Advancement in autogenous self-healing of cementitious materials with mineral additives (Adopted from [17]).
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7877",leadTitle:null,fullTitle:"Perioperative Care for Organ Transplant Recipient",title:"Perioperative Care for Organ Transplant Recipient",subtitle:null,reviewType:"peer-reviewed",abstract:"This book is addressed to physicians and researchers working in the ever-expanding research and practice fields of transplantation medicine. Its purpose is to present the transplantation community with a collection of works written by prominent experts in a variety of transplant-related fields, encompassing the most recent scientific and practical developments and accomplishments in the highly specialized segment of transplantation medicine, such as perioperative care for organ transplant candidates and recipients.",isbn:"978-1-78984-423-8",printIsbn:"978-1-78984-422-1",pdfIsbn:"978-1-83962-242-7",doi:"10.5772/intechopen.77696",price:119,priceEur:129,priceUsd:155,slug:"perioperative-care-for-organ-transplant-recipient",numberOfPages:160,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"f392542b05ddea5e08e4662dbc1dc8f7",bookSignature:"Alexander Vitin",publishedDate:"October 2nd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7877.jpg",numberOfDownloads:8497,numberOfWosCitations:4,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:17,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 22nd 2018",dateEndSecondStepPublish:"December 3rd 2018",dateEndThirdStepPublish:"February 1st 2019",dateEndFourthStepPublish:"April 22nd 2019",dateEndFifthStepPublish:"June 21st 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"201176",title:"Associate Prof.",name:"Alexander",middleName:null,surname:"Vitin",slug:"alexander-vitin",fullName:"Alexander Vitin",profilePictureURL:"https://mts.intechopen.com/storage/users/201176/images/system/201176.jpg",biography:"Dr. Vitin graduated cum laude from Kharkov State Medical University in 1981 (MD). He did his residency in surgery and worked as a surgeon, then as a research fellow. Dr. Vitin obtained his Ph.D. on extracorporeal detoxication in End stage Liver Disease patients. \r\nCurrently he is working as an attending anesthesiologist, faculty and an associate professor at the Department of Anesthesiology, University of Washington, Seattle, WA, USA. Since 2014, he is UNOS-appointed Director of Transplant Anesthesia. His main area of expertise and research interests are anesthesia and perioperative care for solid organ transplantation (liver, kidney, pancreas, intestine and combinations).",institutionString:"University of Washington",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Washington",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"202",title:"Surgery",slug:"surgery"}],chapters:[{id:"67806",title:"Introductory Chapter: Tour De Force of Transplantation Science",doi:"10.5772/intechopen.87078",slug:"introductory-chapter-tour-de-force-of-transplantation-science",totalDownloads:681,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Alexander A. Vitin",downloadPdfUrl:"/chapter/pdf-download/67806",previewPdfUrl:"/chapter/pdf-preview/67806",authors:[{id:"201176",title:"Associate Prof.",name:"Alexander",surname:"Vitin",slug:"alexander-vitin",fullName:"Alexander Vitin"}],corrections:null},{id:"65660",title:"Perioperative Care for Kidney Transplant Recipients",doi:"10.5772/intechopen.84388",slug:"perioperative-care-for-kidney-transplant-recipients",totalDownloads:1798,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Transplantation carries significant mortality benefit compared to dialysis in end-stage kidney disease. Increased perioperative risk, however, results in a higher mortality in the first 3 months post-transplantation compared to remaining on haemodialysis. Consequently, optimal perioperative management is essential. Patients presenting for kidney transplantation require rapid assessment and preparation for theatre to minimise ischaemic times and improve mortality and graft outcomes. This task is often complicated by the presence of multiple medical comorbidities. Furthermore, early complications of hypotension, delayed graft function, renovascular and ureteric surgical complications and rejection render the perioperative phase of transplant challenging for the recipient and for the transplant team. In this chapter, we outline current practices in the assessment and management of kidney transplant recipients during the perioperative period, particularly focusing on their clinical application and the evidence underpinning them.",signatures:"Sebastian Hultin, Carmel M. Hawley, David W. Johnson and Ross S. Francis",downloadPdfUrl:"/chapter/pdf-download/65660",previewPdfUrl:"/chapter/pdf-preview/65660",authors:[{id:"172329",title:"Dr.",name:"Carmel",surname:"Hawley",slug:"carmel-hawley",fullName:"Carmel Hawley"},{id:"172331",title:"Dr.",name:"Ross",surname:"Francis",slug:"ross-francis",fullName:"Ross Francis"},{id:"178936",title:"Prof.",name:"David",surname:"Johnson",slug:"david-johnson",fullName:"David Johnson"},{id:"283620",title:"Dr.",name:"Sebastian",surname:"Hultin",slug:"sebastian-hultin",fullName:"Sebastian Hultin"}],corrections:null},{id:"66962",title:"Viral Infections after Kidney Transplantation: CMV and BK",doi:"10.5772/intechopen.86043",slug:"viral-infections-after-kidney-transplantation-cmv-and-bk",totalDownloads:1492,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Opportunistic infections commonly occur during the first 6 months after kidney transplant, including cytomegalovirus (CMV) and polyomaviruses. Viral pathogens such as CMV and polyomaviruses, JC or BK virus (BKV), are able to replicate in the kidney and/or cause systemic disease, and symptomatic infection with these agents can be associated with significant morbidity and mortality in immunocompromised host. While BK virus usually replicates in kidney transplant causing BK virus nephropathy (BKN) with characteristic decoy cells in the urine, CMV infection more often leads to systemic infection involving the gastrointestinal tract (GIT), lungs, or liver and can only sporadically be detected in renal transplant. In both cases, the disease is most often due to reactivation of a latent virus. Prevention and early treatment of posttransplant infection are therefore crucial with kidney transplant recipients. Since BKV viruria and viremia can be seen without renal injury and viral nephropathy, a diagnosis of BKN must be confirmed by renal biopsy. To date, preemptive treatment is the best strategy for CMV infection, while no available standard therapy, except for reduction of immunosuppression, is available for BKV infection.",signatures:"Večerić-Haler Željka and Kojc Nika",downloadPdfUrl:"/chapter/pdf-download/66962",previewPdfUrl:"/chapter/pdf-preview/66962",authors:[{id:"249591",title:"Prof.",name:"Nika",surname:"Kojc",slug:"nika-kojc",fullName:"Nika Kojc"},{id:"285874",title:"Prof.",name:"Željka",surname:"Večerić-Haler",slug:"zeljka-veceric-haler",fullName:"Željka Večerić-Haler"}],corrections:null},{id:"66702",title:"Antibody Mediated Rejection in Kidney Transplant Recipients",doi:"10.5772/intechopen.85886",slug:"antibody-mediated-rejection-in-kidney-transplant-recipients",totalDownloads:1769,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Antibody mediated rejection (ABMR) presents a significant challenge for long term graft survival in kidney transplantation. New technologies, including genomic studies and assays to detect and define donor-specific antibodies, have provided important insights into the pathophysiology and diagnosis of ABMR. Unfortunately, this progress has not yet translated into better outcomes for patients, as in the absence of a drug able to suppress antibody generation by plasma cells, available therapies can only slow down graft destruction. This chapter reviews the current understanding of ABMR, and details its diagnosis, and treatments, both those established in current routine clinical practice and those on the horizon.",signatures:"Nika Kojc and Željka Večerić Haler",downloadPdfUrl:"/chapter/pdf-download/66702",previewPdfUrl:"/chapter/pdf-preview/66702",authors:[{id:"249591",title:"Prof.",name:"Nika",surname:"Kojc",slug:"nika-kojc",fullName:"Nika Kojc"},{id:"285874",title:"Prof.",name:"Željka",surname:"Večerić-Haler",slug:"zeljka-veceric-haler",fullName:"Željka Večerić-Haler"}],corrections:null},{id:"66282",title:"Perioperative Care for Lung Transplant Recipients: A Multidisciplinary Approach",doi:"10.5772/intechopen.85277",slug:"perioperative-care-for-lung-transplant-recipients-a-multidisciplinary-approach",totalDownloads:1069,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Lung transplantation has evolved as the gold standard for selective patients with end-stage lung disease since the first clinical lung transplant was performed in 1983 in the United States. Over the last few decades, lung transplantation volume has increased worldwide with steadily improving outcomes; however, access to lung transplantation remains limited due to the critical shortage of donor organs. Factors that have contributed to improved outcomes include a multidisciplinary management approach supported by advancements in surgical and anesthetic techniques, nursing and critical care, immunosuppressive therapy, transplant immunobiology, and the perioperative use of extracorporeal membrane oxygenation (ECMO) and ex vivo lung perfusion (EVLP). Excellent outcomes have been achieved in selective patients with high-risk comorbidities such as age over 65 years, concomitant severe coronary artery disease (CAD), and preexisting sensitization with donor-specific antibodies (DSAs). Such comorbidities are no longer considered absolute contraindications to lung transplantation. This chapter provides an overview of perioperative care of lung transplant recipients with focus on a multidisciplinary approach and highlights management strategies for patients with concomitant severe coronary artery disease and end-stage lung disease as well as those with preexisting sensitization with DSAs.",signatures:"Stacey H. Brann, Steven S. Geier, Olga Timofeeva, Norihisa Shigemura, Francis Cordova and Yoshiya Toyoda",downloadPdfUrl:"/chapter/pdf-download/66282",previewPdfUrl:"/chapter/pdf-preview/66282",authors:[{id:"283188",title:"Dr.",name:"Stacey",surname:"Brann",slug:"stacey-brann",fullName:"Stacey Brann"},{id:"288392",title:"Prof.",name:"Steven",surname:"Geier",slug:"steven-geier",fullName:"Steven Geier"},{id:"288393",title:"Dr.",name:"Olga",surname:"Timofeeva",slug:"olga-timofeeva",fullName:"Olga Timofeeva"}],corrections:null},{id:"65734",title:"Cytokine Biomarkers as Indicators of Primary Graft Dysfunction, Acute Rejection, and Chronic Lung Allograft Dysfunction in Lung Transplant Recipients: A Review",doi:"10.5772/intechopen.84661",slug:"cytokine-biomarkers-as-indicators-of-primary-graft-dysfunction-acute-rejection-and-chronic-lung-allo",totalDownloads:749,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Lung transplantation is well accepted form of treatment for end-stage lung disease in selected patients. The number of lung transplants performed worldwide has increased annually with chronic obstructive pulmonary disease being the leading cause. The morbidity and mortality in the early period are due to nonspecific primary graft dysfunction (PGD) and acute lung rejection (ALR). Chronic lung allograft dysfunction (CLAD) is the cause of long-term complications following lung transplantation and seen in almost half of the patient during the first 5 years. Activation of pro- and anti-inflammatory cytokines and chemokines has been described during various phases of lung transplantation recovery. We reviewed the literature for cytokine activity associated with PGD, ALR, and CLAD. This review aims to summarize the specific associations between bronchoalveolar lavage (BAL) and plasma cytokine levels and the association of PGD, ALR, and CLAD.",signatures:"John Hallsten and Wickii T. Vigneswaran",downloadPdfUrl:"/chapter/pdf-download/65734",previewPdfUrl:"/chapter/pdf-preview/65734",authors:[{id:"268004",title:"Prof.",name:"Wickii",surname:"Vigneswaran",slug:"wickii-vigneswaran",fullName:"Wickii Vigneswaran"},{id:"284431",title:"Mr.",name:"John",surname:"Hallsten",slug:"john-hallsten",fullName:"John Hallsten"}],corrections:null},{id:"67081",title:"Delirium Management, Treatment and Prevention Solid Organ Transplantation",doi:"10.5772/intechopen.86297",slug:"delirium-management-treatment-and-prevention-solid-organ-transplantation",totalDownloads:943,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Delirium following solid organ transplant is a very common complication. Post-operative delirium has been shown to be associated with longer length of stays, increased post-operative complications, increased readmission rates, higher costs, and increased mortality. Therefore, every healthcare provider who is involved in the care of transplant recipients should be well educated in the importance of early diagnosis of delirium, treatment of potential contributing factors, and optimizing management. Routine delirium screening to allow prompt diagnosis and workup is paramount to the care of post-operative transplant patients. Identifying high risk individuals for pre-operative rehabilitation to help decrease post-operative delirium rates, as well as focusing on functional and cognitive recovery following delirium are important preventative and rehabilitation efforts to optimize outcomes for transplant patients. This chapter will highlight a proactive approach to delirium prevention and management in the transplant population.",signatures:"Clark D. Kensinger and Jon S. Odorico",downloadPdfUrl:"/chapter/pdf-download/67081",previewPdfUrl:"/chapter/pdf-preview/67081",authors:[{id:"128410",title:"Prof.",name:"Jon S.",surname:"Odorico",slug:"jon-s.