Others also confirmed that CGRP, substance P, somatostatin were characteristic of capsaicin-sensitive DRG neurons [77, 78, 93-95], while CGRP was absent from vagal afferent neurons containing TRPV1 [91]. However, Suzuki et al. [96] demonstrated that the density of CGRP-immunreactive fibers in the mucosa was largely reduced also by vagotomy suggesting CGRP-immunreactive fibers to be of both vagal and spinal origin. The CGRP-and SP-immunreactive fibers were less influenced by vagotomy in the submucosal and muscular layers. Furthermore, major portion of SP-immunreactive fibers in the mucosa is of vagal origin, and in contrast to CGRP, SP-immunreactive fibers are not capsaicin sensitive. In contrast, others showed that capsaicin also induces the release of SP from guinea pig and rat stomach [97]. Sternini et al [93] suggested that while CGRP-containing nerve fibers arise exclusively from extrinsic neurons, SP-containing fibers are of both extrinsic and intrinsic originl.
The gastroprotective effect of both CGRP and capsaicin was blocked by CGRP1 receptor antagonist, CGRP 8-37 [98]. However, not only CGRP1 receptor may mediate gastroprotective effects, since CGRP1 receptor antagonist failed to influence the effect of CGRP against aspirin-induced lesions [99]. CGRP/NO released from the nerve terminal of sensory afferents, induces gastroprotective effect not only by increasing mucosal microcirculation, but also by stimulation of mucin synthesis in the gastric corpus mucosa [100] and by reduction of myoelectrical activity in gastric smooth muscle [101].
On the other hand, TRPV1 activation has been found to exacerbate inflammation and tissue injury [76]. In addition, in the murine gastric mucosa, in ethanol-induced injury TRPV1-mediated release of neuronal substance P and subsequent formation of reactive oxygen species are involved in the development of mucosal damage
[102]. Moreover, colitis induced by dextran sulfate or trinitrobenzene sulfonic acid in rodents was attenuated by TRPV1 antagonist or TRPV1 knockout animals [103, 104]. TRPV1 receptors may also play a proinflammatory role in the ileitis elicited by C. difficile toxin A. Formation of endocannabinoids is supposed to be involved in this process, and endocannabinoids stimulate TRPV1, consequently, induce the release of substance P from sensory nerve fibers. Substance P activates enteric neurons and immune cells, which finally results in hypersecretion, inflammation, and mucosal damage [105].How can CGRP mediate gastric mucosal protection? As mentioned above the gastric mucosa and submucosa are densely innervated by CGRP, which is localized in capsaicin-sensitive afferent fibers. The protective effect of CGRP was lost after blockade of the nitric oxide system, but not the prostaglandin system indicating that the vasodilator and the consequent gastroprotective effect of CGRP is due to NO, but not to PG release [106]. However, the role of prostaglandins in sensory nerve-mediated gastroprotection was suggested by the findings that indomethacin inhibited the mucosal protective effect of capsaicin [107]. Takeuchi et al [108] concluded that capsaicin exhibits gastric cytoprotection, essentially by stimulating sensory neurons, and this action is facilitated by endogenous prostaglandins through EP2/IP receptors, probably sensitizing the sensory neurons to capsaicin.
Substance P, released also from afferent nerve fibers, do not mediate vasodilation in the rats stomach, neither the NK1 or NK2 antagonists influenced capsaicin-induced vasodilatation nor tachykinins dilated the submucosal arteries and increased gastric mucosal blood flow; on the contrary, substance P and neurokinin A induced constriction of submucosal veins [109, 110] and substance P was supposed to be involved in the pathomechanism of ethanol-induced gastric mucosal damage [111, 112]. However, others reported that substance P induce vasodilatation in vivo [113], and the effect could be attenuated by NG-monomethyl-L-arginine – a NO synthase inhibitor – suggesting the role of endogenous NO in the vasodilator response of substance P.
Capsaicin sensitive afferent fibers are also involved in the mucosal protective action of several gastroprotective agents. E.g. defunctionalisation of capsaicin-sensitive afferent nerves by pretreatment with a neurotoxic dose of capsaicin aggravates gastric ulcers in rats and antagonised the gastroprotective effect of capsaicin (10 mg/kg p. os) and lafutidine indicating that gastroprotective activity mediated by capsaicin-sensitive afferent nerves [114].
Similarly, the gastroprotective effect of different flavonoids against ethanol-lesions was reduced by a neurotoxic dose of capsaicin, or by pretreatment with NO synthase inhibitor NG-nitro-L arginine, indicating that plant-originated flavonoids-induced gastroprotection probably due to enhancement of the expression of constitutive NO synthase and the release of CGRP from sensory afferent nerves [115].
EGF was shown to exert a protective role against ethanol-induced gastric mucosal injury (10-30 µg, intragastrically), possibly by dilating the gastric mucosal arterioles via capsaicin-sensitive afferent neurons involving CGRP and NO mechanisms. Namely, the protective effect of EGF was significantly inhibited by pretreatment with capsaicin desensitization, human CGRP1 antagonist hCGRP 8-37, or the NO synthesis inhibitor, Nω-nitro-L-arginine methyl ester [116].
Mozsik et al [117] suggested participation of vanilloid/capsaicin receptors, CGRP and substance P in gastric protection of omeprazole and omeprazole-like compounds.
Moreover, accumulating evidence indicates that capsaicin sensitive afferent fibers play a pivotal role not only acutely in gastroprotection, but also in ulcer healing. In chronic ulcer model, the acetic acid-induced model neurotoxic dose of capsaicin (100 mg/kg s.c.) significantly increased ulcer size, decreased gastric mucosal cell proliferation at the ulcer margin, angiogenesis in the granulation tissue and also gastric mucus content. In addition, the dramatic increase in elevation of EGF levels in salivary glands and serum was completely abolished by neurotoxic dose of capsaicin. The results suggest that capsaicin sensitive nerves contribute to gastroprotective and ulcer healing processes in the stomach probably by stimulation of EGF expression in salivary glands [118].
Besides the periphery, gastric mucosal integrity can be regulated also by central mechanism. In the last decades increasing number of evidence suggested that central nervous system (CNS) has a pivotal role in regulation of gastric mucosal integrity. Different brain areas have been suggested to be involved in centrally induced gastroprotection. Among them, hypothalamus and dorsal vagal complex (DVC) seem to have a particularly important role and well defined interconnections between neuroendocrine hypothalamus and the central autonomic system have been described. Descending hypothalamic efferents carry feedback signals to viscerosensory and brainstem catecholaminergic neurons and regulatory inputs to parasympathetic (dorsal vagal nucleus) and sympathetic (thoracolumbar intermediolateral cell column) preganglionic neurons. These fibers arise mainly from neurons of the paraventricular, arcuate, perifornical, and dorsomedial nuclei and the lateral hypothalamus. Pathways between the hypothalamus and autonomic centers are bidirectional; the descending axons are mainly peptidergic (corticotropin-releasing hormone, vasopressin, oxytocin, somatostatin, enkephalin, pro-opiomelanocortin), while the ascending fibers are both peptidergic (enkephalin, neuropeptide Y, neurotensin, dynorphins) and catecholaminergic [119].
The first pharmacological evidence that neuropeptides by central mechanism are able to influence gastric mucosal lesions was provided by the experiments with bombesin. Bombesin, 14-amino acid peptide, inhibited the gastric lesions induced by cold-restraint stress, aspirin, indomethacin by intracisternal (i.c.) and/or intracerebroventricular (i.c.v.) injection [120, 121]. Several mechanism may be involved in the centrally induced mucosal protective effect of bombesin, such as the antisecretory effect [122], inhibition of gastric motor activity, and stimulation of protective processes (gastric mucus, bicarbonate secretion, gastric blood flow) [123].
In addition, neurotensin, β-endorphin, substance P, and somatostatin proved to be also protective given i.c. against cold restraint ulcer model. [124].
Cold restraint stress ulcer model is an acid dependent ulcer model [125]. As a next step, an acid independent model, the ethanol-induced ulcer model has been used to examine the gastroprotective effect of centally injected neuropeptides, where inhibiton of acid secretion is not likely to contribute to the gastric mucosal protective action. Several neuropeptides were injected either into dorsal motor nucleus of vagus (DMNV), i.c. or i.c.v. First, the effect of thyreotropin-releasing hormon (TRH) or its stable analogue RX-77368, injected in low (0-5-1.5 ng), non-secretory dose into the cisterna magna or DMNV was shown to protect the gastric mucosa against ethanol injury [126, 127].
Hereafter, additional neuropeptides proved to be gastroprotective given centrally, among others adrenomedullin [128] peptide YY [129] amylin [130], leptin, cholecystokinin [131], ghrelin [132], opioids, e.g. β-endorphin, deltorphin II, endomorphins [4, 133] nociceptin, nocistatin [134], TLQP-21, a VGF-derived peptide [135], substance P [136] and angiotensin II [137] (see reviews: [4, 127, 138]).
