**4. Other neonatal fungal infections**

Despite *C. albicans* is known to be primarily responsible for most neonatal fungal diseases, the prevalence of infections caused by other fungi in neonates and young infants is not significant, except for *Malassezia* species, which may occur in epidemic outbreaks [44–46].

Since 1980, this genus has been recognized in sepsis and systemic infections involving neonates receiving lipidic parenteral nutrition using a central venous catheter. It is believed that lipid supplementation facilitates the colonization of the catheter that used to infuse the nutrients. In newborns, colonization by *Malassezia* can progress to fungemia. The removal of the infected catheter is sufficient to limit infection in most cases [46, 47].

The vast majority of cases of fungemia occur in children less than 12 months old. In this population, this *Malassezia* infection rarely remains asymptomatic. Interstitial pneumonia and thrombocytopenia are common clinical manifestations in this group of patients, and the most frequent symptoms in systemic infections are fever and respiratory dysfunction with or without apnea [46, 48].

Other less common symptoms include lethargy, malnutrition, bradycardia and hepatosplenomegaly. However, no signs of erythema, swelling or purulence appear at the catheter entry site. Signs of skin rash are also not evident in children with systemic infections. Interstitial bronchopneumonia can be found in 40% of children [44–46].

The diagnosis of fungal infection by *Malassezia* is made by isolating the microorganism from blood collected through the catheter or by culturing the catheter tip after its removal. In suspected sepsis by *Malassezia*, the tip of the catheter should be cultured in broth enriched with lipids [45, 46].

The standard therapeutic management for systemic infections by *Malassezia* is still not well defined, since the fungemia by this microorganism is relatively unusual. However, some authors recommend the use of amphotericin B to treat these infections [45, 46, 49]. Morrison and Weisdorf [50] found that all patients enrolled in their study were cured without the administration of systemic antifungal therapy.

Studies have indicated that the most important factor for therapeutic success against systemic infection is the removal of the infected catheter and the interruption of lipid infusion, with or without antifungals [18, 45, 46].


**2. Influence of synthesis methods on SnO2 electrical properties**

The processing by mixing oxides is widely used at the industrial scale for the production of varistor ceramics mainly due to its low cost, consisting basically of an initial powder mix and wet milling followed by drying, deagglomeration of powder, forming pellets/bulks, and sintering. The varistor synthesis with large amounts of chemical additives and/or impurities resulting from the process can lead to non-densifying sintering mechanisms. This mean that impurities may accumulate on the material surface and increase the mass flow on the surface or forming more unstable compounds that can evaporate and condense on the surface, favoring grain growth without decreasing pore size. The advancement in ceramic materials process technology aims to find low-cost methods and the viability of the process on an industrial scale. Among the processes available in the literature for the production of ceramics, techniques can be cited as coprecipitation, sol-gel, dehydration by rapid cooling (freeze drying), combustion method, and polymeric precursor method known as the Pechini method [28–31].

*1.3.1. Schottky type*

30 Advanced Ceramic Processing

describes this behavior is [24,25]

*1.3.2. Poole–Frenkel type*

of Schottky type [26]:

be considered [27].

In this model, the electrons are emitted and pass through the potential barriers particularly due to the action of temperature distorting the energy band diagram, near the interface. This distortion modifies the potential barrier favoring the thermal emission. The equation that

\* ½

where *A*\* is the Richardson constant, *φ*b is the potential barrier height, *E* represents the electric field, *T* is the ambient temperature in Kelvin, and *β* is a constant related to the width of the

1/2

The emission of the Poole–Frenkel type assumes the formation of coulombian centers in the grain–intergranular layer interface region. The relationship that describes this type of emission is on Equation 9, where the external electric field variations are more relevant than for issue

> é ù f

 b

½ 2 .. *b*

where *c* is a constant of the material, *T* is the room temperature, *E* is the electric field, *k* is the Boltzmann constant, and *φ*b is the height of the potential barrier. The thermionic emission cannot explain the high nonlinear coefficients observed in varistors. In the post rupture zone with the presence of high electric fields, the possibility that distortion of the energy levels and, therefore, the possibility that electrons pass through the potential barrier by tunneling must

The processing by mixing oxides is widely used at the industrial scale for the production of varistor ceramics mainly due to its low cost, consisting basically of an initial powder mix and wet milling followed by drying, deagglomeration of powder, forming pellets/bulks, and

*E J c E exp kT*

**2. Influence of synthesis methods on SnO2 electrical properties**

 w

é ù f b

ë û (7)

() *n* - = (8)

ë û (9)

2 .. *b*

b

where *n* is the grain number per unit length and *ω* is the width of the barrier.