-odorico",fullName:"Jon S. Odorico"},{id:"285935",title:"Dr.",name:"Clark",surname:"Kensinger",slug:"clark-kensinger",fullName:"Clark Kensinger"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6211",title:"Medical and Surgical Education",subtitle:"Past, Present and Future",isOpenForSubmission:!1,hash:"6c32a9763401f2d6e07b50f3e6451870",slug:"medical-and-surgical-education-past-present-and-future",bookSignature:"Georgios Tsoulfas",coverURL:"https://cdn.intechopen.com/books/images_new/6211.jpg",editedByType:"Edited by",editors:[{id:"57412",title:"Prof.",name:"Georgios",surname:"Tsoulfas",slug:"georgios-tsoulfas",fullName:"Georgios Tsoulfas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6705",title:"Organ Donation and Transplantation",subtitle:"Current Status and Future Challenges",isOpenForSubmission:!1,hash:"e1ab81caf9179b0618c80dcd9bfd84a3",slug:"organ-donation-and-transplantation-current-status-and-future-challenges",bookSignature:"Georgios Tsoulfas",coverURL:"https://cdn.intechopen.com/books/images_new/6705.jpg",editedByType:"Edited by",editors:[{id:"57412",title:"Prof.",name:"Georgios",surname:"Tsoulfas",slug:"georgios-tsoulfas",fullName:"Georgios Tsoulfas"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9790",title:"Surgical Management of Head and Neck Pathologies",subtitle:null,isOpenForSubmission:!1,hash:"8ae195fe1164fd55b69b775d596f1e8a",slug:"surgical-management-of-head-and-neck-pathologies",bookSignature:"Ho-Hyun (Brian) Sun",coverURL:"https://cdn.intechopen.com/books/images_new/9790.jpg",editedByType:"Edited by",editors:[{id:"184302",title:"Dr.",name:"H. 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\r\n\tStaphylococcus are Gram-positive bacteria that can be present in a wide range of hosts, that may simply be colonizing, or that may be causing mild to fatal infections. So Staphylococcus are involved in a wide variety of diseases and are the cause of multiple pathologies. The diversity of its pathologies depends mainly on the large number of virulence factors it has, in addition to having resistance to multiple antibiotics. Staphylococcus can be found both in hospital settings and in the community or on farms. The study of Staphylococcal infections is of great importance worldwide; its implications in both human and animal infections are widely studied globally. This book will aim to contribute to the knowledge and study of Staphylococcal infections in both humans and animals and to try to give an overview of the factors involved in the epidemiology, virulence, and pathogenesis of these microorganisms.
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As a microbiologist with a PhD in Biotechnology, his research is focused on Molecular Epidemiology and Biotechnology approaches to study and control bacterial diseases in animals. The main research topics in his laboratory are Functional Molecular Epidemiology, Molecular Biotechnology of Infectious Diseases and Genetic Regulation of Bacterial Pathogenesis. He has published as author or co-author more than 50 research and divulgation papers in national and international scientific journals and 7 book chapters. 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From chapter submission and review, to approval and revision, copy-editing 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. 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It is a computerized instrument structured on the principle of low-coherence interferometry (Huang et al., 1991; Hrynchak & Simpson., 2007) generating a pseudo-color representation of the tissue structures, based on the intensity of light returning from the scanned tissue. This noninvasive, noncontact and quick imaging technique has revolutionized modern ophthalmology practice. The current applications of OCT have been improvised and expanded dramatically in precision and specificity in clinical medicine and industrial applications. In medicine, the technique has been compared to an in-vivo optical biopsy. As the resolution of OCT has been improving with time, the localization and quantification of the tissues has accordingly, become more refined, faster and predictable (Ryan SJ, 2006). What was initially and mainly a posterior segment procedure, OCT has now wider applications in anterior segment of the eye as well. The first anterior segment OCT (AS-OCT) was available in 1994. Its current use in cornea and refractive surgery including phakic intraocular lens implantation, laser-assisted in situ keratomileusis (LASIK) enhancement, lamellar keratoplasty and intraoperative OCT has opened promising therapeutic and diagnostic options in both research and clinical applications in ophthalmology. With an improved scan speed and resolution, the new models of spectral-domain (SD)-OCT allow measurements with an even lower variability (Leung et al., 2009). Due to reduced measurement errors, e.g. due to motion artifacts, the precision to track and interpret tissues has increased sharply (Leung et al., 2011). OCT is intended for use as a diagnostic device to aid in the detection and management of ocular diseases, however, it is not intended to be used as the sole aid for the diagnosis. Ultra-high resolution (UHR) OCT is a new imaging system that is being used in several clinical and research purposes. It is an objective technique and has been used for evaluation of tear fluid dynamics, contact lens fitting, imaging of corneal structures, and to describe the characteristics of epithelium, stroma and Descemet’s membrane in corneal dystrophies and degenerations (Wang et al., 2010; Shen et al., 2010; Shousha et al., 2010]
\nThere are different models of OCT machine available in the market. This chapter is based on observations made with Cirrus-high definition (HD) spectral domain (SD) OCT (Carl Zeiss Meditech Inc., Dublin, CA; software version 4.0). The light source of OCT is a broadband superluminescent diode laser with a central wavelength of 840 nm. This light generates back-reflections from different intraretinal depths represented by different wavelengths. The acquisition rate of Cirrus-HD-OCT is 27 000 A-scans /second. The axial and transverse resolutions are 15 and 5 µm, respectively. The vast increase in scan speed makes it possible to acquire three-dimensional data sets. Current OCT models are mainly designed for analysis of optic nerve head (optic disc cube), macula and anterior segment of the eye. The tomograms are stored on the computer and/or archive medium, and can be quantitatively analyzed. A CCD video monitors the external eye and assists with scan alignment, while a line scanning ophthalmoscope provides a clear image of the tissue addressed by the scan.
\nThe main hardware components of the OCT include the scan acquisition optics, the interferometer, the spectrometer, the system computer and video monitor. Before scanning the patient looks into the imaging aperture and sees a green star-shaped target against a black background (Figure 1). When scanning stars, the background changes to a bright flickering red, and the patient may see thin bright lines of light, which is the scan beam moving across the field of view. Normally, the patient can look inside the imaging aperture for several minutes at a time without discomfort or tiredness. Patient should be instructed to look at the center of the green target, and not at the moving lights of the scan beam. (Figure 1).
\nPattern of targets seen by the patient during OCT procedure.
Anterior segment OCT uses light source with longer infrared wavelengths (1310 nm) to improve the penetration through light scattering tissues, such as sclera and limbus. Unlike posterior segment OCT, AS-OCT requires greater depth of field. AS-OCT also requires higher energy levels than retinal OCT systems. Visualization of retroiridial structures is limited in current AS-OCT, especially in presence of ocular surface opacities and heavy iris pigmentation (Goldsmith et al., 2005]. Currently Cirrus HD-OCT versions 4.0 and 5.0 cannot be used for anterior segment structures, however, one of the latest software updates of Stratus OCT (version 6.0) can measure corneal thickness and visualize structures of the anterior chamber angle.
\nUHR-OCT uses broadband light sources and has an axial resolution below 5 microns in the tissue.
\nIntraoperative 3D SD-OCT is the current hot spot in ophthalmology. These systems are separate from the operating microscope and surgery has to be halted while performing the scans. An ideal intraoperative OCT system must be integrated into the operating microscope with a head-up display so that real-time imaging of the operative field can be made without disrupting the surgery (Tang et al., 2010).
\nOptic disc cube in a normal patient. See text for details.
This scan measures the retinal nerve fiber layer (RNFL) thickness in a 6 x 6-mm2 area consisting of 200 x200 pixels (axial scans). The RNFL thickness is measured at each pixel and a RNFL thickness map is generated. The optic disc (black arrow) and the cup (red arrow) are represented in the center of the scan. A calculation circle of 3.46-mm diameter consisting of 256-A scans is automatically positioned around the optic disc. It is ideal to have signal strength ≥ 6 for the scans. The scan gives an hour-pattern, quadrant-pattern and mean RNFL thickness, which are color coded (white-thickest; green-normal; yellow-borderline, and red-abnormally thin). The printout gives all credible measurements about the RNFL thickness, rim area, disc area, cup-disc ratio and RNFL symmetry.
\nThe scans of two eyes can be compared for symmetry. Latest models can detect saccadic eye movements with the line-scanning ophthalmoscope overlaid with OCT en face during the scanning. Images with motion artifact are rescanned. The SD-OCT has given a precise correlation between optic disc neuroanatomy and histomorphometric reconstruction, which in turn helps understand the pathogenesis in glaucoma (Alexandre et al., 2012; \n Strouthidis et al., 2009\n ).
\nGenerates a cube of data through a 6mm square grid by acquiring a series of 28 horizontal scan lines each composed of 512 A-scans, except for the central vertical and horizontal scans, which are composed of 1024 A-scans each. There are two versions of the macular cube, 512x128 (Figure 3) and 200x200.