How can the centrally injected neuropeptide induce gastric mucosal protection in the periphery, in gastric mucosa? Convincing evidence suggest the role of vagal nerve in conveying the central stimulus to the periphery. TRH or its stable analogue RX-77368, injected in non-secretory dose into the cisterna magna or DMNV was the first peptide reported to protect the gastric mucosa against ethanol injury through stimulation of vagal cholinergic pathways, since both vagotomy and atropine reversed the gastroprotective effect. As a result of an intensive research additional neuropeptides e.g. amylin, adrenomedullin, neurotensin, opioid peptides, melatonin, ghrelin, leptin, as well as cannabinoids were shown to initiate gastroprotective effect given centrally (i.c.v., i.c. or DMNV), mostly by a vagal dependent mechanism [139-142] (see reviews: [4,127,138,143, 144]).
The mechanism of vagally mediated gastroprotective effect has been well documented by pharmacological studies, demonstrating that activation of vagal cholinergic pathways stimulates gastric prostaglandin and nitric oxide release and the effector function of capsaicin-sensitive afferent fibers containing CGRP [72, 126, 128,129, 145-147, reviews, 4, 127, 143, 144].
In addition, TRH injected intracisternally at low, gastroprotective dose, stimulates gastric splanchnic afferents as was shown by electrophysiological recording [148] and consequently the local effector function of capsaicin-sensitive splanchnic afferent nerves containing CGRP is activated [128, 149]. Pretreatment with high, neurotoxic dose of capsaicin (125 mg/kg sc.), which induces ablation of primary sensory neurons and the depletion of CGRP-containing fibers, pharmacological blockade of peripheral CGRP1 receptors by hCGRP 8-37 and NO synthesis by NO-synthase inhibitor Nω-nitro-L-arginine methyl ester blocked the increased gastric mucosal blood flow induced by i.c. injection of TRH [149-153]. The results indicate that the intact function of sensory fibers containing CGRP and NO is basically important for stimulation of gastric mucosal blood flow and the consequent gastroprotection [152], and the CGRP/NO-mediated gastric hyperemia plays a crucial role to withstand gastric mucosal damage [reviews 61, 154].
Moreover, additional action due to activation of vagal cholinergic pathway might contribute to the mucosal protective effect. Namely, acetylcholine released from efferent nerve terminal of vagal nerve in the periphery, activates α7 subunit-containing nicotinic receptors of macrophages and other immune cells which results in inhibition of the release of proinflammatory cytokines, consequently suppression of inflammation [155, 156].
As the above data suggest DVC has a basic role in the regulation of gastrointestinal functions. We wondered if activation of different receptor populations identified in DVC. e.g. μ-opioid receptors (in NTS and DMNV) [157], cannabinoid receptors (CB1-receptors in NTS and DMNV and CB2-receptors in NTS and brain stem neurons) [158, 159] NK1-receptors in NTS and DMNV) [160, 161], angiotensin AT1 receptors in in the NTS, area postrema and DMNV [162, 163] can influence gastric mucosal homeostasis. Our experimental results demonstrated that opioid peptides [4, 133], anandamide, 2-arachidonoyl glycerol (2-AG) endocannabinoids, ligands of cannabinoid CB1 and CB2 receptors [137, 142], as well as (SP) [136] given i.c.v. induced gastric mucosal protective effect against ethanol-induced lesions.
We wondered, if in the periphery, sensory neuropeptides, such as CGRP or somatostatin may be involved in the centrally-induced mucosal protective effect of endomorphin-2, endocannabinoids, such as anandamide, 2-AG and SP.
Conclusions on the involvement of CGRP in gastric mucosal protection have been established on pharmacological analysis by using a competitive peptide antagonist of CGRP1 receptor, CGRP 8-37 or functional ablation of neuropeptides by neurotoxic dose of capsaicin [149, 152]. However, the gastric mucosal level of CGRP or somatostatin has not been determined following central administration of gastroprotective agents.
Therefore we aimed to determine how the gastric mucosal level of CGRP and somatostatin is influenced by the mucosal damaging agent ethanol, and by endomorphin-2, endocannabinoids and SP.
As Fig 1. shows that endomorphin-2 inhibited the ethanol-induced mucosal lesions in the rat, the maximal effect was induced by 0.1 pmol. The mucosal levels of CGRP and somatostatin were decreased in a significant manner following oral administration of ethanol (after 60 min), while i.c.v. injection of endomorphin-2 reversed the decreased levels of both CGRP and somatostatin.
Panel A: The inhibitory effect of endomorphin-2 (EM-2) on the formation of ethanol-induced mucosal lesions in male Wistar rats. Acidified ethanol (2 ml concentrated HCl+98 ml absolute ethanol) was injected per os after 24 h food deprivation in a volume of 0.5 ml/rat. EM-2 was given intracerebroventricularly (i.c.v.) 10 minutes before the ethanol challenge in a volume of 10 μl in conscious rats. Mucosal lesions were evaluated macroscopically one hour after the administration of ethanol. Each column represents mean ± S.E.M., the number of rats was 5-10/group. ***p<0.001 compared to the respective control group (vehicle-treated rats) (One-way ANOVA, Newman-Keuls post hoc test). Panels B and C: The effect of EM-2 on the mucosal levels of calcitonin gene-related peptide (CGRP) and somatostatin. CGRP and somatostatin concentrations were determined from gastric mucosal tissue extract samples by means of radioimmunoassay (RIA). Peptide concentrations were calculated as the measured amount of peptide per wet tissue weight, expressed as fmol/mg. Detection limits of the assays were 2 fmol/ml (somatostatin) and 0.2 fmol/ml (CGRP). Each column represents mean ± S.E.M., the number of rats was 5/group. **p<0.01, ***p<0.001 compared to the absolute control group (no treatment), ##p<0.01, ###p<0.001 compared to vehicle (saline) i.c.v.+ethanol p.os-treated group (One-way ANOVA, Newman-Keuls post hoc test).
Similarly, anandamide and 2-AG inhibited the mucosal lesions in a dose dependent manner (though the protective effect of 2-AG was diminished in higher, 52.8 nmol dose), and both anandamide and 2-AG increased the ethanol-induced dramatic reduction of the mucosal CGRP and somatostatin levels in the gastroprotective doses (58, and 26 nmol, respectively) (Fig 2. 3.).
Panel A: The inhibitory effect of anandamide (And) on the formation of ethanol-induced mucosal lesions in male Wistar rats. Methods: see in the Legends of Fig. 1. Each column represents mean ± S.E.M., the number of rats was 5/group. *p<0.05, ***p<0.001 compared to the respective control group (vehicle-treated rats) (One-way ANOVA, Newman-Keuls post hoc test). Panels B and C: The effect of anandamide on the mucosal levels of calcitonin gene-related peptide (CGRP) and somatostatin. Methods: see in the Legends of Fig. 1. Each column represents mean ± S.E.M., the number of rats was 5/group. ***p<0.001 compared to the absolute control group (no treatment), ##p<0.01, ###p<0.001 compared to vehicle (ethanol diluted with saline) i.c.v.+ethanol p.os-treated group (One-way ANOVA, Newman-Keuls post hoc test).
Panel A: The inhibitory effect of 2-arachidonoylglycerol (2-AG) on the formation of ethanol-induced mucosal lesions in male Wistar rats. Methods: see in the Legends of Fig. 1. Each column represents mean ± S.E.M., the number of rats was 5/group. *p<0.05, ***p<0.001 compared to the respective control group (vehicle-treated rats) (One-way ANOVA, Newman-Keuls post hoc test). Panels B and C: The effect of 2-AG on the mucosal levels of calcitonin gene-related peptide (CGRP) and somatostatin. Methods: see in the Legends of Fig. 1. Each column represents mean ± S.E.M., the number of rats was 5/group. ***p<0.001 compared to the absolute control group (no treatment), ##p<0.01, ###p<0.001 compared to vehicle (acetonitrile diluted with saline) i.c.v.+ethanol p.os-treated group (One-way ANOVA, Newman-Keuls post hoc test).
SP in pmolar dose range exerted mucosal protective action, the dose response curve proved to be bell shaped, similarly to 2-AG. However, though SP in gastroprotective doses also reversed the ethanol-induced reduction of CGRP mucosal level, it failed to counteract the reduced somatostatin level (Fig. 4.)
