Spinocerebellar functional problems in common SCA types.
\r\n\tThe present book intends to provide to the reader a comprehensive overview of the state of art in empathy studies, embracing the different theoretical points of view and illustrating the advanced research such as the application of new technologies to promote perspective-taking. The critical aspects and the future directions of the study on empathy will also be presented.
",isbn:"978-1-80356-612-2",printIsbn:"978-1-80356-611-5",pdfIsbn:"978-1-80356-613-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"4c1042dfe15aa9cea6019524c4cbff38",bookSignature:"Ph.D. Sara Ventura",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11443.jpg",keywords:"Theoretical Model, Skill, Perspective Taking, Training Programs, Practical Implications, Advanced Research, Future Directions, Virtual Reality, Augmented Reality, New Trends, Assistive Technology",numberOfDownloads:20,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 1st 2022",dateEndSecondStepPublish:"June 8th 2022",dateEndThirdStepPublish:"August 7th 2022",dateEndFourthStepPublish:"October 26th 2022",dateEndFifthStepPublish:"December 25th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Passionate researcher in the application of new technologies to psychological treatments, neuro-rehabilitation, human behavior, and the evolution of the human-computer interaction. In 2017 Dr. Ventura won a competitive grant (Santiago Grisolia) at the University of Valencia at LABPSITEC group, where she was awarded her Ph.D. degree, supervised by Prof. Rosa Baños at the University of Valencia, and co-directed by Prof. Giuseppe Riva of the Catholic University of Milan.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"227763",title:"Ph.D.",name:"Sara",middleName:null,surname:"Ventura",slug:"sara-ventura",fullName:"Sara Ventura",profilePictureURL:"https://mts.intechopen.com/storage/users/227763/images/system/227763.jpg",biography:"Sara Ventura gained a B.Sc in Psychology at the University of Padua (Italy) in 2013 and an M.Sc. in Ergonomic Psychology at the Catholic University of Milan (Italy) in 2015. In 2016, she carried out a postgraduate training at Universidad Nacional Autónoma de Mexico (Mexico) at the Ciberpsychology lab, working on a rehabilitation protocol for people with acquired brain injury through Virtual Reality. In 2020, Sara gained the Ph.D. in Clinical Psychology at University of Valencia (Spain) working with the LabPsitec group and focusing her research on the study of embodiment and empathy with the support of Virtual Reality. Actually, she is working both with Alma Mater Studiorum – University of Bologna (Italy), and the University of Valencia (Spain) on the fields of embodiment, stroke rehabilitation, empathy and patient care. Her research interests mainly focus on the adoption of new technologies, particularly Virtual/Augmented Reality and Artificial Intelligence for the psycho-social wellbeing with clinical and non-clinical populations, the study of human-computer interaction, and the user experience. She is the author of several scientific papers and various presentations at national and international conferences.",institutionString:"University of Valencia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Valencia",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"21",title:"Psychology",slug:"psychology"}],chapters:[{id:"82719",title:"Empathy as a High-Performance Competency",slug:"empathy-as-a-high-performance-competency",totalDownloads:14,totalCrossrefCites:0,authors:[null]},{id:"82888",title:"From Empathy to the Aggression–Compassion Continuum",slug:"from-empathy-to-the-aggression-compassion-continuum",totalDownloads:6,totalCrossrefCites:0,authors:[{id:"191531",title:"Dr.",name:"Neil E.",surname:"Grunberg",slug:"neil-e.-grunberg",fullName:"Neil E. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"17111",title:"Synsedimentary Deformational Structures Caused by Tectonics and Seismic Events – Examples from the Cambrian of Sweden, Permian and Cenozoic of Germany",doi:"10.5772/19466",slug:"synsedimentary-deformational-structures-caused-by-tectonics-and-seismic-events-examples-from-the-cam",body:'Most sedimentary structures occurring within siliciclastic successions are doubtless caused by a variety of depositional processes. Among thousands of these sedimentary structures, a small number can be identified as structures which are not of primary origin. Among these, many are structures generated due to a postdepositional deformation of the primary bedding planes within the sediment. Examples of such deformational structures are mostly synsedimentary folds, ball-and-pillow structures or clastic dykes. Some of these structures have been obviously generated by the liquefaction of the soft, not yet lithified sediment. The existence of unstable layers or density inversions within the succession may promote such processes. However, in most cases these deformational sedimentary structures are obviously caused by heavy earth quakes, generated at actively moving faults. Strong seismic shock waves promote a break-down of the grain structure of sensitive sand layers leading to a short termed liquefaction of these layers and causing the deformational structures mentioned above. Hence, many of these structures are lastly products of tectonic events near or at the active rims of the sedimentary basins. Examples of these tectonically triggered deformational sedimentary structures can be found within sedimentary successions throughout earth’s history and are described e.g. from Proterozoic and Plaeozoic of India (Bhattacharya & Badyopathyay 1998) and Canada (Pollock & Williams), from the Cretaceous of Mexico (Blanc 1998) and Brasilia (Rosetti & Goes 2000, Rosetti & Santos 2003) or the Quaternary of Switzerland (Becker et al. 2002), Spain (Gilbert & al. 2005) or Kyrgystan (Bowman & al. 2004). Within the paper presented here examples are given from Lower Cambrian shallow marine sandstones (Vik Sandstone) in eastern Scania (Skåne, South Sweden), from terrestrial Lower Permian Rotliegend sandstone successions in Hesse (Central Germany), and from Paleogene and Neogene marine as well as terrestrial sediments within the Molasse basin in southwestern Bavaria (South Germany).
The western part of the Bavarian Alpine foreland between River Danube in the N and the Alps in the S is made up of Oligocene and Miocene clays, sandstones and conglomerates, containing detritus from the slowly growing Alpine mountains in the S. These clasitic marine and terrestrial Molasse sediments were deposited upon a steadily downsinking substrate, consisting of a thick blanket of Mesozoic strata overlying the crystalline basement of the Variscides. In the southern part of this Molasse basin the sediments attain a thickness of several kilometres, towards the N the sedimentary succession thins out and is completely eroded in places N of the Danube valley. Due to the compression caused by the prograding Alpine orogenic front the sedimentary filling of the southern part of the Molasse basin has been tectonically deformed. This Folded or Subalpine Molasse forms a 10 to 25 km wide belt in front of the Alpine nappes, characterized by widely deformed synclines and listric thrusts. Separated by a steeply inclined major fault N of the Subalpine Molasse („Südrandstörung“) the Alpine foreland is made up of the flat lying, Unfolded or Autochthonous Molasse. Only at their southern margin and immediately N of the „Südrandstörung” the beds are steeply inclined (Lemcke, 1988, Scholz, 2000).
\n\t\t\tThe Molasse succession exhibits two transgressive-regressive cycles. In Upper Oligocene, lower Early, Middle and Upper Miocene fluvial sediments were deposited on wide and flat lowlands with neglible relief, formig the Lower (LoFM) and the Upper Freshwater Molasse (UpFM) respectively. In times of a relative sea level rise, brackish to marine conditions have been established, evidenced by the intercalation of the Lower Marine Molasse (loMM) in Early Oligocene and the Upper Marine Molasse (UpMM) in latest Early Miocene (Lemcke, 1988).
At several sites and within sand- and silt-dominated Molasse successions deformations of the primary sedimentary structures occur, which obviously are not linked with a postsedimentary (Neoalpine) tectonic deformation of the rocks (fig. 1 / 1-6). Since overlying and underlying horizons of the deformed beds are not deformed, they clearly are of synsedimentary origin. Large ball-and-pillow structures are well developed at many sites at the contact between marls and overlying sandstone successions, mainly within the LoMM (Bausteinschichten) and LoFM. There are also some examples of small and large-scale synsedimentary folds within LoFM and UpMM. The UpMM succession exposed in the Kesselbach gorge just at the German/Austrian border NE of Bregenz contains clastic dykes, cutting through heavily bioturbated shallow marine Molasse sandstones (Scholz & Frieling, 2006).
At the northern slope of Mt. Grünten near Sonthofen above the village of Kranzegg and below Kammerkehr-Alpe, an at least 60 m thick sequence of the LoMM is exposed in a large sandstone quarry (Grüntensteinbruch, fig. 1 / 1, northing: 52.71050, easting: 35.98500). The succession consists mainly of sandstones, belonging to the about 60 m thick Middle Oligocene „Bausteinschichten“, which is the youngest member of the Lower Marine Molasse (LoMM, Schwerd, 1978). The beds dip with 17 to 20° towards ESE and are part of the southernmost syncline of the Subalpine Molasse (Murnau syncline, Schwerd et al., 1996).
Simplified geological map of the investigated area in southwestern Bavaria, Quaternary deposits are ignored. Exact locations of quarries and natural outcrops are described in the text: 1. Grüntensteinbruch (large sandstone quarry, LoMM) at the northern slope of Mt Grünten, 2. Zaumberg (old sandstone quarry, LoFM) at the blind road south of Zaumberg, 3. Niedersonthofen (old sandstone quarry, LoFM) near the road from Niedersonthofen to Seifen,4. Hartenthal (old sand pit, UpFM) southeast of Hartenthal near Baisweil, 5. Burgleiten (old sandstone quarry, UpMM) westernmost foothills of Mt. Auerberg near Stötten,6. Kesselbach (natural sandstone rock wall, UpFM) at Kesselbach gorge in the Mt. Pfänder area
Since Gümbel (1861: 165), this sandstone quarry is looked as the type section of the „Bausteinschichten“, which have been comprehensively described by Schwerd (1978: 9, fig. 2). At the extremely steep slope down-hill of the quarry an at least some hundreds of metres thick sequence of underlying, grey silty marls with intercalated sandstone layers is exposed called „Tonmergelschichten“ (LoMM). This Lower Oligocene sequence is covered with grey, middle- to coarse-grained massive sandstones, the „lower Bausteinschichten“, overlain in turn by an about 5 m thick pelitic succession containing several thin sandstone beds called „middle Bausteinschichten“ (Schwerd 1978: 9). This pelitic sequence is overlain by grey, glauconitic, middle- to coarse-grained, thinnly to massive bedded sandstones called „upper Bausteinschichten“ (Schwerd, 1978: 9, fig. 3), towards the top grading into fine to medium-grained carbonaceous conglomerates (see Kronmüller, 1987):
Lithology and facies of the pelitic „Tonmergelschichten“ and the „middle Bausteinschichten“ are very similar, representing silty shelf sediments. Both pelitic sequences are overlain by sandstone-dominated successions („lower“ and „upper Bausteinschichten“), that have a very similar lithology and facies as well. Their diversity of different bedding types and other sedimentary structures indicate a shallow marine environment, affected by many high energetic storm events. This facies repetition is interpreted by Reineck & Schwerd (1985: 51 ff.)as a repeated progradation of coastal sands on silty shelf sediments towards the N. According to Zweigel et al. (1998) this may be caused by a temporary reduction of sedimentary input leading to a prevailing of the subsidence rather than the result of sealevel changes. For details concerning lithology, sedimentary structures, fossil content, facies and sedimentary environment of this shallow marine sequence see Schwerd (1978: 11), Schwerd et al. (1983: 90), Reineck & Schwerd (1985: 52) and Scholz (1995: 151 f.).
Marl dominated middle Bausteinschichten and sandstone dominated Upper Bausteinschichten (LoMM), exposed in the Grünten quarry near Kranzegg (
At the interface between the pelitic „middle“ and the sand-dominated „upper Baustein-schichten“ erosive channels occur locally filled with fine-grained sand- and siltstones. At the basis of these more than 1 m deep channels flute casts are developed (Schwerd, 1978: 9).These channels are overlain by a 3 to 4 m thick intercalation of fine-grained sandstones and silty marls. At the interface between the pelites below and the overlying sandstone layers large load casts occur with marly flame structures (Roberts, 1989: 48) intruding the sandstones. Towards the hanging wall the penetrative mingling of marls and sandstones is increasingly intimate, grading into sphaerical bulbs, bulges and pillows with diameters of 0.1 bis zu 0.4 m (Schwerd, 1978: 9, fig. 2). In the upper part of this zone no primary bedding is preserved and replaced by a secondary ball-and-pillow structure. Within the several metres thick strata between undisturbed marls below („middle Bausteinschichten“) and undisturbed sandstones above („upper Bausteinschichten“) the preference for ball-and-pillow formation obviously increases. Similar structures are very common and known to occur in many Paleozoic, Mesozoic and Cenozoic clastic successions (Richter, 1971). For more details see Scholz & Frieling (2006: 349 ff. ).
The strata with ball-and-pillow structures are clearly synsedimentarily generated phenomena, that can be traced across the whole quarry over a distance of more than 500 m, although they are not developed everywhere in the quarry in the same quality and thickness and even missing in places. Nowhere else in the entire sequence similar structures occur, not even at the lithologically very similar transition zone between the „Tonmergelschichten“ below and the „lower Bausteinschichten“ above.