\nMacular Cube 512x128 in a normal patient. N-Nasal (left hand side of image); T-temporal (right hand side of image). 1-RNFL; 2- Normal foveal depression; 3- plexiform layer (orange-green); 4-Nuclear layer (black); 5-Retinal pigment epithelium (red band of high reflectivity); Short white arrow- External limiting membrane; long white arrow-junction of inner and outer segments of photoreceptors (area of high reflectivity)
The 512 x 128 module has greater resolution in each line from left to right but less resolution from top to bottom. The 200x200 module also has 6mm square grid and acquires 200 horizontal scans each composed of 200 A- scans, except for the central vertical and horizontal scans, which are composed of 1000 A-scans each. Detailed description of the basics of OCT and its images are available on line (Wali & Kharousi., 2012) A 3-D option offers an added advantage in defining the lesions (Figure 4).
\nA look-alike of a 3-dimensional figure (here on a 2 dimension surface)
This is a custom-built, high speed ultra high resolution device which uses a 3-module superluminescent diode light source allowing an axial resolution of 2 to 3µm. This enables morphologic visualization of conjunctival and corneal architecture. (Shousa et al., 2011 & 2010). The noninvasive nature and quick acquisition time (seconds) makes AS-OCT an ideal imaging technique in handicapped and elderly patients.
\nOptical coherence tomography provides both qualitative and quantitative (thickness and volume) analyses of the tissues examined in-situ. OCT has been exploited in evaluating both anterior and posterior segments of the eye.
\nThe highest impact of OCT has been in aiding the diagnosis and following the response to treatment and in patients suffering from diabetic retinopathy (DR) (Cruz-Villegas et al., 2004), age-related macular degeneration (ARMD) (Mavro frides et al., 2004) and venous occlusions.
\nOther applications include imaging morphology and lesions of posterior hyaloid like vitreomacular traction (Figure 5), vitreomacular adhesion (Figure 6) (Kang et al., 2004), detection of fluid within and under the retina which may not be visible clinically. The retinal edema can be measured and localized to different retinal layers. Macular holes (Mavrofrides et al., 2005) and pseudoholes can be more accurately graded, defined and differentiated. Other indications include diagnosis and defining of epiretinal membranes (ERMs) (Mori et al., 2004), retinoschisis (Eriksson et al., 2004), retinal detachment, drug toxicities, RNFL thickness and optic disc parameters.
\nOCT should not be the only criteria for diagnosis of any ocular disease. Valid perspectives of patient’s systemic and ocular disease, clinical examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), biomicroscopy, and above all, the relevant history of the disease process should always be made partner with OCT imaging.
\nVitreomacular traction (yellow arrows) by posterior hyaloid membrane (red arrows) causing retinoschisis (white arrows). S-superior (right side of image); I-Inferior (left side of image).
Vitreomacular adhesion: A taught thick posteior hyaloid face (yellow arrows) makes areas of adhesions (white arrow) with the retinal surface producing marked irregularity (bumps) of the retinal tissue (red arrow). Note the hard exudates (white box) and marked retinal thickening due to subretinal fluid (white triangle)
There are several advantages of AS-OCT over conventional imaging methods like slit illumination, slit-scanning tomography, Scheimpflug imaging and ultrasound biomicroscopy (UBM). The imaging resolution of AS-OCT is higher than these modalities and gives high resolution cross-sectional 3D images of the anterior segment (Dawczynski et al., 2007; Tan et al., 2011; Goldsmith et al., 2005) Recent models of AS-OCT provide topographic analysis, anterior and posterior elevation maps of the cornea and reliable pachymetric maps (Milla et al., 2011; Nakagawa et al., 2011). It is an ideal research tool to demonstrate ciliary body contraction and lens movement during accommodation (Baikoff et al., 2004).
\nAS-OCT can be used to determine presurgical parameters in planning different anterior segment procedures. These parameters include anterior chamber depth, crystalline lens rise (distance between anterior pole of crystalline lens and the line joining two iridocorneal angle lines) and anterior chamber angle morphology with reference to the scleral spur (Dawczynski et al., 2007; Tan et al., 2011; Goldsmith et al., 2005). Such parameters can also be used to analyze post-surgical chamber angle dynamics and in intraocular lens (IOL) power calculations (Dinc et al., 2010; Tan et al., 2011) Phakic IOL is becoming a very popular refractive surgery technique for treatment of high refractive errors. AS-OCT simulates the position of the phakic IOL before surgery by evaluation of anterior segment structures (Mamalis N., 2010). Postoperatively AS-OCT can visualize the contact between the collamer refractive lens and the crystalline lens (Lindland et al., 2010). In cataract surgery AS-OCT has been instrumental in analyzing the structure, integrity and configuration of corneal incisions after cataract surgery (Jagow Von & Kohnen., 2009) yielding information about corneal wound architecture, Descemet’s detachment and wound leaks. Studies with AS-OCT have also revealed that corneal epithelial closure after cataract surgery was completed in 1-8 days (Can et al., 2011; Torres et al., 2006), postoperative Descemet’s detachment occurred in 40-82% of patients on day one (Fukuda et al., 2011] and that stromal hydration persisted for up to 7 days.
\nAS-OCT has proved very useful in early recognition of localized or total graft dislocation in Descemet stripping automated endothelial keratoplasty (DSAEK), especially in eyes with corneal edema and limited anterior chamber visualization (Kymionis et al., 2010). The technique can also aid in diagnosis of eccentric trephination and inverse implantation of the donor (Ide et al., 2008; Kymionis et al., 2007; Suh et al., 2008). AS-OCT has been pivotal in documenting the cause of hyperopic shift in DSAEK eyes, which was induced by a high ratio of central graft thickness to peripheral graft thickness (Yoo et al., 2008). Epithelial in growth in refractive surgery can be confirmed by OCT images (Stahl et al., 2007).
\nOCT imaging and femtosecond laser-assisted surgeries are the most rapidly advancing technologies in modern day ophthalmology. Thickness is an important parameter in refractive surgery and no technique other than OCT can give accurate, uniform and predictable thickness measurements before, during and after surgery. The pachymetry map of AS-OCT can be used in femtosecond laser-assisted astigmatic keratotomy, LASIK enhancement and intrastromal tunnel preparation for intracorneal ring segments (Hoffart et al., 2009; Nubile et al., 2009). AS-OCT is very helpful in determining the accurate depth of the arcuate incisions, and in the postoperative follow up of patient with femtosecond astigmatic keratotomy and intracorneal ring segments. The images can explain the reasons behind unexpected postsurgical surprises (Yoo & Hurmeric., 2011). Femtosecond-assisted lamellar keratoplasty (FALK) is a highly promising refractive surgical technique that requires OCT data in accurate presurgical planning (Yoo et al., 2008). These procedures include anterior lamellar keratoplasty and deep anterior lamellar keratoplasty. AS-OCT imaging is the first step to measure the depth of anterior stromal scar and this determines the preparation of the donor and the recipient corneas. The morphology of the perfect match (donor and recipient) is confirmed by AS-OCT imaging. AS-OCT helps in careful planning of structure, thickness and shape of LASIK flap (Li et al., 2007; Rosas et al., 2011]. It is the depth of corneal incisions as obtained from AS-OCT that determines the success of new surgical techniques like femtosecond-assisted corneal biopsies, corneal tattooing and collagen crosslinking (Kymionis et al., 2009; Kanellopoulos et al.,2009; Nagy et al., 2009).
\nNew platforms provide integrated OCT systems in the operating microscopes to perform the anterior segment procedures like corneal incisions, continuous curvilinear capsulorrhexis, nucleus softening, lens fragmentation, and focusing the laser in 3D manner in femtosecond-assisted cataract surgery (William et al., 2011; Wang et al., 2009).
\nAnother milestone in OCT technology has been development of intraoperative 3D SD-OCT in the supine position (Dayani et al., 2009). This technique has been used for intraoperative evaluation of the presence of interface fluid between the donor and the recipient corneas in DSAEK.
\nOCT can be used for assessment of conjunctival and corneal tissue planes with high axial resolution. (Christopoulas et al., 2007 ; Shousha et al., 2011]. The technique acts as an adjuvant tool in diagnosing ocular surface squamous neoplasia and pterygia (Jeremy et al.,2012). OCT is in potential use for diagnosis and patient follow-up during the course of medical treatment and continued watch for recurrence of neoplasia without any need for repeated biopsies. Also the technique may be helpful in determining the extent of the tumor to facilitate its complete excision. AS-OCT guided subtenon injections of drugs like triamcinolone has reduced chances of inadvertent perforations and unwanted targets.
\nRecently Fourier-domain OCT has been used to examine the position, patency and the interior entrance site of the anterior chamber aqueous tube shunts. This high resolution OCT shows exact position of the AC entrance relative to Schwalbe’s line and growth of fibrous tissue between the tube and the corneal endothelium. Such findings could not be seen with slit-lamp examination or lower resolution time-domain OCT. The tube position visualized by slitlamp examination differed from OCT finding (Jiang et al., 2012). OCT is also very helpful in correlating the clinical and visual field changes in glaucoma and ocular hypertension patients (Figure 7 & 8).
\nFundus photo showing glaucomatous cupping temporaly.
OCT printout of optic disc cube showing glaucomatous changes. The red measurements indicate abnormal thinning of RNFL, yellow areas represent borderline thickness of RNFL and green areas mean normal thickness of RNFL.
Ultrahigh resolution (UHR) OCT has been more practical and advantageous over confocal microscopy in making a clear distinction between morphologic and histopathologic features between normal and abnormal epithelium in ocular surface squamous neoplasia and pterygia. This is so because OCT is a noncontact method, has rapid image capture, and provides a cross-sectional view of the tissue. One of the recent clinical applications of UHR- OCT is the identification of the opaque bubble layer as a bright white area in mid stroma in femtosecond laser-assisted LASIK flap creation (Nordan et al., 2003). This technique has been of immense help to refractive surgeons in analyzing the flap integrity, indistinct flap interface or epithelial breakthrough in LASIK surgery (Seider et al., 2008; Ide et al., 2009; Ide et al., 2010). OCT is not a substitute for histopathologic specimens; however, it can be a potential noninvasive diagnostic adjuvant in diagnosis and surveillance of anterior segment pathologies of the eye.
\nOCT now has a role in varied types of posterior segment pathologies (inflammatory, non-inflammatory, degenerative, vascular, traumatic, neoplastic, and metastatic) where the technique clearly defines the levels of various pathologic lesions in the posterior hyaloid, retina, retinal pigment epithelium and choroid, which in turn defines the mode and success of therapy. Such lesions may be superficial (epiretinal and vitreous membranes (Figures 6, 9 and 10), cotton wool spots, retinal hemorrhages, hard exudates (Figure 11), cysts (Figure 12), retinal fibrosis, and retinal scars (Figure 13) or deep (drusen-Figure 14), retinal pigment epithelial hyperplasia and detachment (Figure 15), intraretinal and subretinal neovascular membranes (Figure 16), scarring (figure 13) and pigmented lesions).