*E J A T exp kT*

*S*

potential barrier in accordance with the following equation [25]:

*P*

**Figure 3.** Schematic representation of reactions developed in the polymeric precursor method (Pechini method) [31].

The polymeric precursor method involves a complexation reaction of metal ions by an organic complexing agent as carboxylic acid. The metal ions are complexed into carboxylic sites forming a metal carboxylate, which is sequentially polymerized with ethylene glycol, as shown in Figure 3, citric acid is often used as the complexing agent. This process shows advantages such as low temperature of synthesis and high control of stoichiometry, and allows the obtention of powder with nanometric particles. The immobilization of metal ion in organic matrix reduces the segregation of the metal during the decomposition of the polymer at high temperatures, thus ensuring a homogeneous composition [31]. The ceramic powders are obtained by controlled calcination of the resin until total oxide formation.

Another method widely used for controlled synthesis of multifunctional ceramics is the solgel, that is used for the synthesis of a colloidal suspension where the dispersed phase is a solid and the dispersion medium is liquid, and is called sol. Therefore, there is the formation of a dual phase material: a solid body that is occupied by a solvent, i.e., moist gel. The initiator compounds, commonly called precursors, consist of a metal surrounded by many connections and typically are inorganic salts or organic compounds. The two precursors undergo two chemical reactions at sol preparation: hydrolysis and condensation, which resulted from the addition of an acid or base catalyst to form small solid particles or clusters in a liquid (aqueous solvent) [32,33]. The sol-gel method provides homogenous mixtures of cations on an atomic scale and also allows the preparation of ceramic powders with high surface area and films or gels fibers, which have high technological importance. The method has advantages over other conventional methods such as high purity, resin calcination at low temperatures, and synthesis of oxides with defined and controlled properties [32–34].

Also, the controlled precipitation method (CPM) can be used to prepare precursor powders. In this case, the solution containing the cation of interest is added to another solution contain‐ ing a precipitating agent that can be a base or anion (ammonia, urea, and oxalic acid). In this way, the final product precipitate is separated by filtration, washed, dried, and calcined to obtain the oxide. The precipitation process has a complex mechanism, which is dependent on the degree of saturation of the ion to be used. The process starts by formation of cluster from chemical species in the solution, known as nucleation process. Reaching the ion solubility limits the growth stage of formed centers and finally the formation of precipitates [35].

To check the influence of the chemical synthesis route the electrical properties of the SnO2 based varistors, Mosquera et al. [36] carried out the synthesis of tin oxide by controlled precipitation and polymeric precursor (Pechini) methods that's offering the strict control of the chemical purity and the particle size of the raw material. The system SnO2.Co3O4.Nb2O5.TiO.Al2O3, with 1 mol% Co3O4, 0.05 mol% Nb2O5, and 1 mol% TiO2 and variations of 0.05 (named SCNT05A), 0.1 (named SCNT1A), and 0.2 mol% (named SCNT2A) of Al2O3 were prepared. Following synthesis, the materials were submitted to heat treatment at 600°C/1 h (controlled precipitation method, CPM) and 600°C/2 h (Pechini method, PCH) to eliminate organic matter and obtain the full formation of the oxide. The use of dopants in both methods resulted in no change in the SnO2-crystal structure or formation of secondary phases due to have been added small amounts of dopants (Figure 4). The SEM micrographs indicated the influence of the addition of the aluminum grain growth control. The Pechini method showed smaller grains and more porous samples.

**Figure 4.** SEM for sintered samples at 1350°C, obtained by CPM and PCH (a) 0.05% Al2O3 and (b) 0.1% Al2O3. XRD for varistor system whit 0.2% Al2O3 synthesized by CPM and PCH [36].

The aluminum concentration also influenced on the electrical properties, as shown in Figure 5, mainly in the breakdown electric field variation that had been related to decreasing of grain size. The samples showed nonlinear coefficient (*α*) of similar values, but the sample prepared by Pechini method and with 0.2% Al2O3 had the highest value for *α* (21.7) and the breakdown electric field (due to the smaller grain size).

**Figure 5.** log J *versus* log E curves of samples synthesized by (a) CPM and (b) PCH, sintered at 1350°C [36].


**10. Patient education and preventive measures**

Clinicians should work closely with people who are recovering from infectious esophagitis and encourage them to keep all their follow-up medical appointments in order to monitor their progress and treatments outcomes.