Detail from the base of the about 2 m thick deposits of the upper Bausteinschichten converted into ball-and-pillow structures
The region north of Immenstadt belongs to the Subalpine Molasse. This area is dominated by an inclined interbedding of thick fluvial sandstone and marls, belonging to the Lower Freshwater Molasse (LoFM, Upper Oligocene to lowermost Miocene). Conglomeratic layers are very rare, thin and rather fine-grained. North of Immenstadt below Zaumberg, east of a hairpin bend of the old (now blind) road to Immenstadt, an only 6 to 8 m long old quarry is situated at the slope above the road (fig. 1/ 2, northing: 52.72380, easting: 35.89970, Scholz & Frieling, 2006: 357 f.). The fine- to middle-grained fluvial sandstones exposed here belong to the „Steigbachschichten“ (uppermost Oligocene, Schwerd et al., 1983). They show a distinct horizontal stratification with layers a few to about 20 cm thick. These sediments belong to the northern limb of the Salmas Syncline (Jerz, 1974). Primary horizontally lying beds dip with about 21° towards SE. Some of the beds are cross bedded, indicating a sand transport towards different directions.
At two sites some layers are deformed to anticlines, a smaller one in the NE and a bigger one in the SW (fig. 3a). The bending of the layers is very distinct in the lower part of the outcrop, fading towards above. Since the layers are completely undisturbed in the upper part of the outcrop and no joints are referrable to the folding, only a synsedimentary and not a tectonic origin of the folds seem probable. They should have formed within the soft, not yet lithified sediment. For more details see Scholz & Frieling (2006: 357 f.).
Near the road from Niedersonthofen to the hamlet of Seifen in the Iller valley, a small, old, hidden and strongly vegetated sandstone quarry is situated immediately at the eastern road side (fig. 1/ 3, northing: 52.76725, easting: 35.93480, Scholz & Frieling, 2006: 359 f.). According to Jerz (1974) the sandstones belong to the LoFM („Weißachschichten“, lower part of Upper Oligocene). They are part of the northern limb of the Salmas Syncline and dip 19° towards SSE (Jerz, 1974). The succession exposed here consists of sandstones partly showing planar stratification, single layers are up to 20 cm thick. Some beds are cross-stratified indicating a sedimentary transport towards varying directions. At some sites, the sandstones are made of small coss-stratified lenses indicating current ripples. At the lower part of the quarry wall a 10 to 20 cm thick marl intercalation is exposed. At the contact between the marls below and the sandstones above load casts and weakly developed ball-and-pillow structures occur (Scholz & Frieling, 2006: 357 f.).
Part of the Steigbachschichten (LoFM, Upper Oligocene) exposed at the quarry wall at Zaumberg (
Especially within an about 2 m thick bundle of layers the primary ripple-stratified sandstones are intensely deformed into 3 large and rather regular asymmetrical anticlines with amplitudes of more than 50 cm (fig. 3b). The axes of these folds strike more or less E-W. The amplitudes of the folds fade within short distance and seem to grade into undeformed, primary planar stratified sandstones. However, 4 to 5 m further to the N, the same strata show another pronounced but weaker bending of the layers. For more details see Scholz & Frieling (2006: 359 f.). At the hanging wall the intensely deformed strata are overlayn by stratified sandstones without any deformational structures. Thus, a synsedimentary and not a tectonic origin of the folds is proved. As no joints are referrable to the folds, they should have formed within not yet lithified and still soft sediments.
Intensively folded, originally ripple-stratified sands of the upper Freshwater Molasse with a very similar shape and dimension have been found within a small and old sand pit SE of Hartenthal between Baisweil and Bad Wörishofen (Unterllgäu, fig. 1 / 4, northing: 53.16732, easting: 43.92520, see Havlik & Scholz, 2009).
Detail of the Weißachschichten (LoFM, Upper Oligocene) exposed at a quarry wall near Niedersonthofen. The ripple stratified sandstone (
The more than 1055 m high Mt. Auerberg, situated about 10 km ESE of Marktoberdorf is built up mostly by the Upper Marine Molasse (UpMM, Lower Miocene) dominated by coarse-grained conglomerates with sandstone intercalations. About 1 km SW of Stötten at the westernmost foothills of Mt. Auerberg at Burgleiten, coarse- grained pebbly sandstones are exposed within an old quarry close to the road junction, where the B 16 meets the old street from Stötten (fig. 1/ 5 northing: 52.89180, easting: 44.01030, Scholz & Frieling, 2006: 362 f.). According to Kuhnert & Rohr (1975) and Neubert (1999) the succession of the UpMM seems to be several hundred metres thick here, belonging to the northern limb of the Hauchenberg-Peißenberg syncline, which is the northernmost syncline of the Folded Molasse.
Sketch of the old quarry wall at Burgleiten near Stötten (
Detail from 4 a, showing the synsedimentary fold F2 (framed in fig. 4 a) that has generated due to sudden dewatering
Lining more or less a nearly vertical normal fault with a fault throw of at least 1 m, the NNW-SSE orientated quarry wall at Burgleiten is up to 5 m high and about 25 m long. Most of the stratified pebbly sandstones and poorly sorted conglomerates dip with 30 to 40°, at the eastern end even with 60° towards SE. The marine environment of the deposits is proven by a high content of glauconite and the occasional occurrence of marine fossils (mostly fragments of shells belonging to oisters and Pectinaceans). Additionally, coal fragments, skelletons of Bryozoans, shark teeth and carbonate pebbles with drill holes of mussles can be found. The sequence exposed here represents shallow marine near-shore sediments.
The stratification of the coarse grained deposits in the Burgleiten outcrop is indistinct to a certain degree. At some places a planar stratification or cross-bedding of the conglomerates is visible due to intercalated sandstone layers. The strata seem to be slightly bent in places, even distinctly deformed at the central part of the quarry wall. Apart from flexure-like bending of sandstone layers, two asymmetrical folds occur in the lower part of the wall with amplitudes of 50 to 100 cm (fig. 4). The axis of one of the folds with a northwestern vergency strikes 48° (fig. 4b), the axis of the other one with a northeastern vergency strikes about 120°. The overlying strata show no signs of any folding, dipping here constantly with 38° towards SE. Therefore, a tectonic generation of these folds is unlikely the deformation has been rather synsedimentary and formed within not yet lithified and still soft sediments. For more details see Scholz & Frieling (2006: 362 f.).
The Pfänder ridge situated east of Bodensee (Lake Constance) is part of the foreland dip panel, which defines the southern margin of the autochthonous Molasse. The Upper Marine Molasse (UpMM, Lower Miocene) in the Pfänder area (1064 m) is built up mostly by fine-grained glauconitic sandstones with intercalations of thick conglomerates and silty marls. They represent the shallow marine environment of a large delta, prograding from the Alps into the southern rim of the Molasse basin towards the N (Kuhlemann & Kempf, 2002, Berger et al., 2005, Frieling et al., 2009). The up to 400 m thick marine succession is completely exposed within the gorges of Wirtatobel and Kesselbach in the eastern Pfänder area, the strata dipping with about 18° towards NW. Both sections start in the youngest part of the Lower Freshwater Molasse and end in the lowermost part of the Upper Freshwater Molasse (Vollmayr & Ziegler, 1976, Kanzock, 1995, Frieling et al., 2009).
According to Hermann & Schwerd (1983) the lower quarter of the UpMM in the Kesselbach section belongs to the so called Luzern beds. They consist of a succession of platy, fine-grained sandstones showing low angle crossbedding, overlain by an intercalation of conglomerates and sandstones, reflecting a shallow marine environment with repeatedly changing energetic conditions. This part of the section is exposed on both sides of the gorge at more than 30 m high rock walls (fig. 1 / 6, northing: 52.66490, easting: 56.64720, Scholz & Frieling, 2006: 367). The lower part of the western vertical rock wall consists of grey, bedded, fine- to medium-grained, glauconitic sandstones, containing fragments of coal, mussle shells and barnacles. Some beds show a horizontal lamination or cross-bedding, are more or less bioturbated and contain long mostly vertical burrows. Due to bioturbation the primary bedding of an about 2 m thick part of the strata is obliterated or even completely destroyed.
Moreover, these strongly bioturbated sandstones are discordantly cut by two subvertical sandstone dykes, about 2 m long and 10 to 30 cm thick, rooting in a subconcordant sandstone layer with a comparable thickness (fig. 5). About in the middle between the two subvertical sandstone dykes, a third sandstone dyke forks off downwards cutting through well bedded sandstones below. This sandstone dyke roots within a second subconcordant sandstone bed exposed just at the very base of the rock wall. Here at some sites an undistinct layering can be seen, which is deformed where the dyke forks off. The subconcordant higher sandstone level and the discordant sandstone dykes are structure-less and are neither bedded nore bioturbated. The dykes are not lined by joints or faults. It seems to be a system of one source bed below, connected with a sill by a rather short dyke. The sill feeds two subvertical dykes, which thin out towards above.
The contacts between the host rock and the dykes are clear and can be traced mostly as distinct lines. The content of glauconite grains is high in the hosting sandstones and in the dykes and sills. The grain size of the sills and dykes is distinctly coarser than bioturbated host rocks. At sites where the dykes cut perpendicular through the bedded sandstones, the texture of well bedded parts of the host rock is disturbed close to the contacts. Here the lamination is dislocated along densely spaced joints or dismembered into angular or lenticular fragments. For more details see Scholz & Frieling (2006: 367 f.).
Sketch of the lowermost part of the rock wall at Kesselbach gorge (
Photo showing a detail of one of the clastic dykes (area left of the centre of
Jointing and fragmentation seem not to be of tectonic origin. Obviously, the sandy filling of the dykes was liquefied, deriving from the lower part of the strata and intruding towards above. When the sandstone dykes formed their sandy material must have been soft and not yet lithified. Thus, only their synsedimentary origin is imaginable. Discussion on their formation see below (4.3).
The Richelsdorf Mountains in Hesse (Central Germany) represent a block-like uplift of Permian strata within the Triassic Buntsandstein of the Hesse depression. It forms the westernmost part of a NW-SE trending horst structure, which includes the Thuringian Forest further to the E (fig 6a). The Richelsdorf uplift is limited to the SW by a large fault zone (Southwestern Boundary Fault), to the NE by the Sontra Graben (Sontra fault zone). Numerous faults furthermore dissect the Richelsdorf Mountain into a mosaic of individual tectonic blocks (fig 6b).
The Rotliegend was deposited above a Variscan basement with metasedimentary Paleozoic strata (greywackes, phyllites). The probably more than thousand metres thick volcanite-free Rotliegend succession consists of conglomerates and sandstones, where sandstones dominate the lower part, but conglomerates the upper part (Motzka-Nöring, 1987). Most of the succession is known exclusively from the former borehole Nentershausen 1862 (Beyrich & Moesta, 1876). Surface outcrops represent the uppermost 250 m, which consist of alluvial red beds made of an interbedding of conglomerates and sandstones together with some mudstone horizons (Motzka-Nöring et al., 1987, Aehnelt & Katzung, 2007). They are classified in age as Saxonian I (Aehnelt & Katzung, 2007). Saxonian II comprises conglomerates and pebbly sandstones, which exhibit secondary bleaching in transition to the Zechstein. Locally in the W, N and NE two different facies follow: (1) the aeolian Cornberg Sandstone s. str. and (2) a fluvial transitional facies (Oppermann, 1971, Munk et al., 1993, Gast, 1994, Aehnelt & Katzung, 2007).
a) Simplified geological map of Central Germany with the location of the Permian uplift of the Richelsdorf Mountains (RM) within Mesozoic strata of the Hesse Depression. Rectangle marks detail of
In Permian times the Rotliegend deposits filled a small but deep depression within the Saar-Werra Basin, which was surrounded by NW-SE and SW-NE trending uplifts of the Variscan basement in the N, W and SW. From there material has been removed mainly as debris flows and mud flows deposited on alluvial fans and in braided river systems on an alluvial plain. Sands blown out from the alluvial plain built up the dunes of the Cornberg Sandstone s. str. at the western to northern rim of the depression and the bordering flanks of the uplifts.
Sandstone dykes occur in the uppermost conglomeratic members of the Richelsdorf Rotliegend (Saxonian II) exposed in a road cut approx. 2 km south of Nentershausen (northing: 35.65780, easting: 56.51745; fig. 6b). The outcrop exhibits an interbedding of pebbly coarse sandstones and sandy conglomerates with internal even horizontal and cross stratification (fig 7a). Average pebble sizes are between 5 and 20 mm. The succession has been interpreted as deposition of braided river systems on an alluvial plain (Aehnelt & Katzung, 2007).
The clastic dykes are developed as straight-walled, narrow dykes, which cut perpendicular to the stratification of the host rock (fig. 7b, c). They are up to 170 cm in length and appear as filling of thin, partly wedge-shaped fissures. In parts, vertical joints follow the course of the dykes (fig. 7c). The basal part of the dykes is indistinctly defined; it derives from diffuse roots in a sand-rich bed. In parts, disturbance of primary bedding is apparent. The dykes pass through pebbly sandstone beds and terminate upwards more or less in the same stratigraphic horizon. The top is not well defined and ends indistinctly in another sand-rich bed, which is overlain by a conglomerate horizon. The filling material consists of reddish, matrix-rich sandstone with distinct, clear contact to the host rock at the dyke wall. The host rock near the dykes is greyish due to secondary bleaching, and may be enriched in gravels and imporished in sandy matrix. Especially in coarser, gravel-rich host beds the outlines of the dykes are often accompanied by streaks of granules to small pebbles or by lateral gravel lags with clast sizes of up to 30 mm (fig 7 b, c).