\nEpiretinal membrane (arrow) causing ripping of retinal tissue
Retinal infoldings due to epiretinal membrane: 1: color map showing marked thickening (silver white and red areas) of ILM (internal limiting membrane)-RPE (retinal pigment epithelium) interface. 2: grey tone video image showing irregular surface with striations due to fibrous membrane. 3: ILM map showing marked irregularity due to contraction of the fibrous membrane. 4: A relatively intact RPE. Note the teeth-like infoldings of the retinal surface (yellow arrows) produced by ERM.
Hard exudates (white arrows). White triangle indicates the shadow cast by the exudate. The ILM-RPE color map shows three humps due to exudates.
Solitary macular cyst (arrows). Note the blisters (black arrows) in the color map, corresponding to the cyst.
A: Extensive retinal scarring in a thin atrophic retina (orange red hyperreflective band between arrows). 13B- Scarring following involution of CNVM (arrow)
Drusen with bumps in the RPE (arrows). The drusen bumps produce characteristic humps in the color maps of ILM-RPE interface.
Thickened, irregular and detached RPE (arrow)
Myopic CNVM: Fundus photo gives a vivid description of myopic peripapillary atropy and a greyish white neovascular membrane in the macular area (encircled). FFA shows characteristic leakage corresponding to the area of neovascular membrane. OCT image depicts a hyperreflective subfoveal CNVM with increased retinal thickness (thick arrow).
Vitreomacular traction (VMT) and vitreomacular adhesion (VMA) may be difficult to detect clinically. OCT is extremely helpful in such cases by showing hyperreflectivity. The traction by the membrane to the retina induces deformations of the retinal surface (Figure 17).
\nVitreomacular traction. Note the multiple areas of traction caused by taught posterior hyaloid on retinal tissue (arrows).
The most common primary cause of retinal thickening is edema. One of the major achievements of OCT has been quantitative assessment of retinal edema in terms of measuring its thickness and volume, evaluate the progression of the pathologic process, and monitor surgical or non-surgical intervention (Kang et al., 2004). Retinal edema may manifest in different categories:
\nFocal or diffuse edema: Common causes include diabetic retinopathy, central retinal venous occlusion, branch retinal venous occlusion, arterial occlusion, hypertensive retinopathy, pre-eclampsia, eclampsia, uveitis, retinitis pigmentosa and retraction of internal limiting membrane. OCT helps in diagnosis of edema in preclinical stage when there may be no or few visible changes.
\nCystoid macular edema (CME): (Figure 18) Common causes of CME include diabetic retinopathy, age-related macular degeneration (ARMD), venous occlusions, pars planitis, Uveitis, pseudophakos, Irvine-Gass syndrome, Birdshot retinopathy and retinitis pigmentosa. OCT usually shows diffuse cystic spaces in the outer nuclear layer of central macula, and increased retinal thickness which is maximally concentric on the fovea (\n Mavrofrides et al., 2004\n ).
\nCystoid macular edema in a patient with CRVO. Color fundus image shows disc hemorrhage, venous tortuosity, cotton wool exudates and retinal hemorrhages. FFA shows characteristic venous staining, leakge and blocked fluorescence due to underlying hemorrhage. OCT image depicts marked increase in retinal thickness due to edema. Note the intraretinal cysts and subretinal fluid (arrow).
Serous retinal detachment: The cysts of retinal edema over a period of time loose their walls and merge together forming single or multiple pools of fluid within retinal layers or between retinal pigment epithelium (RPE) and the sensory retina (Villate et al., 2004.) (Figure 19)\n
\nSerous retinal detachment (dark zone between white arrows) in a patient with severe nonproliferative diabetic retinopathy. Red arrows indicate subfoveal exudates.
Its pathophysiology involves passage of serous fluid from the choriocapillaries to the sub-RPE space or collection of blood under RPE causing its separation and elevation from the Bruch’s membrane. OCT scans show a classical dome-shaped detachment of the RPE with intact contour in early stages (Figure 14).
\nRPE detachment with hyperplasia (asterisk).
Epiretinal membranes are fibroglial proliferations on the vitreo-retinal interface (Figure 10). They may be sequel of chronic intraocular inflammations, venous occlusions, trauma, postsurgical or may be idiopathic. OCT helps in confirming such membranes (Suzuki et al., 2003; Massin et al., 2000).
\nOCT is important to document the presence, degree and extent of subretinal fluid (Villate et al., 2004), assessment of the level of retinal infiltrates and detect macular edema in patients with chronic uveitis where hazy media may prevent clinical examination to find the cause of reduced vision (Antcliff et al., 2002; Markomichelakis et al., 2004).
\nIt is the separation or splitting of the neurosensory retina into an inner (vitreous) and outer (choroidal) layer with severing of neurons and complete loss of visual function in the affected area (Figure 21). Typically the split is in the outer plexiform layer. In reticular retinoschisis, which is less common, splitting occurs at the level of nerve fiber layer. Retinoschisis may be degenerative, myopic, juvenile or idiopathic. Presence of vitreoretinal traction is an important cause. OCT reveals wide space with vertical palisades and splitting of the retina into a thinner outer layer and thicker inner layer (Eriksson et al., 2004).
\nRetinoschisis: Note the splitting of retina into inner (small arrow) and outer layers (large arrow)
Lamellar hole: OCT depicts a homogenous increase in foveal and perifoveal retinal thickness, and presence of residual retinal tissue at the base of the hole (Figure 22).
\nOCT image of a lamellar thickness macular hole with residual retinal tissue remaining between the base of the hole (arrow) and the RPE.
Full thickness macular hole: Majority of macular holes are idiopathic. Other causes include trauma, high myopia, vascular lesions (DR, venous occlusions, and hypertensive retinopathy) and subretinal neovascularization. OCT features in a full thickness macular hole include complete absence of foveal retinal reflectivity with no residual retinal tissue. Thickened retinal margins around the hole with reduced intraretinal reflectivity are clearly seen in such cases (Figure 23).
\nOCT (S-1): A full thickness macular hole (long arrow) in a diabetic patient with detached posterior hyaloid (short arrow). The T-N axis shows subretinal fluid collection (arrow). Color map: Top: red circle delineates edema; Middle: delineates a hole with elevated margins; Bottom: normal RPE.
OCT is a vital tool in the hands of a vitreoretinal surgeon that aids in diagnosis, treatment and follow up of patients with DR. (Cruz-Villegas et al., 2004; Schaudig et al., 2000).
\nOCT features in DR include retinal edema, cotton wool spots, exudates, hemorrhages and ischemia. (Figures 24, 25)
\nNPDR: color fundus photo shows classical moderate to severe NPDR with hemorrhages, exudates and maculopathy. FA shows retinal edema confined mainly to macular area. The foveal avascular zone is enlarged. OCT image shows VMA (white arrow), detached posterior hyaloid (yellow arrow), retinal thickening and intraretinal edema.
Proliferative diabetic retinopathy (PDR): Color fundus photo shows neovascularization of disc (NVD-blue arrow), neovascularization elsewhere (NVE- white arrow) and exudates. FFA shows corresponding leakge of dye. OCT image shows exudates (white arrows), a thin ERM and mild retinal edema.
OCT studies have started evaluating the retinal / macular toxic side effects of systemic drugs like hydroxychloroquine (Marmor., 2012), chloroquine (Korah and Kuriakose., 2008), tamoxifen (Hager et al., 2010), ethambutol (Menon et al., 2009 ), vigabatrin (Moseng et al., 2011) and tadalafil. (Coscas et al., 2012) Besides, the technique is being used in many research centers for studying retinal effects of a varied number of compounds in animal models.
\nOCT displays common associations of inflammation like edema, hemorrhage and scarring (Figure 26).
\nColor fundus image of a healed lesion of macular toxoplasmosis. OCT image shows scarring (arrow) associated with a retinal cyst (asterix).
Though clinical details of retinal foreign bodies may be quite discernible superficially, OCT gives a detailed description of the retinal layers affected and the sequel of impacted deeper foreign bodies (Figure 27). The sequel of blunt eye injuries may be sub-clinical and OCT helps in determining the cause of unexplained reduced vision in such cases (Figure 27A).
\nEmbedded metallic retinal foreign body (arrow) with inferior retinal hemorrhage. OCT image showing retinal deformation with fibrosis (arrow) and vitreo-retinal debri (asterix). Note the deformation of the ILM-RPE color maps caused by fibrosis.
A(adobe): Submacular retinal detachment (arrows) in a 17 year old boy who sustained blunt eye injury after being hit by a football in the eye.
OCT yields valuable information in such lesions especially when clinical examination may not be decisive due to media opacities (Figure 29).
\nA 57 year old male with metastatic subretinal lesion. OCT image shows large dome shaped retinal (short arrow) and retinal pigment epithelium (long arrow) detachment associated with subretinal fluid (asterix).
The most exploited use of OCT has been in the field of treatment guidelines and response to therapies in diabetic retinopathy (figure 30), retinal vascular occlusions (figure 31), vascular lesions (figure 32), age related macular degeneration (figure 33), and intraocular inflammations. Physicians, who are used to OCT technology, feel more confident in diagnosing and managing such retinal disorders.
\nDiabetic macular edema: FFA shows diffuse leakage of dye in the macular area. OCT image (A): before treatment: diffuse macular edema with cystoid spaces (arrow) and subretinal fluid (asterix; central subfoveal thickness 836 microns). The septa (arrow) between retinal cysts are comprised of Müller’s fibers. OCT image (B): dramatic improvement in retinal edema (central subfoveal thickness 230 microns) after intravitreal bevacizumab injections.
Left: Cystoid macular edema in a patient with branch retinal vein occlusion before therapy. Right: Two months after two intravitreal injections of bevacizumab the edema had resolved and normal foveal architecture was restored.
Juxtapapillary choroidal neovascular membrane in a 39 year old male. Color fundus photo shows the hemorrhage in deeper retinal layers with a circumscribed area of subretinal exudation (delineated by blue arrows). FFA shows leakge of dye from the juxtapapillary neovascular membrane. The dark area corresponds to blocked fluorescence due to hemorrhage. OCT image (A-before treatment) shows classical CNVM mound (arrow) with subretinal fluid in supero-temporal quadrant (asterix). OCT image (B) 18 weeks after three intravitreal injections of anti-VEGF drug ranibizumab shows brick-red organization (fibrosis) of CNVM (arrow) and resolution of subretinal fluid.
Age-related macular degeneration with CNVM. FFA shows a ring and central spot of hyperfluorescence in the macular area. OCT image A (30 April 2012) shows active CNVM (ovoid) with retinal edema and RPE deformity (arrow). The patient received two injections of intravitreal anti-VEGF drug ranibizumab. OCT image B (30 May 2012) shows marked regression of CNVM and retinal edema although retinal contour is altered.
Other therapeutic applications of OCT include accurate assessment of outcome of the effect of pharmacological or surgical interventions like photodynamic therapy (PDT), transpupillary thermotherapy, vitreoretinal surgery, anti-VEGF therapy, intravitreal steroid therapy and therapeutic Intravitreal implants (Rogers et al., 2002).