Panel A: The inhibitory effect of substance P (SP) on the formation of ethanol-induced mucosal lesions in male Wistar rats. Methods: see in the Legends of Fig. 1.. Each column represents mean ± S.E.M., the number of rats was 5/group. **p<0.01, ***p<0.001 compared to the respective control group (vehicle-treated rats) (One-way ANOVA, Newman-Keuls post hoc test). Panels B and C: The effect of SP on the mucosal levels of calcitonin gene-related peptide (CGRP) and somatostatin. Methods: see in the Legends of Fig. 1. Each column represents mean ± S.E.M., the number of rats was 5/group. *p<0.05, ***p<0.001 compared to the absolute control group (no treatment), ##p<0.01 compared to vehicle (saline) i.c.v.+ethanol p.os-treated group (One-way ANOVA, Newman-Keuls post hoc test).
Our experimental results provided direct evidence on the role of sensory neuropeptides in centrally initiated gastroprotective effect. It was shown that while ethanol decreased in a significant manner the mucosal CGRP and somatostatin concentration, the centrally injected endomorphin-2, endocannabinoids and SP were able to reverse the highly reduced mucosal levels of sensory neuropeptides supporting the concept on the role of sensory neuropeptides in centrally initiated gastroprotective effect.
The apparent redundancy in the mechanisms of gastric mucosal defense might be a potential answer to the question raised above: how can gastric mucosa resist to wide variety of endogenous and exogenous mucosal challenges. The redundancy can be observed in the wide scale of mediators involved in mucosal defense, in generation of endogenous substance(s) to noxious stimulus that may attenuate the mucosal injury and stimulate mucosal repair (for instance, peptide gene expression in gastrointestinal mucosal ulceration [164]), and can induce further protective mechanisms or formation of additional protective mediators.
In the early phase of mucosal injury when the gastric epithelium is exposed to acid or any irritant, one of the most rapid and important responses is the increase in mucosal blood flow to remove, dilute and buffer back-diffusing irritant or acid. In this process primary sensory afferent neurons activated by the back-diffusing acid play a crucial role, since sensory nerve endings can sense acid via acid sensing channel [60-68].
In addition, primary sensory afferent neurons are involved also in the actions of gastroprotective agents. Intensive studies revealed that gastric mucosal defense can be initiated also by central mechanism. Dorsal vagal complex is likely to have prominent role in centrally induced gastroprotective effect. Several neuropeptides, and their receptors e.g. μ-opioid receptors [157-159] NK1-receptors [160, 161] angiotensin AT1 receptors [162, 163] TRH receptors [126, 127, 165], neuropeptide Y receptors [166, 167] have been identified in this area, and activation of these receptors result in mucosal protection. Accumulating data suggest that in the periphery the final step in the chain of events of centrally initiated mucosal protective processes is the release of sensory neuropeptides, such as CGRP and partly somatostatin, from the capsaicin sensitive primary afferent neurons, as well as NO and prostaglandins. The process is likely to be vagal dependent, and biochemical and pharmacological studies have shown that vagal cholinergic pathway stimulates gastric prostaglandin and nitric oxide release. In addition, vagal muscarinic mediated release of prostaglandins, histamine and serotonin [147, 150] evoke sensory C-fiber excitation and a subsequent release of neuropeptides from sensory nerve endings.
However, sympathetic nervous system may also be involved in the centrally induced gastroprotective effect, since e.g. the gastroprotective effect of opioid peptides markedly decreased following i.c.v. administration of the catecholaminergic neurotoxin, 6-hydroxydopamine, that reduced the noradrenaline concentration in a significant manner in the NTS[138].
Tache [165] raised that that the redundancy of brain peptides may be linked with different pathophysiological conditions whereby they are recruited into the brain under stress, feeding or damage of the gastric mucosa. Further studies focusing to clarify the role of neuropeptide-interactions in gastroprotection, neuronal projections between brainstem autonomic centers and upper brain areas, additional pathway(s) that may convey central stimulus to the periphery, identification of additional peripheral mechanisms, signaling of peripheral insults of gastric mucosa to the CNS, are some of the opened questions that should be answered and consequently, the better understanding of the central regulation of gastric mucosal homeostatis may result in the development of new strategy and new concept in prevention/treatment of gastric mucosal injuries.
Dehydration is the main clinical manifestation and the most frequent complication in pediatric patients with AGE. It remains to be a common reason for ED visits, and it can lead to significant morbidity and mortality rates [1]. Management of gastroenteritis is based mainly on the proper assessment of dehydration severity and correction of dehydration.
In newborn babies, 75–80% of the total body weight constitutes the total body water (TBW) (varies with the gestational age), which decreases to 67% of body weight (2/3) after the neonatal period. There is a further decrease that reaches 60% by the end of the first year, and this percentage remains the same during the rest of life. After puberty and in adulthood, TBW is 60% in males and 55% in females. The TBW is divided into two components throughout the body: intracellular fluid compartment (ICF), which constitutes 40% of TBW, and extracellular fluid (ECF), which forms the remaining 20%. The ECF comprises interstitial fluid (IF) (15% of the TBW), and the remaining 5% of the TBW comprises intravascular plasma (Figures 1 and 2) [2, 3, 4]. This distribution of body fluids can have an impact on the management of pediatric gastroenteritis, as most of the fluid loss in AGE comes from the ECF. This matters because ECF contains a lot of sodium (135–145 mEq), and ICF contains a lot of potassium (150 mEq). In a brief duration of illness (<3 days), 80% of the deficit is typically from the ECF. After more than 3 days of illness, the deficit from the ECF decreases to 60%. Fluid losses for longer than 7 days are equally lost from ECF (50%) and ICF (50%) [5].
The percentage distribution of body fluids in the various compartments in a 1-year-old infant [2].
Body water compartments in relation to age [2, 3, 4].
Accurate and quick assessment of the degree of dehydration is important for proper treatment and disposition of infants and children with AGE [6]. The percentage of weight loss is the best measure to assess the degree of dehydration, as shown in Eq. (1). However, this method is impractical because in most patients the pre-illness weight is not known [7].
Current validated dehydration scales may help in assessing the versatile presentations of dehydration more objectively. Most of them illustrate clinical signs that can be assessed easily and rapidly, which can facilitate stratification of patients into dehydration categories. There are three clinical scales designed to estimate dehydration severity in children below 5 years of age: the World Health Organization (WHO) scale (Table 1), the Gorelick scale (Table 2), and the Clinical Dehydration Scale (CDS) (Table 3) [8, 9, 10].
Characteristics | No dehydration | Some dehydration (>1 sign) | Severe dehydration (>1 sign) |
---|---|---|---|
Alertness | Well, alert | Irritable or drowsy | Lethargic or poorly responsive |
Eyes | Normal | Sunken | Sunken |
Thirst | Drinks normally | Drinks eagerly | Poor or weak drinking |
Skin turgor | Goes back quickly | Goes back slowly (<2 s) | Return very slowly (>2 s) |
WHO scale for dehydration in children aged 1 month–5 years old.
Characteristics | No or minimal dehydration | Moderate-to-severe dehydration |
---|---|---|
General appearance | Alert | Restless, lethargic, unconscious |
Capillary refill | Normal | Prolonged or minimal |
Tears | Present | Absent |
Mucous membranes | Moist | Dry, very dry |
Gorelick (4-item) scale for dehydration in children aged 1 month–5 years. Scoring: ≥2 clinical signs indicates ≥ 5% loss of body weight from baseline (moderate dehydration), and ≥3 clinical signs indicates ≥ 10% loss of body weight from baseline (severe dehydration). The presence of two or more of these signs had a sensitivity of 79% and a specificity of 87% in predicting 5% dehydration.
Characteristics | Score of 0 | Score of 1 | Score of 2 |
---|---|---|---|
General appearance | Normal | Thirsty, restless, or lethargic but irritable when touched | Drowsy, limp, cold, sweaty ± comatose |
Eyes | Normal | Slightly sunken | Very sunken |
Mouth and tongue | Moist | Sticky | Dry |
Tears | Present | Decreased | Absent |
Clinical dehydration scale (CDS) for children aged 1 month–3 years. Scoring: ≥2 clinical signs indicates ≥ 5% loss of body weight from baseline (moderate dehydration), and ≥3 clinical signs indicates ≥ 10% loss of body weight from baseline (severe dehydration). The presence of two or more of these signs had a sensitivity of 79% and a specificity of 87% in predicting 5% dehydration.
Using common tools to evaluate and assess dehydration would be more helpful in day-to-day practice. Consistent evidence supports the CDS which is more useful and easy to use in assessing dehydration. This scale in combination with other criteria should be used to guide the proper medical interventions in individual cases [11]. Clinical dehydration scales are imprecise and of limited diagnostic value in children with gastroenteritis [12]. As a screening test of dehydration, historical points are moderately sensitive. Classification of dehydration into NO, SOME, and SEVERE are recommended by WHO and other groups [1, 8].
Prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern still remain the best three individual examination signs for assessment of dehydration. Increased capillary refill time was the strongest individual sign as an isolated finding to predict dehydration, and the poor predictor of dehydration was reduced urine output. Combinations of signs perform much better than individual signs. History taking and laboratory tests show limited utility [13].