Beside dykes deformation structures are observed also in the host rock next to the dykes (fig. 7d). These are ball-and-pillow-like structures in the pebbly sandstone beds, which are apparent by grain size separations in (1) areas enriched in reddish, matrix-rich sandstone, (2) greyish gravel lenses and (3) areas with transitional grain sizes. The base of the upper sand-rich horizon, in which the dykes seem to terminate, shows undulation and bulbous outlines owing to deformation and smallscale diapiric intrusion of the underlying gravelly sandstone and gravel lenses respectivelly. In return, small sand dykes of a few centimeters in length finger from the sandstone horizon into the underlying bed. A similar situation is observed at the top of this sand-rich bed: bulbous outlines due to a pillow-like downsinking of gravel lenses into the sandstone bed. At some places gravelly intrusions from below and gravel bulbs from above seem to be connected forming subvertical streaks that cut dyke-like through the sandstone bed and terminate in the overlying, gravel-rich horizon.
The whole deformed complex spans the lateral extent of this road cut of about 20 m, and seems to have a thickness of nearly 2 m (fig 7a). The intensity of deformation seems to increase from the bottom to the top or the upper sand-rich bed respectively. Beds above and below the complex appear undisturbed, at least the latter ones exhibit well defined, undeformed cross beddings. Above the deformed complex massive pebbly sandstones are exposed, which overlay a conglomerate horizon with minor deformation. Sand dykes end in the sand-rich bed below.
Since the sandstone dykes start and end more or less all at the same stratigraphic levels, and can not be traced further upward, their formation must have happened in situ restricted to certain beds in times when the material was still soft. The ball-and-pillow structures as well as bulbous outlines of sand-rich horizons evidence that the host beds were also partly fluidized. Their remobilization caused the destruction of the primary bedding. Thus these features are typical for soft-sediment deformation and prove a formation while sediment was not yet lithified.
a) Photograph of Rotliegend conglomerates and sandstones with synsedimentary deformation features, exposed in a road cut near Nentershausen. Rectangle marks location of detail photos 7b-d; b) Detail from 7a showing clastic dykes with diffuse roots in a sandstone bed and lateral pebble lags in a conglomeratic horizon; c) Detail from 7a showing clastic dykes with lateral pebble lags when passing through gravelly horizons. A vertical joint follows the course of the dyke; d) Synsedimentary deformation structures in the host rock next to the dykes generated by dewatering (d1 foto, d2 sketch)
Originally, marine Paleozoic sediments have been widely spread in southern Scandinavia, primarily forming a more or less continuous blanket on top of the Precambrian crystalline rocks of the Fennoscandian Shield. In post-Silurian times this CambroSilurian cover has been completely removed by fluvial, coastal and glacier erosion in most places (Scholz & Obst, 2004). The Lower Paleozoic sediments have been partly covered with thick Mesozoic sediments and down-faulted by Permosilesian to Paleogene tectonic movements within the Fennoscandian Border Zone (Lindström & Dworatzek, 1979): Remnants of these epicontinental sediments are preserved today e.g. in Scania (Skåne, southernmost Sweden). The coast of the Baltic Sea north of Simrishamn situated in eastern Scania, is made up of Lower Cambrian sediments dominated by shallow marine sandstones, resting unconformably upon Proterozoic plutonic and high-grade metamorphic rocks of the Fennoscandian Shield. The lower part of this transgressive sandstone sequence belongs to the about 110 m thick sandstone-dominated Hardeberga formation, which is rather widespread in Scania. It can be lithostratigraphically subdivided into several members (Nielsen & Schovsbo, 2006). One of these members is the light-grey, hard Vik Sandstone (Vik member) representing an about 25 m thick part in the middle of the formation (Lindström, 1972, Hamberg, 1994). The Vik sandstone is exposed e.g. near Vik north of Simrishamn (Hamberg, 1994: 38; fig. 8). The intensively bioturbated shallow marine sandstones generated near the tide-influenced Lower Cambrian coast, situated not far from the northern rim of the lower Paleozoic Tornquist Ocean.
Simplified geological map of Scania and Bornholm. Thick lines indicate major faults. The position of the investigated area at Vik in eastern Scania is marked with an arrow. Two additional arrows point to the positions of Vang and Listed on Bornholm, locations with sugtrusive sandstone dykes mentioned in the text
The mostly quartzitic, fine to medium grained and mature, cross bedded sandstones are nearly flat lying or gently dipping. However, they contain a couple of horizons where the lamination is completely destroyed by bioturbation. Some of them form very even bedding planes with rough and podgy surfaces, hiatus planes penetrated by densely spaced fossil burrows, mostly to
Irregular distributed narrow ridges rise above these podgy hiatus surfaces, forming branching bulges of several metres in length (fig. 10). Moreover these bedding planes are deformed at several sites and seem to outline conspicuous minor and large circular tub and funnel shaped structures (fig. 11).
Detailed geological map of the investigated area at the coast south of Vik in Scania. The location of extrusive clastic dykes can be seen, as well as the funnel structures FS I-III, forming a more or less straight chain. FS II is identical with „Prästens Badkar“ mentioned in the text
Several slightly curved bulges of light greyish medium grained sandstone occur on top of several hiatus surfaces south of Vik (Scholz et al. 2009: 357, 55° 36’ 46.35’’ N, 14° 17’ 50.71’’ E). Locally they rise 10 to 15 cm above the bedding planes of the Vik sandstone. A few are less than 1 m, others more than 14 m long. Some of these sandstone bulges are only some centimetres, others up to 25 cm thick. Allthough cross-cuts through these bulges are rare. It could be observed that all these bulges continue downwards, where they form dyke-like discordant bodies, which are steeply or even vertically oriented. One of these sandstone dykes is more than 15 cm wide and tracable downwards for at least 70 cm, others cut through the sandstone layers in the hanging wall strata. Some of these sandstone dykes have distinct contacts and differ clearly in colour and / or grain size from the wall rocks. Thin sections of a dyke sample show strong similarities to the wall rocks in maturity and sorting, but they have the comparably least share of matrix (Scholz et al., 2009: 365 f.).
Several strike readings suggest that there is a different favoured orientation of the bulges in different parts of the investigated area. While most of the sandstone dykes in the SE otthe area strike 120-150° and 50-60°, the dykes in the NW strike preferred 70-90°. There is no parallelity between the prevailing majority of the dykes and the normal faults affecting the sandstones. Many sandstone dykes bifurcate, some of them repeatedly at acute angles (fig. 10). Most of them branch only into one specific direction. The dykes in the SE of the mapped area branch off only to the W, NW and NE, dependant on their basic orientation. The dykes in the NW branch off into western or eastern directions.
a,b. Photographs of branching bulges on top of a heavily bioturbated hiatus plane within the lower Cambrian Vik Sandstone at the coast near Vik. These bulges continue downwards and are clastic dykes cutting through the sandstone layers below. These dykes have generated due to the liquification of an unstable sandy layer below the visible surface triggered by seismic shock waves
At some sites the sandy matter of dykes is weakly bioturbated differing in colour and grain size from the wall rock. All these observations point to a synsedimentary origin of the dykes. They formed presumably before the deposits had been lithified and are therefore clastic dykes. Their age relations with the funnel structures and their possible origin are discussed below. For more details see Scholz et al. (2009: 365 f.).
Apart from these sandstone dykes and tectonic faults the nearly flat lying hiatus planes within the Cambrian Vik sandstone are intensively bent and contorted in places. There are several areas with diameters of one up to a couple of metres, where the sandstone layers are centroclinally deformed. The bedding planes within these relatively small structures are nearly horizontal at the rims, dipping with increasing angles approaching the centres and decreasing again in the very middle, forming tub or bowl like structures (Hamberg, 1994, Obst, 2004; fig. 11).
Especially at three different sites close to the water line of the Baltic Sea, three centroclinal structures are exposed with diameters up to several tens of metres (Scholz et al. 2009: 357, 55° 36’ 46.35’’ N, 14° 17’ 50.71’’ E; fig. 9). The hiatus planes are nearly horizontal in the periphery of these three large structures. Within the innermost parts the bedding planes show abnormal steep inclinations, showing a centroclinal strike and attaininging values of 50° to 70° in places (Scholz et al., 2009: 366 f.). Within the very center of these structures the layers flatten in a short distance until they dip steeply into the opposite direction again. Thus, the primarily horizontal bedding planes are deformed to show sterically bent funnel-like surfaces. The bedding planes within one of these three centroclinal structures are fully preserved even within the innermost core. This partly water-filled structure is well known, called „Rosenstenen“ („stone rose“) by the local people, „Prästens Badkar“ („priest’s bath-tub“) on topographic and touristic maps or „Parson’s Bathtub“ by Lindh & Bergman (1995: 220) (fig. 11).
At the outer borders of the three large centroclinal structures (funnel structures) there are many sub-concentrically oriented, minor normal faults, displacing the bedding planes some centimetres or decimetres. The slightly bent fault planes dip steeply towards or away from the centres of the funnel structures. They are best visible within the western and southern periphery of „Prästens Badkar“ (FS II) on top of the hiatus planes. The up and down of these marker horizons suggests horst- and graben-structures. Approaching the core of the structures the vertical separations along the concentrically arranged faults seem to increase, exceeding at least 1 m for each downfaulted block closer to the centre.
Due to the funnel-shaped deformation and the down-faulting within the central parts of the funnel structures, the overlying successions have sunken down and thus partly escaped erosion. The amount of down sinking can be estimated using one of the hiatus planes as a reference level. So a down-sinking of the core of this structure of at least 6 to 7 m can be estimated. For more details concerning the funnel structures of Vik see Scholz et al. (2009: 366 f.).
Because of the funnel-shaped deformation and the down-faulting of the layers within these structures, they have been named „funnel-grabens“ by Lindström (1967). However, the name „graben“ suggests a tectonic origin and implies the formation of a linear rather than a curved and centroclinal structure. Therefore the name „funnel structure“ has been introduced by Scholz et al. (2009: 368). Their age relations compared with the clastic dykes and their possible origin are discussed below.
Photograph of the very centre of the funnel structure FS II „Prästens Badkar“ with funnel-like inclined primary bedding planes. This synsedimentary collapse structure has been synsedimentarily generated most likely above a opening fissure in the crystalline basement below
Photograph of sub-concentrically arranged faults, visible on top of a more or less flat lying hiatus plane just S of „Prästens Badkar”
In most cases the exact age of the clastic dykes in Vik remains unclear. One dyke south of funnel structure II tracable over a distance of more than 14 m on the surface of a large hiatus plane definitely does not to continue into higher stratigraphic levels. However, some dykes forming mushroom-like bulges above the hiatus planes clearly do so. They have generated after the bioturbated bedding plane has been already covered with an at least thin layer of silty sediments. On the contrary, some of the branching dykes may have more or less the same age as the hiatus planes affected. These dykes seem to have cut the former sea floor, were eroded, egalized and bioturbated subsequently in their uppermost parts. The animals causing
Thus, contrary to the opinion of Hamberg (1994: 40), not all clastic dykes have the same age and their formation covers a certain time span. They may be related to several seismic events during the lower Cambrian. Moreover, they seem to rise from different source beds belonging to different stratigraphic levels and are not rooted within the same horizon (Scholz et al., 2009: 368 f., fig. 9).
The tension, deformation and downsinking of the soft sediments have been caused by a loss of volume in the underground below the Vik member. It is possible to estimate the volume of the down-sunk sand that would contain at least 1000 m³. Considering the two additional funnel structures in the vicinity which ar even larger a total material loss of more than 3200 m³ below all three funnel structures must be assumed. For details of the calculation see Scholz et al. (2009: 371 f.)
Most authors agree, that the majority of the structures presented here like load casts, synsedimentarily formed folds, sandstone dykes or funnel structures, seem to generate due to the liquefaction of water-saturated sands (e.g. Richter, 1971, Reineck, 1984, Ricchi-Lucchi, 1995, Jolly & Lonergan, 2002). For a short time span certain beds within water-saturated sediments are converted into a very mobile suspension consisting of water and sand grains, ready to move quickly laterally or even upwards and downwards. Precondition for the liquefaction of sediments is a sudden breakdown of their unstable grain fabric (see Blanc, 1998: fig. 5). There are certain beds which seem to have a principal disposition to liquefy, mostly water-saturated well sorted sands with well rounded grains of high sphericity. Moreover, most of the coarse-grained sand layers within a clastic sedimentary succession seem to have a special predestination to fluidize (Jolly & Lonergan, 2002: 607, Ross & White, 2005). A break-down of their grain fabric causes a sudden overpressure of the pore fluid. The degree of overpressure is dependant on the position within an actively forming sedimentary succession and will increase with the thickness and consequently the lithostatic pressure of the overlying strata. According to Jolly & Lonergan, 2002: 607) this pressure can be much higher than the pore pressure within the deposits above. The fluidization of sediments situated directly at the sedimentary surface will lead to a deformation of the layers, an abrupt dewatering and a quick escape of the water at the surface. The fluidization of deposits deeper below the sedimentary surface will lead to deformations like load casts, ball-and-pillow structures or even clastic dykes, if the pore fluid overpressure is extremely high.
All these processes leading to a deformation of the sediments may happen during or soon after deposition. The principal disposition for a liquefaction of certain beds within the deposits continues to exist, until the layers loose their softness and mobility due to compaction, dewatering and cementation. This disposition should decrease with an increase of age and subsidence.