\nRecently OCT has confirmed benefit of intravitreal recombinant truncated human plasma serine protease ocriplasmin in treatment of non-symptomatic vitreomacular adhesion including macular hole (Decroos et al., 2012; Stalmans et al., 2010). OCT stays as sheet anchor in confirmation of successful surgical closure of macular holes (Jumper et al., 2000; Sato et al., 2003). In partial or unsuccessful surgeries, OCT evaluates the retinal anatomy to find reason for poor visual outcome.
\nSD-OCT allows detection of subclinical anatomic changes in neonates and infants, although experience on its use in retinopathy of prematurity (ROP) is limited (Chavala et al., 2009; Vinekar et al., 2010; Muni et al., 2010; Maldonado et al., 2010; Lee et al., 2011). Cystoid macular edema (CME) can be detected by SD-OCT in premature infants at risk for ROP but not when using indirect ophthalmoscopy (Maldonado et al., 2011). SD-OCT could be useful in detecting CME in neonates with mild and advanced ROP (Vinekar et al., 2011). Tomographic thickness measurements of cystoid macular edema in ROP predict the risk of requiring laser treatment or developing plus disease or ROP stage 3 (Maldonado et al., 2012). OCT is proving innovative in studying the macular characteristics in amblyopic eyes where the average thickness of foveolar neuroretina has been found to be larger than that of normal eyes (Wang et al., 2012)
\nAs with any new technology, limitations are inherent and so are with UHR-OCT. In anterior segment, leukoplakic or hyperreflective lesions often cast shadows on the underlying tissue. This may hide the diagnosis of underlying pathology.
\nBesides having OCT integrated slit lamp, increasing scanning speed and better axial resolution which would allow us to visualize tissues at the cellular level would be and should be the objective of future OCT imaging.
\nConcrete is the most used and efficient construction material in the world. It is durable, can resist high compressive stress, is cheaper than most of the construction materials and can be moulded in a wide variety of shapes. Despite that concrete cracks due to its weakness in tension, shrinkage, fatigue loading, and under the action of environmental conditions. These microcracks can reduce concrete’s toughness, increase permeability, which can ultimately lead to the reduction of concrete’s structural integrity, durability and life span. Self-healing concrete in that context offers an actual solution.
Any process whereby concrete recovers its performance after initial damage is termed self-healing in concrete [1]. A typical self-healing in cementitious materials is presented in Figure 1. The concept of concrete self-healing has evolved from that found in biological life forms, that is, plants and animals that naturally exhibit self-healing performance when any damage appears.
Example of self-healing concrete and cementitious systems (Adopted from [
According to Schlangen and Joseph (Cited in [2]), the strength of concrete gradually decreases when the first repair is required. Also, commonly, a second repair is required in concrete after 10–15 years. However, the initial repair period can be extended considerably with the application of self-healing technology in concrete. Self-healing leads to a longer material lifetime, and it involves no repair and maintenance costs.
This chapter presents the state-of-the-art of self-healing in concrete and cement-based materials. It discusses advancements in this field and limitations. The next section (Section 2) presents the concept of self-healing in concrete and measurement techniques. Then the chapter describes major developments in different self-healing concrete field.
The self-healing system in concrete is principally divided into two types, autogenic and autonomic [1]. Autogenic self-healing in concrete is an intrinsic material-healing property wherein the self-healing process initiates from the generic materials present. For example, cementitious materials exhibit a self-repairing ability due to the rehydration property of unhydrated cement remaining on the crack surface. In contrast, a self-healing process that involves the incorporation of material components that are not traditionally used in the concrete is termed autonomic self-healing [1].
Figure 2 presents the developed autogenic and autonomic self-healing systems. One of the principal causes of autogenic self-healing is the hydration of unhydrated cement remaining in the matrix. Then again, the volume of healing products formed in this process is limited. Hence, the autogenic self-healing is effective within the crack width up to 50–150 μm [4]. Autogenic self-healing performance is higher in early age due to high content of unhydrated cement, and parameters such as compressive stress [5] to restrict crack and wet-dry cycles [6] can increase the healing performance. Autogenic healing performance can also be enhanced using fibres to restrict crack opening and the use of superplasticizer in engineered cementitious composite (ECC) to reduce w/c ratio [6]. Cardiff University research group introduced polyethylene terephthalate (PET) tendons [7], a shrinkable polymer activated with a heating system inside the concrete structural element to compress and close the crack enhancing the autogenous healing process. Considerable enhancement in healing performance is also possible to achieve using optimum supplementary cementitious materials (SCMs) and smart expansive minerals [3, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. Autonomic self-healing in concrete, in contrast to the autogenous healing process, requires the release of the healing agent from reserved encapsulation or a continuous vascular network. Common encapsulating shell materials are glass [23, 24] and polymers [1, 25, 26]. Healing agents in autonomic self-healing are epoxy resins, cyanoacrylates (super glues), alkali-silica solutions [23, 24, 27, 28], methyl methacrylate [24, 28], expansive minerals [16, 29], hydrogel [30] and bacteria-based microorganisms [31, 32, 33].
Self-healing concrete systems.
Self-healing performance in concrete is assessed using visual observation, mechanical strength recovery, permeability, durability improvement and microstructural evaluation (Figure 3). There are three fundamental factors in evaluating the self-healing: visual crack sealing and the identification of healing compounds causing it, the improvement of the durability performance and the recovery of mechanical strength properties [3, 15, 16, 17, 18, 19, 20, 21]. The mechanical strength recovery is limited in most of the concrete self-healing process. Hence, the most reliable self-healing performance is based on the physical crack closure, durability improvement, that is, permeability reduction parameters, and microstructural evaluations.
Self-healing performance in concrete measurement techniques.
Autogenous self-healing in cement was spotted early in the twentieth century by Lauer and Slate [34], and the concept was gradually established by different researchers [35, 36]. The crystallisation of calcium carbonate within the crack is the primary process in autogenous self-healing of matured concrete [35]. Reactions involved in the deposition of calcium carbonate are presented in Eqs. (1)–(3). In those reactions, CO2 dissolved in water from the air, and the calcium ion Ca2+ is derived from concrete.
Reasons for autogenous self-healing proposed by different researchers [36] are: (i) Further reaction of the unhydrated cement, (ii) expansion of the concrete in the crack flanks, (iii) crystallisation of calcium carbonate, (iv) closing of the cracks by fine particles existing in the water and (v) closing of the cracks by spilling off loose concrete particles resulting from the cracking. This five action model is schematically presented in Figure 4.
A model of five steps taking place within three processes, physical, chemical and mechanical (Reproduced from [
The understanding and improvement of autogenous self-healing have developed in four major directions (Figure 2). These are: (i) manipulation of existing conditions, such as age, compressive stress and curing condition (e.g. wet-dry cycle); (ii) fibres to restrict cracks (e.g. ECC); (iii) shrinkable polymers to initiate internal stress after cracking to shrink the cracks and (iv) cement-compatible mineral additives.
Autogenous self-healing of concrete is significantly influenced by its age, internal stress and curing conditions. Early age concrete naturally heals rapidly due to autogenous healing. Concrete prisms with cracks up to 50 μm were autogenously healed under 0.1, 1 and 2 Mpa compressive stresses [5] (Figure 5a). The crack face comes into contact by the impelled compressive stress. Hence, the concrete specimens cured under any amount of compressive stress healed much better than specimens cured under no compression stress (Figure 5b). Only a specific amount of compression is required to keep the crack faces in contact. Samples that are submerged in water during curing recovered their strength. In contrast, specimens stored in 95% RH for 3 months did not heal at all. This is due to insufficient hydration in the high humid condition, which is not enough to trigger the healing process.
(a) Application of compression and (b) stress-displacement curve of specimens after healing with and without applied compressive stress. (Both figures reproduced from [
Fibres can restrict the propagation of crack width, and smaller crack width is favourable for enhanced autogenous healing in concrete. Fibre is a common feature in Fibre-Reinforced Composite Concrete (FRCC) and ECC. Randomly distributed fibres can bridge over cracks, which can decrease the crack width and block the migration of aggressive agents (e.g. chloride ions and CO2) [6, 37]. These properties improve the autogenous self-healing capacity of concrete and composites. A series of wetting and drying cycles on ECC was carried out by [6] to mimic self-healing performance in outdoor environments. Through self-healing, crack-damaged ECC recovered 76–100% of its initial resonant frequency value and attained a distinct rebound in stiffness. The tensile strain capacity after self-healing recovered close to 100% that of virgin specimens without any preloading. This was found even for the specimens deliberately pre-damaged with microcracks by loading up to 3% tensile strain. It takes about four to five wet-dry cycles to attain the full benefit of self-healing. The use of high cement content, low water-to-cement ratio also increases the autogenous self-healing capacity of ECC. However, FRCC, ECC and HFRCC are costly and maintaining homogeneity of fibres in the matrix for consistent self-healing is challenging.
The shrinkable polymers such as PET can shrink when activated by heating in a specific condition. This shrinkage stress can be used for pre-stressing the concrete thus bringing crack-tip closure for efficient healing. Cardiff University self-healing research team is working with the original crack-closure system for cementitious materials using shrinkable polymer tendons [7]. The system involves the incorporation of unbonded pre-oriented polymer tendons in cementitious beams (Figure 6). Crack closure is achieved by thermally activating the shrinkage mechanism of the restrained polymer tendons (PTs) after the cement-based material has undergone initial curing. Upon activation, the polymer tendon completely closes the preformed macrocracks and imparts significant stress across the crack faces. This enhances the autogenous self-healing process in concrete.