Blood biochemistry is generally not accurate and not routinely required for assessment of dehydration. Commonly done laboratory tests such as blood urea nitrogen (BUN) and bicarbonate concentrations are generally helpful only when the results are markedly abnormal. A normal serum bicarbonate concentration of more than 15 or 17 mEq/L appears to be valuable in reducing the likelihood of dehydration. These laboratory tests done for assessing dehydration should not be considered definitive, which could be reserved for children requiring IV fluids and suffering from severe dehydration, altered conscious state or convulsions, suspected hypernatremia, suspicion of hemolytic uremic syndrome and children with pre-existing medical conditions that predispose to electrolyte abnormalities [14, 15]. Historical points and laboratory tests only have limited utility for assessing dehydration [10]. Laboratory investigations should be performed if the results will influence the management and outcome of a specific patient.
Oral rehydration should be the first line of treatment for pediatric gastroenteritis with intravenous (IV) fluid therapy being used if the oral route fails [16, 17].
Oral rehydration is the preferred method for replacing fluid and electrolyte deficits resulting from dehydration secondary to acute gastroenteritis. ORT is a safe, easy-to-use, efficacious, and cost-effective alternative to intravenous rehydration for uncomplicated gastroenteritis in children [18].
The use of ORT is based on the principle of glucose-facilitated sodium transport across the intestinal mucosa. The ORT facilitates the absorption of water and sodium for the compensation of fluid losses. Additionally, the absorption can be adequate for the replacement of significant fluid loss, such as in cholera. The absorption of potassium and bicarbonate is maintained by the osmotic gradient in the intercellular space. Metabolic acidosis, usually associated with dehydration, can be safely corrected by this mechanism. The currently available ORT contains an appropriate amount of sodium, glucose, and other electrolytes and is of appropriate osmolality to maximize clinical efficacy [19].
The WHO, Centers for Disease Control (CDC), and the American Academy of Pediatrics (AAP) all support the use of ORT for some (mild–moderate) dehydration [8, 20, 21]. Rapid ORT in mild dehydration is done by giving 50 ml/kg over 4 hours. For moderate dehydration, 100 ml/kg can be given over the same duration. Generally, children being enterally rehydrated do not require blood tests.
Children who received oral ondansetron initially were less likely to be administered IV rehydration compared with those given placebo. In addition, both oral and IV ondansetron administration are associated with reduced rate of hospitalization [17]. Ondansetron is contraindicated in children with long QT syndrome, concomitant drugs that prolong QT, and to be used cautiously in children with heart disease.
Children can be discharged home when the following levels of recovery are achieved: satisfactory rehydration status as shown by clinical improvement, IV or NG fluids not required, and no significant losses. Adequate family education, proper instructions, and medical follow-up should be provided.
Inform about the expected natural course of the illness, prevention of transmission and looking at signs of dehydration. Encourage breastfeeding continuation in small babies, early refeeding, and the correct method of preparing ORS. Educate about the importance of giving anti-rotavirus vaccination and of course not to use unnecessary medication in simple AGE.
Nasogastric route is a safe rehydration technique with minimal adverse effects which has been adequately studied. Many clinical trials showed this method to have similar efficacy compared to IV therapy. Rapid NG rehydration using gastrolyte, 50 ml/kg for fluid deficit replacement over 4 hours, appears to be appropriate for children with mild-to-moderate dehydration [22]. If nasogastric rehydration is required beyond 4 hours, check urea and electrolyte concentration (UEC) and blood glucose level (BGL), and reassess the patient for hydration status.
Intravenous rehydration should be reserved for patients with severe dehydration or shock and for those with some (mild-to-moderate) dehydration who fail ORT. Fluid containing not less than 0.9% sodium chloride is preferred for rehydration [23, 24]. Using hypotonic fluids predisposes for dilutional hyponatremia due to excess antidiuretic hormone (ADH) secretion in children with AGE. Serum electrolytes and BGL are required in children with severe dehydration and/or requiring IV fluid therapy for correction of dehydration.
The WHO recommends IV rehydration to be rapidly completed over 3–4 hours [8]. Rapid replacement of ECF improves gastrointestinal and renal perfusion, allowing earlier oral intake and a faster correction of electrolyte and acid-base abnormalities, which results in excellent recovery rate and decreased length of stay in ED [25].
Resuscitate shock/near shock with a prompt intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution or Ringer’s lactate solution as fast as possible. Reassessing and repeating boluses given, as necessary, are required until the patient is recovered from shock and then followed by maintenance IV fluids [26].
The clinical standard is to administer 20 mL/kg/h of isotonic crystalloid fluid, such as 0.9% normal saline or lactated Ringer’s solution. Reassess the patient after each bolus, and if the patient is still dehydrated, a total of 2–4 fluid boluses may allow rapid restoration of intravascular volume which can bring rapid recovery. Rapid IV rehydration followed by oral fluids is adequate for initial rehydration for most patients requiring IV fluid therapy. For those refusing oral intake, continuous infusion of maintenance IV fluids are to be given until oral fluids are tolerated [27]. Glucose solution should be added once ECF volume has been restored and addition of potassium considered once the child passes urine and serum electrolytes are known [28].
Refer to the correction of dehydration using a large volume of fluids over a relatively shorter time (50–60 ml/kg/hour). Ultra-rapid IV rehydration may be associated with electrolyte abnormalities and longer hospital stay or delayed discharge and therefore is not recommended [29, 30].
Children with acute watery diarrhea and severe dehydration, such as cholera, who fail ORT, can benefit from large-volume IV rehydration (100 ml/kg) of Ringer’s lactate solution or normal saline over 3–6 hours. Frequent reassessment is required, and if hydration status is not improving, IV fluids should be given more rapidly [31]. Further research investigations are needed to justify the use of rapid large-volume IV rehydration in pediatric gastroenteritis.
Dyselectrolytemia is a serious complication of AGE with dehydration. The majority of electrolyte disorders associated with AGE in children can be adequately treated using ORT.
Hypernatremia leads to hypertonicity that can be potentially dangerous as there is a greater likelihood of neurological manifestations. Most frequently, it is due to water deficit from increased water losses in diarrhea and due to reduced water intake during the illness.
As in any type of dehydration, the primary aim should be restoration of hemodynamic stability by administration of isotonic fluids. The gradual replacement of water deficit remains the gold standard treatment for hypernatremic dehydration [32]. The recent advance in management of hypernatremia is to give isotonic (0.9% sodium chloride + 5% glucose) than hypotonic solution to correct the calculated fluid deficit slowly. The more the solution contains free water, the higher the risk of developing hyponatremia during rehydration [23, 33].
It represents an excess of water in relation to sodium in ECF [34]. Hyponatremia is seldom symptomatic unless the serum Na is <120 or if the hyponatremia occurs quickly [35]. Hyponatremia may be presented with nausea, vomiting, headache, irritability, lethargy, confusion, muscle cramps, convulsions, disorientation, and reduced consciousness and places the patient at risk of neurologic impairment [36].
The initial goal in treating hyponatremia is the restoration of intravascular volume with isotonic saline and to be followed by a slower correction using 0.9% sodium chloride + 5% glucose. In severe hyponatremia or symptomatic children, the goal is to raise the serum sodium to 120–125 mmol/L or until the seizure stops [35]. As a rule of thumb, IV infusion of 3% NaCl, 3–5 ml/kg over 15–30 min, will raise serum Na by 5 mEq/L.
See Figure 3.
Flow chart for the management of pediatric gastroenteritis with dehydration.
The management of a child with a dehydrating gastroenteritis requires careful initial assessment and reassessment of hydration status. The majority of gastroenteritis in infants and children are simple and can be treated by ORT. In children who presented with severe dehydration or those with some dehydration and fail ORT, IV rehydration is required. Rapid IV rehydration using standard boluses of isotonic fluids followed by oral fluid intake or maintenance IV fluids for those refusing oral intake appears sufficient for most patients requiring IV fluids. Patients achieving satisfactory hydration status and tolerating oral intake can be discharge home with proper instructions.
The authors thank physicians and nurses staff who are working at the Pediatric Emergency center (PEC) Alsadd, Hamad Medical Corporation (HMC), Qatar, for their help and support.
The authors declare no conflict of interest.
AGE | acute gastroenteritis |
TBW | total body water |
ECF | extracellular fluid |
ICF | intracellular fluid |
UEC | urea electrolyte concentration |
BGL | blood glucose level |
ORT | oral rehydration therapy |
IV | intravenous |
ADH | antidiuretic hormone |
NICE | National Institute for Health and Care Excellence |
ED | emergency department |
Unsubscribe unsuccessful, no matching records found in our database.