What caused the liquefaction of especially sensitive layers within the sediments leading to the generation of a variety of deformational structures? It can be principially triggered by different conditions and events. According to Richter (1971) or Gamberi (2010) some of the structures mentioned above can simply be created by rapid sedimentation, unevenly distributed load or density inversions. Osborne & Swarbrick (1997) think, that an overpressure of the porewater can also generate from disequilibrium compaction. However, high-energetic events such as heavy storm waves, tsunamis (Reineck, 1984: 15, Reineck & Singh, 1986: 59, Roberts, 1991: 54) seem to play an important role in most cases, especially seismic shock waves. However, Ricchi Lucchi (1995: 159) hesitates to interprete all these structures automatically as seismites, especially clastic dykes. He advises that every single case should be examined very carefully. As triggers for a liquefaction of sensitive layers also a sudden increase of the sedimentary load (result of mass movements or rapid input of unusual large quantities of clastic material), the migration of hydrocarbons from below (Jolly and Lonergan, 2002, Gamberi, 2010), ice tectonics or synsedimentary extensional tectonics (Demoulin, 2003) can be discussed. Additionally, dykes may also generate from the filling of pre-existing ground cracks and fissures from below, created e.g. by deccication, tectonism or slope instability, with larger fissures being more prevalent in arid climates (Holzer & Clark, 1999: 876).
Load casts as well as ball-and-pillow structures occur e.g. within the Lower Marine Molasse (LoMM) exposed in a large sandstone quarry N of Mt. Grünten near Sonthofen (Grüntensteinbruch, fig. 1/ 1) und within the Lower Freshwater Molasse (LoFM) exposed in small abandoned sandstone quarries near Niedersonthofen (Scholz & Frieling, 2006: 349).
According to Reineck (1984: 15) or Ricchi-Lucchi (1995: 159) load casts are sedimentary structures occurring at the base of sandstone layers which have formed due to the down-sinking of water saturated sand into a soft pelitic substrate consisting of clay and silt. An essential condition for their genesis is an unevenly distributed load, which could be caused by a pinch and swell, ripples at the top or scour structures at the base of the sandy layers (Dzulinski & Walton, 1965, cit. in Reineck, 1984: 15). Density inversion and a thixotrope behavior of the underlying pelitic sediments may promote their formation, and are likewise precondition for the genesis of small flame structures, diapires and ball-and-pillow structures.
According to Ricci Lucchi (1995: 163) very similar structures can be generated most easily in experiments, if sediments are strongly shaked. Therefore, these structures seem to form due to high-energetic events, like heavy storm waves, Tsunamis or seismic shock waves (Richter, 1971: 19, Reineck, 1984: 15). Also in case of the Molasse successions such high-energetic events are most probably the cause for the deformational structures described above. The increasing degree of mingling of sandy and silty sediments at the base of the „Obere Bausteinschichten“ could have been caused by the originally decreasing water content towards the top of this sequence. It could also be interpreted as an indication of a synchronous dewatering of the whole strata causing an increase of the pore water pressure towards the hanging wall. Alltogether this is an indication for the generation of all these structures by a unique trigger event.
The lithology of the LoMM sequences is both, nearly identical and genetically related, as well at the base of the sandy „Untere Bausteinschichten“ as at the base of the sandstone-dominated „Obere Bausteinschichten“. According to Reineck & Schwerd (1985: 51) the two sequences reflect a transition from silt dominated shelf sediments into sand dominated shore face deposits, the progradation of psammitic coastal sands on pelitic shelf sediments. In spite of that, ball-and-pillow structures have generated only at the base of the younger „Obere Bausteinschichten“. Below the older „Untere Bausteinschichten“ only some weakly developed load casts are present (see Schwerd, 1978: fig. 3). Shocks caused by strong storms are frequently ocurring events, which should have generated identical structures at the base of the „Untere Bausteinschichten“ as well. Their singular occurrence within the whole sequence supports the idea that they could have generated only by strong seismic shock waves generated by an extremely heavy earthquake. Similar structures are interpreted in the same way also by Obermeier (1996, fig. 35).
Synsedimentary folds are normally considered to be slump folds. However, it is nearly impossible to interprete the folds within Molasse successions described above as synsedimentary slump folds (LoFM in Zaumberg and near Niedersonthofen, figs 1 / 2-3, figs. 3a, b, UpMM at Burgleiten, fig. 1/ 5, fig. 4 and UpFM at Hartenthal, fig. 1 / 4). All slump folds spontaneously forming under the influence of gravity need a clearly inclined sediment surface. The inclined rims of lakes or marine basins and inclined delta fronts are environments where slump folds could develope. In three of the cases described above these synsedimentary folds generated within fluviatile sequences of the LoFM and the UpFM, within sandy, crossbedded deposits of braided rivers. Apart from a few thin intercalations of fine to medium grained conglomerates coarse-grained sediments are missing. Therefore the sedimentary environment of these Oligocene to Miocene mostly sand transporting Molasse rivers should have been mostly even flood planes with very low gradients far below 1‰. This cannot be seen as a good precondition for slumping (Scholz & Frieling, 2006: 371 f.).
Despite of some deposits of oxbow lakes, sediments of large lakes are very rare and even absent at the central part and near the southern rim of the Molasse basin. So the assumption of lacustrine deltas with steeply inclined delta fronts can be excluded. Also marginal marine deltas can not have existed close to Immenstadt in the Upper Oligocene, as this region was situated far inland in this time. The surface of the deltaic UpMM sediments, too, could not have been originally perceptible inclined. The tectonically caused dip of the bedding within the old quarry of Burgleiten is more or less parallel to the inclination of exposed sandy bedding planes in the vicinity, that are widely covered with current and interference ripples, proving their originally more or less horizontal surface. Consequently, one essential prerequisite for a gravity-controlled sliding is missing: a palaeoslope with an inclination of at least some degrees. If the folds described here would be the product of sliding, a basal decollement plane should be visible. However, such a decollement is not visible at the examples given above from the LoFM (1.2) and UpMM (1.3). On the contrary, at Zaumberg and near Niedersonthofen the fold amplitudes seem to increase towards above whereas the fold length remains identical.
Folding of this type is rather typical for the abrupt dewatering of sediments with an unstable grain fabric (Blanc, 1998: fig. 5). The occurrence of these folds near Niedersonthofen together with ball-and-pillow structures is an additional argument for this interpretation. Similar folds are known e.g. from the Proterozoic of India (Bhattacharya & Badyopadhyay, 1998), the Upper Cretaceous of Brazili (Rosetti & Góes, 2000, Rosetti & Santos, 2003) or the Pleistocene of Spain (Gilbert et al., 2005). They too, formed most likely due to heavy seismic shocks (Scholz & Frieling, 2006: 373).
The ocurrence of sandstone dykes within Molasse sequences is referred only from the UpMM of the Pfänder region so long (fig. 1 / 6, fig. 5, Scholz & Frieling, 2006: 365). Similar dykes have been identified by two of the authors within marine Upper Silurian siltstones of southeastern Norway (Oslo region, Steinsfjord) and within siliciclastic marine Cambrian sandstones of southern Sweden (Scania). Shape, material, geometry and contacts to the country rock of all these sandy dykes indicates, that the material has penetrated already pre-existing but still soft sediments. The original bedding of all these sediments has been partly affected by bioturbation prior to the intrusion of the dykes. Different from the intruding mobile quicksands, the sands of the overlying host rocks must have had a rather stiff consistence in this time. The material came obviously from below, using fissures which opened prior or in course of intrusion. None of these dykes has been an open fissure before the intrusion. The filling of the dykes was neither slow nor from above, the penetration occurred very rapidly and from below. This is proved especially at Kesselbach, because of the wedging out of the sandstone dykes towards the hanging wall. Therefore, all these dykes have to be classified as clastic dykes and not as neptunian dykes, open fissures which should have been filled from above slowly and grain by grain (Scholz & Frieling, 2006: 374 f.).
In some cases, the intruding material seems to attain the sedimentary surface. Sandy walls formed by protruding clastic dykes due to strong earthquakes are known to appear on dry tidal flats. Such walls generated by high energetic seismic shocks have been described and investigated in detail near Anchorage in Alaska by Reimnitz and Marshall (1965) and noted by Reineck and Singh (1986: 59). These clastic dykes were not the only result of this earthquake in the early sixties. The tidal flat at Anchorage was uplifted a couple of metres above the water line. So these sandy walls were rather stable and survived for a couple of weeks, as the extruded material rose above a totally dry sedimentary surface.
All bulges visible on the hiatus planes of the Cambrian Vik sandstone in Sweden are obviously clastic dykes, some of them must have cut through the former sedimentary surface as well. Like tooth paste protruding from rather narrow fissures, the material initially may have formed sandy walls as well rising above the sea floor. However, the sands may quickly have flown aside as the sedimentary surface was submerged in this time. Subsequently, the extruded sands were bioturbated by animals. The clastic dykes in the Upper Marine Molasse of the Pfänder area are different, as they did obviously not attain the sedimentary surface. As the dykes wedge out towards above, they seem to have got stuck within the overlying strata.
No indications for mass movements, rapid input of unusually large quantities of clastic material, migration of hydrocarbons from below, ice tectonics or extensional tectonic have been found, which could have caused the synsedimentary clastic dykes neither in the Cambrian shallow marine deposits of Sweden nore in the Miocene shallow marine deltaic sediments of Bavaria. Extreme storm waves as triggers are unlikely at least in the Molasse sediments, as the whole Molasse basin has been a shallow and very narrow sea. Moreover, tsunamis are mostly generated at active and destructive plate boundaries that are missing in both cases (see above). Consequently, the clastic dykes are most likely the result of heavy seismic shock waves. In the case of the Vik Sandstone, this is supported by the fact, that these „extrusive clastic dykes“ (see below) are not straight as the „sugtrusive clastic dykes“ (see below), but rather curved or irregular, probably due to the soft substrate. Determination of the least horizontal stress direction is also difficult. Their favoured strike is 80°. This would imply a N-S oriented extension that is different from the stress regime documented by the clastic dykes in the basement indicating an extension in NE-SW direction (Katzung & Obst, 1997: 168). No data belonging strike and shape of the clastic dykes in cuts parallel to the bedding are available within the Miocene shallow marine deltaic sediments of the Pfänder area.
According Jolly & Lonergan (2002: 614) the formation of clastic dykes can easily be triggered by earthquakes with magnitudes of more than 5 to 6 on the Richter scale. Suggesting that the clastic dykes of Vik are of different ages, the whole succession seems to have been repeatedly affected by heavy earthquakes. As most of the branching dykes bifurcate only into specific directions depending on their orientation (see 3.1), this polarity could perhaps be used to identify the location of the Cambrian epicentres (Scholz et al. 2009: 374).
The deformation structures observed in the Hesse Upper Rotliegend sediments of the Richelsdorf Mountains are restricted to a certain stratigraphic level and evidence the complete in situ disintegration of primary bedding due to sediment remobilization and dyke intrusion.
Since the considered sediments have been deposited in a terrestrial environment under semiarid conditions, trigger events such as tsunamis or heavy storm waves as well as ice tectonics can be excluded. Also, no evidences are found for the assumption of a depositional slope indicating gravity sliding or slumping, or for an extremely rapid sedimentation. Pre-existing cracks created by deccication can be excluded as well when considering the associated deformation structures in the host sediments.
The upward increasing degree of synsedimentary deformation in the host beds (segregation into sand and gravel lenses / ball-and-pillow structures) could indicate increasing pore water pressure towards the top, resulting from a synchronous dewatering of the whole strata. Similar structures have been described by Lützner (1994) from Upper Rotliegend conclomerates of the Eisenach Formation at the eastern margin of the same sedimentary basin (Saar-Werra Basin). They have been interpreted as a result of partially liquefaction of sand-rich conglomerates by seismic waves. This left a lag of pebble and coarse sand, after the sand fraction was segregated and squeezed out together with the pore water (Lützner, 1994: 1312). In the same area gravel-filled dykes have been reported in playa deposits of the Eisenach Formation (Heubeck, 2009). These have been attributed to artesian water initiating subvertical cracks and the intrusion of sand and grit breaking through semi-consolidated mudstones (Heubeck 2009: 53). Thus, the formation of hydraulic fractures could be an important factor in the movement of fluids through and out of low-permeable, semilithified sediments (Cosgrove, 2001).
Likewise these examples, the clastic dykes and deformational structures in the Richelsdorf Rotliegend are considered to be dewatering structures resulting from the generation of overpressure, probably due to a high-energetic event. In course of the break down of an unstable grain structure localized pressure build up within the sediment causing breaching of the overlying, partially sealing lithology. The clastic dykes are most likely expression of pressure-compensating connections between more permeable gravel horizons. After liquification of sediment, a segregation into a sandy and a gravelly fraction happened due to density differences and due to transport by fluid flow affecting the easier remobilizible material in the grain frame work, i.e. finer grain sizes. Uprising sand finally caused deformation by dykes.
The most probable trigger mechanism for these structures is a tectonic-palaeoseismic event caused by tectonic movements.
Several opinions could be estimated in order to explain the formation of the enigmatic funnel structures occurring only within the Cambrian Vik sandstone in Scania (see 3.2). One possibility for their formation is seen in a dewatering process of sediments below the funnel structures (Hamberg, 1994, Lindh & Bergman, 1995, Katzung et al., 1995). If the water is able to separate from the liquefied sand and to escape upwards to reach the sea floor, a volume loss will occur, which could have caused the Vik funnel structures. A similar process is favoured by Hamberg (1994) who interpreted these structures as collapse structures subsequent to sand volcano eruptions, caused by arthesic water. In this case the escaping water should have left traces like vertical pipes, where bedding and other primary structures have been destroyed (Lowe, 1975, Owen, 1987, Obermeier, 1996). However, structures of this type have not been found, and even within the very centres of the funnel-shaped structures the primary sedimentary layering is fully preserved.