The clinicians can suggest the following steps to patients that have ongoing symptoms of painful or difficulty in swallowing:

• Sleeping in flat position should be avoided, and the head of the bed should be elevated by several inches, i.e., six inch blocks. It is also important to discourage patients from sleeping with extra pillows as this may increase intra-abdominal pressure caused by people bending at the waist level.

The importance seeking early medical evaluation at the onset of symptoms should be emphasized to the patients and the general population in health education/health promotion campaigns. In addition, the importance of taking medicines with plenty of water while sitting upright in order to avoid the complications of drug-induced esophagitis should be highlighted to the patients.

Clinicians should also avoid the prescription of certain medications like alendronate in patients with obvious esophageal varices. It should also be noted that giving alendronate to patients who are cirrhotic could precipitate gastrointestinal bleeding from erosions over an esophageal varix.


*5.1. Surgery*

Colorectal cancers may be cured by surgery (hemicolectomy) [2], but only if the entire tumor is localized and no cells have spread to other sites (adenocarcinoma in situ) [22,32]. Moreover, in most of the cases, complementary therapies (adjuvants) are needed before or after surgery and vary from traditional to novel. Traditional chemotherapies are based on 5-FU, which inhibits cancer cell division. Nobody doubts that traditional adjuvant treatments have improved the prognosis of patients; however, they are not beneficial for all cases. For instance, not all women with breast cancer derive benefit from 5-FU-based adjuvant chemotherapy. Many older women (age > 70) with hormone receptor-positive early stage breast cancer treated with adjuvant chemotherapy will not accrue a survival advantage [33]. For CRC, it was demonstrated that extra cycles of traditional chemotherapy, either before or after chemoradiotherapy, have been shown not to improve survival compared with chemoradiotherapy alone. An argument for less chemotherapy is also presented by results from trials investigating neoadjuvant or preoperative therapy in esophageal and gastric cancers. In randomized trials, which enrolled patients with esophageal and gastro-esophageal junction adenocarcinoma, no survival benefit with four cycles of the ECX regimen (epirubicin, cisplatin, and capecitabine) were reported beyond that achieved with two cycles of fluorouracil and cisplatin. These results support the use of a shorter duration of preoperative chemotherapy [34].

5-FU can cause local and systematic toxicity (DNA damage) to healthy cells, generating undesired side e ffects, and favor the mutation of them to malignant cells. These problems can be overcome by using novel approaches such as targeting specific cancer-relevant proteins (such as oncogenic tyrosine kinases), immunotherapy, and reactive oxygen species (ROS)-modulated therapies, which are more specific in generating cancer cell apoptosis and reducing the side e ffects associated with traditional chemotherapy [35,36].


**5.2 Results**

24 Recent Advances in Arthroplasty

Standard monitoring including continuous electrocardiogram, nonivasive automated blood pressure and pulse oxymetry. Cardiovascular and respiratory monitoring was continued at the time following surgery. All patients were transferred in the postoperative care unit after

Crystalloids, colloids were used perioperatively. Homologous blood was used for

Patients with long-term steroids therapy received additional steroid doses during

All patients received antibiotic prophylaxis with Cephazolin 1g on induction and 1 g eight-

For postoperative pain relief, they were given standard analgesic drug consisting of opioid

Exclusion criteria included an ASA≥3, BMI>30 (obesities), Hb≤9g/dl, treatment with

The duration of RA was evaluated and the Disease Activity Score-28 (DAS28) was calculate for all patients before operation. The set of questionnaires was used, the Disease Activity Score-28 was assessed by the number of swollen and tender joints, erythrocyte sedimentation rate (ESR, mm/h) and general health assessment on a visual analog scale

During observation the normally physical examination of respiratory system was performed in all patients. No patient had significant tachycardia, tachypnea or other symptoms of atelectasis. Moreover, none of patient complained of sharp pain burning sensation in urine tract that might be a sign of infection and no patient had documented wound complication

Patients were divided into two groups depending on the activity of the disease being evaluated DAS28. The patients with DAS-28 score lower than 5.0 were classified into the group 1 (G1) and the patient with DAS28 score≥5 were classified into the group 2 (G2).