(a) Schematic of shape memory PET polymer tendon, and (b) photo of the setup (Both reproduced from [
Supplementary cementitious materials (SCMs) and expansive minerals compatible with cement can improve the self-healing capacity of concrete. Depending on minerals, it can serve either or both functionalities, that is, to
Minerals | Composition | Damage type | Curing condition | Performance (healed crack width in time etc.) | Source |
---|---|---|---|---|---|
CSA, aH, bA, cL, Mont. | Up to 10% (concrete) | 3 PB, mechanical | Water | 160–220 μm in 33d Calcite, CASH | [8] |
CSA | 4.44 and 15.24% of cement (concrete) | Tension force | Still/continuous flow water | Reduced flow in 100 μm cracks, continuous flow is efficient | [38] |
CSA, CA, aH, bA, cL, Mont. | PC with 10% CSA and 1.5% CA | Sp. tensile test | Water | 100–400 μm in 56 d Calcite | [9] |
Silica, dCEA, bentonite, CA | 8% individual combination up to 14% | Compression, sp. tensile | Water, wet-dry, air, freeze–thaw | 220 μm in 2 weeks dCEA (individually efficient) silica, bent., CA (combination is efficient) | [11] |
FA, SF, CA | OPC, OPC + 30%FA, OPC + 10%SF, OPC + 1%CA | Splitting tensile test | Water | 50 μm in 12d larger cracks heal efficiently with SF | [39] |
FA | 15–20% with PC (paste) | Shrinkage microcracks | Water | Meso-macro pores at 91, 182 and 364 d | [40] |
FA | 5–15% wt. of sand (concrete) | Freeze–thaw | Water | Improve eDME over 90% in 28d | [41] |
BFS | OPC + 50% BFS | Mechanical | Water | Product formation is three times faster for CEM I | [42] |
FA, slag | 30–40% of cement (mortar) | Shrinkage | Water | Improvement in compressive strength | [43] |
cL, slag, FA | 30, 50% FA; 50, 75, 85% slag (paste/mortar) | 3 PB, mechanical | Water | 200 μm in 42d | [12] |
Slag | 66% of cement (paste) | Sliced, mechanical | Ca(OH)2 solution | 60% of 10 μm in 240 h C-S-H, ettringite, hydrogenate etc. | [44] |
Bentonite | Nanoclay in mortar as internal water reservoir | Mechanical | Water | Enhanced hydration for self-healing | [45] |
Bentonite, slag, cL | 2% PVA by vol. Length = 8 mm, dia = 40 μm | 4 PB | Water, wet-dry cycle, air | Nanoclay improves the reloading deflection capacity | [46] |
Quicklime, FA | (3%) on fly ash-PC cement pastes | Mechanical | Water | Increased SiO2 solubility extra Ca(OH)2 | [14] |
Expanded clay LWAs | Na-MFP and PC coated (mortar) | Mechanical | Water | Absorption decrease sodium, phosphorous and fluoride, CH | [47] |
CSA | PVA coated, up to 10% by wt. of cement (mortar, 1:3) | 3 PB | Water | <100 μm in 11d, 100–200 μm in 14d, >200 μm in 16d | [48] |
CA: cement + sand + microsilica | 1–2% of cement | 4 PB | Water, open air | 60% cracks sealed under open air condition | [49] |
MgO | 4–12% of cement | Drying shrinkage, 3 PB | Water | <500 μm in 28d durability improved | [3] |
Advancement in autogenous self-healing of cementitious materials with mineral additives (Adopted from [17]).
H = hauyne.
A = anhydrite.
L = lime/limestone powder.
CEA = chemical expansive agent.
3/4 PB = Three/four-point bending, OPC = ordinary Portland cement, CASH = calcium aluminosilicate hydrate, CSA = calcium sulphoaluminate, CA = crystalline additive, FA = fly ash, SF = silica fume, eDME = dynamic modulus of elasticity, LWAs = lightweight aggregates, Na-MFP = sodium mono fluorophosphate (Na2FPO3, Na-MFP)
Fly ash (FA) and silica fume (SF) and blast furnace slag (BFS) are mostly used as SCMs in the OPC system to improve concrete self-healing performance [12, 13, 37, 38, 39, 40, 41, 42, 43].
The substitution of FA 15–20% in OPC paste system has increased the volume of C-S-H gel and reduced meso-macropores, increasing the autogenous self-healing performance [40]. Watanabe et al. [41] replaced about 5–15% wt. of sand with FA in concrete and found a better dynamic modulus of elasticity recovery at 5% replacement and improving trend at 15% under the non-destructive ultrasonic test method. While freezing and thawing decreased dynamic modulus to 80% of the initial state, curing in water recovered it to over 93–98% after 28 days.
FA and SF, and a crystalline additive (CA) mineral were used for improving the self-healing performance of concrete [39]. CA was composed of 35.58% CaO, 16.81% SiO2, 15.22% Na2O, 1.98% Fe2O3, 1.93% Al2O3 and 1.29% MgO. Four different mixes (OPC, OPC + 30%FA, OPC + 10%SF, and OPC + 1%CA) were compared. Larger cracks (0.05–0.30 mm) healed better with SF additives. Microcracks in the range of 0–0.05 mm in CA additive mixes completely healed within 12 days.
The blast furnace slag (BFS) was used individually and in combination with FA and other minerals for improving self-healing properties. Fibre-reinforced cement composition with a local waste BFS and limestone powder (LP) in a mix proportion of 1:1.2:2 (C:BFS:LP), 0.5 w/b-ratio and 0.018% total mass of superplasticizer demonstrated improved self-healing performance [13]. The specimens cured under water recovered 65–105% deflection capacity compared to virgin specimens, while specimens cured in the air recovered only 40–60%. Small 25-μm cracks were healed efficiently, while larger cracks such as 60 μm were not healed completely. A higher proportions of BSF (50%) substitution in OPC decreases the formation of the healing material at an early age, which alters after 22 days [42]. However, optimum self-healing ability for the mixing content of slag and FA were 30 and 40%, respectively [43].
A considerable proportion (up to 70% of total weight) of slag and two classes fly ash (FA) were used as SCMs in ECC for improving autogenous self-healing performance [50]. Microscopic observation showed that slag-ECC healed up to 100-μm width crack. On the other hand, both F- and C-Class FA containing ECC sealed up to 50- and 30-μm width cracks, respectively. A microstructural investigation on the self-healed materials revealed that it was mostly composed of calcite and C-S-H gels and that composition varied with the supplementary minerals used (Figure 7). A higher amount of healing products of slag-ECC formed due to the higher pH value of pore solution and CaO content.
Self-healing materials, (a) XRD and (b) SEM image with EDX element detection (Both reproduced from [
Several types of expansive minerals can enhance autogenous self-healing performance of concrete. Calcium sulphoaluminate (CSA) is one of the popular expansive minerals used for improving healing capacity in concrete [8, 9]. A self-healing agent (SHA) composed of silicon oxide (71.3%) and sodium aluminium silicate hydroxide [Na0.6Al4.70Si7.32O20(OH)4] (15.4%) along with various types of carbonates such as NaHCO3, Na2CO3 and Li2CO3 (etc.), and minerals such as bentonite clay (montmorillonite), feldspar and quartz was also used as an expansive self-healing agent [8]. Cracks of about 150 μm were healed within 33 days in the concrete with SHA, forming alumina silicate and modified gehlenite phases (CASH: calcium aluminosilicate hydrate). The reported healing mechanism was a swelling effect initiated by montmorillonite, and then expansion and re-crystallisation triggered by aluminosilicate with calcium ion. Ferrara et al. [51] used an active silica-based crystalline admixture (CA) as an expansive agent in cement and sand to improve the self-healing potential of raw concrete structures. Crack sealing of over 70–80% was required for reasonable mechanical performance to be recovered, such as stiffness (larger than 20%). The healing compounds formed by the crystalline admixture are similar to cement hydration products such as ettringite and calcium silicate hydrates.
Magnesium oxide (MgO), bentonite clay and quicklime were used in different proportions to enhance the autogenous self-healing capacity of concrete and cementitious materials [3, 16, 17, 18, 19, 20, 21]. Substitution of PC with up to 12.5–15% by a mix of the three expansive mineral agents, MgO 5–7.5%, bentonite clay 2.5–5%, and quicklime 2.5–5%, results in optimum enhancement of the autogenous self-healing in the cement mix [17, 18]. A typical crack healing image is presented in Figure 8 that shows how efficiently the expansive mineral containing PC mix sealed 17o-μm crack in 28 days. The flexural strength recovery and crack sealing efficiency of early age (1 day) cracked specimen was enhanced up to 48 and 39%, respectively, in an expansive mineral containing cement mix, compared to the 100% PC cement mix. The permeability (gas permeability coefficient) decreased by about 70% in the expansive mineral containing mix compared to the 100% PC cement mix. Besides common healing compounds, calcite, portlandite, ettringite and C-S-H, MgO formed brucite, other magnesium hydro-carbonate products. Although, the healing capacity of cementitious materials decreases with the increase in the age of cement paste mix at crack formation, expansive minerals improved the autogenous self-healing capacity of PC mixes at all ages compared to the 100% PC paste [18].
The typical crack sealing pattern in 28 days: (a) 100% PC cement mix and (b) cement with expansive minerals (Reproduced from [
Expansive minerals combination, that is, MgO, bentonite clay and quicklime can improve the autogenous self-healing capacity of drying shrinkage cracks in the cementitious materials. The maximum healable drying shrinkage cracks width in 100% PC and PC-expansive minerals mixes were up to 160 and 400–500 μm, respectively, after 28 days healing in water [3, 19]. Contained expansive minerals, such as reactive MgO can enhance healing compounds within the crack (Figure 9) to effectively heal the crack.
Ternary diagrams of healing compounds EDX computed atomic mass percentage formed in PC-MgO cement mixes (Reproduced from [
Expansive minerals can also improve the self-healing capacity of ECCs [46, 52]. Bentonite (Na-Montmorillonite) as a nanoclay was mixed with slag and limestone powder and used in ECC to improve its self-healing performance [46]. An ECC-MgO system resulted in higher flexural strength recovery of pre-cracked prismatic specimens cured under accelerated autoclaved conditions compared to their pre-cracked ECC without MgO [52]. The combined effect of fibre to restrict crack and the expansive minerals to heal the crack is promising.
In the autonomic self-healing system, different kinds of active healing agents are encapsulated into the concrete or composites. Popular encapsulation systems are microvascular glass tube network [23, 24] and microcapsules [1, 25, 26]. Table 2 presents an overall conception of encapsulation materials and technical developments for the autonomic self-healing process. Typically a mobile liquid healing agent is always required. Less viscosity of healing agents is expected so that it can enrich a longer crack path in the damage zone, including microcracks [54]. Healing agents also should possess the ability to make a strong bond between the crack faces.