The swarm of clastic dykes in the vicinity of two of the funnel structures can also not be the result of the same dewatering process, favoured by Hamberg (1994: fig. 2) and Lindh & Bergman (1995: 221). In fact, most of the clastic dykes are older than the funnel structures and have been generated at different times (Scholz et al., 2009). These centroclinal structures must have sunk down after the deposition of the youngest sandstones exposed here, because they have all been affected and deformed.
Another possibility for the formation of the funnel structures is closely associated to the occurrence of clastic dykes within the crystalline basement below Vik. This has been already proposed and discussed by Katzung & Obst (1997) or Scholz et al. (2009). Sandstone-filled fissures within the crystalline basement are well known from many sites in Bornholm as well as from other regions (Baer et al., 1994). According to Jørgart & Nielsen (1995) or Katzung & Obst (1997) these nearly vertical fissures cut through Mesoproterozoic granites which are part of the Fennoscandian Shield. The basement of southeastern Scania consists of similar rocks and nearly the same age. These sandstone dykes cut down tens of metres below the supposed interface between the crystalline basement and the overlying Cambrian sediments (Katzung & Obst, 1997: 160). Sandstone-filled fissures within different granites are known e.g. at Gulehald near Listed (fig. 12) in the eastern part of Bornholm, or north of Vang at the northwestern coast of this island.
Photograph of a Lower Cambrian sandstone dyke cutting through the crystalline basement (Mesoproterozoic Svaneke granite) at Gulehald near Listed at the northeastern coast of Bornholm. This sugtrusive clastic dyke has formed in the Lower Cambrian due to a tectonically opening fissure below a cover of marine sands at the northern rim of Tornquist ocean
The petrography of the sandstones within the fissures has some similarities with the marine lower Cambrian sandstones, which have originally covered the today exposed crystalline rocks of Bornholm (Katzung & Obst, 1997: 169). The sandstone dykes described are some millimetres up to few decimetres wide. In places, e.g. near Vang, they occur as clusters with a cummulative thickness of nearly 1 m. These dykes are thinning downwards but still of up to 18 cm width, even more than 50 m below the supposed Cambrian / basement interface.
Katzung (1995) proposed that the sandstone dykes of Bornholm are extensional fissures of tectonic origin. They have generated during lower Cambrian times due to the opening of the Tornquist Ocean between Baltica and Peri-Gondwana further to the south. All known sandstone dykes of Bornholm are completely filled-up with sand, even some extremely narrow fissures (only 0,1 mm), not much wider than the diameter of the sand grains filled in (Katzung & Obst, 1997: 165). Moreover, none of these dykes displays any sub-horizontal bedding, indicating normal sedimentation into a preexisting open fissure on the sea floor (Katzung & Obst, 1997: 170). Therefore, a formation as neptunian dykes (see below) in the sense of Jolly & Lonergan (2002) by the infill of sand into open, seawater filled gaps from above can be excluded.
In contrast, a sudden opening of fissures within the crystalline basement on the shelf, below the water level and below loose sediments, would cause strong underpressure within the newly created space, sucking sediments implosively downwards (Katzung & Obst, 1997: 170).The fluidization and the rapid infill of the sands will be mainly caused by a strong pressure difference: extremely low pressure within the opening gap below and a comperatively high pressure of the pore-water within the sand above. An increase of pore water pressure within the fluidized sediments, gravity and the load of the water column could have propulsed the injection. Thus a complete infill with sand grains of even very narrow fissures seems possible (see also Lindström, 1967, 1972 und Katzung & Obst, 1997). Most likely, the opening of the joints within the crystalline basement has caused and was accompanied by a seismic event. However, the seismic shock waves would not have been an inalienable precondition for the liquefaction of the sand.
Many tunneling projects are affected by severe accidents caused by comparable mechanisms. Some tunnels are mined in solid rocks, which are covered with unconsolidated and water saturated deposits, mostly Quaternary sand and gravel (e.g., Mikkola & Viitala, 2000). A small leakage within the roof of the tunnel may cause a sudden break-down of the hanging wall, a tunnel collapse accompanied by an implosion-like invasion of liquidized sediments from above. The failure generates at the tunnel roof, moves quickly upwards into the overlying deposits, finally attaining the earth surface, where a large sink hole subsides (e.g. Kontogianni & Stiros, 2006, Philipp, 1987). These sink holes are circular funnel-shaped structures, graben-like down-faulted along sub-concentrically bent normal faults. The dimension of these sink holes corresponds with the volume of the liquefied sands invading the cavity. The fluidization of the sediments, their violent ingression into the tunnel and the cavein on the earth’s surface are only driven by the pressure difference between the artificial cavity below and the pore water within the water saturated sands above. Moreover, the generation and shape of sink holes (mining damages) above old galleries within active or abandoned mining areas is a very similar process (Scholz et al., 2009: 372).
Is it really imaginable that an opening vertical fissure within the crystalline basement could have generated the funnel-shaped structures in Vik? The island of Bornholm is situated within the Baltic Sea, less than 30 km away from the investigated area. Similar fissures are known to exist as well at different places near the southeastern coast of Scania and could also be present in the underground of Vik. A sudden filling of a fissure with sand from above would cause a loss of volume and lead to a partial collapse of the overlying strata. This is followed by the formation of a sink hole at the sea floor and a funnel structure just below. An argument for a hypothetical linear structure below is the fact, that the three funnel structures at Vik form a more or less straight chain with a strike of 144-150° (fig. 9). According to Katzung & Obst (1997: 165) most of the sandstone dykes near Vang in northwestern Bornholm show a WNW to NW oriented strike (100-145°), and also the dykes at Gulehald near Listed in eastern Bornholm are running roughly parallel to the NW-SE striking bundle of major faults of the Scandinavian Border Zone (Scholz et al., 2009: 372:\n\t\t\t\t\tfig. 1).
Sink hole-like cave-in (diameter about 16 m) on a meadow in the Bavarian Alpine foreland near Miesbach, formed 1934 above old galleries in the underground within the Hausham area, where coal mining was active in this time. The generation of mining damages of this type is comparable with the formation of funnel structures at the bottom of the Cambrian sea above suddenly opening fissures in the basement below. Photograph taken from the Museum of coal mining in Hausham
Would the assumption be realistic that such a dyke exists in the basement rocks, regarding the volume loss of sand during formation of the funnel-shaped structures on the sea floor? The centres of the three funnel-like structures exposed south of Vik have distances of 90 to 100 m. Assuming an average distances of about 100 m, the volume missing below one of these structures would have to supply a dyke segment of about 100 m length. Thus, a simplified gap with an average width of 20 cm and a depth of 50 m could have been filled with 1000 m³ of sand, which is very close to the volume loss estimated above (for calculations see Scholz et al., 2009: 373, fig. 18).
The
The clastic dykes within the Lower Miocene Molasse succession of southern Bavaria (fig. 1 / 6), the Rotliegend of Hesse and the Lower Cambrian of southern Sweden are the results of seismic shock waves as well. This type of clastic dykes that is quickly filled with liquefied sediments, immediately after the fissure had formed by hydraulic pressure, has been called
The
Generation of ball-and-pillow structures, synsedimentary folding of bedding planes, protrusive and sugtrusive clastic dykes, neptunian dykes as well as funnel structures, demonstrated with schematic cross sections. All these structures are caused by seismic shock waves or opening fissures below the still soft and not yet lithified sediments. They are distinguishable regarding host rocks, velocity, direction and mechanism of infill.A) Fissures within not yet lithified sediments opening due to seismic shocks are filled rapidly from below and called
They must have been filled anyway from above, because some of the sand-filled fissures cut down at than least 50 m deep into the crystalline rocks. Tectonic extension may have created suddenly opening fissures within the crystalline basement. Immediately opening gaps below the sedimentary succession, deposited above the crystalline basement will have caused a kind of underpressure, sucking the not yet consolidated sands implosively downwards (Katzung & Obst, 1997: 170).The rapid infill of the sands will have been mainly caused by the pressure difference between the opening gap and the pore-water within the liquefied sand. The infill may be supported by gravity and by the load of the water column. Thus even very narrow fissures have been completely filled-up with grains (Katzung & Obst, 1997). Seismic schocks will probably accompany the sudden opening of fissures within the basement rocks, however, they are not inalienable to fluidize the sands. This type of clastic dykes that have been quickly filled with liquefied sediments from above, immediately after the fissure had formed, has been called
The dimension of such a covered, downwards filled clastic dyke below Vik can be estimated by the degree of volume loss within the funnel structures. Their generation is most likely directly connected with the tensional stress caused by the opening of the lower Paleozoic Tornquist Ocean as well (Scholz et al., 2009: 373).
In contrast, dykes which originally have been open cracks at the sea floor are called
Within Oligocene and Miocene sandstone-dominated marine and terrestrial Molasse successions of southwestern Bavaria, special deformations of the primary sedimentary structures occur, which obviously do not have caused by the later tectonic deformation of the rocks. Besides of folds and ball-and-pillow structures clastic dykes occur here. Similar clastic dykes and deformation structures of the strata occur also in Lower Permian terrestrial Rotliegend successions from the Richelsdorf Mountains in the Hesse depression of Central Germany. Moreover, clastic dykes are also reported from Lower Cambrian sandstones of the Vik Member at the eastern coast of Scania in southern Sweden. As over and underlying successions are not affected by similar deformations they are clearly of synsedimentary origin. They were caused most likely by strong seismic shock waves affecting the still soft and not yet lithified sediments. In Scania the upwards filled „extrusive clastic dykes“ occur together with large enigmatic centroclinal funnel-shaped deformation structures with diametres of more than 40 m, affecting this more or less flat lying shallow water sedimentary succession. Most likely, their formation is closely associated with suddenly opening tensional fissures in the crystalline basement below the Cambrian succession, sucking down soft and water saturated sands from the bottom of the Cambrian sea. A couple of such „sugtrusive clastic dykes“ is known within the crystalline basement of Bornholm. Clastic dykes and other deformation structures within the Molasse succession were triggered by seismic shock waves associated with Neoalpine compressive tectonics at the southern rim of the Molasse basin. The structures in the Lower Permian successions have been formed due to seismic shocks most likely caused by tensional tectonics at major normal faults bordering the Rotliegend basins. Both, the funnel structures and the clastic dykes in Scania presumably formed due to tensional stress connected with the opening of the lower Paleozoic Tornquist Ocean.
Spinocerebellar Ataxia (SCA) is well known to be an autosomal dominant progressive disease that significantly affect quality of life [1]. Despite the many types of SCA based on genetic code variations, which are reflected in varying severity of symptoms, studies have shown that balance problem remained to be the mainstay reason in quality of life reductions [2]. Due to the appearance of all these symptoms, it is still a challenge in prioritizing problems to be managed in order to provide the best impact. One common language that is generally used as a functioning concept in physical medicine and rehabilitation field, is known as the International Classification of Functioning, Disability, and Health (ICF) concept [3]. Several investigations had shown that utilizing this concept in rehabilitation would substantially enhance success due to better prioritization of problems. Although rehabilitation had been demonstrated to be a cornerstone in ataxia therapy, reports about ICF in SCA rehabilitation is still very much lacking [4].
While rehabilitation could alleviate several symptoms of SCA, many concerned if these therapies could match the speed of natural progression in this disease [4, 5]. As a general overview of rehabilitation interventions, it could be majorly divided into technique based rehabilitation exercises, and the utilization of modalities [2, 6, 7]. Exercises are then more specifically classified to each professionals in the rehabilitation team, namely physiotherapist, occupational therapist, and speech therapist. Each of the rehabilitation team play an essential part towards the holistic care of SCA subjects, and hence has to be well apprehended. On the other hand, modern therapy modalities have emerged as adjuncts to conventional therapy [8, 9]. These newer modalities are targeted to improve neuroplasticity in SCA subjects as the residual brain potential towards better functioning [10]. Therefore, this chapter is dedicated to review the comprehensive management of SCA from the physical medicine and rehabilitation point of view.
Over the years there seem to be growing evidence on the language of physical medicine and rehabilitation, especially in defining disability and its impact to both the individual and the society they live. The most recent terminology utilizes the International Classification of Functioning, Disability and Health (ICF) concept [3]. The ICF concept is a supplement of the 10th revision of International Statistical Classification of Diseases and Related Health Problems by World Health Organization (ICD X), that comprehensively describes an individual’s health condition while still accounting their performance in community [3]. This concept could then ease physiatrists in creating both treatment goals and therapy focus which are tailor made for the individual.
Utilizing ICF in the daily practice requires the use of several core sets which are specified for the disease, but this however has been a challenge as not all diseases have their specific core sets published. As SCA have no specific core set yet, it is then recommended for physiatrist to adapt to an existing core set which has similar properties, and chronic stroke core set would seem most fitting to an ongoing central neurological disorder [11]. Aside from utilizing the core set, it is important to focus on some components of the ICF concept that could become the focus of the treatment plan, emphasizing on setting achievable goals by using several measuring tools.
In a glance it could be seen that the ICF concept starts with describing the body structure and body function after stating the diagnosis [3]. Afterwards, activity and participation should be listed as to describe the individuals’ challenges in performing activity of daily living or even in the community level [3]. The next subsection of ICF involves description of environmental factors that would affect the individual, be it from physical environment or the community they are involved in [3]. Last but not least, personal factors should be addressed as well, knowing that adherence and motivation would affect the success of a rehabilitation program.