",metaTitle:"Unsubscribe Unsuccessful",metaDescription:"Unsubscribe unsuccessful, no matching records found in our database.",metaKeywords:null,canonicalURL:"/page/unsubscribe-unsuccessful",contentRaw:'[{"type":"htmlEditorComponent","content":""}]'},components:[{type:"htmlEditorComponent",content:""}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5698},{group:"region",caption:"Middle and South America",value:2,count:5172},{group:"region",caption:"Africa",value:3,count:1689},{group:"region",caption:"Asia",value:4,count:10244},{group:"region",caption:"Australia and Oceania",value:5,count:888},{group:"region",caption:"Europe",value:6,count:15650}],offset:12,limit:12,total:117315},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{topicId:"20"},books:[{type:"book",id:"10206",title:"Terahertz Technology",subtitle:null,isOpenForSubmission:!0,hash:"2cdb79bf6297623f1d6202ef11f099c4",slug:null,bookSignature:"Dr. Borwen You and Dr. Ja-Yu Lu",coverURL:"https://cdn.intechopen.com/books/images_new/10206.jpg",editedByType:null,editors:[{id:"191131",title:"Dr.",name:"Borwen",surname:"You",slug:"borwen-you",fullName:"Borwen You"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10575",title:"Magnetic Skyrmions",subtitle:null,isOpenForSubmission:!0,hash:"d93d7485e8a6a30d9e069aed78fdb355",slug:null,bookSignature:"Prof. Dipti Ranjan Sahu",coverURL:"https://cdn.intechopen.com/books/images_new/10575.jpg",editedByType:null,editors:[{id:"251855",title:"Prof.",name:"Dipti Ranjan",surname:"Sahu",slug:"dipti-ranjan-sahu",fullName:"Dipti Ranjan Sahu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10675",title:"Hydrostatics",subtitle:null,isOpenForSubmission:!0,hash:"c86c2fa9f835d4ad5e7efd8b01921866",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/10675.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10957",title:"Liquid Crystals",subtitle:null,isOpenForSubmission:!0,hash:"b8dac1788dc54d12f8fc3d94a7e3e338",slug:null,bookSignature:"",coverURL:"//cdnintech.com/web/frontend/www/assets/cover.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:9},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:16},{group:"topic",caption:"Business, Management and Economics",value:7,count:2},{group:"topic",caption:"Chemistry",value:8,count:6},{group:"topic",caption:"Computer and Information Science",value:9,count:10},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:4},{group:"topic",caption:"Engineering",value:11,count:15},{group:"topic",caption:"Environmental Sciences",value:12,count:2},{group:"topic",caption:"Immunology and Microbiology",value:13,count:4},{group:"topic",caption:"Materials Science",value:14,count:4},{group:"topic",caption:"Mathematics",value:15,count:1},{group:"topic",caption:"Medicine",value:16,count:56},{group:"topic",caption:"Neuroscience",value:18,count:1},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:6},{group:"topic",caption:"Physics",value:20,count:2},{group:"topic",caption:"Psychology",value:21,count:3},{group:"topic",caption:"Robotics",value:22,count:1},{group:"topic",caption:"Social Sciences",value:23,count:3},{group:"topic",caption:"Technology",value:24,count:1},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:12,limit:12,total:4},popularBooks:{featuredBooks:[{type:"book",id:"7802",title:"Modern Slavery and Human Trafficking",subtitle:null,isOpenForSubmission:!1,hash:"587a0b7fb765f31cc98de33c6c07c2e0",slug:"modern-slavery-and-human-trafficking",bookSignature:"Jane Reeves",coverURL:"https://cdn.intechopen.com/books/images_new/7802.jpg",editors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8545",title:"Animal Reproduction in Veterinary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"13aaddf5fdbbc78387e77a7da2388bf6",slug:"animal-reproduction-in-veterinary-medicine",bookSignature:"Faruk Aral, Rita Payan-Carreira and Miguel Quaresma",coverURL:"https://cdn.intechopen.com/books/images_new/8545.jpg",editors:[{id:"25600",title:"Prof.",name:"Faruk",middleName:null,surname:"Aral",slug:"faruk-aral",fullName:"Faruk Aral"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9961",title:"Data Mining",subtitle:"Methods, Applications and Systems",isOpenForSubmission:!1,hash:"ed79fb6364f2caf464079f94a0387146",slug:"data-mining-methods-applications-and-systems",bookSignature:"Derya Birant",coverURL:"https://cdn.intechopen.com/books/images_new/9961.jpg",editors:[{id:"15609",title:"Dr.",name:"Derya",middleName:null,surname:"Birant",slug:"derya-birant",fullName:"Derya Birant"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9157",title:"Neurodegenerative Diseases",subtitle:"Molecular Mechanisms and Current Therapeutic Approaches",isOpenForSubmission:!1,hash:"bc8be577966ef88735677d7e1e92ed28",slug:"neurodegenerative-diseases-molecular-mechanisms-and-current-therapeutic-approaches",bookSignature:"Nagehan Ersoy Tunalı",coverURL:"https://cdn.intechopen.com/books/images_new/9157.jpg",editors:[{id:"82778",title:"Ph.D.",name:"Nagehan",middleName:null,surname:"Ersoy Tunalı",slug:"nagehan-ersoy-tunali",fullName:"Nagehan Ersoy Tunalı"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8686",title:"Direct Torque Control Strategies of Electrical Machines",subtitle:null,isOpenForSubmission:!1,hash:"b6ad22b14db2b8450228545d3d4f6b1a",slug:"direct-torque-control-strategies-of-electrical-machines",bookSignature:"Fatma Ben Salem",coverURL:"https://cdn.intechopen.com/books/images_new/8686.jpg",editors:[{id:"295623",title:"Associate Prof.",name:"Fatma",middleName:null,surname:"Ben Salem",slug:"fatma-ben-salem",fullName:"Fatma Ben Salem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7434",title:"Molecular Biotechnology",subtitle:null,isOpenForSubmission:!1,hash:"eceede809920e1ec7ecadd4691ede2ec",slug:"molecular-biotechnology",bookSignature:"Sergey Sedykh",coverURL:"https://cdn.intechopen.com/books/images_new/7434.jpg",editors:[{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",slug:"sergey-sedykh",fullName:"Sergey Sedykh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9839",title:"Outdoor Recreation",subtitle:"Physiological and Psychological Effects on Health",isOpenForSubmission:!1,hash:"5f5a0d64267e32567daffa5b0c6a6972",slug:"outdoor-recreation-physiological-and-psychological-effects-on-health",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/9839.jpg",editors:[{id:"158692",title:"Ph.D.",name:"Hilde G.",middleName:null,surname:"Nielsen",slug:"hilde-g.-nielsen",fullName:"Hilde G. Nielsen"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. Absi",surname:"Alfaro",slug:"sadek-crisostomo-absi-alfaro",fullName:"Sadek Crisostomo Absi Alfaro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9139",title:"Topics in Primary Care Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ea774a4d4c1179da92a782e0ae9cde92",slug:"topics-in-primary-care-medicine",bookSignature:"Thomas F. Heston",coverURL:"https://cdn.intechopen.com/books/images_new/9139.jpg",editors:[{id:"217926",title:"Dr.",name:"Thomas F.",middleName:null,surname:"Heston",slug:"thomas-f.-heston",fullName:"Thomas F. Heston"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9343",title:"Trace Metals in the Environment",subtitle:"New Approaches and Recent Advances",isOpenForSubmission:!1,hash:"ae07e345bc2ce1ebbda9f70c5cd12141",slug:"trace-metals-in-the-environment-new-approaches-and-recent-advances",bookSignature:"Mario Alfonso Murillo-Tovar, Hugo Saldarriaga-Noreña and Agnieszka Saeid",coverURL:"https://cdn.intechopen.com/books/images_new/9343.jpg",editors:[{id:"255959",title:"Dr.",name:"Mario Alfonso",middleName:null,surname:"Murillo-Tovar",slug:"mario-alfonso-murillo-tovar",fullName:"Mario Alfonso Murillo-Tovar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8697",title:"Virtual Reality and Its Application in Education",subtitle:null,isOpenForSubmission:!1,hash:"ee01b5e387ba0062c6b0d1e9227bda05",slug:"virtual-reality-and-its-application-in-education",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/8697.jpg",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7831",title:"Sustainability in Urban Planning and Design",subtitle:null,isOpenForSubmission:!1,hash:"c924420492c8c2c9751e178d025f4066",slug:"sustainability-in-urban-planning-and-design",bookSignature:"Amjad Almusaed, Asaad Almssad and Linh Truong - Hong",coverURL:"https://cdn.intechopen.com/books/images_new/7831.jpg",editors:[{id:"110471",title:"Dr.