Samples of venous blood were taken before induction of anesthesia (a baseline sample-0 h) and at 6, 12, 24, 36 hours (6h, 12h, 24h, 36h) after the end of surgery. Blood was collected in 5 ml pyrogen –free tube, the samples were centrifuged at 3000 rpm for 10 min then serum was

The serum concentration of interleukins IL-6, TGF-β and C-reactive protein (CRP) were

The serum concentration of IL-6 was determined with a commercially available using ELISA

TGF-β was determined with using DuoSet ELISA kits (R&D System). All determinations

CRP was determined using routine diagnostic test (dry chemistry) in analizator Vitros 250. Statistical analysis of results was performed using a standard computer application Statistica version 9. Continuous parametric data were assessed using one-way analysis of

The study was approved by the medical Ethics Committee of the Institute of Rheumatology

determined in all patients. Serum CRP was determined rapidly after obtaining.

transfusion depending on the patient's requirements.

Thromboprophylaxis with low-molecular weight heparin was given.

The tourniquet was used in all patients. Tourniquet pressure was 350 mmHg.

biologic agents, allergy to local anesthetics, contraindications to spinal anesthesia.

postoperative period in a predefined regiment.

separated and stored at -70oC for future analysis.

were performed according to the manufacturer's instructions.

variance (ANOVA). Statistical significance was considered at the p ≤0,05

and informed written consent was obtained from each patient all the patients.

the operation.

hourly within 3-5 days.

and paracetamol.

during observations.

Blood samples:

kits (R&D System).

(VAS).

The study population consisted of 37 patients (35 women, 2 men) with a primary diagnosis of rheumatoid arthritis underwent total knee arthoplasty under spinal anesthesia. ASA physical status II.

Patients were divided into two groups depending on the activity of the disease being evaluated DAS-28. Group 1 (G1) DAS-28 <5, group 2 (G2) DAS-28≥5

Data are mean ±SD or n

Table 1. Characteristics and surgical data of patients divided into DAS-28 groups (G1, G2)

Details of 37 patients studied are shown in Table 1. The significant difference was observed in relation to age between groups. By contrast, there were no significant differences between groups in terms of volume given fluids and tourniquet duration.

With regard to the DAS, the difference between groups is not statistically significant but this difference is particularly shown in the clinical observation.

No significant differences were observed with cardiovasculary parameters between groups during observation: MAP (p=0.61) and SaO2 (p=0.98). MAP: G1: 89.6±11, G2: 86.7±10.2 and SaO2: G1 97.2±1.3 G2 96.5±1.3, the values are mean ±SD.

Analysis of concentration level of IL-6 shown statistically significant difference between groups (Fv1=1, v2=171 =41.23, p<0.0001). The was no found significant differences in concentration level of IL-6 in time segments (Fv1=4, v2=171 =0.13, p=0.9721). No interaction time and groups for IL-6 (Fv1=4, v2=171 =0.15, p=0.9650).

The concentration of IL-6 before operation was particularly higher in patients in G2. Moreover, a comparison of value of IL-6 concentration thirty-six hours after surgery with baseline value indicated small increase of IL-6 in patients in this group.

Taking into consideration the range of IL-6 value it can be concluded that the concentration of IL-6 was kept on the similar levels after operation.

There were none changes in concentration of IL-6 during observation in patients in G1 (Fig. 1).

In terms of TGF-β concentration, the analysis of results shown no statistically significant variation of mean value across time (Fv1=4, v2=168 =0.29, p=0.8867). There was no found the significant difference between groups (Fv1=2, v2=168 =2.79, p=0.0966). However, in opposition to IL-6, in both group the values of TGF-β measured at 36 hour were lower in comparison with preoperative values (Fig.2).

The Stress Response and Its Functional Implications in the Immune

p<0.005 across time (Fv1=4, v2=160 =26.56, p<0.0001) in both groups.

increased during observation with the peak level at 36 hour (Fig. 3).

and progression of joint damage.

mean

**5.3 Discussion**

CRP, mg/l

Response After Surgery in Patients with Chronic Inflammation Undergoing Arthroplasty 27

The analysis of results of serum CRP concentration shown statistically significant variation

No significant difference was observed in CRP serum concentration between groups across time (Fv1=2, v2=160 =4.10, p=0.0446). In all patients the concentration of CRP systematically

> 0 6 12 24 36 time, h

No significant difference (p>0.05) in DAS 28 was shown between groups. However, these differences were strongly marked in a clinical picture. The patients with higher DAS 28 demonstrated significantly more swollen and painful joint counts that related to disability