The focus of body structure in spinocerebellar ataxia is obviously the cerebellum, in the spinocerebellum (center) portion. It is known that the spinocerebellum gathers a large volume of sensory information from the peripheral organs, as well as relaying information from the motor cortex [12, 13]. Etiologically this is caused by autosomal dominant mutation on the SCA gene, and this would disrupt the connection between multiple layers of cerebellum [1]. Prior studies had shown that severity of symptoms would correlate to the cerebellar areas involvement, and differs between various types of SCA [2, 7, 14]. Ultimately these changes result in functional disturbances as well as learning difficulties [15, 16].
One of the main body function disorders in SCA that should be addressed is balance and postural control [9, 17]. Consistently studies had shown that balance is disturbed both during static and dynamic, hence implies difficulty in performing effective gait, and maintaining standing position [9, 18, 19]. Since cerebellum also becomes a relay center for agonist and antagonistic complimentary contractions, it is natural to see that spinocerebellum lesion would affect effective voluntary muscle contractions, which could also present as central hypotonia [4, 6]. As discussed earlier, learning difficulties in SCA would span its impact from impaired conditional skill learning, up until reduced ability in adapting changes from environment [15, 16]. All these errors in cerebellar signaling would also result in poor coordination, as there are several mismatches in relaying sensory information to produce an effective motor response, as well as poor intra-limb coordination in spinocerebellum damage [20, 21]. Limited study are available in exploration of autonomic function disorder, and it was reported that overactive bladder is most commonly seen in SCA 2 [22]. Therefore, despite the local extent of damage in body structure, the functional impact is notoriously destructive.
Having the body function described, it could be inferred that there would be a wide range of activity and participation disorders in SCA patients. One of the most reported problem in activity would be gait efficacy, as the lesion will interfere limb advancing patterns, as well as poor alternative terrain adaptability [8, 19]. Despite the inferior quality of life in motor control, the patients could still communicate as there are supposedly no barrier in this [23]. Even so, several studies revealed that cognitive impairments are found in SCA with varying severity [15, 16]. A number of studies have also reported that difficulty in verbal memory, learning, and fluency are commonly seen [16, 24]. These cognitive disorders would sum into a restriction in several community participation, but motor abilities still remained to inflict the most significant effect to quality of life in SCA [25]. Reports have mentioned the involvement of visuospatial and executive functioning abilities being reduced in SCA3, as it may correlate with reduced cerebellar perfusion [16]. Learning abilities in particular, were consistently shown to be retained in prodromal SCA2, as neural plasticity may still be prominent with Brain Derived Neurotrophic Factor playing its role, and other parts of the brain compensating for the functional deficit [15]. These evidences of preserved learning abilities in progressive disorders, must be recognized in the highest priority, knowing it would be the key to efficient rehabilitation for SCA cases [26, 27, 28].
The main environmental factor issues that was addressed for SCA is the difficulty to walk on varying level terrains [13, 29, 30]. It should be remembered that stable walking in varying level terrains require several functions ranging from cognition, vision, limb control, and balance. Severe fatigue was also seen in 69% of SCA patients, and thus different SCA types would result in different lesion focus and function disorder [31]. Moreover, since learning abilities are also compromised, a combination of these symptoms would ultimately result in terrain adaptation barriers [1, 4]. These should be identified in each patients, and correlated to their living environment in order to formulate an effective intervention.
Depression were consistently reported in several studies on SCA, and this could correlate significantly with quality of life [22, 30]. As mentioned previously that mobility is the main concern, depression levels were also seen lower in those subjects with better mobility [6, 25]. Even when other causes of depression may revolve around memory and learning ability disorders, most SCA subjects would have learning difficulty in limb control, which becomes a vicious cycle and a hazard for them to perform well in mobile activities of daily living [5]. Therefore, early detection of depression is important, especially in the personal factors subsection of ICF.
Although physical medicine and rehabilitation approach to SCA might differ between studies, it’s observable that the main focus is always towards body function, activity and participation. This focus is generally uncommon to be seen in the published studies, since most of these studies would focus on exploring various types of SCA, such as SCA1, SCA2, SCA3, SCA6 and SCA7 that are commonly found in the community [1, 7, 14, 27]. Shortly put, rehabilitative approach to SCA would place its greatest weigh on identifying disorders of body function through physical examination, rather than determining the SCA type through genetic testing [6]. In any case, each individual must receive tailor made interventions even when they are in the same SCA type.
In response to the stated functional problems, various rehabilitation strategies have been implemented and studied over the years [2, 6, 7]. Surely mobility and balance interventions have been one of the main focus in SCA studies, however through time, studies have widened their range of focus into endurance, cognition, and speech [30]. Rehabilitation strategies may be a combination of several mode of interventions, such as exercise, physical modality, and sensory stimulation [9, 14, 27].
Comprehensive examination is required prior to these interventions, as each patients should receive tailormade intervention, and thus not all of these strategies are administered to all patients. Through utilization of ICF conceptual analysis, then clinicians should focus on body function problems identified in SCA patients, as shown on Table 1 that depicts the common functional problems seen in SCA subtypes. This subsection will discuss these strategies in detail to give an overview of what is being studied in the published studies.
No | Function | SCA Type |
---|---|---|
1 | Sensory and Motor Cortex [13] | 6 |
2 | Ataxia & Cognition [15] | 2 |
3 | Falls, Balance Impairment, & Functional Mobility [29] | 1, 2, 3, 6 |
4 | Non-motor & Extracerebellar [22] | 2 |
5 | Cognitive [24] | 6 |
6 | Action perception cerebellar recruitment [26] | 6 |
7 | Dystonia [32] | 1, 2, 3, 6 |
8 | Cognitive & Socio-cognitive [16] | 1, 2, 3, 6, 7 |
9 | Clinical & Genetic of Brain MRI Changes [33] | 1, 2 |
10 | Motor & Cognitive – brain volume [34] | 7 |
11 | Autonomic Function [35] | 2 |
12 | Non ataxic manifestations [36] | 2 |
13 | Dysphagia [37] | 3, 6 |
Spinocerebellar functional problems in common SCA types.
Majority of the published studies have mentioned how physiotherapy plays a big role in mobility interventions of SCA patients, be it through conventional therapy or through exergames and virtual reality [9]. Since physiotherapy intervention is primarily focused on achieving better gait control, it would naturally revolve on improving balance, strength, endurance, and posture simultaneously [18, 27]. This finding has resulted into a more focused exercise sessions in the recent studies, aiming mainly on trunk balance, as these would be positively reflected in significant improvement of Scale for the Assessment and Rating of Ataxia (SARA) score [19, 38].
Although there are no published guidelines on SCA mobility exercise, several published studies from Cuban Centre for the Research and Rehabilitation of Hereditary Ataxia (CIRAH) had effectively shown the benefits of intensive neurorehabilitation as they have conducted [18, 27]. The whole therapy lasted for four hours per day, five days per week, lasting for 12 weeks in total, hence to the authors’ knowledge, this is the longest exercise duration seen per day. Daily tasks include both physiotherapy and occupational therapy interventions, with several breaks in between to restore both energy and training focus. It could be resumed that majority of the exercises given in CIRAH’s daily tasks include static balance improvement, and positional changes, all to improve trunk control and complement daily living tasks being trained by occupational therapists. Another important component that should be noted is the coordination exercises, which trains intra-limb coordination [18, 27]. These sets of exercises had proven to be very effective in improving cerebellar symptoms, as reflected in constant improvement of SARA scores of both SCA subjects in early prodromal stage and SCA2 diagnosed 11 years mean post onset [18, 27].
Other studies had utilized shorter sessions as compared to the CIRAH neurorehabilitation schedule, but all these had shown significant improvement of SARA scores. One such study reported that partial Body Weight Supported Treadmill Training could improve balance significantly, and general positive trend in improving mobility, endurance, and quality of life [19]. It could be possible that these studies alike are more focused on providing intervention in trunk control, which is parallel to the fact that trunk ataxia has better prognosis as compared to limb incoordination in SCA. Another concern lies that there are controversies in the outcome measurement of SARA scores, as they are very sensitive in detecting cerebellar symptoms, but not for extracerebellar symptoms. Despite those controversies, SARA scores could still be utilized as it correlates closely to functional abilities, and thus would pertain to be an effective evaluation tool in SCA studies.
Additionally, consistent evidence revealed that trunk ataxia could have better rehabilitation prognosis as compared to limb ataxia [8, 39]. The main problem persists that the rate of degeneration at every year must be matched with beneficial gains from exercise, and thus effective regimens would be the primary choice as a rehabilitation goal. The natural progression of SARA score in SCA is noted to be 0.6 to 2.5 points per year, whereas it was shown in most studies how training would effectively reduce SARA at least by one point, displaying clinical importance of these interventions [5].
It could be acknowledged that maintaining the provided gains from exercise is of importance in degenerative disorder [2, 6]. Several recent studies had revealed how exergames (exercise games) and immersive virtual reality would be able to fill up this shortfall in conventional therapy [8, 9]. Exergames here are considered adjuvant to the traditional physiotherapy, and could never replace their roles in ataxia rehabilitation [9]. An important feature in exergames that should be highlighted, is the fact that there are rapidly changing environment, thus demands an accurate anticipation from the ataxic cases, providing excellent gains to the sensorimotor system [9]. These anticipation were shown to correlate with real life situations, and could effectively maintain exercise effects throughout longer period [8, 9].
Proper choosing of modalities would benefit SCA subjects in different stages, where early stages could follow high demand competitive sporting exergames such as ping-pong, badminton and squash [8]. These exergames and virtual reality should be performed on elastic carpet, as it’s shown to give additional benefits in improving coordination and postural control through proprioceptive feedback. More severe ataxia would not allow them to play on competitive exergames, and would obtain greater advantage from good postural control. Games such as tightrope walk, which requires the user to maintain a specific position while still advancing forward, had been reported to effectively enhance both static and dynamic balance [8]. On the other hand, mild to moderate stages would benefit from conventional coordinative physiotherapy and severe stages though have no clear guidelines yet [9]. Hence it’s shown how exergames would play its best role in early stages, and also to maintain the gains accrued from conventional physiotherapy. As stated previously that studies had shown how mobility learning mechanisms may still be preserved in SCA cases, these newer therapies would then be targeted to hone these adaptive skills and apply them to their daily situations.
While many studies had shown how trunk control could have many exercise options, improving limb control has been shown as a big challenge in SCA subjects. It was also reported that good intra limb control is best seen in walking analysis, observing their coordination in performing effective transition from single and double leg stance [19]. Several studies had shown that static cycling would be an effective intervention to improve intra limb control [20, 21]. A controlled trial comprising of four week long cycling exercise was reported to restore the ability in modulating H-reflex inhibition, and is also correlated with better functional performances [40]. Although the impact was not as major as their healthy control counterpart, it could be seen that cycling would present itself as a potential exercise option for improving coordination in SCA subjects [40]. Added effects of endurance and strength gains through stationary cycling has also been reported, especially in mobility disorder patients such as cerebral palsy [41].
Postural exercise approach are generally based on “re-learning” strategies of destabilizing responses, that anticipatory movements are trained in various environments, as well as honing of sensorimotor reflexes in the light of preserved plasticity [9, 13]. Postural instability would also lead to chronic low back pain, and thus stretching must also be given in order to alleviate these before and after training sessions [9]. One voxel based study had shown 2 weeks of postural training would lead to improvement of balance, which was maintained for 3 months after training. Additionally, gray matter volume would also increase, and interestingly it is on the non-affected areas, meaning to say that targeted plasticity lies in the cerebral areas to compensate their cerebellar loss [28]. The study had mentioned that dorsal premotor cortex obtained the most compelling change, as they project to primary motor cortex and cerebellum, all of which are involved in movement planning and motor learning. Both patients and controls demonstrated an increase in gray matter volume in temporal association areas, this may be due to the requirement of performing sequential actions, which would in turn stimulates procedural memories in both hippocampus and basal ganglia. Cerebellar changes post exercise are not seen in cerebellar degenerative disorders as expected, but is significantly seen in healthy controls, with parallel increase in visuospatial and temporal inputs. These would then show how interventions towards premotor cortex growth should be the main goal of exercise in SCA subjects in preserving mobility [28].
Besides physiotherapy interventions, occupational therapy is another important modality within the attempts of improving quality of life in SCA subjects [9, 42]. As mentioned previously, occupational therapy is usually incorporated with physiotherapy courses [18]. In the big picture, they should be given after warm up stretches to obtain better postural control during the specific exercises. In the published studies, mainly occupational therapy intervention would have a one hour duration, and this addition have been proven effective in improving both SARA and Functional Independence Measure (FIM) scores. The program itself consists of basic activity of daily living exercises, which are essentially a part of the FIM and Barthel Index Scoring sheet. Some of the examples include dressing activities such as tying shoelaces, buttoning shirts; tabletop instrumental activities for instance inserting sewing needles, drawing, cutting paper figures, using keyboards; and finally communication activities like reading texts out loud, commenting and interpreting verbal and textual information [18].
Despite the promising effects, studies focusing on occupational therapy as an individual therapy is still lacking due to the progressive nature of the disease, thus could only be shown as an additive effect to the proven effective physiotherapy. A study had shown that occupational therapy would improve Hamilton scores for depression in SCA3, and this improvement was independent from its confounders [42]. So far there are no studies yet on occupational therapy being a home program, but it could be speculated that more frequent practices would eventually trigger better quality synapses in the brain, leading to a more superior functional improvement. Therefore, aside from improving the functional abilities, it could also be inferred that occupational therapy would enhance self-confidence, alleviates depressive mood, and thus forecasts better participation [9, 42].