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:5143},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. Absi",surname:"Alfaro",slug:"sadek-crisostomo-absi-alfaro",fullName:"Sadek Crisostomo Absi Alfaro"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9139",title:"Topics in Primary Care Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ea774a4d4c1179da92a782e0ae9cde92",slug:"topics-in-primary-care-medicine",bookSignature:"Thomas F. Heston",coverURL:"https://cdn.intechopen.com/books/images_new/9139.jpg",editors:[{id:"217926",title:"Dr.",name:"Thomas F.",middleName:null,surname:"Heston",slug:"thomas-f.-heston",fullName:"Thomas F. Heston"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8697",title:"Virtual Reality and Its Application in Education",subtitle:null,isOpenForSubmission:!1,hash:"ee01b5e387ba0062c6b0d1e9227bda05",slug:"virtual-reality-and-its-application-in-education",bookSignature:"Dragan Cvetković",coverURL:"https://cdn.intechopen.com/books/images_new/8697.jpg",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9343",title:"Trace Metals in the Environment",subtitle:"New Approaches and Recent Advances",isOpenForSubmission:!1,hash:"ae07e345bc2ce1ebbda9f70c5cd12141",slug:"trace-metals-in-the-environment-new-approaches-and-recent-advances",bookSignature:"Mario Alfonso Murillo-Tovar, Hugo Saldarriaga-Noreña and Agnieszka Saeid",coverURL:"https://cdn.intechopen.com/books/images_new/9343.jpg",editors:[{id:"255959",title:"Dr.",name:"Mario Alfonso",middleName:null,surname:"Murillo-Tovar",slug:"mario-alfonso-murillo-tovar",fullName:"Mario Alfonso Murillo-Tovar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9785",title:"Endometriosis",subtitle:null,isOpenForSubmission:!1,hash:"f457ca61f29cf7e8bc191732c50bb0ce",slug:"endometriosis",bookSignature:"Courtney Marsh",coverURL:"https://cdn.intechopen.com/books/images_new/9785.jpg",editors:[{id:"255491",title:"Dr.",name:"Courtney",middleName:null,surname:"Marsh",slug:"courtney-marsh",fullName:"Courtney Marsh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7831",title:"Sustainability in Urban Planning and Design",subtitle:null,isOpenForSubmission:!1,hash:"c924420492c8c2c9751e178d025f4066",slug:"sustainability-in-urban-planning-and-design",bookSignature:"Amjad Almusaed, Asaad Almssad and Linh Truong - Hong",coverURL:"https://cdn.intechopen.com/books/images_new/7831.jpg",editors:[{id:"110471",title:"Dr.",name:"Amjad",middleName:"Zaki",surname:"Almusaed",slug:"amjad-almusaed",fullName:"Amjad Almusaed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9376",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 1",isOpenForSubmission:!1,hash:"b9a00b84cd04aae458fb1d6c65795601",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-1",bookSignature:"Stanislaw P. Stawicki, Michael S. Firstenberg, Sagar C. Galwankar, Ricardo Izurieta and Thomas Papadimos",coverURL:"https://cdn.intechopen.com/books/images_new/9376.jpg",editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7769",title:"Medical Isotopes",subtitle:null,isOpenForSubmission:!1,hash:"f8d3c5a6c9a42398e56b4e82264753f7",slug:"medical-isotopes",bookSignature:"Syed Ali Raza Naqvi and Muhammad Babar Imrani",coverURL:"https://cdn.intechopen.com/books/images_new/7769.jpg",editors:[{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9279",title:"Concepts, Applications and Emerging Opportunities in Industrial Engineering",subtitle:null,isOpenForSubmission:!1,hash:"9bfa87f9b627a5468b7c1e30b0eea07a",slug:"concepts-applications-and-emerging-opportunities-in-industrial-engineering",bookSignature:"Gary Moynihan",coverURL:"https://cdn.intechopen.com/books/images_new/9279.jpg",editors:[{id:"16974",title:"Dr.",name:"Gary",middleName:null,surname:"Moynihan",slug:"gary-moynihan",fullName:"Gary Moynihan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7807",title:"A Closer Look at Organizational Culture in Action",subtitle:null,isOpenForSubmission:!1,hash:"05c608b9271cc2bc711f4b28748b247b",slug:"a-closer-look-at-organizational-culture-in-action",bookSignature:"Süleyman Davut Göker",coverURL:"https://cdn.intechopen.com/books/images_new/7807.jpg",editors:[{id:"190035",title:"Associate Prof.",name:"Süleyman Davut",middleName:null,surname:"Göker",slug:"suleyman-davut-goker",fullName:"Süleyman Davut Göker"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"7434",title:"Molecular Biotechnology",subtitle:null,isOpenForSubmission:!1,hash:"eceede809920e1ec7ecadd4691ede2ec",slug:"molecular-biotechnology",bookSignature:"Sergey Sedykh",coverURL:"https://cdn.intechopen.com/books/images_new/7434.jpg",editedByType:"Edited by",editors:[{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",slug:"sergey-sedykh",fullName:"Sergey Sedykh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8545",title:"Animal Reproduction in Veterinary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"13aaddf5fdbbc78387e77a7da2388bf6",slug:"animal-reproduction-in-veterinary-medicine",bookSignature:"Faruk Aral, Rita Payan-Carreira and Miguel Quaresma",coverURL:"https://cdn.intechopen.com/books/images_new/8545.jpg",editedByType:"Edited by",editors:[{id:"25600",title:"Prof.",name:"Faruk",middleName:null,surname:"Aral",slug:"faruk-aral",fullName:"Faruk Aral"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9569",title:"Methods in Molecular Medicine",subtitle:null,isOpenForSubmission:!1,hash:"691d3f3c4ac25a8093414e9b270d2843",slug:"methods-in-molecular-medicine",bookSignature:"Yusuf Tutar",coverURL:"https://cdn.intechopen.com/books/images_new/9569.jpg",editedByType:"Edited by",editors:[{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9839",title:"Outdoor Recreation",subtitle:"Physiological and Psychological Effects on Health",isOpenForSubmission:!1,hash:"5f5a0d64267e32567daffa5b0c6a6972",slug:"outdoor-recreation-physiological-and-psychological-effects-on-health",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/9839.jpg",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde G.",middleName:null,surname:"Nielsen",slug:"hilde-g.-nielsen",fullName:"Hilde G. Nielsen"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7802",title:"Modern Slavery and Human Trafficking",subtitle:null,isOpenForSubmission:!1,hash:"587a0b7fb765f31cc98de33c6c07c2e0",slug:"modern-slavery-and-human-trafficking",bookSignature:"Jane Reeves",coverURL:"https://cdn.intechopen.com/books/images_new/7802.jpg",editedByType:"Edited by",editors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8063",title:"Food Security in Africa",subtitle:null,isOpenForSubmission:!1,hash:"8cbf3d662b104d19db2efc9d59249efc",slug:"food-security-in-africa",bookSignature:"Barakat Mahmoud",coverURL:"https://cdn.intechopen.com/books/images_new/8063.jpg",editedByType:"Edited by",editors:[{id:"92016",title:"Dr.",name:"Barakat",middleName:null,surname:"Mahmoud",slug:"barakat-mahmoud",fullName:"Barakat Mahmoud"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10118",title:"Plant Stress Physiology",subtitle:null,isOpenForSubmission:!1,hash:"c68b09d2d2634fc719ae3b9a64a27839",slug:"plant-stress-physiology",bookSignature:"Akbar Hossain",coverURL:"https://cdn.intechopen.com/books/images_new/10118.jpg",editedByType:"Edited by",editors:[{id:"280755",title:"Dr.",name:"Akbar",middleName:null,surname:"Hossain",slug:"akbar-hossain",fullName:"Akbar Hossain"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9157",title:"Neurodegenerative Diseases",subtitle:"Molecular Mechanisms and Current Therapeutic Approaches",isOpenForSubmission:!1,hash:"bc8be577966ef88735677d7e1e92ed28",slug:"neurodegenerative-diseases-molecular-mechanisms-and-current-therapeutic-approaches",bookSignature:"Nagehan Ersoy Tunalı",coverURL:"https://cdn.intechopen.com/books/images_new/9157.jpg",editedByType:"Edited