Shell material | Core material | Øi (μm) | Øo (μm) | Wall thickness (μm) | Length (mm) | Mixed in | ||
---|---|---|---|---|---|---|---|---|
Capsule for self-healing | Spherical | Expanded clay | Na2FPO3 | x | 4000 | x | x | √ |
Expanded clay | Bacteria | x | 1000–4000 | x | x | √ | ||
Expanded clay | CaC6H10O6 | x | 1000–4000 | x | x | √ | ||
Diatomaceous earth | Bacteria | x | _ | x | x | √ | ||
Gelatin | Acrylic resin | — | 125–297 | — | x | — | ||
Gelatin | Epoxy | — | 50 | — | x | √ | ||
Gelatin | Tung oil | — | 50 | — | x | √ | ||
Gelatin | Ca(OH)2 | — | 50 | — | x | √ | ||
Wax | Retarder agent | — | 120 | — | x | √ | ||
Paraffin | Water | — | 900 | — | x | — | ||
Cement + paraffin | SAP | — | — | — | x | — | ||
UF | Epoxy | — | 120 | 4 | x | √ | ||
UFF | Epoxy | — | 20–70 | — | x | — | ||
PU | Na2SiO3 | — | 40–800 | — | x | √ | ||
Silica gel | MMA/ TEB | — | 4.15 | — | x | √ | ||
Silica | Epoxy | — | — | — | x | √ | ||
Silica Gelatin + acacia gum | Na2SiO3 Mineral oil+ Na2SiO3 | – – | 5000 300–700 | – 5–20 | x x | ∕ √ | ||
Cylindrical | Glass | CA | 800 | 1000 | 100 | 100 | ∕ | |
Glass | CA | 800, 1500, 3000 | — | — | 75, 75, 100 | ∕ | ||
Glass | epoxy | 3000–4000 | 5000–7000 | — | 250 | ∕ – | ||
Glass | CA | 3200 | 4000 | 400 | 200 | ∕ | ||
Glass | CA | — | 100 | _ | 63.5 | √ | ||
Glass | CA, epoxy, polyacrylate, PU, bacteria | 2000–3000 | 2200–3350 | 100 | 20–80 | ∕ | ||
Ceramics | PU | 2500–3500 | 3000–4000 | 250 | 15–50 | ∕ | ||
Perspex | Epoxy | — | — | — | — | ∕ | ||
Plant fibre | — | — | 40–188 | — | — | — | ||
PP with wax concentric glass capsule | MMA MgO, bentonite, lime | – 6150 | – 11,400 | – 450 | – – | ∕ √ | ||
Pellets | Cement PVA PVA | Na2FPO3, Na-MFP MgO CSA | – – – | ∼4000 600–4000 500 | – 10–50 12–73 | x x 500 | √ √ √ | |
Vascular network for self-healing | Tubular | Glass | Alkali silica, epoxy | 800 | 2000 | 600 | x | ∕ |
Glass | CA | 3000 | 4000 | 500 | x | ∕ | ||
Glass | Epoxy | 4800 | 6000 | 600 | x | ∕ | ||
Glass | CA | 3200 | 4000 | 400 | x | ∕ | ||
Glass | Foam, epoxy, silicon, CA | 1500 | — | — | x | ∕ | ||
Spiral twisted wire with EVA | Epoxy | 2000 | 3400 | 700 | x | ∕ | ||
Porous concrete | Epoxy | — | 25,000–35,000 | — | x | ∕ |
Autonomic self-healing: Encapsulation materials and techniques used (‘–’ means ‘not reported’, ‘x’ means ‘not applicable’, ‘√’ means ‘yes’ and ‘/’ means ‘no’). (upgraded from [53]).
Capillary glass tubes are a popular choice for the microvascular network or tabular system to carry the healing agent into the concrete matrix [23, 24, 27, 28]. Diameters of the glass tubes typically range from 0.8 mm [23] to 4 mm [55]. A cyanoacrylate (<5 cP viscosity) enclosed in capillary tubes (0.8 mm inner diameter and 100 mm length), with 50 μl capacity and sealed the end with silicon considerably recovered flexural stiffness in beams [23]. Mihashi et al. [28] used embedded glass pipes with two types of healing agent, alkali-silica based and two-part epoxy resin. Considerable strength recovery performance was noted with both types of the healing agent within the crack range between 300 and 500 μm. Nevertheless, efficient mixing of two-component resin inside the crack was a challenging issue.
Cardiff University researchers have investigated the type of healing agent, delivery technique, mortar mix design and the quantity of steel reinforcement used [27]. They used three popular healing agents, (i) epoxy resins following [28], (ii) cyanoacrylates following [23] and (iii) alkali-silica solutions following [28]. During the first and second loading cycles under a three-point bend test, both primary and secondary healing occurs. Low-viscosity (typically 5 cP) single-agent cyanoacrylate adhesive resulted in optimum self-healing due to its efficient infiltration into microcracks. However, healing agents carried into the cracks are limited due to the capillary action [27]. This limitation can be eliminated with the use of an open-ended system.
The most recent advancement of a vascular network system in concrete was used in a filed trail of a road improvement scheme by Materials for Life (M4L) project [56]. The vascular network systems with shape memory polymer tendons (PET) were combined in large-scale structural elements (Figure 10). The self-healing performances were promising in this field trial.
(a) Vascular network in concrete slab panel and (b) vascular network combination with PET in field trial (Reproduced from [
Microcapsules are developed to avoid challenging issues in tubes-based capsulation systems incorporation in bulk concrete production. In this healing technique, microcapsules preserving reactive healing agents are ruptured by the forces imposed on capsules’ shell due to the cracks propagation in the matrix. The released healing agent then reacts with the cementitious matrix crack surface to form healing compounds that bridge the gap and eventually heal the cracks.
The compatibility of microcapsules with bulk concrete depends on a wide variety of factors. Major influencing factors are the size and volume fraction of microcapsules used, the capsules’ mechanical properties and interlock properties between the capsules and the surrounding materials [57]. The shape of the embedded capsule is another major factor that should be considered for compatibility issues. Spherically shaped capsules provide a more controlled and enhanced release of the healing agent upon breakage. It also reduces the stress concentrations around the void left from the empty capsule. However, a tubular capsule can cover a larger internal area of influence on the concrete for the same volume of a healing agent (higher surface area to volume ratio).
Yang et al. have investigated methyl methacrylate (MMA) as a monomer and triethylborane (TEB) as the healing agent and the catalyst [25]. In the investigation, about 50.2 and 66.8% reduction in permeability has been achieved within 3 and 30 days, respectively. Microscopic imaging confirms that some ruptured microcapsules existed and filled the cracks of the sample after 80% ultimate compressive strength at 28 days.
About 2% crystalline sodium silicate in polyurethane-encapsulated microcapsules with a diameter ranging from 40 to 800 μm increased 24% mechanical load recovery compared to 12% in the control samples [58]. However, the compressive strength of the composite reduced by 12% compared to that of the control mix. In the concrete containing microcapsules, sodium silicate reacts with calcium hydroxide of cement and produces a calcium-silica-hydrate (C-S-H) gel that heals the cracks partially. The C-S-H further reacts with dissolved CO2 in water and sodium oxide, which produced calcium carbonate. This is similar to the main hydration phase of cement, which causes strengthening.
Sodium silicate encapsulated in double-walled polyurethane/urea-formaldehyde (PU/UF) was reported in [59]. The addition of 2.5 and 5% microcapsules resulted in about 24 and 35% healing efficiency based on the crack depth measurements. Further advancement with sodium silicate encapsulated in gelatin and gum arabic shell materials (Figure 11) was found in recent studies [57, 60]. These microcapsules survive mixing with cement and rupture successfully upon crack formation and release sodium silicate solution. Although increasing microcapsules volume fractions in a ∼24% reduced the mechanical properties, the crack sealing was just under 100%. Besides, the crack depth and sorptivity coefficient were decreased by 70 and 54%, respectively. These microcapsules were also successfully implemented in the filed trail of a road improvement scheme by M4L project [61].
(a) Microscopic image of microcapsules (scale bars correspond to 500 μm) and (b) ruptured microcapsules appearing as ‘wet’ spots on the digital image of the split face (Both reproduced from [
The colloidal silica solution capsules up to 16 vol% in PC grout increased the sealing efficiency from ∼20% for the only PC to ∼85% in 28 days [62]. However, monodisperse photo-polymerised acrylate shell with hydrophilic mineral core microfluidic droplets are further advancement in the self-healing microcapsule field [63].
Although the direct addition of potential minerals to the concrete mix improves autogenous self-healing performance, protecting those minerals in initial mixing may further enhance the healing process. With this in mind, pellets of potential healing mineral agents have been used for improved concrete self-healing. Sisomphon et al. [47] used expanded lightweight clay aggregates (LWAs) impregnated with a solution of sodium mono fluorophosphate (Na2FPO3, Na-MFP) and coated by cement paste layers. The entire mechanism is schematically presented in Figure 12a. Pellets with expansive minerals such as a reactive MgO were spray-coated (10–50 μm) with polyvinyl alcohol (PVA) to produce PVA-coated MgO pellets for self-healing concrete applications (Figure 12b). A PVA-coated granulated CSA (calcium sulpho aluminate)-based expansive mineral was used for improving the self-healing performance of cementitious materials [48]. Replacement of CSA pellets was up to 10% by wt. of cement and mortar was prepared with 1:3 cement-to-sand ratio and w/c = 0.5. Cracks in the range of 0.1–0.2 mm were healed completely within 14 days whereas larger crack >0.2 healed within 16 days.
(a) Impregnation of LWAs to prepare pellet and self-healing concept: I-V (Reproduced from [
Granules of expansive self-healing agent coated with an extra layer of cement compounds were investigated by [64]. The self-healing concept is schematically presented in Figure 13. The fundamental concept is that the surface of the coating may hydrate during initial production and mixing while the core healing mineral agent remains unhydrated; this may then dissolute and diffuse into the crack surface after crack propagation and form new products for self-healing.
Concept of self-healing concrete with granules containing expansive mineral agents (Reproduced from [
Alkali-resistant endospore-forming bacteria that precipitate calcite through biological metabolism are used for self-healing in concrete. Examples of these bacteria are
In the urea-based MICP process, hydrolysis of urea with urease results in ammonia and carbonate ions, which increase the pH value into the bacteria cell. Researchers have experimented with urea as a mineral precursor for bio-cementation using bacteria [33, 66]. In the presence of CaCl2 as a source of Ca2+, high pH content bacteria cause CaCO3 crystal precipitation from the solution. Typically, bacteria shell made with various ions are negatively charged to attract positive cautions Ca2+ ions surrounding the cell wall, which reacts with CO32− and precipitate CaCO3 around the cell [66].
Calcium lactate (CaC6H10O6) is a crystalline salt, typically produced from the reaction of lactic acid with calcium carbonate or hydroxide. This was used as an alternative of urea-CaCl2, as a precursor for bacterial metabolism in concrete to avoid ammonia production in hydrolysis reactions. According to [65], metabolic absorption and breakdown of calcium lactate with bacteria lead to the precipitation of CaCO3.
Bacteria cannot survive long if they are mixed directly with fresh cement. The survivability of bacterial spores was optimized in [65], through the technique of packing bacterial spores and organic mineral precursor compounds in porous expanded clay particles before mixing in the concrete matrix. The pellets (2–4 mm) were principally made with the three components of a solid mixture, and they were used as a replacement of some of the similar size coarse aggregate. A high concentration of calcite precipitation has been found in concrete specimens with bacteria incorporated expended clay particles, which efficiently acted in crack-plugging and reduced permeability (Figure 14). About to micron sized (0.15 mm width), cracks were sealed. However, the main drawback in the bacterial pellet process is the negative impact on the mechanical performance of concrete. About 50% of the total aggregate volume requires replacing with bacterial pellets for satisfactory self-healing performance, which negatively impacts the mechanical strength of concrete.
Microscopic images of bacteria based self-healing concrete, (a) Stereomicroscopic image of crack sealing, (b) Stereomicroscopic close-up image of massive columnar precipitate (c–e) ESEM images of top part of massive columnar precipitate indicated in image by dotted square (Reproduced from [
An encapsulation of bacterial spores inside microcapsules is a recent advancement in this field [26]. These microcapsules were reported flexible in humid/water conditions and becoming brittle in the dry environment. With their bacterial encapsulation systems, about 970-μm width cracks were healed successfully, which was four times greater than for non-bacterial mixes. Nevertheless, bacterial activity reduces dramatically with the increase in the pH (>12) value in concrete.