In order to fully complement the comprehensive care of SCA patients, speech and language pathology should be addressed to achieve well-being [23]. However, there are very few studies that discusses this, since only few types of ataxia that has bulbar involvement and thus results in dysphagia due to excess salivation [43]. A study had shown and compared how dysphagia is more severe in SCA3, whereas mild dysphagia is seen in SCA6 [37]. Possible treatment options would depend on related problems, but mostly rehabilitation targets is to increase willingness and independence [23, 43]. At the same time, swallowing exercise would also aim in cueing patients to gain self-recognition in their swallowing process, thus triggering anticipatory self-evaluation [23, 43]. Since cognition is also an identified problem in SCA, this could also be identified by the speech and language pathologist, and self-corrections cueing prove to be effective [23]. In a more severe cases, safe swallowing practice along with appropriate dietary modification may be done in order to prevent aspiration [23]. Despite the scarcity of studies, a Cochrane review on speech disorder treatment for hereditary ataxia revealed that all the rehabilitative interventions have been reported as safe, and hence should be recommended in the comprehensive care [43].
Clinicians should always remember that neuroplasticity plays a big role in alleviating SCA cerebellar signs, as proven in SCA2 subjects [10]. Unfortunately, there are still no reported significant effect on non-ataxia signs [28]. It also appears that SCA2 subjects may have more progressive disorders, and thus 24 weeks of therapy was suggested, whereas for other types such as SCA6 and SCA31, 4 weeks of training may already show better SARA score improvements [27]. Thus, the extent of affected area in the cerebellum would correlate directly to the progressiveness, hence would warrant different sets of rehabilitation strategy. Recognizing the neuroplasticity potential of SCA individuals would assist clinicians in identifying therapy focus, as well as motivating patients and family members to improve exercise adherence.
Although there is no general guideline on this, rehabilitation strategies would adhere to functional disorder basis, that each strategy is given only when the disorder is identified [1, 6, 9]. Due to the progressive nature of the disease though, it is also plausible to administer the intervention even when the disorder have not emerge, knowing the fact that it may alleviate functional deterioration in the future. Two things that should be remembered are that fatigue may be one of the limitation in performing all the available strategies, and secondly, maintenance in quality of life must always be upheld [30]. Despite not many studies focused on quality of life, clinical experiences showed that progressive disease rehabilitation interventions should emphasize on giving life to the rest of the years, rather than adding years to the remaining life.
Aligned with their natural progression of disease, rehabilitation goals in degenerative ataxias would differ significantly from acquired ataxias. It was shown that acquired ataxias such as in stroke cases, would come with focal ischemia, ergo a better prognosis as compared to the diffuse lesion in SCA [1, 44]. Additionally, the degenerative process of SCA is of the highest concern, therefore it must be addressed and evaluated with valid measuring tools. Several subjects that were focused in prior studies include functional abilities, mobility function, balance, endurance, and quality of life [30].
Ataxia specific tools such as SARA and Inventory of Non-Ataxia Symptoms (INAS) are most commonly utilized in many studies [45, 46]. The SARA score is designed to assess cerebellar symptoms semiquantitatively, and exclusively only SCA subjects were tested during the validation process. The SARA score ranges from 0 to 40, higher number showing more severe ataxia, the values then reflect eight physical examination items each with specific numeric scores. Physical examination of gait, stationary standing, and sitting position are observed, with a cut off of maintaining 10 second stationary position without difficulty as sufficient. One common bulbar component of SCA being speech production is also evaluated, and will be scored worst if the subject could only do unintelligible speech during normal conversation. Last but not least, performance of coordination tests namely finger chase, nose to finger test, dysdiadochokinesia, and heel shin test are graded with a score of 4 as the worst performance. As could be seen in these scored items, all of these are included in the general rehabilitation examination of cerebellar symptoms, and therefore this score is very much applicable in daily practice. Consistently it was shown that SARA score would correlate closely to symptom severity, and thus could be practically used to evaluate the efficacy of rehabilitation program [45].
With that being said, the main limitation of SARA would be that other scorings are required in the light of addressing extracerebellar symptoms. Therefore, the same research group had devised INAS score which could quantify the presence and severity of non-ataxia neurological symptoms [46]. The inventory consists of 30 items that is divided into two main section, the first spans widely from addressing cerebellar oculomotor signs, spinal reflexes, upper and lower motor neuron signs through physical examination. The second section on the other hand, lists the possible symptoms that the patient might bring about, such as double vision, dysphagia, urinary dysfunction, cognitive impairment, and other related findings that have not been listed. Similarly, the INAS scoring was also validated by utilizing SCA subjects with varying types, namely SCA1, SCA2, SCA3, and SCA6. Among these SCA types, it was reported that SCA1 and SCA2 presents extracerebellar symptoms along with the baseline ataxia, thus they are good candidates for the INAS, while SCA6 being purely cerebellar would play its role as control. The summation of the score is called INAS count, in which they have concluded that both INAS and INAS count shows good reproducibility, but unsatisfactory responsiveness over extended period due to the wide variation of measurement [46]. However it was clearly shown that INAS is an excellent supplement to the SARA score for SCA subjects.
Other studies had also shown that in very early ataxia stages, both SARA and INAS are ineffective in prodromal stage [18]. Functional test alternatives such as tandem gait for 5 meter test was suggested to be used, as it is very sensitive to changes post rehabilitation [18]. The tandem gait itself is a complex task which may not be performed well by all SCA subjects, therefore traditional balance assessments such as Berg Balance Scale (BBS) [17, 25, 44]. The BBS consist of 14 item list, with an ordinal scale of 0 to 4, higher number meaning better balance function. The main categories in the item list revolves around maintenance of stationary position, transfer, and change of position while performing simple activities. Summation of all the scores for less than 45 would indicate greater risks of falling [47]. In cases that the BBS is not used in total, the components could also be used individually to monitor a specific progression within therapy evaluation.
Another study had also utilized the timed up and go (TUG) test to evaluate balance and function in degenerative ataxia subjects [20, 21]. In several rehabilitation trials, TUG test are well preferred due to their ease of examination, quantification of results in seconds, and finally their best representation to daily living tasks. However in cases of SCA, probably the complete TUG test might not always be performable due to high risk of fall. Several studies had also utilized expanded TUG test, which divides the full TUG test into segments measured by milliseconds, namely sit to stand, gait 1, turning, gait 2, and stand to sit [48, 49]. By separating these components, physiatrists would have a better view on which component are hindering the subject in achieving good TUG performance, and at the same time, would be able to assess improvements more accurately. Although the expanded TUG have not been utilized in SCA studies, it has been commonly used in other chronic neurological cases such as stroke, and hence should be recommended for future studies on degenerative ataxia [48].
Aside from TUG test, a more comprehensive functional test tool such as functional independence measure (FIM) are commonly used in SCA studies [25]. The utilization of FIM had expanded the view on functional activities and illustrate their level of independence in those activities. The FIM tool comprise of several components such as bowel, bladder control, transfer, locomotion, social participation, communication and also self-care activities [50, 51]. These components will then be graded from 1 to 7, when value of 6 and above shows complete dependence, scores 3 to 5 shows moderate dependence, and lastly below 3 shows full dependence. Therefore, this tool would be best used when the subjects are not fully independent, and other individuals such as caregivers are involved. Naturally FIM would have a ceiling effect when the patient is fully independent, and there are no additional scoring for the performance quality.
In SCA subjects it was reported that reduction of 1 point in FIM score would be significantly reflected in 4.49 point decrease in the physical functioning of Short Form 36 (SF-36) score [25]. In the light of SF-36, it is the most commonly used tool to assess quality of life in SCA subjects. As the name implies, this tool has 36 questions which covers eight domains of health, for instance limitations in physical activities, social activities, role function, pain, emotional problem, mental health, fatigue, and finally general health perceptions [52]. Various ordinal options in each questions should firstly be calculated through a formula to obtain domain scores. This finding then reveals how FIM could also be used to assess overtime changes that would complement the changes in other ataxia specific tools, in which better mobility correlates with greater quality of life [25, 53].
In relationship to quality of life, fatigue is pretty much prevalent and thus is essential to note. Aside from SF-36 that touches on the fatigue concept, the fatigue severity scale (FSS) is a specific 9 item scale which measures fatigue in a 1 to 7 scale, 7 being strongly agree with the fatigue item being stated [31]. Accomplishing the FSS requires only 5 minutes, but the questions would not accurately direct the underlying functional disorder beneath, especially in chronic cases where fatigue is evident. Therefore, both cardiovascular and respiratory specific tools must be administered separately in order to evaluate through time. There are a selected number of studies that discuss the changes of cardiorespiratory attributes through evaluation of maximum oxygen consumption (VO2 max), six minute walk test (6MWT), peak expiratory flow (PEF), and maximum inspiratory pressure (MIP) [21, 38, 54].
Evaluation of VO2 max is done by performing ramped ergometer exercise stress testing, while 6MWT could be performed with assistance if the subjects are unable to [21]. With all these limitations, it could be possible that evaluation of cardiovascular function will not be optimal owing to the natural progression of the disease and obstacles in maintaining stationary position. On the contrary, respiratory function has shorter examination time, allowing better examination compliance [54]. A recent study had shown how examination of both PEF and MIP are safe to be performed in SCA2 subjects, when better respiratory function seemed to correlate well with Activity of Daily Living scales, and ataxia specific SARA scales [54]. Additionally, the study had also reported that one third of the subjects complained of dyspnea, with interpretation of restrictive pulmonary disease. It is speculated that the restriction may be caused by the lack of coordination of the respiratory muscles, ultimately resulting in reduced chest expansion [54]. On the other point of view, postural control exercises would be able to improve diaphragmatic excursion, and thus provide attempts in correcting respiratory dysfunction [55, 56, 57]. Therefore, it is only possible that physiotherapy interventions to manage ataxia related symptoms also alleviate respiratory symptoms, thus very mild respiratory dysfunction that could be reported.
Being a progressive degenerative disease, physical medicine and rehabilitation have an important role in alleviating symptoms as well as improving quality of life in Spinocerebellar Ataxia [4]. Initial analysis of SCA begins with identifying the ICF concept, in which body structure being cerebellum, and several body function problems such as postural control and intra-limb control should firstly be addressed [8]. These underlying disorders would lead to below par daily living performance, further leading to restriction in participation, and might also result in depression [25, 30]. Nevertheless it should be remembered that there is a natural progression of functional decline, which is unavoidable in SCA [1]. Therefore, rehabilitation goals are generally focused in maintaining functional capacity, as well as improving social participation and quality of life [4].
Achieving the aforementioned rehabilitation goals could be done through several interventions, but it was shown that physiotherapy exercise sessions focused in improving posture, balance, and gait had proven to be the most effective. Duration of session generally lasts for 1 hour or more, but it should be preceded with stretching to ease pain and provide better proprioceptive feedback [18]. In order to enhance retaining of the exercise gains, proper choices of virtual reality and exergames could be done [8, 9]. Most studies have also incorporated occupational therapy that rehearses daily living activities, and it’s seen to correlate well with quality of life [42]. Simultaneously, speech therapy would also play its role in SCA by managing communication and swallowing disorders that are present in several types of SCA [43]. Several valid outcome measuring tools have been shown effective to monitor changes over time, and it should be remembered that these measures could assess specific components that are being trained [22, 30]. In conclusion, effective rehabilitation approach should comprise of all the previously mentioned components, while always being validated by specific outcome measure tools. In addition to that, further studies should devise a guideline for general rehabilitation of SCA through validated trials.
The authors declare no conflict of interest.
The corresponding author would like to mention a note of thanks to the ever-supporting wife, Gisca Meiviana, for all her constant encouragement during the process of authoring this book chapter, and for being an amazing life partner throughout.