by",editors:[{id:"82778",title:"Ph.D.",name:"Nagehan",middleName:null,surname:"Ersoy Tunalı",slug:"nagehan-ersoy-tunali",fullName:"Nagehan Ersoy Tunalı"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9961",title:"Data Mining",subtitle:"Methods, Applications and Systems",isOpenForSubmission:!1,hash:"ed79fb6364f2caf464079f94a0387146",slug:"data-mining-methods-applications-and-systems",bookSignature:"Derya Birant",coverURL:"https://cdn.intechopen.com/books/images_new/9961.jpg",editedByType:"Edited by",editors:[{id:"15609",title:"Dr.",name:"Derya",middleName:null,surname:"Birant",slug:"derya-birant",fullName:"Derya Birant"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8686",title:"Direct Torque Control Strategies of Electrical Machines",subtitle:null,isOpenForSubmission:!1,hash:"b6ad22b14db2b8450228545d3d4f6b1a",slug:"direct-torque-control-strategies-of-electrical-machines",bookSignature:"Fatma Ben Salem",coverURL:"https://cdn.intechopen.com/books/images_new/8686.jpg",editedByType:"Edited by",editors:[{id:"295623",title:"Associate Prof.",name:"Fatma",middleName:null,surname:"Ben Salem",slug:"fatma-ben-salem",fullName:"Fatma Ben Salem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"90",title:"Computer Science and Engineering",slug:"computer-science-and-engineering",parent:{title:"Computer and Information Science",slug:"computer-and-information-science"},numberOfBooks:33,numberOfAuthorsAndEditors:771,numberOfWosCitations:720,numberOfCrossrefCitations:637,numberOfDimensionsCitations:1179,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"computer-science-and-engineering",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"8423",title:"Security and Privacy From a Legal, Ethical, and Technical Perspective",subtitle:null,isOpenForSubmission:!1,hash:"dc4f0b68a2f903e7bf1ec7fbe042dbf2",slug:"security-and-privacy-from-a-legal-ethical-and-technical-perspective",bookSignature:"Christos Kalloniatis and Carlos Travieso-Gonzalez",coverURL:"https://cdn.intechopen.com/books/images_new/8423.jpg",editedByType:"Edited by",editors:[{id:"219671",title:"Associate Prof.",name:"Christos",middleName:null,surname:"Kalloniatis",slug:"christos-kalloniatis",fullName:"Christos Kalloniatis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8511",title:"Cyberspace",subtitle:null,isOpenForSubmission:!1,hash:"8c1cdeb133dbe6cc1151367061c1bba6",slug:"cyberspace",bookSignature:"Evon Abu-Taieh, Abdelkrim El Mouatasim and Issam H. Al Hadid",coverURL:"https://cdn.intechopen.com/books/images_new/8511.jpg",editedByType:"Edited by",editors:[{id:"223522",title:"Dr.",name:"Evon",middleName:"M.O.",surname:"Abu-Taieh",slug:"evon-abu-taieh",fullName:"Evon Abu-Taieh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6958",title:"High Performance Parallel Computing",subtitle:null,isOpenForSubmission:!1,hash:"dd811128360e48c520a91871f0279659",slug:"high-performance-parallel-computing",bookSignature:"Satyadhyan Chickerur",coverURL:"https://cdn.intechopen.com/books/images_new/6958.jpg",editedByType:"Edited by",editors:[{id:"239076",title:"Dr.",name:"Satyadhyan",middleName:null,surname:"Chickerur",slug:"satyadhyan-chickerur",fullName:"Satyadhyan Chickerur"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6715",title:"Petri Nets in Science and Engineering",subtitle:null,isOpenForSubmission:!1,hash:"b0b98cd043ed2dc582d8365630929d33",slug:"petri-nets-in-science-and-engineering",bookSignature:"Raul Campos-Rodriguez and Mildreth Alcaraz-Mejia",coverURL:"https://cdn.intechopen.com/books/images_new/6715.jpg",editedByType:"Edited by",editors:[{id:"178524",title:"Dr.",name:"Raul",middleName:null,surname:"Campos-Rodriguez",slug:"raul-campos-rodriguez",fullName:"Raul Campos-Rodriguez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5368",title:"Radio Frequency Identification",subtitle:null,isOpenForSubmission:!1,hash:"c86dd0c6a48afce125a9f8f2363fd4b8",slug:"radio-frequency-identification",bookSignature:"Paulo Cesar Crepaldi and Tales Cleber Pimenta",coverURL:"https://cdn.intechopen.com/books/images_new/5368.jpg",editedByType:"Edited by",editors:[{id:"38288",title:"Prof.",name:"Paulo",middleName:"Cesar",surname:"Crepaldi",slug:"paulo-crepaldi",fullName:"Paulo Crepaldi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6038",title:"Wireless Sensor Networks",subtitle:"Insights and Innovations",isOpenForSubmission:!1,hash:"e63cb7f71bc1fed54902b371cbe21a2a",slug:"wireless-sensor-networks-insights-and-innovations",bookSignature:"Philip Sallis",coverURL:"https://cdn.intechopen.com/books/images_new/6038.jpg",editedByType:"Edited by",editors:[{id:"10893",title:"Prof.",name:"Philip John",middleName:null,surname:"Sallis",slug:"philip-john-sallis",fullName:"Philip John Sallis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5966",title:"Heuristics and Hyper-Heuristics",subtitle:"Principles and Applications",isOpenForSubmission:!1,hash:"da699185a8b84a430d96d54bc35acdb2",slug:"heuristics-and-hyper-heuristics-principles-and-applications",bookSignature:"Javier Del Ser Lorente",coverURL:"https://cdn.intechopen.com/books/images_new/5966.jpg",editedByType:"Edited by",editors:[{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5745",title:"Recent Progress in Parallel and Distributed Computing",subtitle:null,isOpenForSubmission:!1,hash:"dba64b23d703d16339860ebf4a13f022",slug:"recent-progress-in-parallel-and-distributed-computing",bookSignature:"Wen-Jyi Hwang",coverURL:"https://cdn.intechopen.com/books/images_new/5745.jpg",editedByType:"Edited by",editors:[{id:"108614",title:"Prof.",name:"Wen-Jyi",middleName:null,surname:"Hwang",slug:"wen-jyi-hwang",fullName:"Wen-Jyi Hwang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5707",title:"Computer Simulation",subtitle:null,isOpenForSubmission:!1,hash:"9eec1723d4d4775dc9755db55aa387a6",slug:"computer-simulation",bookSignature:"Dragan Cvetkovic",coverURL:"https://cdn.intechopen.com/books/images_new/5707.jpg",editedByType:"Edited by",editors:[{id:"101330",title:"Dr.",name:"Dragan",middleName:"Mladen",surname:"Cvetković",slug:"dragan-cvetkovic",fullName:"Dragan Cvetković"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5183",title:"Face Recognition",subtitle:"Semisupervised Classification, Subspace Projection and Evaluation Methods",isOpenForSubmission:!1,hash:"d693acce19fca9cbf40d8f3f759e491d",slug:"face-recognition-semisupervised-classification-subspace-projection-and-evaluation-methods",bookSignature:"S. Ramakrishnan",coverURL:"https://cdn.intechopen.com/books/images_new/5183.jpg",editedByType:"Edited by",editors:[{id:"116136",title:"Dr.",name:"Srinivasan",middleName:null,surname:"Ramakrishnan",slug:"srinivasan-ramakrishnan",fullName:"Srinivasan Ramakrishnan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5150",title:"Electronics Cooling",subtitle:null,isOpenForSubmission:!1,hash:"b95856cfcc87ef3cb7d7c7c7bac4010d",slug:"electronics-cooling",bookSignature:"S M Sohel Murshed",coverURL:"https://cdn.intechopen.com/books/images_new/5150.jpg",editedByType:"Edited by",editors:[{id:"24904",title:"Prof.",name:"S. M. Sohel",middleName:null,surname:"Murshed",slug:"s.-m.