Concrete being one of the most-used construction development materials, early damage and failure within a structure’s design lifetime is a threat to infrastructure industries. A self-healing concrete has great potential to mitigate this challenge. Self-healing in concrete can be broadly classified into two categories: autogenic and autonomic healing [1].
The autogenous self-healing capacity of concrete could be enhanced through restricting crack growth, wet-dry cycle, using SCM’s such as GGBS, fly ash, and silica fume, and using expansive minerals such as MgO, bentonite clay, quicklime, CSA and crystalizing mineral agents. However, the effectiveness of autogenous self-healing is considerably dependant on the remaining unhydrated cement or mineral in the concrete. This is hitherto restricted to smaller healable crack widths, more extended healing periods and the strength recovery.
Autonomic healing in concrete, in contrast to autogenous healing, requires the release of the self-healing triggering agent from reserved encapsulation or a continuous supply network. This is to further improve the self-healing efficiency of concrete compared to the autogenous healing process. Popular autonomic self-healing systems are microencapsulation, microvascular and pellets with different autonomic healing agents such as epoxies, cyanoacrylates, methyl methacrylate, alkali-silica solutions, minerals and microorganisms.
The self-healing concrete technology can be adopted in developing smart and resilient infrastructure development. Different self-healing concrete technology can be utilized depending on different applications. The greatest challenges of all self-healing technology in the concrete industry remain the difficulties in widespread uptake, the additional costs involved and the validation of long-term durability performances. Field trials such as those initiated by the University of Cambridge, Cardiff University and the University of Bath through Materials for Life (M4L) and Resilient Materials for Life (RM4L) research projects are significantly crucial for self-healing concrete validation in large scale.
The authors are grateful for collaboration and support from the Engineering and Physical Sciences Research Council (EPSRC) research projects ‘Materials for Life (M4L)’ and ‘Resilient Materials for Life (RM4L)’.
There is no conflict of interest.
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Emans",authors:[{id:"166989",title:"Dr.",name:"Peter",middleName:null,surname:"Joseph",slug:"peter-joseph",fullName:"Peter Joseph"}]},{id:"44294",title:"Plasma Electrolytic Oxidation Coatings on Lightweight Metals",slug:"plasma-electrolytic-oxidation-coatings-on-lightweight-metals",totalDownloads:4463,totalCrossrefCites:12,totalDimensionsCites:38,abstract:null,book:{id:"3530",slug:"modern-surface-engineering-treatments",title:"Modern Surface Engineering Treatments",fullTitle:"Modern Surface Engineering Treatments"},signatures:"Qingbiao Li, Jun Liang and Qing Wang",authors:[{id:"91954",title:"Prof.",name:"Qing",middleName:null,surname:"Wang",slug:"qing-wang",fullName:"Qing Wang"},{id:"166918",title:"Prof.",name:"Jun",middleName:null,surname:"Liang",slug:"jun-liang",fullName:"Jun Liang"},{id:"166935",title:"Mr.",name:"Qingbiao",middleName:null,surname:"Li",slug:"qingbiao-li",fullName:"Qingbiao Li"}]},{id:"43964",title:"Zinc Oxide — Linen Fibrous Composites: Morphological, Structural, Chemical, Humidity Adsorptive and Thermal Barrier Attributes",slug:"zinc-oxide-linen-fibrous-composites-morphological-structural-chemical-humidity-adsorptive-and-therma",totalDownloads:3412,totalCrossrefCites:2,totalDimensionsCites:6,abstract:null,book:{id:"3530",slug:"modern-surface-engineering-treatments",title:"Modern Surface Engineering Treatments",fullTitle:"Modern Surface Engineering Treatments"},signatures:"Narcisa Vrinceanu, Alina Brindusa Petre, Claudia Mihaela Hristodor,\nEveline Popovici, Aurel Pui, Diana Coman and Diana Tanasa",authors:[{id:"122667",title:"Dr.",name:"Narcisa",middleName:null,surname:"Vrinceanu",slug:"narcisa-vrinceanu",fullName:"Narcisa Vrinceanu"}]},{id:"44855",title:"Surface Modification of Nanoparticles Used in Biomedical Applications",slug:"surface-modification-of-nanoparticles-used-in-biomedical-applications",totalDownloads:6336,totalCrossrefCites:10,totalDimensionsCites:33,abstract:null,book:{id:"3530",slug:"modern-surface-engineering-treatments",title:"Modern Surface Engineering Treatments",fullTitle:"Modern Surface Engineering Treatments"},signatures:"Evrim Umut",authors:[{id:"165375",title:"Ph.D.",name:"Evrim",middleName:null,surname:"Umut",slug:"evrim-umut",fullName:"Evrim Umut"}]}],onlineFirstChaptersFilter:{topicId:"825",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81716",title:"Groove Shape Optimization on Dry Gas Seals",slug:"groove-shape-optimization-on-dry-gas-seals",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.103088",abstract:"In this paper, a topological optimum design for the shape of a groove in a dry gas seal is described. Dry gas seals are widely used in high speed and high pressure rotating machinery such as gas turbines, compressors, and so on because of their high reliability compared to other types of seals. However, recent requirements for reducing emission with further control of leakage are in order. With this background, we propose applying topological optimization to the groove shape in a dry gas seal to reduce its leakage while keeping its stiffness for safe operation. First, the method of topological optimum design as applied to the groove of a dry gas seal is explained via numerical analysis. Next, results of the topological optimization are shown via categorizing an optimum shape map. 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Temperature measurement in abrasive cutting is difficult due to the small size of the heated area (only tenths of mm2), high temperatures (above 1000°C), continuous change of the conditions within one cut-off cycle, large temperature gradient (more than 200°C), high cutting speed (above 50 m/s) and high mechanical load. The infrared thermography (IRT) application for thermal control of elastic abrasive cutting have been studied. The performed thermal measurements have been verified with the results obtained from the temperature models of workpiece, cut-off wheel, and cut piece depending on the conditions in elastic abrasive cutting of two structural steels C45 and 42Cr4. 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Starting from the fundamental formulation of Greenwood and Williamson, an extension is proposed with details on the possible algorithmic implementation to consider the interactions between asperities. A second multi-scale-based approach, considering the self-affine nature of the rough surface, also known as Persson’s theory, is briefly discussed. As a third method, special attention is given to review the standard Boundary Element Method (BEM). Finally, all the mentioned methods are applied to a rough gold surface measured by Atomic Force Microscope (AFM) and the evolution of the real contact area with loading is analyzed. The aim of this contribution is to present the basic guidelines to tackle the problem of contacting rough surfaces, accounting for the real surface topography.",book:{id:"10848",title:"Tribology of Machine Elements - Fundamentals and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg"},signatures:"Farouk Maaboudallah, Mohamed Najah and Noureddine Atalla"},{id:"79807",title:"The Role of Friction on Metal Forming Processes",slug:"the-role-of-friction-on-metal-forming-processes",totalDownloads:65,totalDimensionsCites:0,doi:"10.5772/intechopen.101387",abstract:"The friction that occurs in forming processes plays a fundamental role in the industry as it can be responsible for both manufacturing failure and its success. Scientific research has been done to try to understand this phenomenon as well as simulation software has been implemented aiming to predict the tribological behavior of the metallic pair in contact. Thus, this chapter is dedicated to the analysis of the main parameters that can influence the coefficient of friction, especially for metal manufacturing processes. Some simulation models that try to predict the behavior of friction under certain conditions of process speed, contact pressure and operating temperature will also be presented.",book:{id:"10848",title:"Tribology of Machine Elements - Fundamentals and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg"},signatures:"Luis Fernando Folle, Bruno Caetano dos Santos Silva, Gilmar Ferreira Batalha and Rodrigo Santiago Coelho"},{id:"79676",title:"Grease Lubrication: Formulation Effects on Tribological Performance",slug:"grease-lubrication-formulation-effects-on-tribological-performance",totalDownloads:115,totalDimensionsCites:0,doi:"10.5772/intechopen.101549",abstract:"Grease lubrication performance prediction is challenging. Only recently that empirical equations to predict grease film thickness for prevailing rolling conditions under fully flooded lubrication taking into account thickener properties and content for low, moderate, and high speeds were developed. At starved lubrication, although new insights about the supply and loss mechanisms that govern film formation have been published, contact replenishment and, consequently, film thickness predictions for long-term operation are still not available. Prediction of components efficiency requires film thickness values and properties, including film’s molecular structure, which makes it even more challenging. When it comes to prevailing sliding conditions, the literature is scarce and most of the knowledge developed for prevailing rolling conditions is not applicable. During the sliding of the contacting bodies, boundary and mixed lubrication regimes are expected. In this situation, the tribological response is primarily defined by grease thickener and additives physicochemical interaction with the surface. This complexity leads many researchers to seek simpler relationships between grease formulation and properties with its performance. This review aims to present the state-of-art on grease lubrication and update some of these relationships.",book:{id:"10848",title:"Tribology of Machine Elements - Fundamentals and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg"},signatures:"Tiago Cousseau"},{id:"79311",title:"Analysis of the Tribological Evolution of Nitride-Based Coatings",slug:"analysis-of-the-tribological-evolution-of-nitride-based-coatings",totalDownloads:113,totalDimensionsCites:0,doi:"10.5772/intechopen.100629",abstract:"This chapter describes the fundamental and technological role of nitride-based hard coatings as protective coatings in some applications within the metalworking industry. For this, this chapter will present a critical review of previous research and recent developments on nitride-based coatings in different systems such as (multilayers, quaternaries, among others), where it will be possible to demonstrate their main properties and advantages that they can grant when they are implemented on conventional steels, such as greater hardness, surface control, electrochemical resistance, resistance against wear, among others. These results will determine that this type of coatings are suitable candidates to be implemented as protective coatings on cutting tools, which suffer from high wear in machining processes in the metalworking industry.",book:{id:"10848",title:"Tribology of Machine Elements - Fundamentals and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg"},signatures:"Christian Ortiz Ortiz, Erick Hernandez-Rengifo and Julio Cesar Caicedo"}],onlineFirstChaptersTotal:10},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{},overviewPageOFChapters:[],overviewPagePublishedBooks:[],openForSubmissionBooks:{},onlineFirstChapters:{paginationCount:17,paginationItems:[{id:"81751",title:"NanoBioSensors: From Electrochemical Sensors Improvement to Theranostic Applications",doi:"10.5772/intechopen.102552",signatures:"Anielle C.A. Silva, Eliete A. Alvin, Lais S. de Jesus, Caio C.L. de França, Marílya P.G. da Silva, Samaysa L. Lins, Diógenes Meneses, Marcela R. Lemes, Rhanoica O. 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In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. 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