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Hammad Ather",coverURL:"https://cdn.intechopen.com/books/images_new/5516.jpg",editedByType:"Edited by",editors:[{id:"88868",title:"Prof.",name:"M Hammad",middleName:null,surname:"Ather",slug:"m-hammad-ather",fullName:"M Hammad Ather"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:4,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"54132",doi:"10.5772/67473",title:"Cross-Polarization OCT for In Vivo Diagnostics and Prediction of Bladder Cancer",slug:"cross-polarization-oct-for-in-vivo-diagnostics-and-prediction-of-bladder-cancer",totalDownloads:1119,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"This chapter contains three parts covering recent efforts to increase the accuracy of optical coherence tomography (OCT) differential diagnostics of bladder pathologies. The first part compares the diagnostic efficacy of traditional OCT and cross-polarization OCT (CP OCT); CP OCT and fluorescence cystoscopy (FC) for detecting flat lesions in the bladder at the early stages of cancer. The second part contains a report on achievements in application of CP OCT for detection of recurrent carcinoma in the scar area that is a hardly distinguishable form of bladder cancer using an optimized CP OCT image analysis. The third part of the chapter reviews the results on CP OCT usage for in vivo diagnosis of the bladder cancer after radiation therapy of cervical cancer.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Elena Kiseleva, Gladkova Natalia, Streltzova Olga, Kirillin Mikhail,\nMaslennikova Anna, Dudenkova Varvara, Yunusova Katerina and\nSergeeva Ekaterina",authors:[{id:"68196",title:"Prof.",name:"Natalia",middleName:null,surname:"Gladkova",slug:"natalia-gladkova",fullName:"Natalia Gladkova"},{id:"191970",title:"Dr.",name:"Elena",middleName:null,surname:"Kiseleva",slug:"elena-kiseleva",fullName:"Elena Kiseleva"},{id:"191990",title:"Dr.",name:"Olga",middleName:null,surname:"Streltzova",slug:"olga-streltzova",fullName:"Olga Streltzova"},{id:"191992",title:"Mrs.",name:"Varvara",middleName:null,surname:"Dudenkova",slug:"varvara-dudenkova",fullName:"Varvara Dudenkova"},{id:"191993",title:"Prof.",name:"Anna",middleName:null,surname:"Maslennikova",slug:"anna-maslennikova",fullName:"Anna Maslennikova"},{id:"191994",title:"Dr.",name:"Katerina",middleName:null,surname:"Yunusova",slug:"katerina-yunusova",fullName:"Katerina Yunusova"},{id:"191995",title:"Dr.",name:"Mikhail",middleName:null,surname:"Kirillin",slug:"mikhail-kirillin",fullName:"Mikhail Kirillin"},{id:"193422",title:"Dr.",name:"Ekaterina",middleName:null,surname:"Sergeeva",slug:"ekaterina-sergeeva",fullName:"Ekaterina Sergeeva"}]},{id:"54019",doi:"10.5772/67309",title:"Bladder Cancer Markers and Recent Innovations",slug:"bladder-cancer-markers-and-recent-innovations",totalDownloads:1702,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Bladder cancer (urothelial carcinoma) is the most common tumor of the urinary tract. It occurs more frequently among men about 65 years old on average. Two forms of the tumor are known: a non–muscle-invasive one and a muscle-invasive one. The latter turns out to be very aggressive with a survival of 5 years average. The non–muscle-invasive form frequently recurs (60–70%) and in 15% of cases, it progresses into the invasive form. The diagnosis is made mainly by cystoscopy and urine cytology. A high number of researches were dedicated in order to find a simple test using voided urine to frequently monitor possible tumor recurrence. During the last 10 years, many tests were proposed concerning either special proteins of which the most common are the bladder tumor antigen (BTA) and the nuclear matrix protein 22 (NMP22) or the presence of genetic mutations [most frequently, fibroblasts growth factor receptor 3 (FGFR3) and TP53], alteration of DNA methylation, chromatin structure and, more recently, the presence of specific micro-RNA. Recently the analysis of lipids present in voided urine showed a difference in fatty acids between healthy individuals and those affected by non-invasive forms. These markers appear to have a high specificity and sensitivity: a deepening of these results could lead to the development of a test that avoids invasive treatment and the cost of cystoscopy.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Mariapia Viola-Magni, Samuela Cataldi and Daniela Marocco",authors:[{id:"192375",title:"Prof.",name:"Mariapia",middleName:null,surname:"Viola-Magni",slug:"mariapia-viola-magni",fullName:"Mariapia Viola-Magni"},{id:"197851",title:"BSc.",name:"Samuela",middleName:null,surname:"Cataldi",slug:"samuela-cataldi",fullName:"Samuela Cataldi"},{id:"197852",title:"Dr.",name:"Daniela",middleName:null,surname:"Marocco",slug:"daniela-marocco",fullName:"Daniela Marocco"}]},{id:"54063",doi:"10.5772/67280",title:"Intravesical Chemohyperthermia for NMIBC: Rationale and Results of This Developing Treatment",slug:"intravesical-chemohyperthermia-for-nmibc-rationale-and-results-of-this-developing-treatment",totalDownloads:1395,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Bladder cancer is the fourth most common cancer in men, and the lifetime risk of getting bladder cancer is 2.4%. Approximately 75% of newly diagnosed cases of bladder cancer are non-muscle-invasive bladder cancer (NMIBC), and half of them will show recurrence and/or progression after transurethral resection. Therefore, after transurethral resection, in high-risk patients, intravesical therapy is mandatory. However, bacillus Calmette-Guérin (BCG) is associated with important side effects such as systemic tuberculosis and bladder retraction. Chemohyperthermia (CHT) has shown a 60% lower recurrence rate than standard mitomycin C (MMC). However, its effectiveness in high-risk patients, especially CIS and BCG refractory patients, is even more important. CHT will probably be an option for patients unsuitable for radical cystectomy or those on whom BCG can’t be used. Two main technologies are currently available for intravesical CHT: microwaves and recirculating heated fluids. Both of them have pros and cons that should be known and evaluated by a urologist. In this chapter, we will speak about rationale, technical options, clinical results, ongoing studies, and future perspective for this interesting treatment option for intermediate and high-risk patients with NMIBC.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Sousa-Escandón Manuel Alejandro, Flores Carbajal Javier, Sousa-\nGonzález Daniel and Rodriguez Gómez Silvia",authors:[{id:"191356",title:"Dr.",name:"Alejandro",middleName:null,surname:"Sousa-Escandón",slug:"alejandro-sousa-escandon",fullName:"Alejandro Sousa-Escandón"}]},{id:"54147",doi:"10.5772/67443",title:"Lymphadenectomy in Muscle Invasive Bladder Cancer",slug:"lymphadenectomy-in-muscle-invasive-bladder-cancer",totalDownloads:1273,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Mustafa Ozan Horsanali and Kutan Ozer",authors:[{id:"59702",title:"Dr.",name:"Mustafa Ozan",middleName:null,surname:"Horsanali",slug:"mustafa-ozan-horsanali",fullName:"Mustafa Ozan Horsanali"},{id:"192699",title:"Dr.",name:"Kutan",middleName:null,surname:"Ozer",slug:"kutan-ozer",fullName:"Kutan Ozer"}]},{id:"59222",doi:"10.5772/intechopen.73515",title:"Development of Oncolytic Adenoviruses for the Management of Prostate Cancer",slug:"development-of-oncolytic-adenoviruses-for-the-management-of-prostate-cancer",totalDownloads:1121,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Prostate cancer (PCa) is the fifth most common cause of cancer-related deaths in men globally. Androgen receptor (AR) signalling plays a vital role in initiation and progression and antiandrogens are standard of care first-line therapeutics. However, resistance frequently develops resulting in metastatic castration-resistant prostate cancer (mCRPC). Management of CRPC is currently chemotherapy and/or radiotherapy but is mostly palliative due to rapid development of resistance. The need for novel approaches to eliminate mCRPC is compelling; a promising option is replication-selective (oncolytic) adenoviruses with demonstrated efficacy in preclinical models of multidrug-resistant PCa. The safety of various viral mutants has been confirmed in numerous clinical trials with minimal toxicity in patients. Importantly, oncolytic adenoviruses synergise with the current standard of care for mCRPC even in treatment-resistant cells. In early phase I–II clinical trials, promising efficacy in patients with localised PCa was reported after intratumoural administration, and phase III trials are underway. To enable systemic delivery, for targeting of mCRPC, further developments are necessary because of the short half-life of the adenoviral mutants in human blood. Current progress in preventing the high-affinity binding of adenovirus to erythrocytes, hepatocyte uptake, and elimination by hepatic Kupffer cells will be described.",book:{id:"6423",slug:"prostate-cancer",title:"Prostate Cancer",fullTitle:"Prostate Cancer"},signatures:"Ahmed A. Ali and Gunnel Halldén",authors:[{id:"80427",title:"Dr.",name:"Gunnel",middleName:null,surname:"Hallden",slug:"gunnel-hallden",fullName:"Gunnel Hallden"},{id:"232386",title:"MSc.",name:"Ahmed",middleName:null,surname:"Ali",slug:"ahmed-ali",fullName:"Ahmed Ali"}]}],mostDownloadedChaptersLast30Days:[{id:"70881",title:"Robot-Assisted Partial Nephrectomy: Evolving Techniques",slug:"robot-assisted-partial-nephrectomy-evolving-techniques",totalDownloads:494,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Robotic-assisted partial nephrectomy is now embraced in urology as a recommended treatment option for small localised renal tumours. There is an increasing trend towards setting up robotic-assisted services in urological centres across the world. Our aim is to review the available published common robotic-assisted partial nephrectomy techniques. We present our institutions’ established step-by-step technique for performing robotic-assisted partial nephrectomy, in order to guide aspiring urologists interested in performing robotic-assisted partial nephrectomies. The importance of pre-operative review of imaging in a multi-disciplinary approach is critical. 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The first part compares the diagnostic efficacy of traditional OCT and cross-polarization OCT (CP OCT); CP OCT and fluorescence cystoscopy (FC) for detecting flat lesions in the bladder at the early stages of cancer. The second part contains a report on achievements in application of CP OCT for detection of recurrent carcinoma in the scar area that is a hardly distinguishable form of bladder cancer using an optimized CP OCT image analysis. 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In this chapter, specifically, genetic alterations playing role in the prostate cancer are intended to be reviewed briefly under the subheadings of genomic instability and the hallmarks of cancer which are sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling the replicative immortality, inducing angiogenesis, activating invasion and progression to metastatic disease, reprogramming of the energy metabolism and evading immune destruction.",book:{id:"6423",slug:"prostate-cancer",title:"Prostate Cancer",fullTitle:"Prostate Cancer"},signatures:"Hikmet Köseoğlu",authors:[{id:"111496",title:"Dr.",name:"Hikmet",middleName:null,surname:"Köseoǧlu",slug:"hikmet-koseolu",fullName:"Hikmet Köseoǧlu"}]},{id:"54587",title:"Genital Organs‐Sparing Radical Cystectomy in Female Patients with Muscle Invasive Urothelial Carcinoma of the Bladder",slug:"genital-organs-sparing-radical-cystectomy-in-female-patients-with-muscle-invasive-urothelial-carcino",totalDownloads:1296,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"There has been considerable interest in urethral‐sparing cystectomy and preservation of the gynecological tract to maintain continence mechanism, sexual function, and reproductive function in young patients who undergo radical cystectomy for muscle‐invasive bladder cancer and this new technique gained acceptance in many centers. The issue of oncological safety of a urethra and anterior vaginal wall‐sparing cystectomy in selected patients has been addressed by several authors. The chapter will discuss the following items: (I) Technique of genital‐sparing radical cystectomy in female patients with muscle invasive transitional cell carcinoma of the bladder. (II) Definition and rationale of genital‐sparing radical cystectomy in female patients. (III) Rational and value of urethral preservation in genital‐sparing cystectomy in female patients with urothelial carcinoma. (IV) Previous reports about genital‐sparing cystectomy in patients with urothelial carcinoma. (V) Value of preservation of the internal genital organs in female patients undergoing radical cystectomy.",book:{id:"5516",slug:"bladder-cancer-management-of-nmi-and-muscle-invasive-cancer",title:"Bladder Cancer",fullTitle:"Bladder Cancer - Management of NMI and Muscle-Invasive Cancer"},signatures:"Hosni Khairy Salem",authors:[{id:"96052",title:"Prof.",name:"Hosni",middleName:"Khairy",surname:"Salem",slug:"hosni-salem",fullName:"Hosni Salem"}]},{id:"67209",title:"Robotic Surgery and Successful Set-Up: A Stepwise Approach",slug:"robotic-surgery-and-successful-set-up-a-stepwise-approach",totalDownloads:690,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Robot purchase, implementation, and sustainability require a number of key challenges to overcome. We provide our experience of managing a potentially daunting task, summarizing the key steps to help deliver such an exciting project. 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",coverUrl:"https://cdn.intechopen.com/series/covers/3.jpg",latestPublicationDate:"August 14th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. 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He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7060",title:"Gingival Disease",subtitle:"A Professional Approach for Treatment and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/7060.jpg",slug:"gingival-disease-a-professional-approach-for-treatment-and-prevention",publishedDate:"October 23rd 2019",editedByType:"Edited by",bookSignature:"Alaa Eddin Omar Al Ostwani",hash:"b81d39988cba3a3cf746c1616912cf41",volumeInSeries:4,fullTitle:"Gingival Disease - A Professional Approach for Treatment and Prevention",editors:[{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7572",title:"Trauma in Dentistry",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7572.jpg",slug:"trauma-in-dentistry",publishedDate:"July 3rd 2019",editedByType:"Edited by",bookSignature:"Serdar Gözler",hash:"7cb94732cfb315f8d1e70ebf500eb8a9",volumeInSeries:3,fullTitle:"Trauma in Dentistry",editors:[{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7139",title:"Current Approaches in Orthodontics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7139.jpg",slug:"current-approaches-in-orthodontics",publishedDate:"April 10th 2019",editedByType:"Edited by",bookSignature:"Belma Işık Aslan and Fatma Deniz Uzuner",hash:"2c77384eeb748cf05a898d65b9dcb48a",volumeInSeries:2,fullTitle:"Current Approaches in Orthodontics",editors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6668",title:"Dental Caries",subtitle:"Diagnosis, Prevention and Management",coverURL:"https://cdn.intechopen.com/books/images_new/6668.jpg",slug:"dental-caries-diagnosis-prevention-and-management",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Zühre Akarslan",hash:"b0f7667770a391f772726c3013c1b9ba",volumeInSeries:1,fullTitle:"Dental Caries - Diagnosis, Prevention and Management",editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",institutionString:"Gazi University",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Prosthodontics and Implant Dentistry",value:2,count:3},{group:"subseries",caption:"Oral Health",value:1,count:6}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:3},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\r\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\r\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Orthodontist, Assoc Prof in the Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"August 3rd, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:107,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. 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"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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