-sohel-murshed",fullName:"S. M. Sohel Murshed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4655",title:"Applications of Digital Signal Processing through Practical Approach",subtitle:null,isOpenForSubmission:!1,hash:"b20308efd28e8a487949997c8d673fb8",slug:"applications-of-digital-signal-processing-through-practical-approach",bookSignature:"Sudhakar Radhakrishnan",coverURL:"https://cdn.intechopen.com/books/images_new/4655.jpg",editedByType:"Edited by",editors:[{id:"26327",title:"Dr.",name:"Sudhakar",middleName:null,surname:"Radhakrishnan",slug:"sudhakar-radhakrishnan",fullName:"Sudhakar Radhakrishnan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:33,mostCitedChapters:[{id:"50801",doi:"10.5772/62898",title:"Performance Evaluation of Nanofluids in an Inclined Ribbed Microchannel for Electronic Cooling Applications",slug:"performance-evaluation-of-nanofluids-in-an-inclined-ribbed-microchannel-for-electronic-cooling-appli",totalDownloads:1949,totalCrossrefCites:44,totalDimensionsCites:78,book:{slug:"electronics-cooling",title:"Electronics Cooling",fullTitle:"Electronics Cooling"},signatures:"Mohammad Reza Safaei, Marjan Gooarzi, Omid Ali Akbari, Mostafa\nSafdari Shadloo and Mahidzal Dahari",authors:[{id:"178854",title:"Dr.",name:"Mohammad Reza",middleName:null,surname:"Safaei",slug:"mohammad-reza-safaei",fullName:"Mohammad Reza Safaei"},{id:"179807",title:"Dr.",name:"Mostafa",middleName:null,surname:"Safdari Shadloo",slug:"mostafa-safdari-shadloo",fullName:"Mostafa Safdari Shadloo"},{id:"179809",title:"Dr.",name:"Mahidzal",middleName:null,surname:"Dahari",slug:"mahidzal-dahari",fullName:"Mahidzal Dahari"},{id:"179813",title:"MSc.",name:"Marjan",middleName:null,surname:"Goodarzi",slug:"marjan-goodarzi",fullName:"Marjan Goodarzi"},{id:"185093",title:"MSc.",name:"Omid",middleName:null,surname:"Ali Akbari",slug:"omid-ali-akbari",fullName:"Omid Ali Akbari"}]},{id:"5184",doi:"10.5772/6180",title:"From the Lab to the Real World: Affect Recognition Using Multiple Cues and Modalities",slug:"from_the_lab_to_the_real_world__affect_recognition_using_multiple_cues_and_modalities",totalDownloads:3132,totalCrossrefCites:34,totalDimensionsCites:51,book:{slug:"affective_computing",title:"Affective Computing",fullTitle:"Affective Computing"},signatures:"Hatice Gunes, Massimo Piccardi and Maja Pantic",authors:null},{id:"5197",doi:"10.5772/6167",title:"Generating Facial Expressions with Deep Belief Nets",slug:"generating_facial_expressions_with_deep_belief_nets",totalDownloads:3140,totalCrossrefCites:1,totalDimensionsCites:46,book:{slug:"affective_computing",title:"Affective Computing",fullTitle:"Affective Computing"},signatures:"Joshua M. Susskind, Geoffrey E. Hinton, Javier R. Movellan and Adam K. Anderson",authors:null}],mostDownloadedChaptersLast30Days:[{id:"68505",title:"Research Design and Methodology",slug:"research-design-and-methodology",totalDownloads:16004,totalCrossrefCites:1,totalDimensionsCites:2,book:{slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Kassu Jilcha Sileyew",authors:null},{id:"15946",title:"Wake-Up-Word Speech Recognition",slug:"wake-up-word-speech-recognition",totalDownloads:4003,totalCrossrefCites:3,totalDimensionsCites:3,book:{slug:"speech-technologies",title:"Speech Technologies",fullTitle:"Speech Technologies"},signatures:"Veton Kepuska",authors:[{id:"24379",title:"Prof.",name:"Veton",middleName:null,surname:"Kepuska",slug:"veton-kepuska",fullName:"Veton Kepuska"}]},{id:"51031",title:"Face Recognition: Issues, Methods and Alternative Applications",slug:"face-recognition-issues-methods-and-alternative-applications",totalDownloads:10292,totalCrossrefCites:2,totalDimensionsCites:4,book:{slug:"face-recognition-semisupervised-classification-subspace-projection-and-evaluation-methods",title:"Face Recognition",fullTitle:"Face Recognition - Semisupervised Classification, Subspace Projection and Evaluation Methods"},signatures:"Waldemar Wójcik, Konrad Gromaszek and Muhtar Junisbekov",authors:[{id:"24059",title:"Dr.Ing.",name:"Konrad",middleName:null,surname:"Gromaszek",slug:"konrad-gromaszek",fullName:"Konrad Gromaszek"}]},{id:"56541",title:"Routing Protocols for Wireless Sensor Networks (WSNs)",slug:"routing-protocols-for-wireless-sensor-networks-wsns-",totalDownloads:4344,totalCrossrefCites:9,totalDimensionsCites:11,book:{slug:"wireless-sensor-networks-insights-and-innovations",title:"Wireless Sensor Networks",fullTitle:"Wireless Sensor Networks - Insights and Innovations"},signatures:"Noman Shabbir and Syed Rizwan Hassan",authors:[{id:"206600",title:"Mr.",name:"Noman",middleName:null,surname:"Shabbir",slug:"noman-shabbir",fullName:"Noman Shabbir"},{id:"206601",title:"Mr.",name:"Syed Rizwan",middleName:null,surname:"Hassan",slug:"syed-rizwan-hassan",fullName:"Syed Rizwan Hassan"}]},{id:"62639",title:"Reliability Evaluation for Mechanical Systems by Petri Nets",slug:"reliability-evaluation-for-mechanical-systems-by-petri-nets",totalDownloads:514,totalCrossrefCites:1,totalDimensionsCites:2,book:{slug:"petri-nets-in-science-and-engineering",title:"Petri Nets in Science and Engineering",fullTitle:"Petri Nets in Science and Engineering"},signatures:"Jianing Wu and Shaoze Yan",authors:[{id:"238979",title:"Dr.",name:"Jianing",middleName:null,surname:"Wu",slug:"jianing-wu",fullName:"Jianing Wu"}]},{id:"70973",title:"Social Media, Ethics and the Privacy Paradox",slug:"social-media-ethics-and-the-privacy-paradox",totalDownloads:850,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"security-and-privacy-from-a-legal-ethical-and-technical-perspective",title:"Security and Privacy From a Legal, Ethical, and Technical Perspective",fullTitle:"Security and Privacy From a Legal, Ethical, and Technical Perspective"},signatures:"Nadine Barrett-Maitland and Jenice Lynch",authors:[{id:"311821",title:"Ph.D. Student",name:"Nadine",middleName:null,surname:"Barrett-Maitland",slug:"nadine-barrett-maitland",fullName:"Nadine Barrett-Maitland"},{id:"311822",title:"Ms.",name:"Jenice",middleName:null,surname:"Lynch",slug:"jenice-lynch",fullName:"Jenice Lynch"}]},{id:"50437",title:"Face Recognition: Demystification of Multifarious Aspect in Evaluation Metrics",slug:"face-recognition-demystification-of-multifarious-aspect-in-evaluation-metrics",totalDownloads:2343,totalCrossrefCites:4,totalDimensionsCites:7,book:{slug:"face-recognition-semisupervised-classification-subspace-projection-and-evaluation-methods",title:"Face Recognition",fullTitle:"Face Recognition - Semisupervised Classification, Subspace Projection and Evaluation Methods"},signatures:"Mala Sundaram and Ambika Mani",authors:[{id:"180904",title:"Mrs.",name:"Mala",middleName:null,surname:"Sundaram",slug:"mala-sundaram",fullName:"Mala Sundaram"},{id:"180905",title:"Mrs.",name:"Ambika",middleName:null,surname:"Mani",slug:"ambika-mani",fullName:"Ambika Mani"}]},{id:"50065",title:"Heat Pipes for Computer Cooling Applications",slug:"heat-pipes-for-computer-cooling-applications",totalDownloads:4038,totalCrossrefCites:2,totalDimensionsCites:4,book:{slug:"electronics-cooling",title:"Electronics Cooling",fullTitle:"Electronics Cooling"},signatures:"Mohamed H.A. Elnaggar and Ezzaldeen Edwan",authors:[{id:"178453",title:"Dr.",name:"Mohamed",middleName:null,surname:"Elnaggar",slug:"mohamed-elnaggar",fullName:"Mohamed Elnaggar"},{id:"184278",title:"Dr.",name:"Ezzaldeen",middleName:null,surname:"Edwan",slug:"ezzaldeen-edwan",fullName:"Ezzaldeen Edwan"}]},{id:"5175",title:"Facial Expression Recognition Using 3D Facial Feature Distances",slug:"facial_expression_recognition_using_3d_facial_feature_distances",totalDownloads:3825,totalCrossrefCites:5,totalDimensionsCites:10,book:{slug:"affective_computing",title:"Affective Computing",fullTitle:"Affective Computing"},signatures:"Hamit Soyel and Hasan Demirel",authors:null},{id:"68561",title:"Cyberspace and Artificial Intelligence: The New Face of Cyber-Enhanced Hybrid Threats",slug:"cyberspace-and-artificial-intelligence-the-new-face-of-cyber-enhanced-hybrid-threats",totalDownloads:527,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Carlos Pedro Gonçalves",authors:[{id:"278948",title:"Prof.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves"}]}],onlineFirstChaptersFilter:{topicSlug:"computer-science-and-engineering",limit:3,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"10176",title:"Microgrids and Local Energy Systems",subtitle:null,isOpenForSubmission:!0,hash:"c32b4a5351a88f263074b0d0ca813a9c",slug:null,bookSignature:"Prof. Nick Jenkins",coverURL:"https://cdn.intechopen.com/books/images_new/10176.jpg",editedByType:null,editors:[{id:"55219",title:"Prof.",name:"Nick",middleName:null,surname:"Jenkins",slug:"nick-jenkins",fullName:"Nick Jenkins"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:1},route:{name:"profile.detail",path:"/profiles/87553/anup-sane",hash:"",query:{},params:{id:"87553",slug:"anup-sane"},fullPath:"/profiles/87553/anup-sane",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()