High, as well as the very high, the cytokines concentration such as IL-6 and TGF-β was observed in all patients before the surgery. The disease severity common with degenerative joint changes were directly influence on the high cytokines concentrations. This also consistent with previous publications demonstrated the high serum IL-6 level in patients with chronic inflammatory disease (Kaneko et al., 2000; Desgeorges et al., 1997). The preoperative stress has also been proposed as one of factor could affect the IL-6 level (Hirano et al. 1988; Tanno et al., 2004). However, taking into consideration the very high baseline level of IL-6 the stress factor did not seem play significant role in this study. Besides that, the preoperative stress response was reduced with midanium premedication in all patients before the surgery. The autoimmune disease severity, as well as joint cartilage

Fig. 3. Changes in serum CRP concentration against time in group G1 and G2. Data are

G1 G2

Fig. 1. Changes in serum IL-6 level against time in group G1 and G2. Presented values are mean.

Fig. 2. Mean serum levels of TGF-β at predefined time in group G1 and G2.

The analysis of results of serum CRP concentration shown statistically significant variation p<0.005 across time (Fv1=4, v2=160 =26.56, p<0.0001) in both groups.

No significant difference was observed in CRP serum concentration between groups across time (Fv1=2, v2=160 =4.10, p=0.0446). In all patients the concentration of CRP systematically increased during observation with the peak level at 36 hour (Fig. 3).

Fig. 3. Changes in serum CRP concentration against time in group G1 and G2. Data are mean


**Plants with Hypolipidaemic Effects from Nigerian Flora**

Ngozi Justina Nwodo, Charles Okeke Nnadi, Akachukwu Ibezim and Chika John Mbah

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/57181


**4.1 Cytochrome P-450scc**

The cytochrome P-450scc side chain cleavage is an enzyme present in the inner mitochondrial membranes. The enzyme is involved in three catalytic cycles on the cholesterol molecule: the introduction of hydroxyl groups at positions C-22 and C-20, and the subsequent scission of the side chain between these carbons. ACTH and LH stimulate cytochrome P-450scc synthesis in a mechanism that depends on cAMP synthesis as a second messenger (Auchus & Miller, 2000; Straus & Hsue, 2000).


Author details

polymer melt. In addition, the radial temperature difference of torsional screw is 15° C, whereas the radial temperature difference of conventional screw is 20°C, which is 25% higher than that of torsional screw. As the experiment data indicate that the radial temperature difference of melt decreases in the torsional configured screw, it can be concluded that the torsional configuration has a superior heat and mass transfer performance to achieve better temperature distribution than traditional

One of the fundamental questions of non-uniform heat and mass transfer in viscous fluid was addressed by proposing a radial torsional flow pattern, by designing a torsion element and validating the same in a melt-phase polymer extrusion process. The synergistic interaction mechanisms between velocity and velocity gradient and velocity and temperature gradient have been investigated by considering theoretical and numerical aspects, which provides a new perspective to understand the polymer processing. Considering the multi-field synergy, a new design concept of torsion screw configuration has been proposed to facilitate phase-

The spiral-shaped torsional flow induced by torsion configurations in a polymer channel changes the radial velocity direction, which in turn improves the interaction between velocity and temperature fields and helps to achieve good heat

transfer and temperature homogeneity. The new torsion elements and their arrangement provide a novel pathway to achieve good thermal management of polymer melt by enhancing multi-field coupling. These results can be achieved to guide the screw design used for preparing high-performance composites, especially heat-sensible and biodegradable nanocomposites or microcellular foam controlled

This work was supported by the National Natural Science Foundation of China (grant number 51576012). Support from China Scholarship Council is also gratefully

CV constant-volume specific heat capacity, J/ (kgK) Cp constant-pressure specific heat capacity, J/ (kgK)

λ thermal conductivity, W/(mK)

δ velocity boundary layer thickness, m

screw, which is also in agreement with the simulation results.

to-phase thermal and molecular mobility.

acknowledged for Ranran Jian's joint PhD grant.

τ stress, Pa P pressure, Pa

ρ fluid density, kg/m3 v fluid velocity, m/s

T fluid temperature, K x, y, z Cartesian coordinates, m

Appendices and Nomenclature

7. Conclusions

Thermosoftening Plastics

by temperature.

30

Acknowledgements

Ranran Jian1,2, Hongbo Chen3 and Weimin Yang1 \*

1 College of Mechanical and Electrical Engineering, Beijing University of Chemical Technology, Beijing, China

2 Centre for Biocomposites and Biomaterial Processing, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada

3 College of Electromechanical Engineering, Qingdao University of Science and Technology, Qingdao, China

\*Address all correspondence to<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.